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Biomedical subjects

W McCaughey

Publications and source records attributed to W McCaughey.

At least 19 recordsLinked to original sources
PubMed1998

Dextromethorphan and pain after total abdominal hysterectomy.

Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist which has been shown to inhibit the development of cutaneous secondary hyperalgesia after tissue trauma. We studied 60 ASA I-II patients undergoing total abdominal hysterectomy in a randomized, double-blind, placebo-controlled study. Patients received either dextromethorphan 27 mg capsules, two doses before operation and three doses in the first 24 h after operation, or placebo. Visual analogue pain scores (VAS) at 24 and 48 h were assessed at rest, on coughing and on sitting up, and were not significantly different between groups. Morphine consumption from a patient-controlled analgesia (PCA) device was also not significantly different between groups. Evidence of secondary hyperalgesia was assessed with von Frey hairs 10 cm above the Pfannenstiel incision. Both groups of patients exhibited evidence of secondary hyperalgesia after 24 and 48 h but there were no significant differences between groups. There was also no difference between groups in VAS scores at 1 month.

Adult↗
PubMed1997

The effect of pre-operative administration of bupivacaine compared with its postoperative use.

Eighty patients undergoing lower third molar surgery under general anaesthesia were assigned to one of two groups to receive local anaesthetic blockade either 10 min prior to surgery or after surgery just before leaving the operating theatre. Patients in both groups received the local anaesthetic block whilst unconscious. Pain was assessed using visual analogue scales at 6 h and 1, 3 and 6 days after surgery. A McGill Pain Questionnaire was also completed on the morning following surgery. At no time was it possible to detect any significant difference in pain between the two groups. The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing this type of surgery. The local anaesthetic, however, does provide excellent analgesia during the first few hours following surgery.

Adult↗
PubMed1994

Diclofenac sodium versus fentanyl for analgesia in laparoscopic sterilization.

The effectiveness of an anaesthetic technique employing diclofenac sodium as an analgesic given preoperatively by intramuscular injection was compared against one employing intravenous fentanyl in patients undergoing laparoscopic sterilization. Postoperative pain was marked and both drugs provided partial relief only. Patients in the diclofenac group had pain scores that were initially higher than those in the fentanyl group and the difference between the groups was statistically significant (P < 0.02). Patients in the diclofenac group who received postoperative supplemental morphine analgesia recorded lower pain scores at 30 min than comparable patients in the fentanyl group (P < 0.03). These findings suggest that neither drug provides sufficient analgesia for laparoscopic sterilization when given as a sole analgesic. Investigation of a combined analgesic technique employing morphine and a non-steroidal anti-inflammatory drug is warranted.

Adult↗
PubMed1988

Comparison of propofol and methohexitone as anaesthetic agents for electroconvulsive therapy.

Propofol was compared to methohexitone for induction of anaesthesia for electroconvulsive therapy. Seizures were significantly shorter after the use of propofol, in respect of both visible seizures and duration of cerebral electrical seizure activity. This suggests the possibility that additional treatments may be needed for the same clinical effect in psychiatric illness when propofol is used as the induction agent. Propofol was more effective than methohexitone at obtunding the hypertensive response to electroconvulsive therapy without causing significant hypotension.

Adult↗
PubMed1988

Nalbuphine and pentazocine in an opioid-benzodiazepine sedative technique: a double-blind comparison.

Sedation by a combination of an opioid drug such as pentazocine with a benzodiazepine is commonly used for minor surgical and investigative procedures. Nalbuphine is a newer drug which, like pentazocine, is an opioid agonist-antagonist. Its actions are similar, but it has theoretical advantages in its profile of cardiovascular side effects. Nalbuphine or pentazocine in combination with diazepam were compared as components of a sedative technique for invasive radiology. The doses used were in the ratio of 2.5:1--ie nalbuphine 0.2 mg kg-1 and pentazocine 0.5 mg kg-1. Both regimens gave satisfactory results, and no difference could be detected between them in terms of sedation, analgesic efficacy, cardiovascular or respiratory changes, or recovery. Nalbuphine provides a safe and effective alternative to pentazocine in this situation. The study confirmed the need for caution because of the respiratory depressant effects of both drugs.

Aged↗
PubMed1984

Oral ranitidine in labour.

Ranitidine 150 mg orally was given every 6 hours to 909 women in labour, while a control group of 378 women received conventional alkali therapy. No differences in incidences of operative intervention, placental retention or post-partum haemorrhage were observed between groups. Gastric sampling during emergency anaesthesia revealed a pH less than 2.5 in four of 51 women who received ranitidine and in two of 31 women who received magnesium trisilicate. Gastric volumes were slightly lower (mean 83 ml) in the study group than in the control group (mean 122 ml). Absorption of ranitidine was greatly slowed following narcotic administration and gastric volume was significantly higher in those patients given narcotics in labour. Apgar scores were similar in both groups of infants, and babies whose mothers were given ranitidine showed no delay in achieving high gastric acidity and no increase in bacterial colonization of the gastro-intestinal tract. Low levels only of ranitidine were found in the blood of babies at 2-3 hours and approximately 12 hours after birth.

Anesthesia, Obstetrical↗
PubMed1983

Ranitidine as an antacid before elective Caesarean section.

