bluuebunny/crossref_metadata_2025 huggingface dataset:
Alfentanil in an anaesthetic technique for penetrating eye injuries
Authors: Morton N.S. , Hamilton W.F.D.
Published: February 2007

Alfentanil in three doses (10, 20 and 30 μ/kg)was added to an anaesthetic technique suitable far penetrating eye injuries. All three doses proved effective in abolishing the marked present response to tracheal intubation which occurs with this technique, but at least 20 μg/kg was needed to obtund the heart rate response significantly and to facilitate early intubation. Transient hypotension and bradycardia occurred in some patients who received the highest dose of alfentanil. The incidence of postoperative sequelae was small in all groups. Thus, the optimal dose of alfentanil in an anaesthetic technique for penetrating eye injuries appears to be 20 μg/kg.
Single breath end‐tidal Pco2, measurement during high frequency jet ventilation in critical care patients
Authors: Mason C.J.
Published: February 2007

The relationship between arterial and end‐tidal carbon dioxide tensions following a single large breath was investigated in seven critically ill patients receiving high frequency jet ventilation. There was a close correlation (r = 0.989) between arterial and end‐tidal carbon dioxide tensions over a wide range (3.29–8.95 kPa). Measurement of the end‐tidal carbon dioxide tension following a single large breath may be useful in monitoring the efficiency of high frequency jet ventilation in the elimination of carbon dioxide.
The effects of continuous intravenous naloxone on epidural morphine analgesia
Authors: THIND G. S. , WELLS J. C. D. , WILKES R. G.
Published: February 2007

Forty–Jive patients undergoing Caesarean section under epidural anaesthesia with bupivacaine were randomly allocated to three groups. Group I received 4 mg of epidural morphine immediately postoperatively and 2 mg naloxone by intravenous infusion for 12 hours postoperatively; group 2 was treated as group I but without naloxone infusion: group 3 received 10 mg morphine intramuscularly and 20 ml epidural saline after delivery of the baby. Epidural morphine 4 mg produced better postoperative analgesia than 10 mg of morphine intramuscularly (p < 0·001) and the intravenous infusion of naloxone did not ablate the analgesic effects of epidural morphine. The incidence of itching and vomiting was higher in the epidural opioid groups (p < 0.05) and intravenous naloxone, although it reduced the severity of the itching, did not reduce its overall incidence. Respiratory depression was not detected in any of the three groups.
Hypotensive anaesthesia for microsurgery of the middle ear. A comparison between isoflurane and halothane
Authors: Fairbairn M.L. , Eltringham R.J. , Young P.N. , Robinson J.M.
Published: February 2007

Fifty patients undergoing microsurgery of the ear were anaesthetised using thiopentone, nitrous oxide, oxygen and either halothane or isoflurane, via a low flow circle system with carbon dioxide absorption. Systolic blood pressure was reduced to approximately 70 mmHg by the additional use of increments of labetalol; the patients breathed spontaneously. The degree of haemostasis was assessed by the surgeon who was unaware which volatile agent was being used to supplement anaesthesia. Isoflurane, although it is a potent vasodilator produced operating conditions which were indistinguishable from halothane. Isoflurane is thus a safe and reliable alternative to halothane as a volatile agent used to supplement anaesthesia when using induced hypotension for middle ear surgery.
Nikolai Ivanovich Pirogoff
Authors: SECHER O.
Published: February 2007

A short description of the life of Nikolai Ivanovich Pirogoff and some of his accomplishments are given. His book on administration of ether for anaesthesia (analgesia) by inhalation and by rectum is of special interest. In this book he also describes his experiments, mainly on dogs, with all kinds of administration. He was one of the first to write a book on ether and also to utilise anaesthesia under war conditions. Later he tended to favour chloroform, which he considered to be better. He accomplished a lot in life and was highly regarded at home and abroad.
Atypical plasma cholinesterase
Authors: MILLIGAN K. R. , HAYES T. C. , HUSS B. K. D. , BEATTIE B.
Published: February 2007

The plasma cholinesterase status of 22 people resident in the same small town was investigated. A high incidence of the atypical cholinesterase gene was found.
Prolonged neuromuscular blockade following suxamethonium in a patient with a normal genotype
Authors: SAPSFORD D. J. , BUSH G. H.
Published: February 2007

A patient is described who developed prolonged apnoea following a single normal dose of suxamethonium which was shown by nerve stimulation to be due to persistent neuromuscular blockade. The plasma cholin‐esterase projile demonstrated a normal genotype.
Bacterial contamination of compressed air for medical use
Authors: Bjerring P. , ØBerg B.
Published: February 2007

The present study demonstrates a previously unnoticed source of bacterial contamination of locally manufactured compressed air for medical use. Air samples were drawn into a specially constructed device, and bacterial contents were identified from growth on agar plates. Various factors contributing to bacterial contamination of compressed air during production are mentioned and preventive measures are discussed.
Plasma bupivacaine Concentrations following psoas comprirtment block
Authors: Odoom J. A. , Zuurmond W. W. A. , SIH I. L. , Bovill J. , Osterlof G. , Oosting H. V.
Published: February 2007

