bluuebunny/crossref_metadata_2025 huggingface dataset:
Topical nonsteroidal anti‐inflammatory gel for the prevention of peripheral vein thrombophlebitis
Authors: PAYNE‐JAMES J. J. , BRAY M. J. , KAPADIA S. , RANA S. K. , MCSWIGGAN D. , SILK D. B. A.
Published: February 2007

A double‐blind, randomised, placebo‐controlled study was undertaken to determine whether topical application of a nonsteroidal anti‐inflammatory gel to skin overlying peripheral vein cannula sites has a role in reducing the incidence or delaying the onset of peripheral vein thrombophlebitis. Fifty normal subjects had intravenous cannulae placed in right and left arms. Subjects were randomised to receive twice daily application of either active nonsteroidal anti‐inflammatory gel or placebo gel to each cannula site. Cannula sites were observed and signs and symptoms of inflammation recorded up to 108 h. If any site had signs extending beyond 2 cm then the cannula was removed. Cannula sites that had ‘active’ gel applied had half the incidence of marked signs at 108 h (44% vs 22%, p < 0.05). These results suggest that local application of topical nonsteroidal anti‐inflammatory gel to cannula sites may have a significant role to play in the prevention of peripheral vein thrombophlebitis.
Fentanyl‐prilocaine mixture for intravenous regional anaesthesia in patients undergoing surgery
Authors: PITKÄNEN M. T. , ROSENBERG P. H. , PERE P. J. , TUOMINEN M. K. , SEPPÄLÄ T. A.
Published: February 2007

The effect of the addition of 0.1 mg or 0.2 mgfentanyl to 40 ml 0.5% prilocaine in intravenous regional anaesthesia of the arm was investigated in 37 patients in a randomised, double‐blind study. The characteristics of the sensory and motor block were studied. There was no difference in the speed of onset of analgesia in the groups (mean latency approximately 4 min in each group). However, significantly more patients in thefentanylO.2 mg group (7/12) had complete anaesthesia at 15 min than in the fentanyl 0.1 mg group (1/13) and the control group (2/12) (p < 0.05). There were no differences in the incidence of tourniquet pain immediately before cuff deflation (tourniquet time 45–87 min). After cuff deflation, in those patients who complained of wound pain within 30 min, on average the pain appeared later in the fentanyl 0.2 mg group (six patients, mean 14.3 min) than in the control group (eight patients, mean 9.4 min) (ns). In the fentanyl groups, the incidence of central nervous system side effects was greater than in the control group (fentanyl 0.1 mg 7/13 patients, fentanyl 0.2 mg 6/12 patients, control 1/12 patients) (p < 0.05). The plasma concentrations of prilocaine after cuff deflation were higher, in a dose‐dependent fashion, in the fentanyl groups than in the control group, but the concentrations of prilocaine and fentanyl did not correlate with the symptoms. Postoperative nausea occurred only in the patients who had received fentanyl.
Anaesthesia for cardiac surgery in children with nemaline myopathy
Authors: ASAI T. , FUJISE K. , UCHIDA M.
Published: February 2007

Nemaline myopathy is a rare congenital myopathy associated with skeletal deformities and respiratory complications. Three children with nemaline myopathy who underwent cardiac surgery are described where the heart rate decreased during induction of anaesthesia and body temperature increased during or after the surgery. The anaesthetic implications in the management of patients with nemaline myopathy are discussed.
Clinical evaluation of doxacurium chloride
Authors: Maddineni V. R. , Cooper R. , Stanley J. C. , Mirakhur R. K. , Clarke R. S. J.
Published: February 2007

Doxacurium was administered to 50 adult patients for determination of potency (n = 10), onset and duration of clinical relaxation (n = 40). Cumulative dose‐response showed the ED95 to be 33.24 μg.kg−1 (95% confidence limits 27.4–39.3). Doxacurium 33 μg.kg−1 was then administered to four groups of 10 patients each who had anaesthesia maintained with either fentanyl‐droperidol or halothane and nerve stimulation carried out with single‐twitch stimulation at 0.1 Hz or train‐of‐four stimulation at 2 Hz every 12 s. The onset and duration showed wide individual variation. The mean (SD) times to occurrence of maximal block were 8.5 (4.6), 6.1 (1.9), 6.7 (1.8) and 4.7 (1.3) min in the single twitch‐fentanyl, train‐of‐four‐fentanyl, single twitch‐halothane and train‐of‐four‐halothane groups respectively, although it ranged from 3.4 to 13.1 min in individual patients. The mean (SD) durations of clinical relaxation (recovery of single twitch or first response in train‐of‐four to 25%) were 65 (22.8), 52 (21.7), 70 (33.4) and 72 (21.0) min respectively with individual values ranging from 31 to 103 min. Although halothane administration increased the duration of clinical relaxation and train‐of‐four stimulation accelerated the onset of effect, the changes due to these were not significant. There were no adverse effects on heart rate or indirectly measured arterial pressure.
Circulatory responses during electroconvulsive therapy
Authors: O'FLAHERTY D. , HUSAIN M. M. , MOORE M. , WOLFF T. R. , SILLS S. , GIESECKE A. H.
Published: February 2007

