Biomedical subjects
Publications and source records attributed to T M Ramsay.
We report the management of anaesthesia for Caesarean section in a woman with severe extensive tracheal stenosis. Management was initially with spinal anaesthesia, but general anaesthesia became necessary as a result of profuse intra-operative bleeding. We describe the use of the Hayek oscillator cuirass ventilator to allow instrumentation of the larynx whilst maintaining respiratory support, and for weaning from mechanical ventilation.
We have investigated 195 pre-menopausal women undergoing third molar extractions, in a prospective study, to assess the influence of the day of the menstrual cycle on the incidence of postoperative nausea or vomiting. In the 95 patients taking the oral contraceptive pill the incidence of postoperative nausea or vomiting was higher on days 9 to 15 of the menstrual cycle (P < 0.05) than on days one to eight and days 16 to the end of cycle. In the 100 patients who were not taking the oral contraceptive pill the incidence of postoperative nausea or vomiting was not higher on days 9 to 15. The strongest predictor for postoperative nausea or vomiting in our study was a previous episode of postoperative nausea or vomiting (P < 0.005). Patients with a tendency to motion sickness did not have a higher incidence of postoperative nausea or vomiting.
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Ten patients received increasing doses of pipecuronium at induction of anaesthesia. A dose response relationship was then constructed from which ED90 and ED95 values were measured as 43.4 micrograms.kg-1 and 50.5 micrograms.kg-1 respectively. A further 30 patients received pipecuronium in a dose sufficient to produce greater than 90% neuromuscular block. When the first contraction of the train-of-four had returned to 10% of control, a small increment of atracurium (1.1 mg), vercuronium (0.25 mg) or pipecuronium (0.21 mg) was administered, and this was repeated subsequently using the same criterion of recovery on each occasion. The duration and intensity of the block with pipecuronium increments remained constant. The duration of the block following atracurium or vecuronium was progressively less with subsequent increments until steady state was reached. The final mean durations at steady state were pipecuronium 7.37 min, atracurium 6.99 min, and vecuronium 5.15 min.
Thiopentone, propofol and etomidate inhibit the contractions of the rat isolated atria and portal vein. The actions of thiopentone and propofol summate with those of verapamil and nifedipine. Verapamil potentiates the action of etomidate on both preparations. The depressant actions of thiopentone and propofol on the portal vein are associated with a reduced response to calcium. Etomidate does not reduce the response to calcium in this preparation.