Fourteen patients undergoing hip replacement surgery under psoas compartment block combined with general anaesthesia were studied. Group 1 (n = 7) received plain and Group 2 (n = 7) received 0.25% bupivacaine with adrenaline. The mean maximirm peak concentrations were 1.93 (SEM 0.46) μg/ml and 1.04 (SEM 0.19) μglmlat 10 minutes in groups I and2 respectively. Bupivacaine concentrations were higher at all times in the group which received plain that the group receiving solution containing adrenaline. These differences were statistically significant at 10, 15 (p< 0.05) and 30 minutes (p < 0.025). The highest recorded plasma bupivacaine concentration was 4.54 μg/ml in one patient receiving plain bupivacaine. No patient developed any signs of toxic svmptoms, the duration of analgesia was longer (p < 0.005) in the group receiving bupivacaine with adrenaline. Bupivataine 0.25% with adrenaline 1:200 000 is safe for psoas compartment block, and is recommended for hip surgery.
Profound atracurium induced neuromuscular blockade
Authors: Casson W.R. , JONES R.M.
Published: February 2007

Speed of reversal of profound atracurium induced neuromuscular blockade following edrophonium (0.5 or 1.0 mg/kg) or neostigmine (0.04 or 0.08 mg/kg) was measured using the train‐of‐four pattern of nerve stimulation. In all patients adequate clinical reversal was present when the ratio of the strength of the fourth to the first twitch (T4 ratio) was 0.5. Both doses of edrophonium were associated with a significantly faster speed of reversal than the smaller dose of neostigmine (p<0.05 in both cases). However, the larger dose of neostigmine was associated with a reversal time approaching that of Edrophonium. Possible explanations for these findings are discussed in terms of contemporary theories of neuromuscular pharmacology.
The effect of halothane on cerebral electrical activity
Authors: WARK KATHRYN J. , SEBEL P. S. , VERGHESE C. , MAYNARD D. E. , EVANS S. J. W.
Published: February 2007

Recordings of cerebral electrical activity were obtained using the cerebral function analysing monitor from eight unpremedicated patients anaesthetised with increasing concentrations of halothane in oxygen. The amplitude of the processed EEG increased at one and decreased at two minimal alveolar concentrations. The frequency distribution of the weighted EEG signal showed a linear increase of delta activity with a corresponding decrease in beta activity with increasing concentrations of halothane.
The digital control of anaesthetic gas flow
Authors: BOADEN R. W. , HUTTON P.
Published: February 2007

The theory and construction of a prototype digital gas flow controller are described. Using eight preset needle valves, it has the ability to deliver any flow from 50 to 12750 ml/minute in steps of 50 ml/minute. Under given conditions, the accuracy of this de vice is very high and its variation in performance with pipeline supply pressures is quantified. The required flow is requested from a BBC ‘B’ microcomputer which is interfaced with the equipment via a program written in Basic and the 1MHz bus port. The possible uses and potential of a microcomputer‐controlled flow regulator in anaesthesia and intensive care are discussed.
Sensitivity to propofol in the elderly
Authors: DUNDEE J. W. , ROBINSON FRANCES P. , McCOLLUM J. S. C. , PATTERSON C. C.
Published: February 2007

Two studies were carried out on 609 fit, unpremedicated patients to assess the influence of patient age on the response to the rapidly‐acting hindered phenol, propofol, which is being evaluated for induction of anaesthesia. In the first study, 1.25 mg/kg was injected over 20 seconds followed by 10‐mg increments every 15 seconds until loss of verbal contact. This showed a great individual variation in response to the drug. A reduction in the ‘induction’ dose was found in elderly patients, which became marked around 60 years. In the second (340), doses ranging from 1.5–3.0 mg/kg in patients under 60 years and 1.25–2.25 mg/kg in those over 60 years were injected as a bolus over 20 seconds. Doses of 2.25–2.5 mg/kg were required to induce anaesthesia in patients under 60 years, whilst 1.5–1.75 mg/kg was adequate in those over 60 years. Side effects were more marked with the rapid injection and doses in excess of 1.75 mg/kg caused significant hypotension and apnoea in the elderly. These studies reveal marked sensitivity to propofol in the elderly with respect to both induction dose and acute toxicity.
Comparison of effects of fentanyl and alfentanil on intra‐ocular pressure
Authors: MOSTAFA S. M. , LOCKHART A. , KUMAR D. , BAYOUMI M.
Published: February 2007

The effects of fentanyl and alfentanil on intra‐ocular pressure during anaesthesia were investigated in 50 consecutive patients in a double‐blind controlled trial. Both drugs produced a significant reduction in intraocular pressure (p < 0.01). Alfentanil produced significantly greater reduction (48.5 percent) than fentanyl (28.6 percent) (p < 0.01). A small but statistically significant reduction in arterial pressure (15 percent approximately) and heart rate (18 percent approximately), were observed with both agents, but no significant differences between them were noted. It is suggested that alfentanil may be a suitable alternative to fentanyl in ophthalmic anaesthesia.
Anaesthetic management and postoperative care of cardiac surgical patients in a general recovery ward
Authors: Aps C. , Hutter J.A. , Williams B.T.
Published: February 2007

The postoperative care of 143 cardiac surgical patients has been successfully conducted in a general surgical recovery ward. Admission was limited to overnight stay only and all but two patients were returned to the general ward the following day. There were no deaths. The intra‐operative anaesthetic management was considered to have played an important part in the success of this technique.
Quality of axillary brachial plexus block
Authors: TUOMINEN M. K. , PITKÄNEN M. T. , NUMMINEN M. K. , ROSENBERG P. H.
Published: February 2007

