bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol in anaesthesia and surgical resuscitation
Authors: WHITBY J. D.
Published: February 2007

The anaesthetic and analgesic properties of alcohol have been known for several thousand years, but there is little evidence that surgeons were employing it frequently for these purposes in the days before the discovery of reliable inhalation anaesthesia. Its main use was as a stimulant for resuscitation. Attempts to introduce its use into anaesthetic practice in this century have not been successful.
Experiences with epidural blood patch
Authors: Crawford J. Selwyn
Published: February 2007

Sixty‐six of a series of 116 patients had a postural headache resulting from an inadvertent dural puncture (despite in 64 cases the provision of an epidural drip) and 50 had headache following a spinal block. Experience suggested that it is advisable to inject 20 ml of blood unless during the course of injection the patient complains of pain or discomfort. Blood should also be taken for culture. In only one patient (who had three dural punctures) of the 98 so treated has the patch failed to relieve the headache. Arguments are presented against the use of a prophylactic patch, and against utilisation of the epidural catheter as a route for injecting the patch.
Carcinoid syndrome in a diabetic patient
Authors: FLEMING FREDA W.
Published: February 2007

A diabetic patient who subsequently developed carcinoid syndrome is described. The responses to the anaesthetic technique and drugs used demonstrated the interactions of serotonin and bradykinin. Undiagnosed carcinoid syndrome can simulate an anaphylactic reaction under general anaesthesia.
Tracheostomy tube connections for infant patients
Authors: INKSTER J.S. , BRAY R.J. , MAYBEE L.
Published: February 2007

Attachments to tracheostomy tubes for infant patients are described. These ensure that secure fixation in the optimal position is attained and, in the semi‐permanent tracheostomy, prevent accidental occlusion of the tracheostome.
Vessel puncture with epidural catheters
Authors: VERNIQUET A.J.W.
Published: February 2007

The reported incidence of blood vessel puncture after placement of a needle and catheter into the lumbar epidural space in obstetric practice appears to vary between 1 and 10%. This study was undertaken to assess the incidence of blood vessel puncture related to catheter insertion. Two methods of catheter placement were used to see if there were any difference in the incidence of vessel puncture. The incidence of blood vessel puncture after direct catheter placement was found to be 9% compared to 3% after prior injection of 10 ml of 0·5 % plain bupivacaine into the epidural space, (p = 0·05)
Postoperative pain prevention by continuous epidural infusion
Authors: ROSS R.A. , CLARKE J.E. , ARMITAGE E.N.
Published: February 2007

A method for postoperative pain prevention is described using epidural bupivacaine infused by means of a variable rate peristaltic pump. High plasma concentrations of bupivacaine were found but no serious signs of bupivacaine toxicity were observed and the method proved satisfactory in practice. Theoretical and practical considerations and aspects of clinical management are discussed.
Dysrhythmias during oral surgery
Authors: WRIGHT C.J.
Published: February 2007

Continuous electrocardiographic monitoring was employed in one hundred healthy adult patients during minor oral surgery under either halothane or enflurane anaesthesia. A significantly lower incidence of cardiac dysrhythmia during enflurane anaesthesia was observed and this suggests that enflurane may be the agent of choice, particularly in patients at risk because of cardiac disease.
Metoprolol in anaesthesia for oral surgery
Authors: WHITEHEAD M. H. , WHITMARSH V. B. , HORTON J. N.
Published: February 2007

Metoprolol, a cardioselective beta‐adrenergic blocking drug, was given, with a placebo as an alternative, in a double‐blind trial to 60 patients who were undergoing removal of third molar teeth under general anaesthesia. Dysrhythmias occurred in significantly fewer patients in the metoprolol group than in the control group, and when ventricular dysrhythmias occurred they were abolished in every case by the administration of metoprolol. It is concluded that metoprolol is effective in preventing cardiac dysrhythmias occurring during oral surgery carried out under general anaesthesia.
Agent‐specific filling devices
Authors: O'CARROLL T.M. , GREENBAUM R. , THORNTON P.G.N.
Published: February 2007

Two prototype agent‐specific devices have been tested and neither in its present form is ideal. Filling of vaporisers may be delegated to inexperienced persons, but the devices tested do not ensure that vaporisers can only be filled with the correct agent. Significant atmospheric pollution with the volatile anaesthetic agent may occur at the time of filling. At present, the devices are limited to three agents, enflurane, halothane and methoxyflurane.
Emotional reactions during lumbar extradural anaesthesia
Authors: Donchin Y. , Katz A.
Published: February 2007

The degree of anxiety of 26 male and female patients undergoing hernia repair while receiving lumbar extradural anaesthesia was measured using the galvanic skin response. The single, most anxiety‐provoking feature during the surgical procedures proved to be verbal interactions directly concerned with the patient's well‐being. The psychological implications of this feature are discussed.
The audiovisual reaction time test
Authors: GRANT I.S. , SMITH G. , SHIRLEY A. W.
Published: February 2007

Recovery from anaesthesia with Althesin, nitrous oxide, oxygen and halothane was assessed in 29 female patients undergoing minor gynaecological surgery using an audiovisual reaction time test. A further 29 female patients not undergoing anaesthesia or surgery were subjected to the audiovisual reaction time test at similar time intervals as the anaesthetised group. The mean reaction time was significantly greater at 40 min after induction (p <0·01) and equal to the pre‐anaesthetic value at 100 min after induction. Similar decreases in mean reaction times in both anaesthetised and control subjects occurred at between 100 and 160 min which presumably reflects a learning effect, but this change was not significant.
Central venous pressure measurement
Authors: KNELL P.J.W.
Published: February 2007

