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T Peachey

Publications and source records attributed to T Peachey.

13 recordsLinked to original sources
PubMed2002

A standard XML Schema for computerised anaesthetic records.

We believe that one of the most influential developments for the practice of anaesthesia in this decade will be the introduction of a national (or possibly international) standard XML Schema for computerised anaesthetic records, and that such development should be actively promoted by appropriate professional groups. We discuss the implications of such a schema, and make suggestions regarding its requirements. We also report on one approach to the development of an XML Schema for anaesthetic records (provisionally named SnowSchema in honour of Dr John Snow), and compare the current version with the suggested requirements.

Anesthesia↗
PubMed2001

The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients.

UNLABELLED: The IV administration of sodium chloride solutions may produce a metabolic acidosis and gastrointestinal dysfunction. We designed this trial to determine whether, in elderly surgical patients, crystalloid and colloid solutions with a more physiologically balanced electrolyte formulation, such as Hartmann's solution and Hextend, can provide a superior metabolic environment and improved indices of organ perfusion when compared with saline-based fluids. Forty-seven elderly patients undergoing major surgery were randomly allocated to one of two study groups. Patients in the Balanced Fluid group received an intraoperative fluid regimen that consisted of Hartmann's solution and 6% hetastarch in balanced electrolyte and glucose injection (Hextend). Patients in the Saline group were given 0.9% sodium chloride solution and 6% hetastarch in 0.9% sodium chloride solution (Hespan). Biochemical indices and acid-base balance were determined. Gastric tonometry was used as a reflection of splanchnic perfusion. Postoperative chloride levels demonstrated a larger increase in the Saline group than the Balanced Fluid group (9.8 vs 3.3 mmol/L, P = 0.0001). Postoperative standard base excess showed a larger decline in the Saline group than the Balanced Fluid group (-5.5 vs -0.9 mmol/L, P = 0.0001). Two-thirds of patients in the Saline group, but none in the Balanced Fluid group, developed postoperative hyperchloremic metabolic acidosis (P = 0.0001). Gastric tonometry indicated a larger increase in the CO2 gap during surgery in the Saline group compared with the Balanced Fluid group (1.7 vs 0.9 kPa, P = 0.0394). In this study, the use of balanced crystalloid and colloid solutions in elderly surgical patients prevented the development of hyperchloremic metabolic acidosis and resulted in improved gastric mucosal perfusion when compared with saline-based solutions. IMPLICATIONS: This prospective, randomized, blinded trial showed that, in elderly surgical patients, the use of balanced IV solutions can prevent the development of hyperchloremic metabolic acidosis and provide better gastric mucosal perfusion compared with saline-based fluids.

Acid-Base Equilibrium↗
PubMed1994

Conjunctival oxygen tension monitoring during liver transplantation.

Conjunctival oxygen tension has been noted in animal studies to correlate with oxygen delivery. In order to assess this relationship in man, we compared the proportional changes in conjunctival oxygen tension with those in oxygen delivery that occur on the placement and release of the inferior vena caval clamps in 10 patients during orthotopic liver transplantation without veno-venous bypass. We also examined the changes in mixed venous oxygen saturation at these times. We found a statistically significant correlation between both parameters and oxygen delivery (p < 0.001). However, analysing the data on a Bland and Altman plot of difference versus mean, it is our conclusion that the variation in the data is such that neither conjunctival oxygen tension nor mixed venous oxygen saturation can be used clinically to predict the changes in oxygen delivery that occur during liver transplantation.

Blood Pressure↗
PubMed1993

Comparison of alfentanil with suxamethonium in facilitating nasotracheal intubation in day-case anaesthesia.

We have performed a prospective study in 100 adults (ASA I or II) undergoing day-case dental extraction to compare the conditions for intubation and the postoperative sequelae of suxamethonium and alfentanil as adjuncts to propofol. The patients were allocated randomly to two groups comparable in age, sex and weight. Successful intubation was achieved in 100% of the suxamethonium group and 90% of the alfentanil group. Of the patients who received suxamethonium, 74% developed myalgia on the day after surgery, compared with 20% in the alfentanil group (P < 0.001). The proportion of patients who developed sore throat was also less in the alfentanil group than in the suxamethonium group (P < 0.05). The proportion of patients who complained of nausea in the two groups was not significantly different. We conclude that alfentanil, as an adjunct to propofol to facilitate tracheal intubation, is more acceptable to patients than suxamethonium in anaesthesia for day-case surgery.

Adolescent↗
PubMed1991

Intracranial and cerebral perfusion pressure changes before, during and immediately after orthotopic liver transplantation for fulminant hepatic failure.

Several centres that perform liver transplantation for fulminant hepatic failure have experience of patients who have not regained consciousness despite adequate graft function. In some of these, decerebration because of elevation in intracranial pressure was thought to have occurred intraoperatively or in the early post-operative period. In the present study six patients with fulminant hepatic failure who were transplanted had extradural monitors inserted before operation. Intracranial pressure had been controlled prior to transplantation and rose during the pre-clamp phase of the operation. Levels fell during the anhepatic phase but rose again during the reperfusion phase (p = 0.033). Overall, from the induction of anaesthesia to the reperfusion phase there was a significant increase in mean intracranial pressure (p less than 0.01). The cerebral perfusion pressure fell after induction of anaesthesia from a median 54 mmHg (range 46-62) to a median 35 mmHg (range 19-49, p less than 0.001) in the pre-clamp phase and remained low throughout the operation. During the first 10 hours after transplantation, three patients had further episodes of intracranial hypertension requiring treatment and it is important that monitoring should be continued through this period.

Adolescent↗
PubMed1988

Regulation of GDP binding and uncoupling-protein concentration in brown-adipose-tissue mitochondria. The effects of cold-acclimation, warm-reacclimation and noradrenaline.

We have used a specific immunoassay for uncoupling protein and [3H]GDP binding to study the acute and chronic responses of brown-adipose-tissue (BAT) mitochondria of warm-acclimated rats to housing at 4 degrees C and cold-acclimated rats to housing at 27 degrees C. These studies have shown the following. (1) In the cold-exposed rat the increase in mitochondrial uncoupling-protein concentration parallels the increase in GDP binding from 1 day to 5 days, but that acutely (initial 4 h) the increase in GDP binding is not associated with any change in uncoupling-protein concentration. 2. In the cold-acclimated rat rehoused at 27 degrees C, GDP binding fell by over 50% in the first 2 days, without any change in uncoupling-protein concentrations. 3. Noradrenaline acutely (30 min) increased BAT mitochondrial GDP binding of lean and obese Zucker rats, without any change in uncoupling-protein concentrations. 4. The increases in GDP binding in cold-exposed rats were associated with increases in the rate of swelling of mitochondria in the presence of valinomycin and potassium acetate. The evidence supports the hypothesis that the acute response of the rat to changes in environmental temperature are associated with unmasking or remasking of uncoupling protein, whereas chronically changes in uncoupling-protein concentration predominate.

Adaptation, Physiological↗
PubMed1988

Systemic air embolism during laser bronchoscopy.

We report a case of massive, fatal, systemic gas embolism which occurred during the course of laser bronchoscopic resection of a bronchial carcinoma. The clinical features of systemic air embolism are discussed.

Aged↗