bluuebunny/crossref_metadata_2025 huggingface dataset:
Intubating conditions using cisatracurium after induction of anaesthesia with thiopentone
Authors: Rimaniol J. M. , Kersuzan Y. , Duvaldestin P.
Published: January 2004

We studied tracheal intubation conditions produced by the muscle relaxant, cisatracurium, following induction of anaesthesia with fentanyl (2 μgkg−1) and thiopentone (6 mgkg−1). Sixty patients were randomly assigned to receive cisatracurium in a single bolus dose of either 0.15 or 0.20 mgkg−1. Tracheal intubation was commenced 120 s after injection of the relaxant. The mean (SD) time taken to achieve intubation was significantly shorter in the 0.20 mgkg−1 group (137 (16) s) than the 0.15 mgkg−1 group (149 (12) s; p < 0.05). The intubating conditions were better after the larger dose. Our results suggest that when anaesthesia is induced using thiopentone, a dose of 0.20 mgkg−1 of cisatracurium is recommended to ensure satisfactory intubating conditions.
A comparison of the infusion pharmacokinetics and pharmacodynamics of cisatracurium, the 1R‐cis 1′R‐cis isomer of atracurium, with atracurium besylate in healthy patients
Authors: Smith C. E. , Van Miert M. M. , Parker C. J. R. , Hunter J. M.
Published: January 2004

We have compared the pharmacokinetics of cisatracurium with atracurium when given by bolus dose followed by continuous infusion. Twenty healthy patients were anaesthetised with thiopentone, midazolam, fentanyl and 70% nitrous oxide in oxygen. Ten patients (Group C) were randomly allocated to receive cisatracurium 0.1 mgkg−1 and 10 patients (Group A) were given atracurium 0.5 mgkg−1. Neuromuscular block was monitored using a mechanomyograph. When the first twitch of the train‐of‐four had recovered to 5% of control, an infusion of cisatracurium 3 μgkg−1.min−1 was started in Group C and an infusion of atracurium 10 μgkg−1.min−1 was started in Group A. The infusion rates were adjusted to maintain the first twitch of the train‐of‐four at 5% of control. The times to 90% and maximum depression of the first twitch of the train‐of‐four were significantly longer after cisatracurium than atracurium (2.2 and 3.4 min compared with 1.3 and 1.8 min, respectively; p < 0.01 in each instance). No significant differences were found in recovery parameters between the two groups. Blood samples were taken at regular intervals following the bolus, during the infusion and for 8 h thereafter. The plasma samples were analysed using high‐performance liquid chromatography for cisatracurium and atracurium (using a method which distinguishes between the three geometric isomer groups), laudanosine and monoquaternary alcohol. The results were analysed using the Non‐linear Mixed Effects Model program. A two‐compartment model was fitted to the data. The different isomer groups of atracurium have different pharmacokinetics, the trans–trans group having the highest clearance (1440 mlmin−1) and the cis–cis group the lowest (499 mlmin−1). The clearance of cisatracurium (425 mlmin−1) is less than that of cis–cis atracurium and its elimination half‐life is longer (34.9 min and 21.9 min, respectively). The plasma concentration of laudanosine after cisatracurium was one‐fifth of that after atracurium.
Experience with the McCoy laryngoscope in difficult laryngoscopy
Authors: Chisholm D. G. , Calder I.
Published: January 2004

We report our experience with the McCoy levering laryngoscope in 48 patients who were a Cormack and Lehane grade 3 or grade 4 view at direct laryngoscopy. The view with the blade in neutral position was grade 3 in 39 patients and grade 4 in nine patients. Elevation of the levered tip of the blade in the grade 3 group improved the view to grade 2 in 17 patients (44%), in 17 patients (44%) the view remained unchanged and in five patients (12%) the view deteriorated to grade 4. In the patients initially grade 4, the view improved to grade 3 in one patient and remained unchanged in eight patients. The McCoy laryngoscope is a useful tool to aid intubation in about half of patients who are a grade 3 view at laryngoscopy. Our experience indicates it is unlikely to improve a grade 4 view.
Subarachnoid block for a case of multiple system atrophy
Authors: McBeth C. , Murrin K.
Published: January 2004