Electroconvulsive therapy is usually accompanied by activation of the autonomic nervous system, which may be harmful in patients with cerebrovascular or ischaemic heart disease. We have compared this haemodynamic response in a series of 82 electroconvulsive treatments randomly assigned to receive either nitroglycerin 3 μg.kg−1, esmolol 2 mg.kg−1 or placebo. These drugs were given shortly after the suxamethonium and 2 min before the electroconvulsive therapy in all cases. Heart rate was significantly lower with esmolol 1 min after therapy as was blood pressure (systolic and diastolic). The pulse rate was higher following nitroglycerin than placebo, which in turn was higher than esmolol. The three groups did not differ with regard to seizure duration. The results demonstrate that esmolol is more effective than nitroglycerin in controlling the haemodynamic response to electroconvulsive therapy. With recent emphasis on stabilisation of heart rate in preference to blood pressure in at‐risk cardiac patients, our study suggests that, in the doses selected, esmolol is preferred to nitroglycerin to control the heart rate response to electroconvulsive therapy.
Changes in arterial blood pressure during traction of extra‐ocular muscles. A study in rabbits
Authors: KHURANA I. , KHURANA A. K. , SINGH P. I. , GOMBAR K. K.
Published: February 2007

A significant reflex fall in mean arterial blood pressure from baseline values was observed during extra‐ocular muscle traction in rabbits. This effect could be abolished only by retrobulbar block (afferent pathway block) and not by vagotomy, intravenous atropine or glvcopyrronium, suggesting that it is distinct from, and independent of, the oculocardiac reflex. We suggest that these reflex changes in blood pressure be known as the ‘oculodepressor reflex’.
Forces applied during laryngoscopy and their relationship with patient characteristics
Authors: BUCX M. J. L. , VAN GEEL R. T. M. , SCHECK P. A. E. , STIJNEN T. , ERDMANN W.
Published: February 2007

The relationships between patients' height, weight, age, body mass index, gender and presence of maxillary incisors and a series of laryngoscopic factors have been studied. These included the duration of laryngoscopy, maximally applied force, mean applied force and the integral of force over time. There was a positive correlation between height and weight and laryngoscopic factors. Sex and age also showed a positive correlation but these could be explained by differences in height, weight and the presence of maxillary incisors. This latter factor was the dominant patient characteristic influencing the measured laryngoscopic factors. Use of these laryngoscopic factors as a measure of difficulty of laryngoscopy is discussed.
An automated system for testing the accuracy of patient‐controlled analgesia devices
Authors: HAWKINS D. J. , ROBERTS D. R. D. , ILSLEY A. H. , PLUMMER J. L. , OWEN H.
Published: February 2007

A system was developed to test the accuracy of patient‐controlled analgesia devices in situations simulating clinical use. Bolus requests are made automatically at predetermined intervals, and the infusate delivered is measured and recorded without the need for operator presence. To ensure clinical relevance, the bolus request times used in this study corresponded to a pattern typical of those requested by patients on the ward. Graseby, Abbott Provider 5500 and IVAC patient‐controlled analgesia devices were tested and found to deliver reasonably accurately over a 24 h period. However, when an infusion was started in an unprimed system or after a period of no bolus requests in a bolus‐only mode the Graseby and IVAC machines under‐delivered. This system provides a means of testing patient‐controlled analgesia devices operating in any delivery mode.
Profound hypotension following intravenous codeine phosphate
Authors: PARKE T. J. , NANDI P. R. , BIRD K. J. , JEWKES D. A.
Published: February 2007

Three adults are described who developed life‐threatening hypotension following intravenous codeine phosphate. It is recommended that codeine phosphate should not be given intravenously to adults.
Plasma concentrations of flumazenil during liver transplantation
Authors: Park G. R. , Podkowik B. I. , Hoffmann‐La F.
Published: February 2007