A device is described which automatically and continuously indicates the zero point on a saline manometer used to measure central venous pressure. It can be made from materials readily available in any operating theatre, intensive care unit or ward.
Continuous epidural infusion of fentanyl for postoperative analgesia
Authors: Bailey P.W. , Smith B.E.
Published: February 2007

A continuous epidural infusion of fentanyl was used for control of postoperative pain in a series of 30 patients who had received an epidural anaesthetic for general surgical procedures. Fentanyl was originally administered at a maximal rate of 50 μg/hr but later reduced to 25 μg/hour or less. Satisfactory analgesia was provided in 24 patients, who required no other form of analgesia whatsoever. Three patients derived significant analgesia from the infusion, but did require occasional small supplementary doses of opiates. Three patients derived little or no benefit from the procedure. The only noticeable side effect was nausea and vomiting, which was less of a feature with the weaker solution.

The method was used on general surgical wards with no extra demands being made on nursing staff. Many nursing procedures and physiotherapy could be carried out more conveniently than usual in the postoperative period.
Migraine and surgery
Authors: Fell R.H.
Published: February 2007

Six patients who had had severe migraine attacks after previous operations were given sedation before operation and dextrose 50 g and haloperidol 1·5 mg during surgery. All six patients noticed a marked improvement in their postoperative condition.
Atropine—a safe drug
Authors: ARTHURS G.J. , DAVIES R.
Published: February 2007

Three children received 1000 limes the prescribed dose of atropine sulphate and recovered from the main effects of excitatory behaviour and hallucinations in 48 hours. Diazepam was effective in the control of this behaviour. It is suggested that physostigmine should be available where atropine and hyoscine are used or where overdoses are managed.
The Norfolk and Norwich infusion box
Authors: CHAPMAN ROBERT B. , KEEP PHILIP
Published: February 2007

An apparatus is described to facilitate the pressurisation of plastic fluid containers during rapid intravenous infusion.

The advantages offered by this system over the ‘infusion cuff’ method include greater mechanical stability, faster pressurisation and change‐over of infusion containers and clear visibility of the contents of the containers.
Anaesthesia for carotid artery surgery
Authors: ERWIN DIANA , PICK M. J. , TAYLOR G. W.
Published: February 2007

Twenty‐one carotid endarterectomies were performed on 18 patients anaesthetised using droperidol, fentanyl and a cervical plexus block. This technique permitted testing for motor function during carotid clamping, and allowed the operation to proceed safely without a shunt in the majority of patients.
Total intravenous anaesthesia: a technique using flunitrazepam, ketamine, muscle relaxants and controlled ventilation of the lung
Authors: Barclay A. , Houlton P.C. , Downing J.W.
Published: February 2007

A potentially acceptable and uncomplicated technique of total intravenous anaesthesia is described using flunitrazepam for induction, and maintenance by ketamine infusion with neuromuscular blockade and controlled ventilation using oxygen‐enriched room air.

A significant complication was the 23% incidence of nausea and/or vomiting encountered in the fifty‐six patients studied. Definite factual recall of the surgical experience was reported by one patient. This was attributable to an accidental error in technique. Postoperative drowsiness was also a feature of the technique.

The usual cardiovascular and psychomimetic effects associated with ketamine administration appeared markedly attentuated by flunitrazepam induction. Fifty‐three (96–3%) patients expressed their willingness to receive the same anaesthetic again. Further experience of total intravenous anaesthesia with the introduction of cerebral function monitoring, allowing correlation of depth of anaesthesia with drug dosage, should allow further refinement of the technique to ensure successful and acceptable anaesthesia.
Droperidol and endotracheal intubation Attenuation of pressor response to laryngoscopy and intubation
Authors: Curran J. , Crowley M. , O'Sullivan G.
Published: February 2007

The cardiovascular responses to anaesthesia, laryngoscopy and tracheal intubation were studied in 20 healthy adult patients. The mean arterial pressure increase following intubation was 1–60 mmHg (SEM ± 3 52 mmHg) in patients to whom droperidol 150 μg/kg was given intravenously before anaesthesia compared with a rise of 26 50 mmHg (SEM ± 4 35 mmHg) in a control group of patients.
Editorial
Authors: Trevelyan G.M. , Boulton T.B.
Published: February 2007

Socrates gave no diplomas or degrees, and would have subjected any disciple who demanded one to a disconcerting catechism on the nature of true knowledge.
Cardiac arrest during moderate hypothermia for cerebrovascular surgery
Authors: BELOPAVLOVIC M. , BUCHTHAL A.
Published: February 2007

A case of cardiac arrest during moderate hypothermia and profound hypotension following rupture of a cerebral aneurysm is described. The patient survived with few neurological sequelae directly attributable to the period of cerebral ischaemia. The protective effect of hypothermia in the prevention of neurological damage is illustrated as are the difficulties of resuscitation.
Morbidity after outpatient Anaesthesia.
Authors: HENEGHAN CHRISTOPHER , McAULIFFE ROMAYNE , THOMAS DAVID , RADFORD PATRICK
Published: February 2007

A comparison was made of two anaesthetic techniques for outpatient dental surgery; the basis for comparison was symptomatic morbidity. One group of patients was managed with spontaneous breathing of nitrous oxide, oxygen and halothane; the other was ventilated mechanically, and received fentanyl and alcuronium. The latter anaesthetic was associated with a significantly higher incidence of morbidity on the day of operation, but not subsequently. The incidence of dysrhythmias was not significantly different. The comfort and safety of patients are discussed in relation to the choice of anaesthetic.
Plasma cortisol levels
Authors: SAINSBURY J.R.C. , STODDART J.C. , WATSON M.J.
Published: February 2007

The plasma cortisol levels of 30 very sick patients were measured to determine whether evidence of suprarenal failure could be found. Volunteers were given 100 mg hydrocortisone intravenously and their plasma cortisol leoels were measured.

