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Biomedical subjects

T Randell

Publications and source records attributed to T Randell.

At least 55 records · Page 3Linked to original sources
PubMed1993

Isoflurane inhibits muscle fasciculations caused by succinylcholine in children.

The incidence and intensity of muscle fasciculations as well as the occurrence of cardiac arrhythmias following succinylcholine were evaluated in 36 premedicated children (1.0-5.7 years) after intravenous induction with thiopentone or after inhalation induction with isoflurane (3.75 vol-% in 70% nitrous oxide in oxygen). The study was randomized. In the thiopentone group, fasciculations were seen in all children and in the isoflurane group in 5 of 18 children (P < 0.001). The median of the duration of fasciculations was 15 s with a minimum of 5 s and maximum of 36 s (1st quartile 9 s and 3rd quartile 20 s) in the thiopentone group and 0 (0-15) s with a 1st quartile of 0 and a 3rd quartile of 3 s in the isoflurane group (P < 0.001). No cardiac arrhythmias were noted in either group. In conclusion, isoflurane in nitrous oxide inhibits succinylcholine-induced muscle fasciculations in children.

Anesthesia, Inhalation↗
PubMed1992

Is nasotracheal intubation safe in surgery for mandibular cancer?

A retrospective study of problems of postoperative airway maintenance after surgery for mandibular cancers was conducted. Twenty-seven patients treated in an intensive care unit after mandibular resection and primary reconstruction were included. The mean duration of nasotracheal intubation in 22 patients was 33.7 hours. Reintubation because of breathing difficulties was required in four cases. In one of these cases, failed intubation led to an emergency cricothyroidostomy. Failure to perform reintubation resulted in the death of one patient. One patient was tracheostomized after 5 days of nasotracheal intubation. Prolonged nasotracheal intubation after major surgery for oral malignant neoplasms may be an alternative to tracheostomy, provided that adequate monitoring is available after extubation. The safe duration of endotracheal intubation is difficult to determine. Primary reconstruction does not eliminate the need for an artificial airway after tumor surgery.

Adult↗
PubMed1992

Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl.

The effects of the new, highly selective alpha 2-adrenergic agonist, dexmedetomidine, were studied in a randomized, placebo-controlled, double-blind trial in 24 ASA I patients. Dexmedetomidine 0.6 micrograms kg-1 or saline was given i.v. 10 min before induction of anaesthesia. The required dose of thiopentone was significantly (P less than 0.001) smaller in the dexmedetomidine group (mean 4.4 (sd 0.9) mg kg-1) than in the control group (6.9 (1.6) mg kg-1), and the drug attenuated the cardiovascular responses to laryngoscopy and tracheal intubation. The concentration of noradrenaline in mixed venous plasma was smaller in the dexmedetomidine group during all phases of induction (P less than 0.01). During surgery, fentanyl was required in a dose of 0.5 (0.6) mg kg-1 and 2.8 (2.6) mg kg-1 in the dexmedetomidine and control groups, respectively (P less than 0.001). During 2 h postoperative follow-up, oxycodone 0.06 (0.06) mg kg-1 and 0.16 (0.1) mg kg-1 (P less than 0.05) was given to the two groups respectively.

Adrenergic alpha-Agonists↗
PubMed1992

Topical anaesthesia of the nasal mucosa for fibreoptic airway endoscopy.

We have compared four methods of topical anaesthesia of the nostril for fibreoptic airway endoscopy in a randomized study with 31 unpremedicated volunteers, each serving as his or her own control. Lignocaine spray, EMLA cream, three cotton swabs soaked in 4% lignocaine solution, or 2% lignocaine gel was applied in a nostril for 3 min. Application of lignocaine spray was rated as the most unpleasant and EMLA cream the least unpleasant. Spray and gel caused an increase in arterial pressure. Anaesthesia of the mucosa, tested by passing a bronchoscope through the nose to the oropharynx was best with lignocaine spray or gel. Gel or EMLA, but not the local anaesthetic applied with swabs, obscured vision. When slight obscurity of vision is not a problem, local anaesthetic gel is recommended for anaesthesia of the nasal mucosa. Premedication or sedation is recommended for all the methods described here.