Six patients were given flumazenil (1 mg) during the anhepatic period of liver transplantation. We found higher mean plasma flumazenil concentrations during the anhepatic period than occurred in patients with hepatic cirrhosis. It was only possible to measure plasma flumazenil concentrations in four patients after revascularisation of the donor liver. Of these, elimination half‐lives could be calculated in only three patients (normal in one and prolonged in two). In these two patients the elimination half‐lives were prolonged to the same extent as in patients with fulminant hepatic failure. The changes during the anhepatic period occur because the liver contributes to the central volume of distribution. After revascularisation of the donor organ the prolonged half‐lives indicate that transplanted livers may not recover normal metabolic functions immediately.
Day case laparoscopy
Authors: Goodwin A. P. L. , Rowe W. L. , Ogg T. W.
Published: February 2007

Forty women undergoing day case laparoscopy were randomly allocated to receive either an inhalational or total intravenous anaesthetic. All patients breathed spontaneously through a Brain laryngeal mask. There were no clinically significant cardiovascular or respiratory differences between the two techniques. No episodes of clinical aspiration occurred and there were no peri‐operative arrhythmias. We conclude that spontaneous respiration with a laryngeal mask is a safe and effective method of anaesthesia for laparoscopy provided certain guidelines are followed.
Comparison of digital blood pressure, plethysmography, and the modified Allen's test as means of evaluating the collateral circulation to the hand
Authors: Fuhrman T. M. , Reilley T. E. , Pippin W. D.
Published: February 2007

The collateral circulation to the hand was evaluated on 70 hands of healthy volunteers. Comparisons were made between the results of the modified Allen's test alone and the Allen's test combined with either plethysmography or digital blood pressure. The modified Allen's test requires patient cooperation and the results can be subjective. Plethysmography does not require patient cooperation and produces a signal that varies directly with flow; however, this is not a quantifiable signal. Digital blood pressure (measured by the 2300 Finapres noninvasive blood pressure monitor, Ohmeda, Englewood, CO, USA) also requires no patient cooperation. The values produced are of clinical value and reproducible. Both the plethysmograph and digital blood pressure monitors were able to demonstrate the dominant arterial vessel of the hand. The digital blood pressure monitor produces an objective recordable numerical value, an accepted clinical parameter, and it does not require patient cooperation. The use of a digital blood pressure monitor may prove to be an acceptable alternative to the traditional Allen's test.
Erythropoietin in a patient following multiple trauma
Authors: Kraus P. , Lipman J.
Published: February 2007

We report on a Jehovah's Witness who had severe blood loss following major trauma. The problems of her management without blood transfusion, and with the use of recombinant human erythropoietin therapy for severe anaemia, are described.
Catecholamine response to laryngoscopy and intubation
Authors: CHRÆMMER‐JØRGENSEN B. , HERTEL S. , STRØM J. , HØILUND‐CARLSEN P. F. , BJERRE‐JEPSEN K.
Published: February 2007

The haemodynamic response and changes in plasma catecholamine concentrations associated with laryngoscopy and tracheal intubation were compared during anaesthesia employing three strictly standardised techniques with commonly used drug combinations. Thirty‐six patients were investigated consecutively resulting in 12 patients in each of three study groups. Anaesthesia was induced with thiopentone 5 mg.kg−1 (group 1), fentanyl 6 ng.kg−1 with thiopentone 5 mg.kg−1 (group 2). or midazolam 0.2 mg.kg−1 with fentanyl 6 ug.kg−1 (group 3). Undesirable changes in haemodynamic effects and an elevation of plasma catecholamine concentrations during laryngoscopy and intubation occurred in group 1. Heart rate and mean arterial pressure increased significantly (34% and 23% respectively). Noradrenaline concentration increased by a maximum of 147%. The addition of fentanyl (groups 2 and 3) attenuated the adverse haemodynamic response and elevation of plasma catecholamine concentrations; heart rate and mean arterial pressure did not differ from pre‐intubation values and plasma catecholamine concentrations decreased steadily. Substitution of thiopentone by midazolam in combination with fentanyl abolished the adverse haemodynamic response and modified the increase in plasma catecholamine concentrations. ‘High‐dose’ opioid anaesthesia is not necessary to produce optimal conditions during laryngoscopy and intubation.
Cardiovascular effects of fibreoptic oral intubation
Authors: SCHAEFER H.‐G. , MARSCH S. C. U. , STREBEL S. P. , DREWE J.
Published: February 2007

