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Biomedical subjects

T K Howell

Publications and source records attributed to T K Howell.

11 recordsLinked to original sources
PubMed2003

Plasma paracetamol concentrations after different doses of rectal paracetamol in older children A comparison of 1 g vs. 40 mg x kg(-1).

We compared the plasma paracetamol levels attained after the administration of different doses of rectal paracetamol in healthy children to see if they attained therapeutic levels (> 10 microg x ml(-1)). We recruited 24 children (ASA I-III) over 25 kg undergoing elective surgery. They were randomly assigned to receive rectal paracetamol at a dose of 1 g or 40 mg x kg(-1). Blood samples were taken for analysis at 2, 3, 4 and 5 h post dose. Most children in the 1 g group failed to attain therapeutic plasma levels, whereas those in the 40 mg kg(-1) group did achieve therapeutic levels (mean maximum concentration = 7.8 vs. 15.9 microg x ml(-1), p = 0.009).

Acetaminophen↗
PubMed2002

A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children.

Oral transmucosal fentanyl citrate (OTF) was compared with midazolam as a premedicant in a prospective, randomised, placebo-controlled, double-blind trial. Eighty children (ASA grade 1 or 2, aged 3-9 years) who presented for tonsillectomy were randomly allocated to receive either 2.5 ml OTF (15-20 microg.kg(-1)) in a lollipop format and 0.5 ml.kg(-1) placebo syrup, or midazolam syrup (0.5 mg.kg(-1)) and a placebo lollipop (2.5 ml). The acceptability of sedation, anxiety and compliance with anaesthetic induction were assessed. The children were given an 'emergence' score for their recovery. Analgesia requirements, the incidence of vomiting, itching and any behavioural changes were assessed for 6 h postoperatively. Oral transmucosal fentanyl citrate was as effective as midazolam in aiding compliance with anaesthesia, but is significantly better in its appeal to children (p < 0.001) and emergence (p < 0.001) characteristics. In conclusion, OTF may be particularly useful as a premedicant in paediatric practice.

Administration, Oral↗
PubMed1999

Tears at bedtime.

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Acetaminophen↗
PubMed1998

A change in resistance? A survey of epidural practice amongst obstetric anaesthetists.

Five hundred members of the Obstetric Anaesthetists Association were surveyed regarding their technique for identification of the epidural space. Eighty-one per cent of the questionnaires were returned completed. Fifty-nine per cent of respondents first learned a loss of resistance to air technique, 33.4% to saline and 7.4% another technique. Presently, 37.1% and 52.7% use only a loss of resistance to air or saline, respectively. Six per cent use both techniques and 3.2% use other techniques. Twenty-eight per cent taught a loss of resistance to air, 57.2% taught a loss of resistance to saline and 12.9% taught both techniques. Twenty-three per cent changed from a loss of resistance to air, to a saline technique, and 4.2% vice versa. Forty-seven per cent of those using air felt that loss of resistance to air was not associated with a clinically significant difference in the incidence of accidental dural puncture compared with saline.

Air↗
PubMed1998

Appropriate size and inflation of the laryngeal mask airway.

We have compared size 3 and size 4 laryngeal masks in 30 females and size 4 and size 5 in 30 males for success rate of insertion, incidence of airleak and pressure exerted on the pharynx. First, the ex vivo volume-pressure relationship of the mask was obtained. Second, after insertion of a mask, the cuff was inflated with the recommended maximum volume of air and intracuff pressure measured. Third, the incidence of airleak during a steady airway pressure of 18 cm H2O was noted. Fourth, the cuff was deflated until it just prevented airleak, and cuff pressure was measured. The mask was removed, the other size was inserted and the same procedure repeated. At the end of operation, final in vivo and ex vivo pressures were measured. The pressure exerted on the pharynx was calculated as the difference between ex vivo and in vivo intracuff pressures. It was always possible to insert both sizes in both sexes. In females, airleak occurred in 15 patients with the size 3 and in five patients with the size 4 (difference: P = 0.005) and in males, 21 patients with the size 4 and in four patients with the size 5 (P < 0.001). Removal of air to the minimum effective volume significantly decreased intracuff pressure and pressure on the pharynx; on removal of the mask, pressures were similar to, or lower than, initial pressures. Therefore, a larger mask (size 4 in females and size 5 in males) provided a better seal than a smaller size without producing higher pressures on the pharynx.

Adolescent↗