The results suggest that suprarenal failure is a very uncommon occurrence. The results obtained from the volunteers imply that relatively small amounts of hydrocortisone given intravenously cause a marked elevation of plasma cortisol levels.
Unexpected complication of successful nerve block
Authors: HANKS G.W. , TWYCROSS R.G. , LLOYD J.W.
Published: February 2007

A case is reported of a 76‐year‐old man with a right‐sided mesothelioma who required large doses of oral narcotics to control his severe chest pain. After a successful chlorocresol intrathecal nerue block, respiratory failure was induced by doses of oral morphine at the same level as those used before the block, and also by substantially smaller doses. A considerable reduction in analgesic requirements may be possible following non‐drug intervention to relieve pain and may be essential in patients with compromised respiratory function. This observation emphasises the importance of pain as a potent stimulator of the respiratory centre in patients with reduced respiratory reserue who are receiving narcotic drugs.
Adverse reaction to methohexitone and gallamine
Authors: HARRISON G.R. , THOMPSON I.D.
Published: February 2007

A case is presented in which a patient detieloped an acute anaphylactoid reaction after receiving methohexitone and gallamine for the induction of Anaesthesia. The problem of eliciting the responsible agent is discussed, with comments on the method of treatment and preventative measures.
Autologous transfusion of mediastinal drainage blood
Authors: CARTER R.F. , McARDLE B. , MORRITT G.M.
Published: February 2007

A system for autologous transfusion of postoperative, mediastinal drainage blood, after cardiopulmonary bypass is described. The method is evaluated for quality of blood, ease of usage and cost.
Postoperative pain relief
Authors: KAY B.
Published: February 2007

The rate of use of alfentanyl was compared with that of fentanyl for the treatment of postoperative pain in 21 patients using an On‐Demand Analgesia Computer. Both drugs produced good pain relief. The mean rate of use of fentanyl was 0·88 μg/minute and of alfentanyl 8·1 μg/minute, a ratio of 1:9·2, which correlates well with an estimated potency ratio of 3:1, and duration of action ratio of 3:1.
Supernumerary senior house officers in anaesthesia: a review of a regional training scheme, 1962–1972
Authors: Thornton J.A. , Sharman E.M.
Published: February 2007

The Shefield Regional Hospital Board, which became the Trent Regional Health Authority in 1974. initiated a scheme for training of Senior House Oficers in anaesthesia in 1962; between 1962 and 1972, 73 graduates passed through the scheme of whom 29 (40%)* held consultant posts at the time of the review (mid 1979), another 8 (11%)* were senior registrars and on the way to consultant status. None of the 16 overseas graduates had achieved consultant status although one was a senior registrar. Twenty‐six (35.6%)* of the 73 doctors (15 (20.5%)* United Kingdom or Republic of Ireland graduates and 11 (15.1%)* from overseas) are thought to have left the practice of anaesthesia although some of these were not traced and may indeed be practising. and some of the females have indicated an intention to return to the specialty when their children are older.
Career opportunities in anaesthesia for doctors with domestic commitments
Authors: EDMONDS‐SEAL J. , McNEILLY R.H.
Published: February 2007

The position of doctors with domestic commitments (DDCs) at present training in the specialty of anaesthesia in the British National Health Service is considered and proposals are made for their future employment in career grades.
Fat embolism in Eisenmenger syndrome
Authors: MERRILL S.B.
Published: February 2007

A case of fat embolism with known Eisenmenger syndrome is described, in whom the right‐to‐left shunt appeared to protect the patient from further hypoxaemia. The potential value of an intravenous filter to eliminate air in patients with reversed intracardiac shunts is noted.
The Blease 5300 ventilator: an assessment
Authors: FLETCHER I.R. , HEALY T.E.J. , POOLE T.R.
Published: February 2007

The Blease 5300 ventilator is described. A laboratory assessment of its performance gave satisfactory results and confirmed the favourable impressions formed by medical and nursing staff, in the intensive therapy unit during a trial lasting 3 months.
Forum
Authors: Knight R.J. , Houghton I.T.
Published: February 2007

Experience gained by two anaesthetists using the Triservice halothane, trichloroethylene air and oxygen draw‐over apparatus in the field and in a sophisticated hospital is described and discussed.
The microcomputer in self‐assessment for examinations in anaesthesia
Authors: Parbrook Geoffrey D. , Davis Paul D. , Parbrook Evelyn O.
Published: February 2007

A series of 30 multiple choice questions were modified for presentation on a microcomputer which was programmed to present them to the user and mark them. In a preliminary study, 15 trainee anaesthetists all agreed the system was satisfactory as an aid to preparation for the FFARCS.
My heart stood still
Authors: GOLDSMITH E.
Published: February 2007