In a preliminary study, 20 women in labour received ranitidine 50 mg intravenously. No significant changes were seen in the height, frequency or amplitude of uterine contractions or in fetal heart rate or pattern. No neonatal problems attributable to ranitidine were found. Ranitidine crossed the placenta, the mean fetal-maternal ratio being 0.9. Levels in the infants 12 hours following delivery were all very low. Ranitidine 150 mg orally was given to 80 healthy women undergoing elective Caesarean section at varying times from 75 to 510 minutes pre-operatively. From 2 to 6 hours following ingestion, the pH of gastric contents was greater than 2.5 in all but one patient. The mean volume aspirated (8 ml) was significantly lower than in a control group receiving magnesium trisilicate (mean volume 30 ml). Neonatal assessment included Apgar scoring, neurobehavioural examination, feeding progress, measurement of acidity and culture of gastric aspirates. No significant differences between groups were found. Blood levels indicated that the oral drug is readily absorbed by the parturient and that a smaller proportion is transferred to the fetus, mean fetal-maternal ratio at delivery being 0.38.

Adult↗
PubMed1983

Use of cimetidine as an oral antacid in obstetric anesthesia.

The H2-receptor antagonist, cimetidine, was used instead of magnesium trisilicate BPC as routine antacid therapy before both elective and emergency obstetric anesthesia. Two trials of its efficacy in increasing intragastric pH and decreasing the volume of gastric contents in parturients are reported. In the first trial, 400 mg of cimetidine given orally to patients being delivered by elective cesarean section effectively decreased gastric acidity, providing induction of anesthesia occurred 90-150 min after its administration. Of 62 patients requiring emergency anesthesia during active labor and who had been treated with 200 mg of cimetidine orally at 2-h intervals, 80% had gastric contents with a pH higher than 2.5. Failure to decrease gastric acidity to this level was mainly due to anesthesia being required within 60 min of the loading dose, but it also was considered that inaccurate timing of repeat doses and possibly delay in uptake due to gastric stasis by narcotic analgesia played a part. In trial 2 the same cimetidine regimen plus a 15-ml oral dose of 0.3 M sodium citrate given 10 min before induction of anesthesia was studied. All 72 women delivered by elective cesarean section had a low volume of gastric contents with pH greater than 2.5. Only 4% of 135 patients requiring emergency anesthesia had gastric aspirates the pH of which was less than 2.5. The volume (97 +/- 8.4 ml) of gastric contents removed from the latter patients were considered to still pose a hazard at induction of general anesthesia. No maternal or infant side effects related to cimetidine therapy were noted.

Administration, Oral↗
PubMed1982

Cimetidine as an oral antacid before elective Caesarean section.

The H2-receptor antagonist cimetidine was used as a pre-operative antacid in 64 women scheduled for elective Caesarean section. All were given cimetidine 400 mg 90-215 minutes before induction, with 20 of them having an extra 400 mg dose the previous night. The intragastric pH at induction of anaesthesia was reliably above 2.5 if the treatment was given 90-150 minutes beforehand. The volume of gastric contents was reduced when compared with a control series of women receiving either no pre-operative antacid or 30 ml magnesium trisilicate mixture BPC. No adverse effects on mothers or infants were detected.

Adult↗
PubMed1982

A field trial of cimetidine as the sole oral antacid in obstetric anaesthesia.

Cimetidine was used as the routine antacid treatment for 1323 parturients. The findings from 70 of those who needed an emergency general anaesthetic are reported. Once sufficient time had elapsed for absorption of the drug, and provided that the dosage regime was adhered to, 96% of the women studied had an intragastric pH above 2.5. Neonatal monitoring revealed no abnormalities related to the cimetidine treatment.

Anesthesia, Obstetrical↗
PubMed1982

The respiratory depression of epidural morphine. Time course and effect of posture.

In order to investigate the time course of the late respiratory depression which has been reported following epidural opiates, the response to CO2 was measured in 11 patients. Epidural morphine 2 mg was given 1 hour after operation under bupivacaine epidural anaesthesia, and the patients nursed supine. The results show a consistent pattern of respiratory depression commencing at approximately 48 hours, and continuing until 18-24 hours after administration of morphine. A similar group of 10 patients nursed in a sitting position did not show the same degree of depression, and a modifying effect of posture on the development of central effects is suggested.

Carbon Dioxide↗
PubMed1981

Cimetidine in elective Caesarean section. Effect on gastric acidity.

Aspiration pneumonitis, Mendelson's syndrome, continues to be an important cause of maternal morbidity and mortality in obstetric anaesthesia, despite widespread adoption of the practice of routine administration of alkalis. Histamine H2 receptor blocking drugs have been shown to reduce gastric secretion in non-obstetric patients. Cimetidine was given intravenously to fasting patients before elective Caesarean section. In all 10 patients who received cimetidine 200 mg intravenously at 60--80 minutes before anaesthesia, the pH of gastric contents at the time of induction was above 2.5. When the interval between administration of the drug and induction of anaesthesia was only 30--40 minutes (six patients) or was over 90 minutes (20 patients) then the pH was raised to above this value in only two-thirds of patients. By contrast eight of 10 untreated patients were found to have a gastric pH of less than 2.5. No adverse effects of cimetidine were seen in mothers or infants.

Anesthesia, General↗