R J Fergusson

Bio: R J Fergusson is an academic researcher from Northern General Hospital. The author has contributed to research in topics: Respiratory function & Breathing. The author has an hindex of 5, co-authored 9 publications receiving 117 citations.

Suxamethonium is dangerous in polyneuropathy.

Abstract: Case 1?A 23-year-old woman developed weak arms and legs and diplopia during her second pregnancy. On examination she had a mild peripheral sensory disturbance, definite distal muscle weakness, and absent tendon reflexes. Cerebrospinal fluid (CSF) protein was 20 g/1. The neuropathy relapsed over the next five years until she presented with deteriorating pulmonary function and an inability to cough due to muscle weakness, for which she required artificial ventilation. She was given atropine and thiopentone to induce anaesthesia and then paralysed with suxamethonium (succinylcholine) before in? tubation. During this procedure she developed a ventricular tachycardia, which returned promptly to sinus rhythm with intravenous lignocaine and DC cardioversion. Case 2?A 42-year-old man presented with paraesthesia in the hands and feet and left-sided facial weakness. Over the next seven months his arms and legs became progressively weak, extending proximally. He was almost completely paralysed in the arms, legs, and trunk and had a peripheral sensory dis? turbance and absent reflexes. CSF protein concentration was raised at 2-84 g/1. Because he could not cough effectively and his respiratory function was deteriorating he required artificial ventilation. He was given atropine 0-3 mg, thiopentone 200 mg, and suxamethonium 75 mg intravenously before intubation. His pulse was lost immediately, and ECG monitoring showed ventricular tachycardia, which progressed to ventricular fibrillation. He was given intravenous lignocaine and cardio verted on four occasions before returning to sinus rhythm. No further arrhythmias were noted. Case 3?A 75-year-old man was admitted with a five-month history of progressive weakness of the legs. On examination he had flaccid paralysis of all muscle groups with absent tendon reflexes. CSF protein concentration was 3-2 g/1. He developed purulent sputum and a chest radiograph showed consolidation in the right lower lobe. Because he was unable to cough and blood gas concentrations were falling he was intubated, artificial

Comparison of oral prednisolone and intramuscular depot triamcinolone in patients with severe chronic asthma.

Abstract: In a double blind crossover study oral prednisolone was compared with intramuscular depot triamcinolone in the treatment of 20 patients with severe chronic asthma. A short term study comparing each treatment over four weeks showed only minor differences in therapeutic efficacy, but at the end of 24 week periods on each of the two treatments triamcinolone was significantly more effective than prednisolone in terms of forced expiratory volume in one second and forced vital capacity. Better control of asthma was accompanied by a significant fall in weight and some evidence of reduced adrenal suppression (improved cortisol response following a short tetracosactrin test). Side effects, including menstrual irregularities, muscle pain, and hirsuitism, were, however, more common during treatment with triamcinolone.

Nebulised salbutamol without oxygen in severe acute asthma: how effective and how safe?

Abstract: Thirty two patients with severe acute asthma, all of whom were hypoxaemic, entered a double blind comparative assessment of three doses of salbutamol (1.25, 2.5, and 5 mg) nebulised by an electrically operated air compressor. The study lasted for two hours, during which oxygen and corticosteroid treatment were withheld. All patients were observed in an intensive care area during this period. Four patients had to be withdrawn from the study. Two became distressed immediately after receiving salbutamol and were excluded from further analysis. Two other patients were withdrawn, one with persistent respiratory distress and an unchanged one second forced expiratory volume (FEV1) and the other because of the development of profound hypoxaemia and a deteriorating FEV1 within 60 minutes of treatment. No significant differences were observed between the three dosage groups. In the 28 patients completing the study there were only small increases in mean FEV1 (0.8 to 1.1 l) and forced vital capacity (FVC) (1.3 to 1.8 l) over the two hours. There was a fall in the mean pulse rate at 120 minutes of 15 beats per minute (117-102). No significant change in oxygen tension (PaO2) was observed at 15 or 60 minutes after administration of nebulised salbutamol in any of the three groups. Salbutamol nebulised in air, in a single dose of 5 mg, produces only slight relief of airflow obstruction and no worsening of hypoxaemia in severe acute asthma.

Rigid bronchoscopy under intravenous general anaesthesia with oxygen Venturi ventilation.

Abstract: In a study of 100 patients undergoing rigid bronchoscopy under intravenous general anaesthesia with oxygen Venturi ventilation no major complications were observed. Minor complications included one adverse reaction to alphaxalone-alphadolone acetate (Althesin), one prolonged episode of laryngeal spasm after removal of the bronchoscope, and subsequent muscle pain attributed to suxamethonium in 36 patients. The last complication occurred significantly less frequently (p less than 0 . 025) in those patients who were pretreated with a small dose of a non-depolarising neuromuscular blocking agent. Serial arterial blood gas sampling in 10 patients showed adequate ventilation during bronchoscopy, but carbon dioxide retention developed in nine cases immediately after the bronchoscope was withdrawn. With adequate precautions, however, the procedure is safe and well tolerated, even in patients with severe impairment of respiratory function.