The author–an anaesthetist–describes his experiences as a patient undergoing open‐heart surgery. He reports excellent professional management and a very satisfactory result but offers some constructive criticisms.
Magnesium flux during open heart surgery
Authors: MANNERS J.M. , NIELSEN M.S.
Published: February 2007

The Hearse St Thomas' Hospital cardioplegia infusate is one method of preserving the myocardium in the absence of coronary perfusion, during open heart surgery. The infusate contains 16 mmol magnesium/litre and 20 mmol potassium/litre. Peri‐operative plasma magnesium levels and urinary excretion of magnesium have been measured, when the infusate was returned to the circulation in 12 patients. The plasma level (±SEM) rose to 1·86 mmol/litre (±0·1) 5 minutes after cardiopulmonary bypass commenced, was 1·57 mmol/litre (±0·09) shortly before termination of cardiopulmonary bypass but was normal on the first day after surgery.

Urinary excretion of magnesium was 55% of the administered quantity by Day 1 and 77% by the second day. Two patients excreted less than 40% of the administered magnesium within 24 hours probably indicating magnesium depletion. There were no adverse effects from a magnesium load of 16–32 mmol magnesium given during cardiopulmonary bypass.
Intensive care in England and Wales
Authors: GILSTON ALAN
Published: February 2007

A questionnaire circulated to members of the Intensive Care Society in England and Wales brought 101 replies, representing 74 hospitals, including 16 teaching hospitals. Anaesthesia is the dominant specialty in this field and the majority of general units included in this survey are staffed and directed by consultants from this specialty, though their involvement in such work varies widely. Only about half the units are largely supervised by consultants with a heavy commitment to it. The junior staff too are predominantly anaesthetists. Whilst the FFARCS examination strongly emphasises the importance of intensive care to the specialty, only about half the members believe present training in this field, including academic activity, is satisfactory. The dearth of full‐time training posts, their brevity and their domination by the teaching hospitals are major problems. There is considerable support for the idea of National Training Standards, and for a full‐time training period of not less than 2 years, including special experience in certain fields, for those with a special interest in and aptitude for this type of work. But there is much less support for a Diploma.

Despite this agreement on special training, only a small minority of members believe intensive care work should largely be restricted to separate career specialists, ‘intensivists’. However most recognise the need for each unit to have a largely full‐time manager and coordinator, whose personal qualities are more important than his original specialty.

Most units have one kind of problem or another, the most common being a shortage of money and nurses.
Brachial plexus palsy after anaesthesia in the sitting position
Authors: SAADY ALBERT
Published: February 2007

An unusual case of brachial plexus palsy developed in a patient following general Anaesthesia in the sitting position. Congenitial skeletal anomalies together with severe bony degenerative changes surrounding the nerve roots probably precipitated the palsy.
Mixed neuromuscular block
Authors: FERGUSON ANN , BEVAN D.R.
Published: February 2007

The effects of precurarisation, with small doses of pancuronium, curare or gallamine, on the neuromuscular blockade following suxamethonium, 1 mg/kg, were studied using train‐of‐four stimulation. The duration of the block was reduced by pretreatment with d‐tubocurarine and gallamine but increased with pancuronium.

The degree of competitive neuromuscular blockade, both after administration of the precurarising dose and at full recovery from suxamethonium was mild and was insufficient to be a cause of postoperative muscle weakness.
Fentanyl and the metabolic response to gastric surgery
Authors: COOPER G.M. , PATERSON J.L. , WARD I.D. , HALL G.M.
Published: February 2007

The effect of the supplementation of nitrous oxide‐oxygen anaesthesia with either 50 μg fentanyl/kg body weight or 0·5–1·0% halothane on the metabolic and hormonal response to gastric surgery was investigated in 16 patients. Those patients who received fentanyl showed a significant decrease (p<0·05) in the hyperglycaemic response to surgery after 30 and 90 minutes and a significant decrease (p<0·05) in the plasma cortisol response after 30 minutes. Profound respiratory depression occurred at the end of surgery in all patients who were given fentanyl. This required the intravenous administration of naloxone and careful supervision in the early postoperative period. It is concluded that the transient metabolic and endocrine benefits produced by fentanyl do not compensate for the severe respiratory problems postoperatively and thus ‘high‐dose fentanyl’ cannot be recommended for upper abdominal surgery.
Chondro‐calcinosis and difficult intubation in acromegaly
Authors: EDGE W.G. , WHITWAM J.G.
Published: February 2007

Difficulties encountered in carrying out tracheal intubation in acromegalic patients have been well documented.1–8 This paper reports the difficulty encountered in a patient with acromegaly complicated by extensive calcification of the larynx.
Clinical evaluation of an automatic potassium electrode.
Authors: TREASURE TOM , AVELING W.
Published: February 2007

A Nova 1 potassium analyser has been evaluated for the first 3 months of its use in a cardiac surgical intensive care unit. The machine was out of action for 11 out of 104 days. 515 external calibrations were performed with 4·50 mmol/l potassium standards: mean 4·49 mmol/l, standard deviation 0·07. 692 comparisons were made with routine laboratory flame photometer measurements on the same sample: correlation coefficient r=0·815. It is concluded that Nova 1, if kept in working order, can provide potassium estimations quickly and accurately.
Anaesthesia at King Edward VIII Hospital, Durban, South Africa
Authors: Holloway Alison M.
Published: February 2007