The cardiovascular response to fibreoptic oral intubation under total intravenous anaesthesia with propofol or a balanced volatile technique with thiopentone I enflurane was compared in 50 patients of physical status ASA 1 and 2 who were scheduled for elective ear, nose and throat surgery. Patients were randomly assigned to receive propofol or enflurane. There was no significant difference between the two anaesthetic techniques in haemodynamic profile either before, during or after fibreoptic intubation (the study design was adequate to detect a 20% difference with > 90% statistical power), in incidence of postoperative sore throat or in lime taken for intubation. In no patient did the oxygen saturation decrease to below 95% or the CO2 tension exceed 5.8 kPa.
Are electrocardiogram changes the first sign of impending peri‐operative pneumothorax?
Authors: BOTZ G. , BROCK‐UTNE J. G.
Published: February 2007

A patient in the right lateral position underwent left nephrectomy, after which he was placed supine for insertion of an arteriovenous fistula. All haemodynamic and respiratory values, including peak inspiratory pressure, were within normal limits and unchanged from baseline measurements. However, following the position change we noted that the amplitude of the electrocardiogram complexes were dramatically reduced. Our differential diagnosis included the possibility of a pneumothorax, which was subsequently confirmed by both physical examination and chest X ray. A chest drain was planned to be inserted at the end of the surgery, but 25 min after the electrocardiogram changes were noted, the patient's vital signs suddenly deteriorated. Emergency treatment for pneumothorax was instituted with good effect. The diagnostic use of the electrocardiogram and the treatment of this intra‐operative pneumothorax are discussed.
The use of a checklist for anaesthetic machines
Authors: BARTHRAM C. , MCCLYMONT W.
Published: February 2007

The use of the Association of Anaesthetists of Great Britain and Ireland checklist for anaesthetic machines, based on an oxygen analyser, was surveyed over a 5‐week period in a teaching hospital. Fifty‐five completed checklists were analysed; no problems developed during anaesthesia which were missed by the checklist. The mean time taken to complete the checklist for one machine was 8.9 min with a range of 5 to 19 min; for two consecutive machines it was 18.25 min with a range of 10 to 30 min. The most frequent faults detected were the poor reliability of some oxygen analysers, absent ventilator disconnection alarms, and absent oxygen supply failure alarms on some older machines. Faults were found in 60% of the machines checked; 18% of these were deemed to be serious.
A comparison of the performance of two types of infusion device
Authors: O'KELLY S. W. , EDWARDS J. C.
Published: February 2007

The delivery performance of two types of infusion pump, the IVAC 711 series syringe driver and the IVAC 531 series drop‐counter, was examined by measuring the output of 16 pumps. We found that despite careful attention to the setting up of all apparatus, the IVAC 711 series syringe drivers had a significant lag phase before output matched the set rate, and that this lag phase was more pronounced at low rates of infusion. This was not the case with the IVAC 531 series which delivered the set rate from the outset. We suggest, that when the timing and rate of an infusion of drug is important from the outset and when these types of pump are being used, that either the syringe driver pump is primed by a brief period of high rate infusion vented by a three‐way tap or that a drop‐counter pump is used.
Diclofenac for analgesia after Caesarean section
Authors: Bush D. J. , Lyons G. , Macdonald R.
Published: February 2007

The analgesic efficacy of a single intramuscular dose of 75 mg diclofenac given after elective Caesarean section was studied in 50 women in a double‐blind randomised manner using a patient‐controlled analgesia system. The mean 18 h papavaretum consumption of the placebo group was significantly greater (91.4 mg compared to 61.4 mg). Subjective experience of pain and observed sedation were significantly greater in the control group up to 6 h after operation.
A study into the incidence of methaemoglobinaemia after ‘three‐in‐one’ block with prilocaine
Authors: Bellamy M. C. , Hopkins P. M. , Halsall P. J. , Ellis F. R.
Published: February 2007

A 34‐year‐old female patient developed methaemoglobinaemia following a femoral nerve block using prilocaine. The concentrations of methaemoglobin in the blood of the next eight patients receiving this block were assayed, and found to be significantly increased above baseline concentrations, but very significantly less than the concentration in the patient with symptomatic methaemoglobinaemia. Pulse oximetry was of value in making the diagnosis.
Intermittent positive pressure ventilation through a laryngeal mask airway
Authors: Graziotti P.J.
Published: February 2007