We report a case of multiple system atrophy in a 60‐year‐old man who presented twice for optical urethrotomy. Multiple system atrophy is associated with autonomic neuropathy, cerebellar ataxia, disordered control of respiration and paralysis of the abductors of the vocal cords and thus poses several problems for the anaesthetist. Subarachnoid block, which has not been described before in this group of patients, was administered twice and was well tolerated on both occasions.
Halothane treatment of severe asthma to avoid mechanical ventilation
Authors: Padkin A. J. , Baigel G. , Morgan G. A.
Published: January 2004

A 41‐year‐old woman was admitted to the Intensive Care Unit with a severe exacerbation of asthma. She was exhausted despite maximal standard medical treatment. Instead of tracheal intubation and mechanical ventilation a subanaesthetic dose of halothane was delivered in 100% oxygen using a close‐fitting face mask. Her brochospasm resolved within minutes. The argument for using inhaled halothane to avoid tracheal intubation, mechanical ventilation and their side‐effects is presented.
The effect of propofol on midazolam metabolism in human liver microsome suspension
Authors: Leung B. P. , Miller E. , Park G. R.
Published: January 2004

We have studied the inhibitory effects of propofol on the metabolism of midazolam using human liver microsomes. In addition, we also investigated whether the lipid in which propofol is solubilised inhibits the metabolism of midazolam. Only high concentrations of propofol (>100 mmol), greater than those found in clinical practice, inhibited the metabolism of midazolam. The lipid had no effect on the metabolism of midazolam. This study differs from other laboratory studies looking at the inhibitory effects of propofol. These showed inhibition at concentrations similar to those seen in patients. The reasons for the differences may be explained by the use of different substrates or methodology. Propofol may be an enzyme inhibitor, but this remains to be shown to be important in patients.
Bilobar atelectasis after difficult tracheal intubation
Authors: Sprung J. , Lozada L. J. , Zanettin G. , Banoub M.
Published: January 2004

Acute intra‐operative collapse of a lobe without apparent cause is rare. We report a case of transient bilobar atelectasis that developed without any apparent cause after a difficult tracheal intubation in a healthy young patient. Intrabronchial obstruction was ruled out by bronchoscopy. The bilobar atelectasis developed acutely and resolved quickly with mechanical ventilation. The characteristics of the lung collapse were atypical, suggesting either its reflex nature or acute reduction of lung volume owing to intubation‐induced coughing. We present a review of the mechanisms of atelectasis.
Oxygen enrichment during emergence with the laryngeal mask — the ‘T‐bag’ versus the T‐piece
Authors: Martin J. , Brimacombe J. R.
Published: January 2004

We have compared the performance of a new oxygen enrichment device, the ‘T‐bag’, with a T‐piece during emergence from spontaneous breathing anaesthesia with the laryngeal mask airway. Thirty patients were randomly allocated to each group. Inspired and end‐tidal gases were sampled from the proximal end of the laryngeal mask airway. Cardiorespiratory variables were recorded immediately prior to discontinuation of anaesthesia, 2 min later and then at 5‐min intervals until removal of the laryngeal mask airway. The mean inspired oxygen concentration was greater than 70% and the inspired carbon dioxide was less than 2 mmHg in both groups throughout emergence. There were no episodes of hypoxia (oxygen saturation < 92%). Both devices performed well, but the ‘T‐bag’ offered advantages in terms of respiratory monitoring and ventilatory capability.
The influence of epidural administration of fentanyl infusion on gastric emptying in labour
Authors: Porter J. S. , Bonello E. , Reynolds F.
Published: January 2004