The cultural and medical background to the practice of the department of anaesthetics is reviewed
Anaesthesia in Banjul, The Gambia
Authors: Sroczynski Zbigniew
Published: February 2007

This is a report of experience of anaesthesia in one year in The Gambia. The problems related to the development of an anaesthetic service are described and the important function of nurse anaesthetists is emphasised. Recommendations are made about future developments of the specialty.
Selective obstetric epidural service in a developing country
Authors: Ukpoma S.O. , Oronsaye A.U.
Published: February 2007

Epidurals were performed on 100 Nigerian women in labour in an attempt to assess the feasibility of setting up an epidural service in a developing country. The results indicate that a service is possible, constraints notwithstanding, provided patients are carefully selected and the personnel involved are properly trained.
Intubating conditions with ORG NC45
Authors: HARRISON P. , FELDMAN S.A.
Published: February 2007

The ease oftracheal intubation using two doses of the new steroidneuromuscular blocking compound ORG NC45 (Nor cur on) 0.1 and 0.15 mg/kg was compared with a standard dose ofpancuroniwn 0.1 mg/kg at 60, 90 and 120 seconds. The results did not reveal any statistically significant benefit of the new drug within 2 minutes of administration over the control.
The para‐carotid approach for internal jugular catheterization
Authors: Oda M. , Fukushima Y. , Hirota T. , Tanaka A. , Aono M. , Sato T.
Published: February 2007

We have deqeloped a para‐carotid approach for internal jugular cannulation which utlizes only the carotid artery as a landmark. This technique allows us to locatedhe puncture site regardless of an individual patient's physical, skeletal or postural variations. This study was undertaken in the period from January 1979 to June 1980 on 456 consecutive patients in a wide range of age groups and various clinical conditions. The overall success rate was 96.1%. The only complications encountered during our study were Five carotid artery punctures with formation of two haematomas.
Sex and surgical stress
Authors: MOORE R.A. , SMITH R.F. , McQUAY H.J. , BULLINGHAM R.E.S.
Published: February 2007

The endocrine and metabolic response to anaesthesia and surgery was studied in 12 men and eight women undergoing elective total hip replacement using buprenorphine as the intra‐ and postoperative analgesic. Plasma glucose, cortisol and prolactin were measured, and the results obtained for men and women compared. Statistically significant differences between men and women were found for prolactin during and after operation, and also for cortisol postoperatively. Men, but not women, demonstrated a significant fall in plasma cortisol following a dose of buprenorphine after operation. These results are discussed in relation to known procedures for ablating the stress response and to the neuroendocrine effects of opiate agonists and partial agonists.
Effects of intravenous administration of glycopyrrolate and atropine in anaesthetised patients
Authors: MIRAKHUR R. K. , JONES C. J. , DUNDEE J. W.
Published: February 2007

The effects of glycopyrrolate in doses of 5, 10 and 15 μ/kg and atropine 10, 20 and 30 μ/kg on heart rate and rhythm were studied in anaesthetised patients. Both drugs produced a dose‐related increase in heart rate. Glycopyrrolate was approximately twice as potent as atropine in increasing heart rate. The average time taken to achieve peak effect was 2.6 and 3.7 minutes for atropine and glycopyrrolate respectively, and this was significantly different. The smallest doses of both drugs were generally associated with supraventricular dysrhythmias, whereas these were mainly ventricular following the highest doses of both drugs.
Persistent abdominal pain
Authors: DUTHIE ASHLEY M. , INGHAM VAL
Published: February 2007

The organic and psychological problems of patients suffering from chronic abdominal pain are described and three case histories of patients who had undergone multiple surgery for their abdominal pain are presented. All three were treated by lumbar sympathetic lysis, resulting in relief of their pain. The possible reasons for this success are discussed.
A year's experience of functional budgeting in a clinical department
Authors: Walker J. Secker
Published: February 2007

The experience of running a department budget is described together with the likely problems which might arise.
Rectal premedication in children
Authors: LINDAHL STEN , OLSSON A.‐K. , THOMSON DICK
Published: February 2007

Rectal premedication with diazepam, morphine and hyoscine has been used in 20 healthy children undergoing minor surgery. Satisfactory sedation was achieved in the majority of children and the anticholinergic effects were also adequate. Peak plasma levels of diazepam and morphine were reached within 30 minutes, and the plasma levels decreased after 2 hours. No adverse effects on ventilation were seen during anaesthesia.
Bupivacaine infiltration after lumbar laminectomy
Authors: TEDDY P.J. , FABINYI G.C.A. , KERR J.H. , BRIGGS M.
Published: February 2007

This is a report of a double‐blind controlled trial to test the hypothesis that peroperative local infiltration of the wound of lumbar laminectomy with bupivacaine produces a significant reduction in postoperative back pain. No such effect was demonstrated when the linear analogue was used to record the patients' subjective response to pain. It is suggested that this treatment is not indicated as a routine method.
Acceptability of continuous nasal nitrous oxide during labour—a field trial in six maternity hospitals
Authors: ARTHURS G. J. , ROSEN M.
Published: February 2007

In six maternity hospitals 516 mothers during labour received 50% nitrous oxide and 50% oxygen (Entonox) continuously at 5 litres/minute through a single‐end nasal catheter and intermittently by a mouthpiece for a mean duration of 3 hours 30 minutes (513 mothers). A comparison was made with a control group of 575 mothers who had intermittent inhalation of Entomox only for a mean duration of 3 hours 6 minutes (574 mothers). The midwives had no difficulty learning to manage the administration of nasal Entonox. Eighty‐six per cent of mothers agreed to use the nasal method and 70% continued for the duration of their labour. The midwives reported that pain relief was improved, and 51 (92%) would wish to continue offering the technique.
Syringe pump malfunction
Authors: CHOW A.E.
Published: February 2007