A nasogastric tube was used to aspirate air insufflated into the stomach during intermittent positive pressure ventilation through a laryngeal mask airway and a tracheal tube. No difference was found in the amount aspirated between patients with a tracheal tube, a laryngeal mask airway with the nasogastric tube closed or a laryngeal mask airway with the nasogastric tube open, when the nasogastric tube was aspirated at 15 min intervals for the first hour of anaesthesia.
The management of tracheal rupture using bilateral bronchial intubation
Authors: MITCHELL J.B. , WARD P.M.
Published: February 2007

The management of a patient who required positive pressure ventilation following pharyngolaryngo‐oesophagectomy during which tracheal injury was sustained is described. Ventilation with a tracheal tube resulted in a massive pneumoperitoneum. Bilateral bronchial intubation was employed with success.
The rebreathing characteristics of the Hudson oxygen mask
Authors: CAMPKIN N.T.A. , OOI R.G. , SONI N.C.
Published: February 2007

A lung model was used to study the effect of varying minute ventilation, oxygen flow and inspiratory: expiratory ratio on the rebreathing chracteristics of the Hudson oxygen mask. The onset of rebreathing was detected using two different sets of criteria; those defined by Kain et al. and Humphrey. The onset of rebreathing was also quantified in terms of the inspired volume of carbon dioxide and increases in deadspace. The magnitude of rebreathing was increased by reducing oxygen inflow and increasing minute ventilation. Variation in I:E ratio between 1:1 and 1:4 had little effect on rebreathing. Using the clinical criteria of Kain et al, the onset of rebreathing was detected when oxygen inflow/minute ventilation ratio was reduced below 0.78 on average. With the other criterion, rebreathing occurred when the ratio was 0.46.
Dural taps revisited
Authors: STRIDE P. C. , COOPER G. M.
Published: February 2007

The records from 34 819 obstetric epidurals performed at Birmingham Maternity Hospital over the period 1969–1988 were examined. During that time there were 460 dural taps (overall incidence 1.3%). Of the methods used to detect the epidural space, loss of resistance to injection of saline was associated with the lowest incidence of dural tap (0.6%). The incidence of typical postdural puncture headache when managed conservatively was 86%. Provision of an epidural drip after delivery reduced the incidence of headache to 70%. Elective forceps delivery conferred no additional benefit, and tended to delay the onset of headache. Blood patches were performed on 135 patients and provided complete relief of headache in 93 (68%). A further 23 patients (16%) obtained partial relief.
Interpleural analgesia and phrenic nerve paralysis
Authors: LAUDER G. R.
Published: February 2007

A case of phrenic nerve paralysis following interpleural analgesia for cholecystectomy is reported. The pre‐operative chest X ray was normal but chest X ray after cholecystectomy and interpleural analgesia revealed a raised right hemidiaphragm. This resolved after discontinuation of the interpleural analgesia and was probably a result of phrenic nerve paralysis produced by the interpleural local anaesthetic.
Anaesthetists' attitudes to parental presence at induction of general anaesthesia in children
Authors: Roman D. E. M. , Barker I. , Reilly C. S.
Published: February 2007

Attitudes of anaesthetists of various grades working in different types of hospital in England and Wales, to parental presence in the anaesthetic room during induction of anaesthesia in children were assessed by means of a postal questionnaire. Of the 300 questionnaires sent out, 244 (82%) were completed. The majority of anaesthetists were in favour of parental presence in the anaesthetic room for induction of anaesthesia in children over the age of 1 year undergoing routine day case surgery. A small but significant number expressed reservations about some aspects of parental presence. The grade of anaesthetist and type of hospital did not appear to influence the response.
Isoflurane in labour
Authors: WEE M. Y. K. , HASAN M. A. , THOMAS T. A.
Published: February 2007

A comparison of the analgesic efficacy of Entonox (50% nitrous oxide in oxygen) and Entonox with 0.2% isofturane was made in 18 consenting mothers during the first stage of labour. The inhalational gases were self‐administered during contractions over a 3 h study period using a standard Entonox demand valve and breathing system. Isoflurane 0.2% was added from an Ohmeda Isotec drawover vaporizer and the inspired concentration ofisoflurane was analysed continuously using a Datex Ultima analyser. Linear analogue scores for pain were significantly lower (p < 0.001) during the Entonox‐isoflurane administration compared with Entonox alone. Drowsiness was not a clinical problem and there was a high acceptance rate for Entonox‐isoflurane inhalational analgesia during labour.
Changes in blood flow and vascular resistance in the arm and leg during spinal anaesthesia and vasopressor therapy with methoxamine
Authors: FOGARTY D. J. , HOWE J. P.
Published: February 2007