The effect of epidural infusions containing fentanyl on maternal gastric emptying in labour was examined using the rate of paracetamol absorption. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with fentanyl 2.5 μgml−1 at a rate of 10–12 mlh−1. Paracetamol 1.5 g was given orally to women after either 30 ml of the infusion solution had been given (mean time 2.5 h, study A) or 40–50 ml (mean time 4.5 h, study B). Six venous blood samples were taken over the next 90 min for measurement of plasma paracetamol concentration. There were no significant differences in maximum plasma paracetamol concentration, time to maximum paracetamol concentration and area under the concentration–time curve between the two groups for study A. In study B the time to maximum plasma paracetamol concentration was significantly delayed in women receiving > 100 μg fentanyl compared with controls (p < 0.05). We conclude that the dose of fentanyl that may delay gastric emptying when given by epidural infusion is greater than 100 μg.
Reliability of the next of kins' estimates of critically ill patients' quality of life
Authors: Rogers J. , Ridley S. , Chrispin P. , Scotton H. , Lloyd D.
Published: January 2004

The aim of this study was to determine the reliability and validity of relatives' assessment of patients' quality of life and to measure the agreement between patients' and relatives' responses to the Short Form 36 quality of life questionnaire, at discharge from and 6 months following intensive care treatment. Ninety‐nine patient–relative pairs were studied. Reliability was quantified by using measures of internal consistency (Cronbach's alpha and correlation coefficients) and reliability coefficients. Relatives' responses met the required standards of reliability and validity, but reliability was consistently weaker in the mental health dimension. Relatives' and patients' scores differed significantly in six dimensions at discharge; however, agreement between patients' and relatives' responses, as measured by the Kappa statistic, was fair, improved over 6 months, and was greatest in aspects concerning physical health. We conclude that relatives are able to give a good proxy assessment of functional aspects of quality of life.
Compliance in administration of prescribed analgesics
Authors: Boer C. , Treebus A. N. , Zuurmond W. W. A. , De Lange J. J.
Published: January 2004

In this noninterventional study, the implementation of ‘modern’ pain management in clinical practice was investigated by recording the regular prescription, administration and efficacy of analgesic drugs. This resulted in a reproducible and superficial quality control design for hospitals. One hundred and fifty surgical patients were followed during 5 days postoperatively. For every patient, pain, mood and sedation were measured using visual analogue and verbal descriptive scores; the prescription of analgesics at set times and administered doses of analgesics were also recorded. Only paracodeine and naproxen were administered regularly as prescribed, unlike paracetamol and morphine. The prescribed daily dose of morphine was only received by 4.2% of all patients. Although the postoperative pain treatment pathway was considered to be improved after better education and communication, in fact the opposite was found. This is probably caused by traditional thinking, lack of control and time pressure on the hospital staff and the subservient attitude of the patient.
A laboratory comparison of two techniques of emergency percutaneous tracheostomy
Authors: McLure H. A. , Dob D. P. , Mannan M. M. , Soni N.
Published: January 2004

This laboratory study was designed to compare the speed of placement of a percutaneous tracheostomy using two common methods and to evaluate any damage caused to the trachea. The same operator who was experienced with both techniques placed 10 percutaneous tracheostomies into a pig tracheal model, five using the Griggs tracheostomy forceps technique and five using the Ciaglia sequential dilatation technique. Placement of the tracheostomy was significantly faster using the Griggs technique (mean 89 s, range 69–105 s) than using the Ciaglia sequential dilator technique (mean 217 s, range 180–267 s). Damage to the posterior wall was noted in four of the tracheas. We concluded that the Griggs technique is rapid and in trained hands may be suitable for emergency airway access. In addition, the pig trachea model is easy to set up and provides a very useful training tool.
Predictors of postoperative myocardial ischaemia  The role of intercurrent arterial hypertension and other cardiovascular risk factors
Authors: Howell S. J. , Hemming A. E. , Allman K. G. , Glover L. , Sear J. W. , Foe¨x P.
Published: January 2004