A perivascular catheter technique (PVT) and a nerve stimulator technique (NST) for axillary brachial plexus block were compared in terms of quality: complete, incomplete or failed blocks. In a randomised series, 30 PVT blocks and 30 NST blocks were performed by three staff anaesthetists. In the NST group, surgical anaesthesia was always achieved, whereas in the PVT group, four blocks required supplementation with general anaesthesia. In both groups eight patients needed supplementation with addilioncd conduction blocks of 1–3 peripheral nerves. It is concluded that a nerve stimulator technique may increase the success rate of axillary brachial plexus block to some extent.
Anaesthesia in the prune‐belly syndrome
Authors: HENDERSON A. M. , VALLIS C. J. , SUMNER E.
Published: February 2007

Between 1959 and 1984, 36 children with the prune‐belly syndrome underwent 133 operations at the Hospital for Sick Children, Great Ormond Street. The anaesthetic and surgical problems have been reviewed. Minor postoperative respiratory tract infections followed eight anaesthetics. Three deaths occurred in the postoperative period. In two of these there were multifactorial causes, not directly related to the prune‐belly syndrome. One death was related to the sequelae of the syndrome. Normal doses of muscle relaxants are recommended when intermittent positive pressure ventilation is used during anaesthesia. Monitoring of the patient's respiratory state and active physiotherapy are advisable postoperatively. Analgesies should be used with caution.
Myoeardial ischaemia during non‐cardiac surgery†
Authors: GRIFFIN R. M. , KAPLAN J. A.
Published: February 2007

Computerised ST segment analysis was used to compare the frequency of ischaemia occurring in electro‐cardiographic leads II, V5, CS5 and CB5. Three out of 15 patients with ischaemic heart disease developed ischaemic changes, which were evident in all four leads in each patient. A single bipolar lead may be substituted for a true K5 lead when monitoring patients at increased risk of developing myoeardial ischaemia. ST segment analysis facilitates the early diagnosis of peri‐operative myoeardial ischaemia, which may otherwise be missed on the standard electrocardiogram.
Isoflurane for anaesthesia in the dental chair. A comparison of the incidence of cardiac dysrhythmias during anaesthesia with halothane and isoflurane
Authors: Cripps T.P. , Edmondson R.S.
Published: February 2007

A randomised single‐blind trial was performed to compare the effects on cardiac rhythm of isoflurane and halothane in 100 dental outpatients having extractions under general anaesthesia in the dental chair without tracheal intubation. The incidence of supraventricular dysrhythmias did not differ significantly. No patient in the isoflurane group developed a ventricular dysrhythmia, whilst nine of those who received halothane did so (p = 0.0013). The quality of anaesthesia was acceptable in the isoflurane group, but induction time was longer (p < 0.05) and the maximum heart rate was faster (p < 0.01). There was no difference in the maximum end tidal carbon dioxide concentrations measured in a further 20 cases.
Postoperative headache in young patients after spinal anaesthesia
Authors: Flaatten H. , Rodt S. , Rosland J. , Vamnes J.
Published: February 2007

Spinal anaesthesia was performed on 247 young adult patients with a 25‐G needle. Rectal administration of indomethacin had no significant effect on the incidence of postdural puncture headache, which occurred in 16.8% of patients who received the drug compared to 24.5% who received a placebo. A history of headache pre‐operatively did not influence the incidence of post lumbar puncture headache.
Fluorocarbons
Authors: FAITHFULL N. S.
Published: February 2007

This article presents information on medical applications of fluorocarbons. These inert chemicals have a high solubility for the respiratory gases and, in emulsified form, are present in the oxygen‐transporting plasma substitutes now undergoing clinical trials. Oxygen content is directly related to arterial partial pressure of oxygen (PaO2). Thus, although oxygen transport of Fluosol‐DA 20% (FDA) is only 0.75 ml per 100 ml per 10 kPa, oxygen delivery at the tissues will be adequate in the presence of a high Pao2. FDA has a low viscosity at low shear rates and this, together with a very small emulsion particle size of 0.1 μm, helps provide improved tissue oxygenation in conditions of ischaemic hypoxia. Fluorocarbon plasma substitutes may be employed as ‘blood’, but may also he used for a wide range of purposes in clinical practice. This review describes some current and potential future applications.
Anaesthesia and intra‐ocular pressure in young children
Authors: DEAR G. de L. , HAMMERTON M. , HATCH D. J. , TAYLOR D.
Published: February 2007

This study compares the effects of three anaesthetic techniques on intra‐ocular pressure (IOP) in infants and children: spontaneous ventilation using nitrous oxide with halothane (group 1) or isoflurane (group 2) and controlled ventilation with atracurium (group 3). The IOP remained constant in groups 1 and 2 until the administration of suxamethonium when it rose significantly; this rise was maintained during tracheal intubation. In group 3 IOP increased on administering atracurium and a further increase was seen during tracheal intubation. Diagnostic intra‐ocular pressure measurements should he made during spontaneous breathing prior to tracheal intubation. The IOP was not directly affected by arterial blood pressure or by expired CO2 tension.
Anaesthesia and glucose‐6‐phosphate dehydrogenase deficiency
Authors: SMITH C. L. , SNOWDON S. L.
Published: February 2007

Anaesthetic management of a patient with glucose‐6‐phosphate dehydrogenase deficiency is described. The pathogenesis and various complications relating to this common hereditary blood disorder are reviewed. Problems related to anaesthesia in the presence of glucose‐6‐phosphate dehydrogenase deficiency are discussed.
Use of a low‐power nerve stimulator during sciatic nerve block
Authors: SMITH B. E. , ALLISON A.
Published: February 2007