Suxamethonium Is Dangerous in Polyneuropathy

Abstract: Case 1?A 23-year-old woman developed weak arms and legs and diplopia during her second pregnancy. On examination she had a mild peripheral sensory disturbance, definite distal muscle weakness, and absent tendon reflexes. Cerebrospinal fluid (CSF) protein was 20 g/1. The neuropathy relapsed over the next five years until she presented with deteriorating pulmonary function and an inability to cough due to muscle weakness, for which she required artificial ventilation. She was given atropine and thiopentone to induce anaesthesia and then paralysed with suxamethonium (succinylcholine) before in? tubation. During this procedure she developed a ventricular tachycardia, which returned promptly to sinus rhythm with intravenous lignocaine and DC cardioversion. Case 2?A 42-year-old man presented with paraesthesia in the hands and feet and left-sided facial weakness. Over the next seven months his arms and legs became progressively weak, extending proximally. He was almost completely paralysed in the arms, legs, and trunk and had a peripheral sensory dis? turbance and absent reflexes. CSF protein concentration was raised at 2-84 g/1. Because he could not cough effectively and his respiratory function was deteriorating he required artificial ventilation. He was given atropine 0-3 mg, thiopentone 200 mg, and suxamethonium 75 mg intravenously before intubation. His pulse was lost immediately, and ECG monitoring showed ventricular tachycardia, which progressed to ventricular fibrillation. He was given intravenous lignocaine and cardio verted on four occasions before returning to sinus rhythm. No further arrhythmias were noted. Case 3?A 75-year-old man was admitted with a five-month history of progressive weakness of the legs. On examination he had flaccid paralysis of all muscle groups with absent tendon reflexes. CSF protein concentration was 3-2 g/1. He developed purulent sputum and a chest radiograph showed consolidation in the right lower lobe. Because he was unable to cough and blood gas concentrations were falling he was intubated, artificial

British guideline on the management of asthma: A national clinical guideline

Abstract: These guidelines have been replaced by British Guideline on the Management of Asthma. A national clinical guideline. Superseded By 2012 Revision Of 2008 Guideline: British Guideline on the Management of Asthma. Thorax 2008 May; 63(Suppl 4): 1–121.

Autonomic involvement in Guillain-Barré syndrome : a review

Abstract: Autonomic neuropathy is an important and common complication of Guillain-Barre syndrome (GBS). Manifestations be present in cardiovascular, sudomotor, gastrointestinal and other systems involving both sympathetic and parasympathetic fibers. Some apparently selective acute autonomic neuropathies may be subvarieties of GBS. Experimental work in animal models, pathological studies of GBS patients, and autonomic function studies have provided some help in the understanding of this complication. In managing GBS patients with autonomic dysfunction there are important practical considerations that can improve their care. In this article we review the literature on autonomic neuropathy in GBS and propose a management scheme to accommodate it in the overall treatment of the neuropathy.

The Saudi initiative for asthma - 2012 update: Guidelines for the diagnosis and management of asthma in adults and children

Abstract: This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.

Salbutamol in the 1980s. A reappraisal of its clinical efficacy.

Abstract: Salbutamol (albuterol) is a beta 2-selective adrenoceptor agonist which accounts for its pronounced bronchodilatory, cardiac, uterine and metabolic effects. During the intervening years since salbutamol was first reviewed in the Journal (1971), it has become extensively used in the treatment of reversible obstructive airways disease. Numerous studies in this disease (including severe acute, childhood and exercise-induced asthma) have confirmed the bronchodilatory efficacy of salbutamol, and it has been shown to be at least as effective as most of the currently available bronchodilators, if not more effective. The onset of maximum effect of salbutamol is dependent on the formulation used and the route by which it is administered. In most patients inhaled salbutamol is a first-line therapy, since it offers rapid bronchodilation, usually relieving bronchospasm within minutes. Although oral salbutamol has often proved to be less efficacious than the inhaled formulation, it still affords clinically significant bronchodilation, and it is particularly useful in those patients unable to coordinate the use of inhalers. Parenteral formulations of salbutamol are generally reserved for the treatment of severe attacks of bronchospasm and they are one of the treatments of choice in these life-threatening situations. Studies of the concomitant use of salbutamol and other agents such as anticholinergics, methylxanthines and beclomethasone dipropionate have usually shown a complementary response in the majority of patients, as might be expected from the different mechanisms of action of these groups of drugs. Salbutamol is generally well tolerated and any side effects observed are a predictable extension of its pharmacology. Since the frequency of side effects is dose related, and therefore dependent on the route of administration, it is not surprising that they are much more common following intravenous and oral rather than inhalation therapy. Tremor, tachycardia and hypokalaemia are the most frequently reported adverse effects. After nearly 20 years of use, salbutamol is well established as a 'first-choice' treatment in reversible obstructive airways disease. Indeed, throughout this time many new bronchodilatory agents have been studied but none have proved more effective. Clinical evaluation of salbutamol in the treatment of premature labour, hyperkalaemia and cardiac failure awaits further studies, although to date some encouraging results have been reported.

Management of Severe Asthma

Abstract: Publisher Summary This chapter explains the way to manage patients with severe acute asthma. A minority of asthmatic patients are able to tolerate severe airflow limitation without showing much respiratory distress, and the severity of disease in these patients can only be assessed accurately by objective measurements—particularly arterial blood-gas analysis. Hospitals accepting patients with severe acute asthma should be fully equipped for respiratory resuscitation and assisted ventilation. Every attempt should be made to speed up the admission process for all patients, and the organization of more formal self-admission services should be encouraged. Family physicians should be persuaded to treat patients in their own homes with bronchodilators and corticosteroids, and it must be ensured that oxygen in high concentration is administered by the ambulance crew if admission to the hospital is necessary. The facility now exists in many regions for a β 2 -adrenoreceptor agonist to be given in ambulances, and full use of this service must be encouraged. Ideally, all ambulances should be equipped with nebulizers and all ambulance personnel should be trained to administer a nebulized β 2 -adrenoreceptor agonist in oxygen.