One hundred and eighty‐three patients were studied to examine the role of a number of risk factors in the development of silent ischaemia after general anaesthesia for general and vascular surgery. We collected evidence of cardiovascular risk factors using a binary questionnaire. The patients were monitored pre‐ and postoperatively using a Holter ECG monitor. Usable data were collected on 140 patients. Pre‐operative silent myocardial ischaemia was found to be strongly associated with postoperative silent myocardial ischaemia (odds ratio: 10.8, 95% confidence intervals: 3.8–30.7). A history of hypertension, indicated by treatment with antihypertensive drugs, was associated with increased risk (odds ratio: 2.58, 95% confidence intervals: 1.12–5.96). A linear trend was found for risk associated with increasing admission systolic blood pressure (odds ratio: 1.20 for each 10‐mmHg increase in systolic pressure, 95% confidence intervals: 1.01–1.42). An association between vascular surgery and postoperative silent myocardial ischaemia was also confirmed (odds ratio: 2.36, 95% confidence intervals: 1.1–5.1).
Effect of the size of a tracheal tube and the efficacy of the use of the laryngeal mask for fibrescope‐aided tracheal intubation
Authors: Koga K. , Asai T. , Latto I. P. , Vaughan R. S.
Published: January 2004

We randomly allocated 60 patients with normal airways into three groups to compare the ease of fibrescope‐aided tracheal intubation using 8.0‐mm internal diameter (group F8) and 6.0‐mm (group F6) reinforced tracheal tubes and to evaluate the efficacy of the laryngeal mask as an aid for fibreoptic tracheal intubation (group L). In group F8 tracheal intubation was optimal in 2 of 20 patients and in two patients in whom intubation over the fibrescope was difficult the attempts resulted in inadvertent oesophageal intubation. In group F6 intubation was always successful and significantly easier than in group F8 (p < 0.005; 95% confidence interval for the difference in the proportion of the optimal intubation grade: 20–70%). In group L tracheal intubation was optimal in 18 of 20 patients and easier than in group F6 (p = 0.014; 95% confidence interval for difference: 10–60%). In both groups F6 and L tracheal intubation was completed within less than about 1 min. We conclude that conventional fibrescope‐aided tracheal intubation with a 6.0‐mm tracheal tube is easier than with an 8.0‐mm tube and that the laryngeal mask facilitates fibrescope‐aided tracheal intubation.
Accuracy of pulse oximetry in patients with low systemic vascular resistance
Authors: Secker C. , Spiers P.
Published: January 2004

In order to assess the accuracy of pulse oximeters in patients with septic shock, we compared 80 paired readings of oxygen saturations taken from pulse oximeters and oxygen saturations obtained from co‐oximetry in patients receiving intensive therapy with indwelling pulmonary artery flotation catheters. Comparison between groups with low or normal systemic vascular resistance indices showed a small (1.4%) but significant (p < 0.001) underreading of the saturation from the pulse oximeter in the presence of a low systemic vascular resistance. With normal or high systemic vascular resistance pulse oximeter readings correlated well with co‐oximetry. We hypothesise that the main cause of this underreading is because the pulse oximeter is sensing pulsatile venous flow due to the opening of arteriovenous channels in the skin in septic states.
Serious spinal cord injury due to haematomyelia caused by spinal anaesthesia in a patient treated with low‐dose heparin
Authors: Greaves J. D.
Published: January 2004

Failed spinal anaesthesia for left total hip arthroplasty was followed postoperatively by dense motor paralysis and sensory deficit in the right leg. The patient had received a dose of subcutaneous heparin 1 h before the spinal anaesthetic was attempted. She died of pulmonary embolism on the ninth postoperative day. At autopsy extensive haematomyelia was found in relation to the needle track.
Low‐dose aspirin and intracranial surgery A survey of the opinions of consultant neuroanaesthetists in the UK
Authors: James D. N. , Fernandes J. R. , Calder I. , Smith M.
Published: January 2004