The use of a low‐power nerve stimulator to aid nerve location during the performance of sciatic nerve block was compared with a conventional anatomically based technique. The success rate, both in terms of the production of an effective block and the duration of postoperative analgesia, was significantly higher in the stimulator groups than in the non‐stimulator groups. The implications of the study for both clinical and teaching practice are discussed.
Retention of auditory information presented during anaesthesia
Authors: STANDEN P. J. , HAIN W. R. , HOSKER K. J.
Published: February 2007

Surgical procedures that involve a local anaesthetic block are often accompanied by light general anaesthesia. It is possible that under these circumstances, the patients are more likely to register auditory events while apparently unconscious. Two groups of children were exposed to auditory stimuli during surgery; one group received a lighter level of anaesthesia than the other. Retention of the stimuli was tested using a cued recall technique, and the performance of the two experimental groups was compared with a control group which had not been exposed to the material but was tested in the same way. The light anaesthesia group retained more items than did the other two groups but this difference was significant (p < 0.05) only when compared with the other experimental group. This is not very strong evidence of auditory registration, but a greater effect might be found with exposure to emotionally significant material. It is suggested that patients should be protected from unfortunate theatre conversation.
Failure of critically ill patients to metabolise midazolam
Authors: SHELLY M. P. , MENDEL L. , PARK G. R.
Published: February 2007

The pharmacokinetics of midazolam and its metabolite, 1‐OH midazolam, were studied in six critically ill patients during and after a continuous intravenous infusion of midazolam. Four patients had an increased elimination half‐life of midazolam; two were associated with a reduction in plasma clearance with low plasma concentrations of the metabolite, and two with normal metabolite levels and increased volume of distribution. The two patients with reduced clearance suffered from septic shock and were studied over a longer period. Their altered clearance was due to a reduced capability to form the 1‐OH metabolite. As their condition improved, plasma concentrations of 1‐OH midazolam increased and midazolam clearance returned towards normal. The impaired ability of critically ill patients with septic shock to metabolise midazolam, may be due to reduced organ perfusion and may lead to cumulation of midazolam in these patients.
Somatostatin, anaesthesia, and the carcinoid syndrome
Authors: ROY R. C. , CARTER R. F. , WRIGHT P. D.
Published: February 2007

A patient with carcinoid syndrome on long‐term antiserotonin therapy with parachlorophenylalanine, experienced a flushing attack with hypotension during the prophylactic administration of aprotonin prior to the induction of anaesthesia. When she was subsequently prepared with a long‐acting somatostatin analogue, octreotide (Sandostatin, Sandoz SMS 201–995), plasma levels of tumour‐released hormones were reduced and anaesthesia for resection of hepatic metastases was uneventful. The advantages of an anaesthetic approach based on inhibition of carcinoid tumour activity, rather than antagonism of released hormones, are discussed.
Hypertension during anaesthesia with monoamine oxidase inhibitors
Authors: SIDES C. A.
Published: February 2007

A hypertensive response to the induction of anaesthesia with etomidate and atracurium in a patient who recently received tranvlcypromine is described. The possible cause is discussed.
Day‐case herniotomy in children.
Authors: Reid M.F. , Harris R. , Phillips P.D. , Barker I. , Pereira N.H. , Bennett N.R.
Published: February 2007

Forty‐nine boys scheduled for day‐case inguinal herniotomy Here studied to compare ilio‐inguinal nerve block and wound infiltration for postoperative analgesia. Both techniques were simple to perform and produced no complications. In the ilio‐inguinal block group, 100% had either no pain or very mild discomfort when assessed 60 minutes after return to the day unit, compared to 95% in the infiltration group. Some children did appear to have pain following discharge but in all cases this responded well to simple analgesics. We conclude that both techniques provide satisfactory analgesia whilst the complications of narcotics are avoided, and suggest that simple infiltration of the wound with local anaesthetic solution should be encouraged in paediatric anaesthesia.
Epidural catheter migration during labour
Authors: Phillips D.C. , Macdonald R. , Wing Gledhow
Published: February 2007

A study was undertaken to determine the incidence, magnitude and direction of catheter migration in 100 patients who had epidural analgesia for pain relief in labour. Over 50% of catheters migrated from the original position at siting. The relevance of this migration and the usefulness of its measurement are discussed.
Propofol combined with nitrous oxide‐oxygen for induction and maintenance of anaesthesia
Authors: HERREGODS L. , ROLLY G. , VERSICHELEN L. , ROSSEEL M. T.
Published: February 2007

After a bolus of 2 mg/kg, propofol was given by continuous infusion (150 μg/kg/minute for 30 minutes and then 100 μg/kg/minute) supplemented with nitrous oxide for anaesthesia during ear surgery in 12 patients. Cardiovascular changes were not significant except for a decrease in heart rate after 60 minutes. Acid‐base balance was unaffected by the amount of fatty emulsion. Cortisol levels showed a nonsignificant decrease during the prolonged administration of propofol but had recovered completely by one hour following anaesthesia. Mean blood concentrations of propofol were 10.5 μg/ml (SEM 1.2) at the onset of unconsciousness, between 3.4 and 4.5 μg/ml during continuous infusion and 2.9 μg/ml (SEM 0.3) on awakening. Patients opened their eyes 6 minutes (SEM 1) after discontinuation of the infusion, and were responsive at 7.5 minutes (SEM 0.5), which suggests that propofol infusion can be used safely for surgery of 2 hours' duration.
Vecuronium infusions in patients with renal failure in an ITU
Authors: SMITH C. L. , HUNTER J. M. , JONES R. S.
Published: February 2007

The use of an infusion of vecuronium is described in seven patients with renal and respiratory failure in an intensive therapy unit. Neuromuscular function was monitored throughout using the train‐of‐four twitch technique. A bolus dose of vecuronium (0.1 mg/kg) was given, followed immediately by a continuous infusion (0.05 mg/kg/hour). The infusion rate was adjusted until the first twitch of the train was helow 20% of control and then run at a constant rate.