Administration, Topical↗
PubMed1992

The effect of amrinone on recovery from severe bupivacaine intoxication in pigs.

Cardiovascular collapse following intravascular bupivacaine may be resistant to treatment. The effect of amrinone on recovery from bupivacaine-induced severe cardiovascular depression was evaluated in 20 pigs (13-26 kg) in a placebo-controlled randomized double-blind study. Under 0.7% isoflurane anesthesia at FIO2 0.21, 0.5% bupivacaine 2 mg.kg-1.min-1 was infused until mean arterial pressure was 40% of the baseline. Cardiac output and heart rate decreased 75% and 50% from the baseline, respectively. The total dose of bupivacaine was 17 +/- 6 (SD) mg.kg-1 in the control and 19 +/- 5 mg.kg-1 in the amrinone group, resulting in mean plasma concentrations of 42 +/- 6 and 53 +/- 19 micrograms.ml-1, respectively. A bolus of amrinone 4 mg.kg-1 (n = 10) was given immediately after cardiovascular depression, followed by an infusion of 0.6 mg.kg-1.min-1. The control animals received corresponding volumes of physiologic saline (n = 10). After cardiovascular depression, the lungs were ventilated with FIO2 1.0 without anaesthetics or sympathomimetic support. Electric activity of the heart ceased in all control animals in 3.9 +/- 2 min after cardiovascular depression despite atropine and external cardiac compression. All animals in the control group and 5 of 10 animals in the amrinone group were given atropine (P less than 0.01). The animals receiving amrinone survived without cardiac compression (P less than 0.0001). During bupivacaine infusion, all animals developed burst suppression in the electroencephalogram. At the time of cardiovascular depression, in 8 of 10 control and in 6 of 10 amrinone animals, the electroencephalogram was isoelectric.(ABSTRACT TRUNCATED AT 250 WORDS)

Amrinone↗
PubMed1992

Sedation for bronchofiberoscopy: comparison between propofol infusion and intravenous boluses of fentanyl and diazepam.

Two methods of sedation were evaluated in unpremedicated patients undergoing elective bronchofiberoscopy. The patients were randomly allocated to receive either propofol infusion 1 mg kg-1 h-1 preceded by a 1 mg kg-1 bolus (15 patients) (the propofol group) or intravenous fentanyl 1 micrograms kg-1 and diazepam 0.05 mg kg-1 (15 patients) (the fentanyl+diazepam group). Thirteen patients were treated twice during the study period and sedated with both methods (the first treatment according to random order and the second with the method not used on the first occasion). A topical anaesthetic was applied to the selected nostril with two cotton swabs soaked in 4% lidocaine. Epiglottis, vocal cords, trachea and bronchi were anaesthetized by spraying 4% lidocaine through the working channel of the fiberoscope as the instrument was advanced. The patients in the propofol group were more sedated than those in the fentanyl+diazepam groups (P less than 0.01). The working conditions were the same. After sedation, respiratory frequency decreased only in the fentanyl+diazepam group (P less than 0.05). Before sedation, haemoglobin saturation of oxygen was 95 +/- 2% (mean +/- s.d.) in the propofol group and 94 +/- 3% in the fentanyl+diazepam group. Immediately before the start of bronchofiberoscopy, it was 89 +/- 4% and 90 +/- 3%, respectively. The decrease was statistically significant in both groups (P less than 0.001). After sedation, systolic arterial pressures (SAP) decreased in both groups (P less than 0.01). Compared to values immediately before starting bronchofiberoscopy, SAP increased during the procedure in both groups (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Ketamine anaesthesia in a patient with septic shock.

A 71-year-old male patient was operated on in a septic state (tachycardia, hypotonia, fever peaks, disorientation) because of an occluding tumour of the biliary tract. Ketamine was used as the main anaesthetic. Mean arterial pressure increased markedly and diuresis started during the anaesthesia. The inotropic support (dopamine, dobutamine, noradrenaline) could be reduced. Ketamine anaesthesia seemed to have a beneficial haemodynamic effect in septic shock.