Increasing numbers of patients presenting for surgery are receiving concurrent medication with low‐dose aspirin. We surveyed the opinions and working practices of consultant members of the Neuroanaesthesia Society regarding patients who present for elective intracranial surgery whilst taking this form of medication. Identical questionnaires were sent to 140 members of the society and proffered four main questions: (1) the adherence to any policy of stopping aspirin pre‐operatively, (2) the preferred method of treatment for excessive bleeding in this context, (3) personal knowledge of haemorrhagic complications in this group of patients, (4) the neurosurgical unit concerned. There were 121 responses (86.4%) of which 116 (82.9%) were valid. Of the respondents, 78 (67.2%) were unaware of a written departmental policy for the discontinuation of pre‐operative aspirin treatment and had no personal policy. Thirty‐two respondents (27.6%) had a personal policy but were unaware of a written departmental policy; only six respondents (5.2%) stated that a written departmental policy was in place. The mean time suggested for discontinuation of aspirin pre‐operatively was 11.3 days (range: 1–42 days). Fifty‐one respondents (44.0%) considered that patients taking low‐dose aspirin were at increased risk of excessive peri‐operative haemorrhage and 15 (12.9%) anaesthetists reported having personal experience of such problems. Fifty‐seven respondents (49.1%) would use a platelet infusion, alone or in association with other blood products or prohaemostatic agents, if haemorrhagic complications developed. The majority of neuroanaesthetists felt that aspirin was a risk factor for haemorrhagic complications associated with intracranial procedures, but most adopt no policy regarding its pre‐operative discontinuation.
Thoracic epidural analgesia started after cardiopulmonary bypass
Authors: Fawcett W. J. , Edwards R. E. , Quinn A. C. , MacDonald I. A. , Hall G. M.
Published: January 2004

The effects of thoracic epidural analgesia started after cardiopulmonary bypass were studied on the subsequent adrenergic, cardiovascular and respiratory responses. Sixteen cardiac surgical patients received either a standardised general anaesthetic (control group) or a standardised general anaesthetic and thoracic epidural analgesia (epidural group). The epidural catheter was sited before surgery and heparinisation. Following discontinuation of cardiopulmonary bypass, patients in the epidural group were given 15 ml bupivacaine 0.5% down the catheter followed by an infusion of bupivacaine 0.375% at 5–8 ml.h−1 after surgery. The control group received an intravenous morphine infusion on completion of surgery. The adrenergic response was assessed by measuring arterial catecholamine concentrations. Respiratory function was determined by spirometry, peak expiratory flow and arterial partial pressure of oxygen while breathing air. Pain scores were also obtained. After cardiopulmonary bypass the increases in catecholamine concentrations were effectively inhibited in the epidural group for the remainder of the study (p < 0.05). Postoperative respiratory function was less impaired in the epidural group, with higher forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow (p < 0.05). Pain scores were also significantly lower in the epidural group (p < 0.05). There were no significant differences in cardiovascular parameters.
Effects of propofol emulsion and thiopentone on T helper cell type‐1/type‐2 balance in vitro
Authors: Salo M. , Pirttikangas C‐O. , Pulkki K.
Published: January 2004

We have earlier found increased percentages of T helper cells (CD4‐positive lymphocytes) in the blood circulation after propofol infusion anaesthesia. Cytokines interferon‐γ (IFNγ) and interleukin‐4 (IL‐4) are important in the differentiation of T helper cells into subtypes T helper type‐1 (Th1) and type‐2 (Th2). To study the effects of propofol emulsion, its solvent Intralipid® and thiopentone on Th1/Th2 balance, measurements of IFNγ and IL‐4 production by mononuclear leucocytes were carried out in vitro. As IL‐2 has a central role in immune responses to surgery, its production was also measured. Concanavalin A‐stimulated mononuclear cells were cultured in the presence of propofol emulsion at 3.5 or 10 μg.ml−1, Intralipid® 35 or 100 μg.ml−1, or thiopentone 3 μg.ml−1. Cytokine production was measured from the conditioned media of mononuclear cell cultures. Decreased IFNγ (p <0.001) and IL‐4 concentrations (p < 0.01) were found in the presence of thiopentone, but IL‐2 production was unaffected. By contrast, propofol emulsion or Intralipid® had no effects on IFNγ, IL‐2 or IL‐4 concentrations. Propofol 10 μ.ml−1 increased the IFNγ/IL‐4 ratio from the control value median 243 (162–562) (25th–75th percentile) to 363 (195–1028) (p < 0.01), but thiopentone decreased it to 145 (60–214) (p < 0.01). These findings show that propofol and thiopentone have different effects in vitro on Th1/Th2 balance and suggest that they have different modulating effects on the immune response.
Near‐infrared spectroscopy changes during hypothermic circulatory arrest with retrograde cerebral perfusion
Authors: Rigg C. D. , Clutton‐Brock T. H.
Published: January 2004