An electronic syringe pump accidentally delivered a solution of buprenorphine at an accelerated rate. Following an extensive investigation by the manufacturers, this malfunction was attributed to a short circuit in the electronic control system by a particle of extraneous conductive material within the unit.
Cardiopulmonary resuscitation in a teaching hospital
Authors: Scott Ralph P.F.
Published: February 2007

Seventy‐eight cases of cardic arrest occurring outside intensive care units and emergency rooms were analysed. 44° of patients were initially resuscitated, and 14° were still alive at 28 days. The preiously well documented relationships between survival and location of arrest, age of patient and initial dysrhythmia were confirmed.

A diurnal variation in the incidence of cardiac arrest has recently been postulated, but was not noted in this survey. However, the proportion of arrest patients who were initially resuscitated did show a significant fluctuation over the 24‐hour period as tested by a sinusoidal logistic regression.
The relationship between reported atopy or allergy and immunoglobulins: a preliminary study
Authors: WATKINS J. , CLARKE R.S.J. , FEE J.P.H.
Published: February 2007

The serum of 50 surgical patients with a history of asthma, hay fever or allergy has been analysed for IgE levels and compared with a control group without such a history. The values in the ‘normal’ group largely fell within the accepted range (below 200 iu./ml). Those in the ‘hypersensitive’ group had a wide range extending to over 1000 iu./ml but many of those with low values in this group had contact dermatitis and similar minor allergies. However, analysis of cases studied shows that any patient with a history of atopy or allergy is at risk from Cremophor‐containing intravenous anaesthetics.
Minaxolone: an evaluation with and without premedication
Authors: McNEILL H.G. , CLARKE R.S.J. , DUNDEE J.W. , BRIGGS L.P.
Published: February 2007

Minaxolone, a water‐soluble steroid intravenous anaesthetic, has been used in clinical trials for induction and maintenance in patients presenting for minor operations. A standard induction dose of 0.5 mg/kg was given. There was a low incidence of pain on injection and venous sequelae. Excitatory effects occurred commonly at induction but these were reduced by opiate premedication. The frequency of uneventful induction was significantly greater when the 5 mg/ml solution of minaxolone was given at a rate of 6 ml/minute than at a rate of 24 ml/minute. Minaxolone has been withdrawn from clinical trials following equivocal toxicological findings in rats which require further investigation.
Narcotic addiction in patients with chronic pain
Authors: EVANS P.J.D.
Published: February 2007

The notes of 717 patients attending the Regional Pain Relief Unit, Abingdon, were reviewed. One hundred and thirty patients (18°) were taking narcotic analgesics. Of these, 74 were suffering from cancer and 56 (9·7°) had chronic benign pain. Nine patients were considered to be addicted to their analgesics.

Nine men and five women were able to discontinue their narcotic analgesics as a result of therapy. All of these patients had been receiving oral agents for more than one year.
Postoperative analgesia for day‐case herniorrhaphy patients
Authors: WOOD G.J. , LLOYD J.W. , BULLINGHAM R.E.S. , BRITTON B.J. , FINCH D.R.A.
Published: February 2007

Patients were admitted as day‐cases for inguinal herniorrhaphy under epidural anaesthesia and chlormethiazole sedation. The patients were given oral analgesia, and in addition, some were given either a paravertebral block with a dextran/bupivacaine mixture or cryoanalgesia of the ilio‐inguinal nerve for postoperative pain relief. These anaesthetic and analgesic techniques are discussed in relation to day‐case herniorrhaphy.
Influence of cerebrospinal fluid on epidural pressure
Authors: Shah J.L.
Published: February 2007

The pressure in the epidural space was measured with a water manometer in 40 women receiving elective epidural for pain relief in labour, and in three patients who were undergoing lumbar puncture. Injection of a small volume of fluid in the epidural space produced a positive pressure in all subjects, with a mean of 14 cmH2O (range 6·5–20 cmH2O). Pressure varied with posture, respiration, cough and jugular venous compression. The variations in pressure agreed closely with those reported for cerebrospinal fluid (CSF) pressure. It is suggested that in the lumbar region the dura fills the vertebral canal and is both compressible and expansile. When fluid is injected into the epidural space, the dura acts as a movable membrane and pressures on either side of it tend to equalise. Measurement of epidural pressure may provide a less traumatic way of estimating CSF pressure than traditional methods.
Pain relief in labour using epidural pethidine with adrenaline
Authors: Perriss Brian W. , Malins Andrew F.
Published: February 2007

The degree of pain was assessed by use of a visual analogue scale in 20 patients in established labour before and after the epidural injection of pethidine 50 mg with adrenaline 1: 200,000. Forty‐two doses were administered and of these 83% gave good pain relief and only 5% had no effect at all. The duration of action was longest following the first dose decreasing with subsequent doses. No evidence of sympathetic or motor blockade was found and side‐effects were minimal. In the postpartum period 17 of the mothers expressed full satisfaction with the technique.
Editorial
Authors: Boulton T. B. , Lunn J. N.
Published: February 2007

Time present and time past

Are both perhaps present in time future.

