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Publications (9)13.3 Total impact

  • M. VUCEVIC, B. TEHAN, F. GAMLIN, J. C. BERRIDGE, M. BOYLAN
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    ABSTRACT: Central venous access is an essential part of patient management in many clinical settings. Traditionally this has been achieved by a blind, external landmark guided technique which may not correlate exactly with the location of the vessel. We have prospectively evaluated the SMART needle, a new Doppler ultrasound guided vascular access device, in 40patients, to evaluate whether it can improve on the standard technique. The SMART needle was easy to use and reliably distinguished between arterial and venous signals. No advantage was demonstrated in‘easy’internal jugular vein cannulations. Although ease of cannulation in difficult cases was subjectively improved, the differences in time to cannulation and number of passes between the groups failed to reach statistical significance and the complication rates were similar. However, the use of the SMART needle on two occasions enabled avoidance of carotid artery puncture by correctly distinguishing the artery from the vein, so that it may have a rôle in patients in whom difficult internal jugular venous cannulation is anticipated.
    Anaesthesia 02/2007; 49(10):889 - 891. · 3.49 Impact Factor
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    ABSTRACT: The marked vasodilator and negative inotropic effects of propofol are disadvantages in frail elderly patients. We investigated the safety and efficacy of adding different doses of ephedrine to propofol in order to obtund the hypotensive response. The haemodynamic effects of adding 15, 20 or 25 mg of ephedrine to 200 mg of propofol were compared to control in 40 ASA 3/4 patients over 60 years presenting for genito-urinary surgery. The addition of ephedrine to propofol appears to be an effective method of obtunding the hypotensive response to propofol at all doses used in this study. However, marked tachycardia associated with the use of ephedrine in combination with propofol occurred in the majority of patients, occasionally reaching high levels in individual patients. Due to the risk of this tachycardia inducing myocardial ischemia, we would not recommend the use in elderly patients of any of the ephedrine/propofol/mixtures studied.
    Anaesthesia and intensive care 11/1999; 27(5):477-80. · 1.40 Impact Factor
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    ABSTRACT: It is believed that moderate hypothermia (25-32 degrees C) during cardiopulmonary bypass provides cerebral protection by reducing the cerebral metabolic rate (CMRO2). Nevertheless episodes of ischaemia do occur and thus it has been suggested that cerebral oxygenation should be monitored by jugular venous oximetry. However, this technique is cumbersome and invasive. Near infrared spectroscopy (NIRS) provides a non-invasive assessment of cerebral oxygenation and this was used together with continuousjugular venous oximetry in 21 patients undergoing hypothermic cardiopulmonary bypass. During the hypothermic period, jugular venous oximetry indicated reduced oxygen extraction consistent with a reduction in CMRO2 (increase from 61 +/- 2.5% to 74 +/- 2.5%). In contrast, near infrared spectroscopy demonstrated increased oxygen extraction (HbO2 - 11.5 +/- 1 microM, HHb + 3.2 +/- 0.3 microM) and a fall in the cerebral concentration of oxidized cytochrome oxidase ( - 1.7 +/- 0.3 microM) indicating ischaemia. These results suggest that cerebral ischaemia occurs during hypothermic cardiopulmonary bypass with a spurious rise in jugular venous oxygen saturation, which represents arterio-venous shunting. Thus if hypothermia does facilitate cerebral protection it does not appear to be a direct result of a reduction in CMRO2 and oxygen requirement.
    Cardiovascular Surgery 07/1999; 7(4):425-31.
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    ABSTRACT: Forty ASA1 patients presenting for minor gynaecological surgery were randomly allocated into four study groups to compare the haemodynamic effects of adding different doses of ephedrine to an induction dose of propofol. Heart rate, oxygen saturation and non-invasive arterial blood pressure were monitored before and for 5 min after induction. In those patients who received propofol alone, there was a significant decrease in both systolic (p < 0.001) and diastolic (p = 0.003) blood pressure. The addition of ephedrine 15 mg or 20 mg to 1% propofol 20 ml was very effective in maintaining blood pressure at pre-induction values. There was a statistically significant increase from baseline in systolic (p = 0.004) and diastolic (p = 0.031) pressures, but this only occurred at 1 min postinduction. The addition of ephedrine 10 mg was insufficient to prevent hypotension. There was no significant effect on either heart rate or oxygen saturation in any group. We conclude that ephedrine may be safely employed to reduce the degree of hypotension during induction with propofol in this patient group.
    Anaesthesia 04/1996; 51(5):488 - 491. · 3.49 Impact Factor
  • The Asia Pacific Journal of Thoracic & Cardiovascular Surgery 01/1996; 5(1):56-56.
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    ABSTRACT: The adequacy of right ventricular (RV) preservation and cooling with retrograde cardioplegia has been questioned. We compared the effects of retrograde with antegrade cardioplegia on the recovery ventricular function inpatients undergoing coronary artery surgery. Two groups of similar age, left ventricular function and extent of disease received either retrograde (RC) or antegrade (AC) multidose cold-blood cardioplegia. A right ventricular rapid-response catheter measured right ventricular haemodynamics before and after bypass. Needle thermistors recorded intramyocardial temperatures in the right ventricular free wall, the left ventricular free wall and the septum. There were no differences in bypass times, ischaemic times, inotrope requirements or arrhythmia frequency between the 2 groups. RV haemodynamics were similar in both groups before bypass. Immediately after bypass the RV end diastolic volume index was lower in the retrograde group than in the antegrade group, and RV ejection fraction was higher. This indicates better RV preservation with retrograde cardioplegia early after bypass. By 30 min after bypass all haemodynamic variables had returned to baseline values in both groups. Retrograde cardioplegia provided effective cooling in all areas of the heart. The mean time to achieve electromechanical quiescence was longer with retrograde cardioplegia, and a larger total volume of cardioplegia was required. Except for a minor advantage for RC soom after bypass, this study suggests that RV protection during coronary artery surgery is the same whether retrograde or antegrade cardioplegia is used. The time taken o achieve diastolic arrest with retrograde cardioplegia may presuade surgeons that combination of antegrade and retrograde cardioplegia remains the most satisfactory technique.
    The Asia Pacific Journal of Thoracic & Cardiovascular Surgery 01/1996; 5(1):9-13.
  • M Vucevic, B Tehan, F Gamlin, J C Berridge, M Boylan
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    ABSTRACT: Central venous access is an essential part of patient management in many clinical settings. Traditionally this has been achieved by a blind, external landmark guided technique which may not correlate exactly with the location of the vessel. We have prospectively evaluated the SMART needle, a new Doppler ultrasound guided vascular access device, in 40 patients, to evaluate whether it can improve on the standard technique. The SMART needle was easy to use and reliably distinguished between arterial and venous signals. No advantage was demonstrated in 'easy' internal jugular vein cannulations. Although ease of cannulation in difficult cases was subjectively improved, the differences in time to cannulation and number of passes between the groups failed to reach statistical significance and the complication rates were similar. However, the use of the SMART needle on two occasions enabled avoidance of carotid artery puncture by correctly distinguishing the artery from the vein, so that it may have a rôle in patients in whom difficult internal jugular venous cannulation is anticipated.
    Anaesthesia 11/1994; 49(10):889-91. · 3.49 Impact Factor
  • Journal of Cardiothoracic and Vascular Anesthesia 10/1994; 8(5). · 1.45 Impact Factor
  • Journal of Cardiothoracic and Vascular Anesthesia. 8(3):26.