There was a marked variation in the dose of vecuronium administered (0.01—0.65 mg/kg/hour). Two patients, who appeared to be most sensitive to the drug, were both receiving metronidazole. Recovery of neuromuscular function was extremely prolongea and widely variable (6–37 hours) on stopping the infusion. No adverse cardiovascular effects or evidence of histamine release were seen as a result of administration of the drug. Vecuronium is probably more suitable for administration in bolus doses rather than by infusion in patients with renal and respiratory failure.
High frequency jet ventilation for bilateral bullectomy
Authors: McCarthy G. , COPPEL D. L. , GIBBONS J. R. , COSGROVE J.
Published: February 2007

This case report describes the use of high frequency jet ventilation for resection of bilateral lung bullae. Low airway pressures reduced the risk of pulmonary barotrauma. A continuous infusion of ketamine provided acceptable anaesthesia.
Arterial to end‐tidal carbon dioxide tension difference during anaesthesia for tubal ligation
Authors: SHANKAR K. BHAVANI , MOSELEY H. , KUMAR Y. , VEMULA V. , KRISHNAN A.
Published: February 2007

Twenty‐nine patients scheduled for postnatal tubal ligation by minilaparotomy under general anaesthesia were studied. Arterial and end‐tidal carbon dioxide tensions were determined during anaesthesia. The mean arterial to end‐tidal carbon dioxide tension difference was 0.08 kPa (SEM 0.05). Thirty‐one percent of the patients had negative values. These results were similar to those observed during Caesarean section. The physiological changes responsible for reduced arterial to end‐tidal carbon dioxide values, persist into the postnatal period. It is predicted from the regression analysis of the time between delivery and anaesthesia for tubal ligation and arterial to end‐tidal CO2 difference, that the values might return to normal nonpregnant levels by 8 days following delivery.
Myalgia and biochemical changes following intermittent suxamethonium administration
Authors: LAURENCE A. S.
Published: February 2007

One hundred gynaecological patients for laparoscopy divided into five groups were studied to determine the effects of a number of pretreatments on serum myoglobin, creatinine kinase and myalgia following intermittent suxamethonium administration. One group acted as controls, while the other groups were given intravenous pretreatments of alcuronium 2 mg, midazolam 0.15 mg/kg, lignocaine 1.5 mg/kg and suxamethonium 7 mg. Serum myoglobin was determined by radio‐immunoassay. The mean increases in the control group were 167 μg/litre myoglobin at 20 minutes and 196 IU creatinine kinase at 24 hours; 13 out of 20 patients responded with a marked increase of serum myoglobin at 20 minutes and of creatinine kinase at 24 hours. Only alcuronium pretreatment prevented myoglobin increase at 20 minutes, abolished creatinine kinase increase at 24 hours and reduced 24‐hour myalgia. The other pretreatments slightly reduced myoglobin increase at 20 minutes and 24‐hour creatinine kinase but did not reduce myalgia. Only one patient in the whole study had markedly elevated serum myoglobin at 24 hours. We conclude that only non‐depolarising relaxant pretreatment is effective in the reduction of some of the adverse effects of suxamethonium administration.
Prolonged paralysis following an infusion of alcuronium in a patient with renal dysfunction
Authors: SMITH C. L. , HUNTER J. M. , JONES R. S.
Published: February 2007

The case is described of a patient who underwent artificial ventilation in an intensive therapy unit and received an infusion of alcuronium 10 mg/hour for more than 4 days, in the presence of significant renal (and later, some degree of hepatic) impairment. Prolonged and profound neuromuscular block persisted despite haemodialysis (5 hours on each of 3 days) followed by 72 hours of continuous haemofiltration; it appeared to resolve only after plasma exchange (4 litres). The total period of persistent block, for 9 days after the infusion had been stopped, is thought to be the longest period ever reported after administration of alcuronium. Neuromuscular block was monitored throughout this period using the train‐of‐four twitch technique. The potentiating effects of concurrent aminoglycoside therapy and hepatic dysfunction on the degree of paralysis are discussed.
Postoperative complications of dystrophia myotonica
Authors: MOORE J. K. , MOORE A. P.
Published: February 2007

A 44‐year‐old man with known mitral stenosis presented for minor surgery. Anaesthesia was induced with fentanyl, droperidol and etomidate and maintained with nitrous oxide, oxygen and vecuronium. Surgery and anaesthesia were uneventful but the postoperative course was stormy, with respiratory arrest, Haemophilus pneumonia, refractory cardiac dysrhythmias and gastrointestinal atony. A diagnosis of dystrophia myotonica was made after 3 weeks in the intensive care unit, and he spent 6 weeks in hospital. A high index of suspicion for this disease must be maintained and intensive care facilities and monitoring should be available for all procedures.
Tactile orotracheal tube placement test
Authors: CHARTERS P. , WILKINSON K.
Published: February 2007

The development of a tactile clinical test of the positioned orotracheal tube is described which allows confirmation of its location within the larynx. It was possible, after preliminary experience with the test, to confirm laryngeal placement confidently in an average of 97% of cases in two concurrent series each of which consisted of 100 patients. Inevitably, there are limitations to its usefulness but it has the advantage that no special apparatus is required for its performance. The implications of this test are discussed in relation to difficult intubation, obstetric anaesthesia, the teaching of applied anatomy and checking by their trainers of intubations performed by very junior anaesthetists. Familiarity with this test should be considered essential for its reliable implementation.
Anaesthesia for laparoscopy
Authors: de GROOD P. M. R. M. , HARBERS J. B. M. , van EGMOND J. , CRUL J. F.
Published: February 2007