Aged↗
PubMed1992

Alfentanil inhibits muscle fasciculations caused by suxamethonium in children and in young adults.

The effect of alfentanil on suxamethonium-induced muscle fasciculations was studied in a double-blind study in 34 children (mean age 6.8 years) and in 30 adults (mean age 20 years). After pretreatment with either alfentanil 50 micrograms kg-1 or saline, each patient was anaesthetized with a sleep dose of thiopental followed by suxamethonium 1.5 mg kg-1 for endotracheal intubation. Compared to the control groups, alfentanil significantly decreased the intensity of visible muscle fasciculations caused by suxamethonium. In children, the duration of muscle fasciculations was shorter in the alfentanil than in the control group. In adults, the intensity rather than the duration of fasciculations was attenuated by alfentanil. The inhibition of fasciculations caused by alfentanil was also demonstrated in children in the surface electromyogram recorded on the biceps. There was no circulatory response to endotracheal intubation in the groups pretreated with alfentanil.

Adolescent↗
PubMed1991

Isoflurane in nitrous oxide and oxygen increases plasma concentrations of noradrenaline but attenuates the pressor response to intubation.

The haemodynamic response to laryngoscopy and intubation was evaluated in 52 ASA I patients anaesthetized with thiopentone 4-6 mg.kg-1. Vecuronium 0.1 mg.kg-1, followed by 3 min mask ventilation with nitrous oxide in oxygen with (isoflurane group) or without (control group) 3% inspired isoflurane preceded tracheal intubation. In 21 of 52 patients, concentrations of noradrenaline (NA), adrenaline and 3,4-dihydroxyphenylethyleneglycol (DHPG) were measured from central venous plasma. During the 3-min ventilation, in the isoflurane group, heart rate increased by 22% but remained stable in the control group. A marked pressor response to laryngoscopy and intubation was seen in the control but not in the isoflurane group. During the 3-min ventilation, the plasma concentration of NA was doubled in the isoflurane group and increased by 49% in the control group (P less than 0.05). The concentration of DHPG also increased in the isoflurane group. Peripheral skin temperature increased similarly after 3 min ventilation in both groups. After intubation, it was significantly higher in the isoflurane than in the control group (P less than 0.05). In conclusion, compared to nitrous oxide in oxygen, ventilation with isoflurane in nitrous oxide in oxygen causes a sympathetic activation combined with an increase in heart rate and peripheral temperature while the pressor response to laryngoscopy and intubation is attenuated.

Adult↗
PubMed1991

Oral atropine enhances the risk for acid aspiration in children.

Two modes of administration of an anticholinergic drug were compared in 58 healthy children undergoing adenoidectomy. The study was double-blind and randomized. All children were premedicated with oral midazolam 0.5 mg/kg. Twenty-nine children received oral atropine 0.03 mg/kg (Group A) and the rest were given i.v. glycopyrrolate 0.005 mg/kg at the induction of anaesthesia (Group G). In Group A, of 29 children, the stomach was empty in 2, pH was less than 2.5 in 23, the gastric volume was greater than 0.4 ml/kg in 19, and both these risk factors were present in 17 children. The same figures in Group G were 5 (NS), 14 (P less than 0.05), 10 (P less than 0.05) and 9 (P less than 0.05) children, respectively. The antisialagogue effect was similar in both groups.

Administration, Oral↗
PubMed1991

Comparison of inhalation induction with isoflurane or halothane in children.

