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Biomedical subjects

V A Goat

Publications and source records attributed to V A Goat.

At least 19 recordsLinked to original sources

The antiemetic effectiveness of droperidol during morphine patient-controlled analgesia.

This prospective, double-blind study examined the antiemetic effectiveness of the addition of droperidol to a morphine solution for use in patient-controlled analgesia in a group of 50 patients undergoing elective lumbar laminectomy. The addition of 20 mg droperidol to 120 mg morphine in 60 ml saline given by a Baxter 'Infusor' patient-controlled analgesia device reduced the incidence of vomiting as compared to the addition of sodium chloride from 42.8% to 12.5% (p = 0.028) and of nausea from 71.4% to 29.2% (p = 0.005). The proportion of patients requiring rescue antiemetic therapy was reduced from 47.6% to 16.7% (p = 0.025) and the time interval to the first use of rescue antiemetic agent was significantly prolonged (p = 0.029). The use of droperidol was associated with an increased degree of sedation during the first 12 h after operation.

Adult↗

Two cases of barotrauma associated with transtracheal jet ventilation.

Two patients suffered barotrauma whilst undergoing transtracheal jet ventilation (TTJV). In the first, TTJV was provided by a Sanders injector and in the second it was given by a high frequency jet ventilator. Barotrauma was a consequence of the expiratory pathway becoming blocked. The mechanism of barotrauma and a method of airway pressure monitoring during TTJV are discussed. It is recommended that meticulous care is taken to ensure an adequate path for expiration when jet ventilation is used.

Barotrauma↗

Atracurium infusion during paediatric craniofacial surgery. Closed loop control of neuromuscular block.

A simple feedback control system was used to administer atracurium to 10 infants aged between 5 and 36 months during craniofacial reconstruction. The purpose of the study was to establish whether the system, previously evaluated only in adults, would be effective in paediatric patients. The individuals studied underwent long procedures with substantial blood loss and the potential for thermal and electrolyte disturbances. The system maintained the level of neuromuscular block successfully between 88 and 100% in all patients and between 90 and 100% in nine patients. The mean duration of feedback control was 179 (range 111-440) minutes. The mean (SD) dose of atracurium required was 0.40 (0.12) mg/kg/hour. The mean (SD) recovery time to a train-of-four ratio of 0.75 was 24.8 (9.9) minutes.

Atracurium↗

Feedback control of neuromuscular blockade. A simple system for infusion of atracurium.

A simple system for closed-loop control of neuromuscular blockade is described. It comprises a Datex Relaxograph, a small relay and a syringe pump. The equipment is commercially available and requires no complex custom-built electronics. Atracurium was infused in a semicontinuous manner to 11 patients who underwent general anaesthesia for a variety of surgical procedures. Neuromuscular blockade oscillated within a narrow range around the preset level. The mean rate of infusion of atracurium was 0.5 mg/kg/hour (SD 0.13). The mean recovery time was 25.5 minutes (SD 7.95).

Adult↗

Adverse effects of suxamethonium. Failure of prevention by atracurium or fazadinium.

One hundred patients were allocated randomly to pretreatment with atracurium 2.5 mg, atracurium 5 mg, fazadinium 3.75 mg or saline 3 minutes before the injection of suxamethonium. The effect upon neuromuscular conduction was studied by recording the mechanical response of the adductor pollicis muscle to indirect stimulation of the ulnar nerve using repeated 2 Hz train of four stimuli. Blood samples were taken at intervals for the measurement of serum potassium. There was no significant difference in the incidence of postoperative muscle pains between the groups in the first 72 hours following anaesthesia. The use of the larger pretreatment dose of atracurium resulted in clinically significant neuromuscular blockade in three of the subjects. Minimal changes in serum potassium occurred in all patients but there was no statistical difference between the groups.

Adolescent↗

Intracranial pressure after phenoperidine.

The problem of sedating patients requiring prolonged controlled ventilation has recently received considerable attention. Various therapeutic regimes are available and there appears to be a general move away from the use of muscle relaxants towards sedative drugs. Phenoperidine is a popular agent for this purpose. One survey from a district general hospital reported that 66% of their ventilated intensive therapy unit patients received phenoperidine, either alone or as part of a sedation regime. However, enthusiasm for its use must be tempered by recent reports of cardiovascular collapse following its administration. We wish to report a case of intracranial hypertension following the use of phenoperidine in a ventilated patient with a severe head injury.

Blood Pressure↗

Suxamethonium: a new look at pretreatment.

Fifty patients were pretreated with either suxamethonium 10 mg or gallamine 20 mg before an injection of suxamethonium 1 mg kg-1. The effect of the pretreatment upon neuromuscular transmission was monitored by recording the mechanical response of the adductor pollicis muscle to indirect stimulation, using a 2-Hz train-of-four stimulus repeated every 12 s. The pretreatment injection of suxamethonium caused fasciculation in one-quarter of the patients studied. Significant neuromuscular blockade occurred during pretreatment in 16 of the 25 patients investigated. Pretreatment with gallamine 20 mg predictably decreased the efficacy of the intubating injection of suxamethonium, making intubation more difficult. The frequency of muscle pain was similar in both groups.

Adolescent↗

Recovery from pancuronium. A comparison between old and young patients.

The rate at which paralysis from pancuronium could be reversed by neostigmine was monitored in two groups of patients, one elderly and the other young adults. Some patients were found to have prolonged recovery times, and this slow reversal occurred more frequently in the older group of patients. Possible reasons for this are discussed.

Adolescent↗

The Bain system: gas flows in small subjects.

Rabbits weighing 2-4 kg were ventilated using a Bain type co-axial circuit. Acceptable blood-gas tensions were achieved with a tidal volume of 10 ml kg-1, a frequency of 40 b.p.m., and a fresh gas flow of 3 litre min-1. This technique may be applicable to neonatal anaesthesia.

Animals↗

Recovery from neuromuscular blockade. a comparison between old and young patients.

Thirteen young and thirteen elderly patients undergoing elective surgery were given an anaesthetic using tubocurarine as the sole muscle relaxant. Following reversal with neostigmine, the time taken to recover from neuromuscular blockade was measured. No significant difference was found between the two groups of patients.

Adolescent↗

The effect of blood flow upon the activity of gallamine triethiodide.

The onset, depth and recovery from paralysis produced by gallamine triethiodide were studied using the tibialis anterior muscle/sciatic nerve preparation in mongrel dogs, during changes in blood flow to this muscle. A roller pump was used to effect the blood flow changes via an aorto-femoral shunt. The onset and depth of paralysis were related directly to muscle blood flow. There was no correlation between the rate of recovery from paralysis and the blood flow to the muscle.

Animals↗