This is a report about five anaesthetic techniques for laparoscopy. Propofol and etomidate were used for total intravenous anaesthesia. Propofol, etomidate and thiopentone were used as induction agents prior to inhalational anaesthesia with isoflurane and nitrous oxide. Fentanyl was used for analgesia. Induction with propofol and thiopentone was rapid. Etomidate induction was characterised by myoclonus. Maintenance was smooth with inhalational anaesthesia. Of the groups that received total intravenous anaesthesia, propofol provided stable anaesthesia but required extra bolus doses. Recovery was the most rapid following total intravenous anaesthesia with propofol. Postoperative side effects were much lower after propofol. No difference was observed between the groups with regard to changes in arterial blood pressure and heart rate.
Controlled release morphine tablets: a double‐blind trial in patients with advanced cancer
Authors: HANKS G. W. , TWYCROSS R. G. , BLISS J. M.
Published: February 2007

Eighteen of 27 patients with pain due to advanced cancer, completed a randomised crossover comparison of4‐hourly aqueous morphine sulphate and twice daily controlled release morphine tablets. There was no difference between the two regimens in analgesic efficacy or adverse effects, but there was an apparent improvement in quality of sleep on the controlled release tablets. After completion of the study, 17 patients continued with the latter medication for periods that ranged from 2 days to 94 weeks (median 6.5 weeks). Controlled release morphine tablets given twice daily provide a simpler and more convenient treatment regimen than a 4‐hourly opioid for patients with cancer pain, once they have been stabilised.
Anaesthetic properties of pregnanolone emulsion
Authors: HØGSKILDE S. , WAGNER J. , CARL P. , SØRENSEN M. BREDGAARD
Published: February 2007

The anaesthetic properties of pregnanolone emulsion, a new steroid preparation for intravenous administration, were evaluated in rats and compared to those of Althesin, propofol, thiopentone and midazolam. The therapeutic index was found to be 50% higher than that of Althesin and 6–8 times higher than those of propofol, thiopentone and midazolam. Induction with pregnanolone emulsion was reliable and fast, with only minor excitatory side effects, although induction time was longer compared to Althesin, propofol and thiopentone. Movement of unstimulated rats during sleep was similar to that seen with Althesin but movement on painful stimulation was less than with propofol and thiopentone. Recovery was rapid and smooth, and the proportion of sleeping time to recovery time was higher than found for the other four anaesthetics. No cumulative effects were seen on repeated administration and there were no venous sequelae. The results indicate that pregnanolone emulsion may provide a shortacting, less cumulative and less toxic alternative to existing intravenous anaesthetic agents.
A comparison of the early pharmacokinetics of midazolam in pregnant and nonpregnant women
Authors: WILSON C. M. , DUNDEE J. W. , MOORE J. , HOWARD P. J. , COLLIER P. S.
Published: February 2007

The early pharmacokinetics of midazolam were compared in pregnant (active labour, awaiting and during elective Caesarean section) and matched gynaecological patients scheduled to undergo elective hysterectomy, half of whom were given an oxytocin infusion. A standard dose of 5 mg was given intravenously. For the first 15 minutes patients in labour had significantly higher plasma midazolam levels compared to all other groups. This was associated with the largest area under the curve (2 hours), the smallest volume of distribution and lowest clearance. Midazolam when given immediately before Caesarean section, can result in depression of the infant.
Interview method affects incidence of postoperative sore throat
Authors: Harding C.J. , McVey F.K.
Published: February 2007

Two hundred and forty‐two routine surgical patients who had undergone general anaesthesia, were questioned about postoperative sore throat by one of two methods, either direct or indirect questioning. A significantly higher incidence of sore throat was obtained by direct questioning (P < 0.001).
Comparison of epidural fentanyl with sufentanil
Authors: MADEJ T. H. , STRUNIN L.
Published: February 2007

Duration of analgesia and side effects following single bolus doses of epidural fentanyl (100 μg) or sufentanil (10, 20, 30 or 50 μg) were studied in 50 patients who underwent Caesarean section under epidural anaesthesia. Fewer patients experienced pain peroperatively in the fentanyl group than in a joint group of those given sufentanil 20 or 30 μg (p < 0.05). The combined fentanyl and sufentanil 50 μg groups had fewer patients in pain than the sufentanil 10 μg group at 3 hours after injection (p < 0.05). Patients given fentanyl also had a longer pain‐free interval than those who received sufentanil 10 μg (p < 0.02). The sufentanil 50 μg group had more patients asleep than the 10 μg group and also had more patients with pruritus than the 10 μg or 30 μg groups (p < 0.02). The patients given sufentanil 30 and 50 μg had more emetic sequelae than those who received sufentanil 10 and 20 μg or fentanyl 100 μg (p < 0.05). There was no detectable excretion of drug into breast milk and no significant respiratory depression at the time of first postoperative analgesia in the patients who received fentanyl or 30 μg or less of sufentanil.
Low dose sufentanil pretreatment
Authors: FURNESS G. , DUNDEE J. W. , MILLIGAN K. R.
Published: February 2007