We report on the changes in cerebral near‐infrared spectroscopy during grafting of a thoraco‐abdominal aneurysm. A 58‐year‐old man presented with a complex dissecting aortic aneurysm. Repair of the aneurysm was performed under hypothermic circulatory arrest with retrograde cerebral perfusion. Cerebral near‐infrared spectroscopy monitoring revealed a reduction in the values recorded for total haemoglobin, oxygenated haemoglobin and cytochrome aa3 along with an increase in deoxygenated haemoglobin during circulatory arrest. When retrograde cerebral perfusion was commenced the signals representing total haemoglobin, oxygenated haemoglobin and cytochrome aa3 were all restored to near baseline values. Deoxygenated haemoglobin, however, remained elevated. These changes support the hypothesis that some cerebral perfusion occurs during retrograde cerebral perfusion.
Intrathecal morphine for Caesarean section: an assessment of pain relief, satisfaction and side‐effects
Authors: Swart M. , Sewell J. , Thomas D.
Published: January 2004

In a prospective, randomised, double‐blind study of 60 patients who had an elective Caesarean section under spinal anaesthesia we compared 0.1 mg intrathecal morphine with intrathecal saline placebo. All patients received morphine intravenously by patient‐controlled analgesia after the operation. Pain, satisfaction and side‐effects were assessed at 4 and 24 h after the operation. Pain measured by a 100‐mm visual analogue scale was less in the intrathecal morphine group at both times (p <0.05) and morphine consumption was lower (p <0.01). At 4 h the intrathecal morphine group had more pruritus (p <0.001) but there was no difference in satisfaction. At 24 h there was no significant difference in side‐effects, but overall satisfaction measured by visual analogue scale was better in the intrathecal morphine group (p <0.01). Intrathecal morphine improves pain relief and patient satisfaction after Caesarean section.
Comparison of ondansetron, metoclopramide and placebo as premedicants to reduce nausea and vomiting after major surgery
Authors: Alexander R. , Fennelly M.
Published: January 2004

In a randomised, double‐blind study, we have compared the incidence of postoperative nausea and vomiting in 124 patients undergoing major lower limb orthopaedic surgery following oral premedication with temazapam and ondansetron 8 mg, metoclopramide 10 mg or placebo. They received a standardised epidural and general anaesthetic. An epidural mixture containing bupivacaine 0.1% and fentanyl 10 mg.ml−1 was infused postoperatively. The occurrence of nausea and vomiting was assessed every 4 h for 24 h. The incidence of vomiting significantly decreased from 55% and 43% in the placebo and metoclopramide groups, respectively, to 26% in the ondansetron group (p = 0.03). The incidence of nausea and vomiting in patients who had previously suffered was also significantly reduced from 67% and 68% in the placebo and metoclopramide groups, respectively, to 29% in the ondansetron group (p = 0.035). We conclude that oral premedication with ondansetron 8 mg was superior to metoclopramide 10 mg and placebo in preventing postoperative nausea and vomiting following major orthopaedic surgery in patients given epidural opioid analgesia.
Postdural puncture symptoms in a child
Authors: McHale J. , O'Donovan F. C.
Published: January 2004

An 11‐year‐old boy suffered an inadvertent dural puncture during placement of an epidural catheter for postoperative analgesia. He developed symptoms of mild headache only, but severe and protracted orthostatic nausea and dizziness, which eventually resolved completely following epidural blood patch. His symptoms were atypical and could have been misinterpreted in the context of dural puncture for diagnosis, or for administration of intrathecal chemotherapy. The reported incidence of headache following dural puncture in children is low. It may be that the manifestations are different from those of adults and that the true incidence of symptoms related to leakage of cerebrospinal fluid is higher in children than currently recognised.
Pain after vasectomy
Authors: McConaghy P. , Reid M. , Loughlin V. , Huss B. K.
Published: January 2004