And time future contained in time past.
A field trial of cimetidine as the sole oral antacid in obstetric anaesthesia
Authors: JOHNSTON J. R. , McCAUGHEY W. , MOORE J. , DUNDEE J. W.
Published: February 2007

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.
Evaluation of a computer simulation program for teaching halothane uptake and distribution
Authors: HEFFERNAN P. B. , GIBBS J. M. , McKINNON A. E.
Published: February 2007

A pilot evaluation of a simulation program used during a tutorial for the teaching of uptake and distribution of the inhalational anaesthetic halothane shows a highly significant improvement in the students' answers after the tutorial using a ‘before and after’ questionnaire. The students showed an understanding of the program's display and model limitations. This encourages the further use of the program.
Hypotension during epidural anaesthesia for Caesarean section
Authors: HALLWORTH D. , JELLICOE J. A. , WILKES R. G.
Published: February 2007

The incidence of hypotension occurring in women undergoing elective Caesarean section with epidural anaesthesia was investigated in 20 patients receiving an intravenous preload of 1 litre of Hartmann's solution and in 20 patients receiving 0.5 litre of polygelatin (Haemaccel) and 0.5 litre of Hartmann's solution. Hypotension occurred in 45% of the Hartmann's group but in only 5% of the polygelatin and Hartmann's group. An argument for the use of a 2‐litre intravenous preload of crystalloid solution is offered to provide prophylaxis against hypotension occurring during Caesarean section under epidural anaesthesia.
Regional hip blockade in osteoarthrosis
Authors: EDMONDS‐SEAL J. , TURNER A. , KHODADADEH S. , BADER D. L. , FULLER D. J.
Published: February 2007

Eighteen patients with unilateral osteoarthrosis of the hip were investigated in a trial which involved the injection of nine with bupivacaine and nine with normal saline. All the patients completed daily pain analogue charts. Their pain, mobility and functional activity were assessed and gait characteristics analysed, once before the injection and then at three monthly intervals. All the patients recorded a decrease in pain level within two weeks of injection, but it subsequently rose to pre‐injection levels. There were no other significant general improvements after the injection. A significant increase in the maximum force at toe‐off for the good leg was recorded one month after the injection. However, no further significant differences were found in the gait performance of either group of patients throughout the study. It is concluded that the hip nerve regional blockade offers no useful relief to the pain of osteoarthrosis of the hip joint.
Safety check procedures to eliminate faults in anaesthetic machines
Authors: CUNDY J. , BALDOCK G. J.
Published: February 2007

The potential defects in anaesthetic machines are reviewed and methods of detecting these defects are described. A logical checking procedure is presented together with a short procedure which could be used in emergency circumstances. It is suggested that these procedures are used in all anaesthetic training and practice.
Tapered connectors in patient breathing systems
Authors: SHAW A. , DAVIS P. D. , ANDERSON I. M.
Published: February 2007

Investigations using recommended gauging tools have shown that many tapered connectors on breathing systems do not meet the relevant standard. It would be important to improve dimensional tolerances so that better inter changeability is achieved. This improvement may make it unnecessary to employ ‘anti‐disconnexion’ fittings.
Laparoscopy — a stressful procedure
Authors: COOPER G. M. , SCOGGINS A. M. , WARD I. D. , MURPHY D.
Published: February 2007

The metabolic and hormonal response to laparoscopy was investigated in 22 patients, in whom nitrous oxide‐oxygen anaesthesia was supplemented with either 150 μg fentanyl or an Althesin infusion. There were significant increases in plasma cortisol (p < 0.05) from 303 to 458 mmol/litre and prolactin from 1869 to 3918 mU/litre (p < 0.01) at the end of laparoscopy in both groups of patients; these were sustained during the first hour of the recovery period. The blood glucose concentration increased significantly (p < 0.05) from 4.48 to 5.28 mmol/litre at the end of laparoscopy in the Althesin patients and remained increased 1 hour postoperatively at 5.54 mmol/litre (p < 0.01). The blood glucose concentration increased significantly (p < 0.05) from 4.43 to 5.36 mmol/litre in the fentanyl patients only during the recovery period. There was no significant difference between the metabolic and hormonal changes observed with the two anaesthetic techniques.
Pre‐operative starvation in children
Authors: ALLISON C. W. , CATER J. I. , GRAY I. G. , STAZIKER ANN C.
Published: February 2007

Ninety‐two children aged between 8 months and 8 years were fasted overnight prior to surgery. Plasma glucose and alanine concentrations were measured after the induction of anaesthesia.

Of 30 children under four years, 23% had plasma glucose concentrations less than 3.3 mmolllitre. Underweight children were particularly at risk.