The effects of pretreatment with varying doses of sufentanil on the subsequent induction of anaesthesia with thiopentone, methohexitone or midazolam were studied in 240 healthy patients. The induction dose requirements for the barbiturates were significantly reduced by sufentanil 5.0 μg (methohexitone p < 0.05. thiopentone p < 0.01). Excitatory effects following methohexitone were decreased (p < 0.01) but brief respiratory depression was increased in both cases. Midazolam onset time was reduced, as was the frequency of failed induction, after sufentanil 5.0 μg (p < 0.01).
Liver tumours and muscle relaxants
Authors: BROWN T. C. K. , GREGORY M. , BELL B. , CAMPBELI P. C.
Published: February 2007

Electromyographic studies of the onset of action of tubocurarine or alcuronium were performed on eight occasions in five patients who had liver masses. There was a slow onset of action and an increased dose requirement in those with malignant disease. Normal responses were found in a patient with benign nodular hyperplasia and in another where the malignant tumour was successfully treated with chemotherapy.
The use of opioids in neonates. A retrospective study of 933 cases
Authors: Purcell‐Jones G. , Dormon F. , Sumner E.
Published: February 2007

This is a retrospective study on the use of postoperative opioids in neonates admitted to the surgical intensive care unit at Great Ormond Street over a 5‐year period (1980 84). A total of 131 (14%) babies received opioids out of 933 neonates admitted to the unit. The use of opioids increased from 9.7% to 27.2% of admitted cases during the survey period. Postoperative ventilation of the lungs was necessary in 240 (25.7%) cases and 88 (36.6%) of these were given opioids. Four babies initially failed to wean from controlled ventilation as a result of opioid induced respiratory depression. A total of 51 (7.35%) spontaneously breathing neonates received opioids and seven (13.7%) of these developed apnoea or respiratory failure thought to be induced by opioids. The administration of opioids by nurses occurred most frequently in the late evening and early hours of the morning, when medical cover is at its lowest level.
Gastric emptying and small bowel transit times in volunteers after intravenous morphine and nalbuphine
Authors: YUKIOKA H. , ROSEN M. , EVANS K. T. , LEACH K. G. , HAYWARD M. W. J. , SAGGU G. S.
Published: February 2007

Gastric emptying half‐times and small intestinal transit times were measured in a double‐blind crossover study of 17 volunteers who received an intravenous injection of nalbuphine (5 or 10 mg), morphine (5 mg) or placebo. Both times were monitored using a gamma camera after a radioactive test meal and gastric emptying half‐time was calculated. Small intestinal transit time was measured by the appearance of radioactivity in the caecum and also of hydrogen in end tidal air. Gastric emptying was prolonged over placebo by nalbuphine 10 mg, which had more effect than nalbuphine 5 mg or morphine 5 mg: morphine 5 mg had less effect than nalbuphine 5 mg. Small intestinal transit time was prolonged over placebo by nalbuphine 10 mg more than by nalbuphine 5 mg or morphine 5 mg, which had approximately equal effects. In these respects, the potency ratio of nalbuphine appears roughly equivalent to morphine. Small intestinal transit times measured by end tidal hydrogen concentration and gamma camera showed close agreement.
The morphine sparing effect of ketorolac tromethamine
Authors: GILLIES G. W. A. , KENNY G. N. C. , BULLINGHAM R. E. S. , McARDLE C. S.
Published: February 2007

A randomised, double‐blind study of patients after upper abdominal surgery was undertaken to assess the analgesic efficacy of ketorolac tromethamine, a new, parenteral non‐steroidal anti‐inflammatory agent. Postoperatively, patients received a 24‐hour intramuscular infusion of either saline (n = 20), ketorolac 1.5 mg/hour (n = 21) or ketorolac 3.0 mg/hour (n = 20). Cumulative morphine requirements were measured using a patient‐controlled analgesia system which delivered intravenous increments of morphine on demand. Pain was assessed by visual analogue scores. Arterial blood gas analyses were performed pre‐operatively and on the first postoperative day.

Patients who received low and high dose ketorolac infusions required less morphine than the control group (p < 0.05 and p = 0.06, respectively). This was associated with significantly lower pain scores. Patients who received the higher ketorolac dose had significantly less postoperative increase in arterial carbon dioxide tensions than controls. This study suggests that ketorolac tromethamine is a useful analgesic drug with significant morphine sparing properties.
Gross hypernatraemia associated with the use of antiseptic surgical packs
Authors: THORP J. M. , MACKENZIE I. , SIMPSON E.
Published: February 2007

A severely ill patient with gas gangrene developed hypernatraemia associated with the use of wound packs soaked in a hypertonic solution called Eusol substitute, a commonly used stable alternative to true Eusol.
Intercostal catheterization
Authors: MOWBRAY A. , WONG K. K. S. , MURRAY J.M.
Published: February 2007

Twenty‐one patients scheduled to undergo thoracotomy or median sternotomy had intercostal catheters inserted pre‐operatively. During thoracotomy, under direct vision, the spread of 20 ml of a solution containing bupivacaine and methylene blue was followed. In most cases the spread involved one or two intercostal spaces. However, in all but one patient, dye spread medially to the paravertebral space where it then spread in both caudad and cephalad directions to reach between two and five vertebrae. In three cases, dye was seen crossing the anterior surface of the vertebrae to reach the contralateral aspect. It is concluded that a major component of dermatomal block during intercostal catheterisations may be secondary to paravertebral spread.
A red patient: immunological reaction to glycine?
Authors: MOSKOVITS P. E. , RICHES P. , SONI N.
Published: February 2007

A case of immunological adverse reaction to the commonly used bladder irrigation fluid, glycine, is reported, with discussion of the immunological investigations and possible significance of the results.
The new generation gelatins
Authors: SADDLER J. M. , HORSEY P. J.
Published: February 2007