Thirty-six children (mean age 2.4 years) premedicated with oral chloral hydrate 70 mg kg-1 and atropine 0.03 mg kg-1 were anaesthetized with either 3.75% isoflurane or 2.5% halothane in 70% nitrous oxide in oxygen. The eyelash reflex disappeared in 39 +/- 7 s (mean +/- SD) with isoflurane and in 56 +/- 16 s with halothane (P less than 0.001). Tachypnoea was seen with both anaesthetics. Coughing, breath holding, stridorous breathing and respiratory depression were seen during isoflurane but not during halothane induction (P less than 0.01). In nine of 20 children anaesthetized with isoflurane, the ventilation had to be assisted before intubation. Endotracheal intubation was possible in 224 +/- 35 s with isoflurane and in 281 +/- 64 s with halothane (P less than 0.01). Intubating conditions were satisfactory in 80% of the children anaesthetized with either volatile agent. Cardiovascular responses to endotracheal intubation were minimal with both anaesthetics. No cardiac dysrhythmias were noted. Heart rate was higher during isoflurane than during halothane induction. Diastolic arterial pressure was lower during isoflurane than during halothane induction immediately and 5 min after intubation.

Analysis of Variance↗
PubMed1990

Maxillofacial fractures related to work accidents.

Work-related maxillofacial fractures were studied retrospectively over a six-year period. There were 98 cases accounting for 4.5% of all facial bone fractures treated in our hospital between 1981 and 1986. Of the patients, 89.8% were male. The mean age of the injured was 36.4 years. The incidence of work-related maxillofacial fractures was 0.37 per 1000 workers. Most of the injuries (66%) occurred in factories and construction work. Such work was associated with an to 15 times higher risk of maxillofacial fracture than service and office work. Of the fractures, 20.4% were sustained on the way to or coming from work. At the place of work, the commonest causes of injury were blows from objects or falls from a height (70%). On the way to or coming from work, the aetiological factor was most often a traffic accident. Assault and battery had caused facial bone fractures in 11.2% of cases. Fifty-five patients with midface and 45 patients with mandibular fractures were found, of these, 8 patients had bimaxillary fractures. In 6 cases, only dentoalveolar fractures were found. Of the patients, 55.1% were treated operatively. Sixty-six patients were hospitalized, the mean length of hospital stay being 3.2 days (range 1-12 days).

Accidents, Occupational↗
PubMed1990

Minitracheotomy: complications and follow-up with fibreoptic tracheoscopy.

Complications and changes in tracheal mucosa after minitracheotomy were evaluated in 28 patients. Tracheal mucosa was inspected fibreoptically after the insertion of a minitracheotomy cannula, and then at 3-day intervals until the cannula was removed. Thereafter, assessments were made every third day until the mucosa was considered normal. Three significant complications occurred: mediastinal puncture, paratracheal entrance of the cannula and subcutaneous emphysema. Difficulties at insertion of the minitracheotomy cannula were encountered in 15 of 28 patients (54%). Air flow detected through the cannula in one patient, and lack of air flow in another patient, were misleading signs of the position of the cannula. Passing a suction catheter in three patients and a normal end-tidal carbon dioxide tracing in one patient, were also found to be misleading. The correct position and possible complications could be verified only by fibreoptic tracheoscopy. Changes in the tracheal mucosa were independent of the duration of minitracheotomy therapy.

Aged↗
PubMed1990

Effects of alfentanil on the responses to awake fiberoptic nasotracheal intubation.

Intubation conditions and pressor response were assessed in 30 healthy patients undergoing awake nasotracheal intubation. The patients were premedicated with peroral diazepam. All the patients were sedated with intravenous diazepam 0.1 mg/kg. Alfentanil 20 micrograms/kg or saline was administered in a double-blind fashion. Alfentanil caused moderate respiratory depression but significantly improved conditions for fiberoscopy. In the control group, arterial pressures and heart rate increased significantly immediately after tracheal intubation. These responses were attenuated by alfentanil.

Adult↗
PubMed1990

Position of minitracheostomy tube verified fiberoptically--a report of 2 cases.

Two reports concerning difficulties at insertion of a minitracheostomy cannula are presented. In one patient, a minitracheostomy tube perforated the posterior wall of the trachea, resulting in pneumomediastinum. In another patient, conventional signs, i.e. airflow and passing of a suction catheter through the cannula, were misleading in assessing the position of the tube. Fiberoptic tracheoscopy immediately after the performance of minitracheostomy revealed the position of the cannula in both cases.

Adult↗