The effects of subarachnoid block with hyperbaric bupivacaine 0.5% on forearm and calf blood flow and vascular resistance were examined using venous occlusion plethysmography in 10 fit patients. Following blockade there was an increase in mean (SD) calf blood flow from 2.0 (0.4) to 2.6 (1.2) ml.100 ml−1.min−1 (p = 0.057), a decrease in mean (SD) calf vascular resistance from 55 (15) to 38 (14) R units (p < 0.01), a decrease in mean (SD) forearm blood flow from 3.1 (1.2) to 1.8 (0.9) ml.100 mr−.min− (p < 0.01) and an increase in mean forearm vascular resistance from 38 (16) to 62 (24) R units (p < 0.01). Methoxamine 2 mg was administered intravenously when the mean arterial blood pressure decreased by 15%. There was a resultant marked increase in mean (SD) forearm blood flow from 1.8 (0.9) to 3.0 (0.8) ml.100 ml−1.min−1 (p < 0.001) but a decrease in mean (SD) calf blood flow from 2.6 (1.2) to 2.1 (1.4) ml.100 ml−1.min−1 (p = 0.11). Correspondingly, the mean (SD) forearm vascular resistance decreased from 62 (24) to 46 (17) R units (p < 0.01) with an increase in mean (SD) calf vascular resistance from 38 (14) to 56 (22) R units (p < 0.01). These findings indicate that whereas methoxamine produces the anticipated constrictor response in the calf vessels it causes a simultaneous reduction in vascular resistance in the forearm.
Trans‐septal left atrial catheterisation
Authors: FUKUTOME T. , KOHJIRO M. , SESE A. , UENO Y.
Published: February 2007

A newly designed 4 FG double‐lumen catheter with the second port located either 5 or 7 cm proximal to the tip was tested in five children undergoing open heart surgery. The catheter was inserted percutaneously and initially positioned in the superior vena cava, right atrium or inferior vena cava. During cardiopulmonary bypass, the tip of the catheter was repositioned manually in the left atrium across the interatrial septum. In all patients, left atrial pressure was monitored successfully while central venous pressure was monitored with the second port positioned in the superior vena cava. Removal of the catheter from the left atrium was easily performed and caused no problems.
Clinical features of neuroleptic malignant syndrome in basal ganglia disease
Authors: HAYASHI K. , CHIHARA E. , SAWA T. , TANAKA Y.
Published: February 2007

Hallervorden‐Spatz disease is a rare autosomal recessive disorder in which dopaminergic deficiency in the substantia nigra and its nigrostriatal projection has been identified. It is characterised by a slow but progressive course culminating in death. This case report describes a 13‐year‐old male, with a clinical diagnosis of Hallervorden‐Spatz disease, who developed recurrent episodes of an acute illness, the features of which closely resembled those of the neuroleptic malignant syndrome. However, in this patient there had been no exposure to neuroleptic medication. The clinical events in this case suggest that dopaminergic hypoactivity, which is characteristic of Hallervorden‐Spatz disease, can trigger episodes of neuroleptic malignant syndrome.
Intermittent thiopentone for teaching fibreoptic nasotracheal intubation
Authors: Yentis S. M. , Jankowski S. , Gregory I. C.
Published: February 2007

A technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubatingfibrescope. During endoscopy patients spontaneously breathed oxygen‐enriched air and passage of the tracheal tube was facilitated by suxamethonium. Arterial blood pressure, heart rate and arterial oxygen saturation were monitored continuously. Time from loss of eyelash reflex to successful intubation was 113 (90) (35–480) s (mean (SD) (range)). Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients; the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.
Combined high frequency ventilation in the management of respiratory failure in late pregnancy
Authors: RAPHAEL J. H. , BEXTON M. D. R.
Published: February 2007

We describe a pregnant patient with respiratory failure due to an atypical pneumonia and asthma that was successfully treated with the combination of high frequency oscillatory ventilation and intermittent positive pressure ventilation. This combined high frequency ventilatory technique is not commonly used in adults with respiratory failure and is largely contraindicated in patients with prolonged respiratory time constants such as occurs in asthma because of the risk of gas trapping. We suggest that this technique be considered in cases of respiratory failure refractory to conventional intermittent positive pressure ventilation and, that with appropriate monitoring of airways pressure, is worthy of a trial in patients with prolonged respiratory time constants.
Capnothorax: implications for the anaesthetist
Authors: PEDEN C. J. , PRYS‐ROBERTS C.
Published: February 2007