Gelatin solutions of various kinds have been used as intravenous infusions since the First World War and belong to a heterogeneous group of fluids which tend to maintain the colloid osmotic pressure. They are produced by the breakdown of bovine collagen to yield solutions with a range of molecular weights. Anaphylactoid reactions are a rare but well‐recognised complication of their use. The solutions help to fill a hiatus that exists between crystalloids and blood products.
The control of intra‐ocular pressure during the induction of anaesthesia for emergency eye surgery. A high‐dose vecuronium technique
Authors: Abbott M. A. , Samuel J. R.
Published: February 2007

A technique of rapid sequence induction of anaesthesia for use in patients with penetrating eye injuries is described. This utilises a three maximal breaths method of pre‐oxygenation, the intravenous injection of thiopentone and high dose vecuronium (0.2 mg/kg). Using the loss of eyelash reflex as the starting point for timing, all patients were intubated after 60 seconds without coughing and bucking. No postintubation increases in intra‐ocular pressure were seen in 70% of patients and in no patient did the increase in intra‐ocular pressure exceed 5 mmHg. After 3 minutes of apnoea, the minimum haemoglobin oxygen saturation was 94% with a mean value of 97.6%.
The effects of thiopentone and propofol on upper airway integrity
Authors: McKEATING K. , BALI I. M. , DUNDEE J. W.
Published: February 2007

One hundred and fifty‐eight unpremedicated patients scheduled for elective surgery were allocated randomly to receive an unsupplemented induction dose of thiopentone or propofol. Visualisation of the vocal cords by standard laryngoscopy was possible more often after propofol (p < 0.01). Pharyngeal and laryngeal reactivity was similarity depressed more frequently.
Anti‐adrenal action of a subanaesthetic dose of etomidate
Authors: DIAGO M. C. , AMADO J. A. , OTERO M. , LOPEZ‐CORDOVILLA J. J.
Published: February 2007

The effects of subanaesthetic doses of etomidate on corticosteroid synthesis have been studied in vivo. In the group of patients who received etomidate (n = 10), cortisol and aldosterone responses to adrenocorticotrophic hormone were blunted, while 11 de‐oxycortisol response was increased, as compared to a control group (n = 10). These results suggest that a single bolus of 0.04 mg/kg etomidate, which produces sedation, without loss of consciousness, is able to block adrenal 11 hydroxylase.
Comparison between propofol and thiopentone for induction of anaesthesia in children
Authors: Valtonen M. , Iisalo E. , Kanto J. , Tikkanen J.
Published: February 2007

Propofol 2.5 mg/kg was compared with thiopentone 5 mg/kg in a randomised open study, as an induction agent in paediatric anaesthesia. One hundred and twenty children who were to undergo elective surgery were included in the study. Both propofol and thiopentone produced a rapid and smooth induction with a low incidence of side effects. A similar decrease (10%) in mean arterial pressure was observed with both agents, hut propofol showed better suppression of the haemodynamic response to tracheal intubation. Respiratory upsets occurred less frequently with propofol than with thiopentone, but propofol frequently induced discomfort on injection. Both agents provided satisfactory and controllable induction of anaesthesia and no major adverse reactions occurred during or after anaesthesia. We conclude that propofol is a useful alternative as an induction agent in children.
The Oxford Miniature Vaporizer in paediatric anaesthesia. An experimental study
Authors: Wilson I. H. , Page R. J. E. , Yeats M. J. H.
Published: February 2007

An experimental study of the Oxford Miniature Vaporizer in combination with a paediatric resuscitation bag has demonstrated efficient halothane vaporization at small tidal volumes. This technique will be appropriate in paediatric anaesthesia with the Triservice apparatus.
Halothane and isoflurane in outpatient anaesthesia
Authors: MILLIGAN K. R. , HOWE J. P. , DUNDEE J. W.
Published: February 2007

The speed and quality of recovery after anaesthesia were studied in 60 outpatients. Anaesthesia was induced using propofol and maintained by nitrous oxide in oxygen supplemented with either halothane or isoflurane. Initial clinical recovery was significantly faster in the halothane group hut no differences were found during subsequent psychomotor testing. Minor postoperative side effects were common in both groups.
Isoflurane and primary pulmonary hypertension
Authors: CHENG D. C. H. , EDELIST G.
Published: February 2007

Primary pulmonary hypertension is a rare and fatal disease. These patients represent an anaesthetic challenge because of the high mortality associated with the marked intra‐operative increase in pulmonary vascular resistance and right ventricular de‐compensation. This is a first case report which demonstrates the safe and beneficial effects of isoflurane in lowering pulmonary arterial pressure and pulmonary vascular resistance in such a patient for a short surgical procedure. The anaesthetic considerations in these patients are discussed.
The oesophageal detector device
Authors: WEE M. Y. K.
Published: February 2007

A new method to distinguish oesophageal from tracheal intubation using the oesophageal detector device was evaluated. In 100 healthy adults, observers of differing experience reliably and rapidly detected 51 oesophageal and 49 tracheal intubations in a randomised, single‐blind trial. In one case, blockage of the tracheal tube was detected swiftly and allowed corrective steps to be taken. This method can be used in patients with bronchospasm to detect correct tracheal placement when auscultation and decreased compliance of the chest may make clinical confirmation difficult. It can be concluded from this study that the oesophageal detector device is a reliable, rapid, inexpensive and easy to use method for the detection of oesophageal intubation and its very low cost should make it readily available in all situations where tracheal intubation is carried out.