We studied the influence of the timing of injection of bupivacaine into the vas deferens on the intensity and duration of scrotal pain following vasectomy. Forty‐two patients undergoing vasectomy under general anaesthesia were randomly allocated to have the operation performed on either the left or the right side first. On the first side to be operated upon, 5 ml bupivacaine 0.5% was infiltrated along the line of the scrotal incision. The vas deferens was identified and 1 ml bupivacaine 0.5% was injected into its lumen, with 0.5 ml directed proximally and 0.5 ml directed distally. After completion of the procedure on that side, the operation continued on the other side. On this occasion, the same dose of bupivacaine was injected into the vas deferens after division and ligation, and subcutaneously along the scrotal incision after skin closure. Median [interquartile range] visual analogue pain scores on the first side to be operated upon were significantly lower than on the second side on day 1 (7 [1.5–19] vs. 11 [2.5–47]) (p < 0.01) and day 7 (0 [0–8.5] vs. 0 [0–18.8]) (p < 0.05) postoperatively. The median [interquartile range] duration of postoperative discomfort was less on the first side operated upon than on the second (3 [1–7] vs. 6 [2–7]) (p < 0.01). Although statistically significant differences occurred between the treatment groups, the actual differences were small and may not be clinically significant.
Airway auscultationA new method of confirming tracheal intubation
Authors: Nicoll S. J. B. , King C. J.
Published: January 2004

Unrecognised accidental oesophageal intubation remains an important cause of morbidity and mortality in anaesthetic practice. We have evaluated a new method of distinguishing tracheal from oesophageal intubation using a simple adaptation of an ordinary stethoscope which is inserted into the patient end of the breathing system. We call this technique ‘airway auscultation’. Characteristic sounds are heard with the stethoscope during inflation and deflation which allow the observer to diagnose the position of the tube. When the tube is in the trachea loud breath sounds are heard. In contrast, when the tube is in the oesophagus either squeaks or a flatus‐like noise is heard or else there is no sound. In 100 healthy adults two observers rapidly identified 99 intubations correctly in a randomised single‐blind trial. We recommend further widespread evaluation of this device as it appears to be an effective, simple and rapid method of detecting oesophageal intubation and confirming tracheal intubation which may be of particular use in situations where capnography is not available.
Transoesophageal echocardiography in the critically ill
Authors: Poelaert J. , Schmidt C. , Colardyn F.
Published: January 2004

Echocardiography offers real‐time bedside diagnosis and monitoring of a variety of structural and functional abnormalities of the heart. Transoesophageal echocardiography, in particular, provides information on cardiac contractility, filling status and output, valvular morphology and function and on the structure of the ascending and descending aorta in the critically ill patient. The full range of modalities of echocardiography, including M‐mode, 2‐D‐mode, colour Doppler and spectral Doppler, is at the disposal of the intensive care specialist. In this review, the indications for and the clinical impact of transoesophageal echocardiography and Doppler are discussed.
Accidental pleural puncture by a thoracic epidural catheter
Authors: Zaugg M. , Stoehr S. , Weder W. , Zollinger A.
Published: January 2004

We report the occurrence of an accidental pleural puncture by an epidural catheter that happened during the attempted induction of thoracic epidural anaesthesia using a paramedian approach in an awake patient. The incorrect placement of the catheter was recognised while the patient was undergoing thoracoscopic surgery. The possibility of accidental pleural puncture during attempted thoracic epidural catheter placement by either the paramedian or the midline approach should be borne in mind. A misplaced catheter may injure lung tissue and result in a potentially dangerous intra‐operative tension pneumothorax.
Postoperative analgesic effect of intrathecal neostigmine and its influence on spinal anaesthesia
Authors: Klamt J. G. , Slullitel A. , Garcia l. V. , Prado W. A.
Published: January 2004