Ten patients underwent a laparoscopic surgical technique for thoracic and cervical dissection of the oesophagus during oesophagogastrectomy. Thoracotomy was avoided with potential benefits to the patient. To facilitate surgical access the right lung was collapsed using a double‐lumen bronchial tube and carbon dioxide was insufflated into the right pleural cavity to compress the lung. Changes in haemodynamic and respiratory variables occurred. In the majority of the patients airway pressure and end‐tidal CO2 increased, despite alterations in ventilation. In five patients systolic blood pressure decreased suddenly by between 15 and 35 mmHg, and in four patients Spo2 decreased to 91% or less, despite an Fio2 of 1.0. If carbon dioxide was insufflated too fast, or the lung failed to deflate adequately, the clinical picture was that of a tension pneumothorax. One patient developed surgical emphysema and a contralateral pneumothorax. Postoperatively two patients had recurrent laryngeal nerve damage. Suggestions are made to minimise the changes in haemodynamic and respiratory variables during carbon dioxide insufflation into the thorax.
Fibreoptic intubation
Authors: JONES H. E. , PEARCE A. C. , MOORE P.
Published: February 2007

A randomised study was carried out in 60 patients to assess the influence of tracheal tube tip design on the ease of railroading a tracheal tube during fibreoptic intubation. A new design of tracheal tube with a tapered tip, without a bevel, was compared with a tracheal tube of standard design. The new design was found to be greatly superior in both oro‐ and nasotracheal fibreoptic intubation, when compared with the traditional tracheal tube (p < 0.001). The shape of the tip of a tracheal tube is an important determinant of the ease of railroading the tube over an inserted fibrescope.
Lumbar plexus block: an anatomical study
Authors: HANNA M. H. , PEAT S. J. , D'COSTA F.
Published: February 2007

The anatomy of the lumbar plexus and the various approaches used to perform lumbar plexus blockade are reviewed. A single needle technique for a posterior approach to the plexus at the L2–3 interspace is described. This technique was used bilaterally in six intact cadavers, and the extent of spread of an injected dye was documented photographically during a subsequent detailed dissection of the region. In all cases, dye was confined to the posterior part of the psoas muscle, and tracked down the nerves of the lumbar plexus. No dye was seen anterior to the psoas, around the sympathetic chain, on the sacral plexus or in the extradural or subarachnoid spaces. Further studies in patients with needle position and drug dispositon being confirmed using computerised tomography and X ray scanning were in agreement with the results observed in the cadavers. This technique represents a simple approach to the lumbar plexus which does not require needle localisation by X ray screening.
Inadvertent suppression of a fixed rate ventricular pacemaker using a peripheral nerve stimulator
Authors: O'FLAHERTY D. , WARDILL M. , ADAMS A. P.
Published: February 2007

Electromagnetic interference usually produces only minor effects in patients with pacemakers. Nevertheless, the possibilities of serious and even fatal consequences of this complication must be recognised. This case reports an unusual anaesthetic source of interference, caused by activation of a popular nerve stimulator, resulting in cardiac arrest in a patient with a fixed‐rate ventricular pacemaker.
A computer‐controlled closed anaesthetic breathing system
Authors: LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

We describe the design and working of a computer‐controlled, closed anaesthetic breathing system which rapidly achieves and maintains a prescribed end‐tidal concentration ofisoflurane in oxygen. The system is simple to set up and not expensive; the only nonstandard component is a modified glass syringe. We have demonstrated that gas analysers may contribute as much as the patient to the accumulation of nitrogen within the breathing system. Details of our clinical experience with the system are presented in an accompanying article.
A combined chest drain and intrapleural catheter for post‐thoracotomy pain relief
Authors: Broome I. J. , Sherry K. M. , Reilly C. S.
Published: February 2007

This study examined the effectiveness of a new type of chest drain, which incorporates an additional lumen within its wall to facilitate the administration of intrapleural bupivacaine. Nine patients who received a bolus dose of 1.5 mg.kg−1 bupivacaine with 1:200 000 adrenaline through this chest drain used less morphine, and had lower visual analogue pain scores in the first 6 h after thoracotomy than patients in whom a standard chest drain had been used. Bupivacaine levels were found to be within safe limits in all patients.
Postpartum meningitis
Authors: DAVIS L. , HARGREAVES C. , ROBINSON P. N.
Published: February 2007

A case of meningitis following obstetric epidural anaesthesia is reported in which a group B, beta‐haemolytic streptococcus was isolated as the causative organism.
Three diagnostic conundrums solved using the laryngeal mask airway
Authors: LAWSON R. , LLOYD‐THOMAS A. R.
Published: February 2007