The mean plasma alanine was low (0.17 mmolllitre) indicative of a shortfall in this essential substrate for gluconeogenesis. This probably reflects the greater obligatory glucose need of young children relative to their body protein mass.
Fluorine compounds in anaesthesia (9)
Authors: BURNS T. H. S. , HALL J. M. , BRACKEN A. , GOULDSTONE G.
Published: February 2007

Six heavily fluorinated aliphatic compounds and four heavily fluorinated derivatives of diethyl ether have been examined as anaesthetics, using mice. Two compounds are felt to be worth further examination. These are 1,1,1,‐trifiuoro‐2,2‐dichIoroethane (halothane with the bromine atom replaced by a second chlorine) and 1,1,2,2,4,5,5‐heptafluoro‐3‐oxapentane (ordinary diethyl ether with seven hydrogen atoms replaced by fluorine).
Liver enzyme studies with disoprofol (ICI 35,868) and midazolam
Authors: KAWAR P. , BRIGGS L. P. , BAHAR M. , McILROY P. D. A. , DUNDEE J. W. , MERRETT J. D. , NESBITT G. S.
Published: February 2007

Liver enzyme studies were carried out before and following the use of two new intravenous agents, disoprofol and midazolam. These showed no major abnormal changes attributable to either drug, the findings being similar to those with thiopentone.
Iatrogenic facial nerve paresis
Authors: NIGHTINGALE P. J. , LøNGREEN A.
Published: February 2007

A case is presented of iatrogenic pressure paresis of the facial nerve, caused by pressure exerted at the angle of the jaw to maintain the airway, during 40 minutes of general anaesthesia.
Plasma and cerebrospinal fluid barbiturate levels during prolonged continuous thiopentone infusion
Authors: AIREY I. L. , SMITH P. A. , STODDART J. C.
Published: February 2007

During an infusion of thiopentone to control status epilepticus secondary to hypoxic brain damage, thiopentone and pentobarbitone levels were measured in the serum and cerebrospinal fluid (CSF). Pentobarbitone was found to be present in the serum between 7.8 and 11.1% of the thiopentone levels. There was a prompt response in serum levels of thiopentone to changes in the infusion rate. The CSF thiopentone varied between 15 and 40% of the serum levels. The CSF anticonvulsant threshold for thiopentone for this patient was between 5 and 15 mg/litre.
Pharmacokinetics and pharmacodynamics of thiopentone
Authors: CHRISTENSEN J. H. , ANDREASEN F. , JANSEN J. A.
Published: February 2007

The induction doses of thiopentone in eight elderly male patients (60–80 years) were significantly lower (p < 0.01) than in eight young male patients (ranges 3.09–5.06 mg/kg body weight in the elderly and 4.88–8.11 mg/kg in the young). The sleep concentrations in venous as well as in arterial blood did not differ between the two groups. In the elderly the arterial concentrations were significantly higher than the venous (p < 0.05). A three compartment open model was used to describe the disappearance of the drug from the venous blood. Significant increases were found in V3(means 145.9 and 51.2 litres) and in T½β(means 781 and427 minutes) in the elderly. The redistribution rate constant, K1,2, was decreased in the elderly (p < 0.05).

By impedance cardiography 5 minutes after sleep mean percentages of the pre‐induction value of cardiac output were 94.6% in the young and 87.0% in the elderly (p < 0.05). In the young a correlation was found between cardiac output and induction dose, (r =0.85, p < 0.01).
Temazepam as premedication in elderly patients
Authors: CLARK G. , ERWIN D. , YATE P. , BURT D. , MAJOR E.
Published: February 2007

One hundred and forty‐five men were randomly allocated on a double‐blind basis to receive either temazepam 20 mg, diazepam 10 mg or placebo as premedication. Temazepam produced more sedation than either diazepam or placebo. Postoperative recovery was assessed by a simple visuo‐motor co‐ordination test and was best in the placebo group. Two hours into recovery, temazepam patients could almost match their baseline performance whereas the performance of the diazepam patients was still significantly worse than pre‐operatively. Temazepam is suggested as a suitable premedicant for elderly patients undergoing minor surgery.
A test to show correct placement of epidural catheter
Authors: SHAH J. L.
Published: February 2007

Positive pressure created in the epidural space has been used to confirm correct placement of a lumbar epidural catheter in 125 patients.
Extradural anaesthesia in parturients with severe cardiovascular disease
Authors: McMurray T. J. , Kenny N. T.
Published: February 2007

The use of extradural block (EDB) in healthy parturients for normal delivery and operative procedures is now a widespread and established practice. However, clinical reports of its use in those parturients with severe cardiovascular disease are rare. Here we present two case reports of patients with severe cardiovascular disease delivered under EDB and discuss the merits of this method of anaesthetic management.
Disoprofol and fentanyl for total intravenous anaesthesia
Authors: MAJOR E. , VERNIQUET A. J. W. , YATE P. M. , WADDELL T. K.
Published: February 2007

Ninety patients undergoing a variety of surgical procedures were anaesthetised with a disoprofol infusion and increments of fentanyl. The first 40 patients constituted a preliminary dose finding study and the subsequent 50 patients a dose comparison study. The second 50 patients were alternately allocated to receive a maintenance infusion of disoprofol 150 or 200 μg/kg/minute. Fentanyl (1 μg/kg) at induction was followed by further small increments when indicated. Maintenance dosage of 200 μg/kg/minute provided good operating conditions and rapid uncomplicated recovery in spontaneously breathing patients, while 150 μg/kg/minute proved inadequate to prevent patient movement.
Mediastinal tumour causing airway obstruction in anaesthetised children
Authors: BRAY R. J. , FERNANDES F. J.
Published: February 2007

Two cases of mediastinal tumour causing airway obstruction after the induction of anaesthesia are reported. The management of these cases is described and possible causative factors are discussed.
Acute cyanide poisoning
Authors: PETERS C. G. , MUNDY JANITHA V. B. , RAYNER P. R.
Published: February 2007

The management of a case of acute cyanide poisoning is described. Treatment includes the prompt administration of an antidote together with respiratory support utilising 100% inspired oxygen. Available antidotes are reviewed.