A clinical trial was conducted to evaluate the postoperative analgesic efficacy and the safety of intrathecal neostigmine in patients undergoing anterior and posterior vaginoplasty under spinal anaesthesia. Thirty‐six patients were randomly divided into three groups to receive: normal saline (1 ml), morphine (100 μg in 1 ml of saline) or neostigmine (100 μg in 1 ml of saline) intrathecally just before a spinal injection of hyperbaric bupivacaine (0.5%, 4 ml). The mean [SD] time to the first analgesic (nonsteroidal anti‐inflammatory drug) administration was significantly prolonged by intrathecal neostigmine (10.7 [4.3] h) and morphine (15.3 [3.0] h) compared with saline (4.5 [1.0] h). The three groups also differed in the number of patients requiring subcutaneous morphine to complement the analgesia provided by the intramuscular nonsteroidal anti‐inflammatory drugs and the mean [SD] times for their administration: eight patients in the saline group (8.0 [3.8] h), one patient in the morphine group (18 h) and two patients in the neostigmine group (8 and 12.9 h). The morphine and neostigmine groups showed similar analgesic effectiveness. The characteristics of spinal anaesthesia were not modified by intrathecal morphine or neostigmine. Severe nausea and vomiting, sweating and distress during surgery were the most obvious adverse effects of intrathecal neostigmine. On the other hand, less hypotension was observed in the neostigmine group. The usefulness of intrathecal neostigmine as the sole postoperative analgesic may be restricted by the severity of its adverse effects.
Latex allergy: an emerging clinical and occupational health problem
Authors: Kam P. C. A. , Lee M. S. M. , Thompson J. F.
Published: January 2004

Allergy to latex products has become a problem of increasing dimensions, affecting both patients and health‐care professionals. Certain high‐risk groups and sources of latex exposure have been identified. The clinical manifestations vary from contact eczema through a range of allergic syndromes including life‐threatening anaphylaxis. An understanding of the clinical and immunological features of latex allergy provides the basis of therapeutic and preventive strategies. Latex allergy is also becoming a major occupational health issue.
Patient‐maintained propofol sedation
Authors: Irwin M. G. , Thompson N. , Kenny G. N. C.
Published: January 2004

We have developed a system which allows patients to operate a target‐controlled infusion of propofol to provide sedation and we have studied its use in 36 unpremedicated patients undergoing local and regional anaesthetic procedures lasting 10–280 min. An intravenous propofol infusion was started at a target plasma level of 1 μg.ml−1. The patient was able to increase the target propofol concentration in 0.2‐μg.ml−1 increments by pressing a demand button. There was a lockout interval of 2 min and a maximum permissible target concentration of 3 μg.ml−1. There was considerable interindividual variability in propofol consumption (mean 39.3 μg.kg−1.min−1, range 3–131 μg.kg−1.min−1), no cardiovascular instability and little oversedation. Eight patients required supplementary oxygen. Optimal sedation was provided at median target concentrations of 0.8–0.9 μg.ml−1. The target‐controlled infusion system bias was − 47% and the inaccuracy was 48%. Patient satisfaction was high and 89% said that they would definitely use the technique again. This technique combines the benefits of target‐controlled infusion with patient‐controlled feedback and produces safe intra‐operative sedation.
The use of paraglossal straight blade laryngoscopy in difficult tracheal intubation
Authors: Henderson J. J.
Published: January 2004

In 10 cases of unexpected difficult tracheal intubation using the Macintosh laryngoscope blade, the larynx could not be seen. In each case, a good view was achieved using the Miller blade lateral to the tongue, which enabled tracheal intubation under direct vision. The results achieved using narrow, low‐profile straight laryngoscope blades with this technique are reviewed. The improved view obtained with this technique is a consequence of reduced tongue compression as compared with the Macintosh technique. This leads both to an improved line of sight, and to a reduced risk of backward displacement of the tongue and epiglottis. In addition, the molar or retromolar variation of the technique reduces the intrusion of maxillary structures into the line of sight, so that a better view of the larynx is achieved for a given degree of soft tissue compression. Paraglossal straight blade laryngoscopy may have an advantage over use of the Macintosh technique when intubation proves unexpectedly difficult. It is perhaps time to question standard teaching about the role of the curved blade in such patients or, more particularly, whether the technique of laryngoscopy as currently taught is optimal. The paraglossal straight blade technique needs to be practised in routine intubation before it can be used with confidence in difficult cases.