Three cases are described in which conventional laryngoscopy and bronchoscopy failed to provide adequate information but insertion of an laryngeal mask airway allowed fibreoptic bronchoscopy which enabled the diagnosis to be made.
Nitrous oxide uptake during spontaneous and controlled ventilation
Authors: BENGTSON J. P. , BENGTSSON A. , STENQVIST O.
Published: February 2007

The rate of uptake of nitrous oxide was studied in 40 orthopaedic patients anaesthetised with either enflurane or isoflurane in nitrous oxide and with either spontaneous or controlled ventilation. A variant of the Douglas bag method was used in combination with low fresh gas flows to a circle system. There were no significant differences in nitrous oxide uptake between the groups and the uptake rates followed‘the square root of time concept', with an overall best fit curve of 1080.t‐0.505 ml.70 kg‐1.min‐1. During spontaneous ventilation, the nitrous oxide uptake rate was similar or even higher than the corresponding rate during controlled ventilation, in spite of lower minute volumes.
Acute respiratory distress during Caesarean section under spinal anaesthesia A probable case of anaphylactoid reaction to Syntocinon
Authors: MORRISS W. W. , LA VIES N. G. , ANDERSON S. K. , SOUTHGATE H. J.
Published: February 2007

A case of life‐threatening respiratory distress during a Caesarean section under spinal anaesthesia is reported. Possible causes of the event including anaphylactoid reactions and the methods of their diagnosis are discussed. The most likely cause of the episode was felt to be an anaphylactoid reaction to Syntocinon.
Analgesia after laparoscopic sterilization Effect of 2% lignocaine gel applied to Filshie clips
Authors: Barclay K. , Calvert J. P. , Catling S. J. , Edwards N. D. , Rees A.
Published: February 2007

We performed a randomised controlled study in patients undergoing day case laparoscopic sterilisation to assess whether coating Filshie clips with 2% lignocaine gel prior to application to the Fallopian tubes would reduce postoperative pain. Sixty‐two patients were studied, in 33 of whom the Filshie clips were coated in sterile 2% lignocaine gel. Pain scores in the lignocaine gel group were significantly lower than in the control group at 1 h after return to the ward, but no differences were found immediately on return to the ward, or at discharge or at 24 h. There were no significant differences between the two groups in postoperative analgesic requirements or in side effects.
Decreased cardiac index as an indicator of tension pneumothorax in the ventilated patient
Authors: BEARDS S. C. , LIPMAN J.
Published: February 2007

We describe three critically ill patients receiving pressure‐controlled ventilation who suffered acute hypotensive episodes associated with the development of tension pneumothoraces. In four documented episodes of tension pneumothorax a major decrease in cardiac index was the most consistently detected abnormality. The expected increases in central venous pressure and heart rate did not occur in three of the episodes in two of the patients, both of whom were receiving inotropic therapy. Any increases in airway pressure could not be assessed on pressure‐controlled ventilation. The physiology of tension pneumothorax in the ventilated patient is described and the importance of decreased cardiac index as a haemodynamic indicator of tension pneumothorax is discussed.
External ophthalmoplegia after total intravenous anaesthesia
Authors: Marsch S. C. U. , Schaefer H.‐G.
Published: February 2007

Eye‐opening and eye movements were assessed in 110 awake and cooperative ASA class 1 and 2 patients after elective ENT surgery with total intravenous anaesthesia using propofol, fentanyl and atracurium. Following tracheal extubation and after regaining consciousness 21 patients showed a complete transient bilateral inability to open their eyes combined with a total gaze paresis, while another 30 patients showed an impairment of eye‐opening and/or eye movements to a lesser extent. In all patients affected symmetrical recovery of both impaired eye‐opening and eye movements occurred during the following 20 min. The occurrence of ophthalmological symptoms was not related to the duration of anaesthesia or the propofol infusion rate. Thus a complex ophthalmological phenomenon occurred after total intravenous anaesthesia in approximately 50% of awake and cooperative patients. The aetiology of this phenomenon and the implications for the understanding of the mechanisms of general anaesthesia remain to be determined.
Single oral dose ondansetron in the prevention of postoperative nausea and emesis
Authors: RUST M. , COHEN L. A.
Published: February 2007

In two placebo‐controlled, double‐blind, multicentre studies, the efficacy and safety of single oral doses of ondansetron 4mg, 8mg and 16 mg were evaluated for the prevention of postoperative nausea and vomiting in female inpatients. For the total study populations, 26% (European study) and 32% (US study) of placebo‐treated patients experienced no emesis compared with 54% (European study) and 52% (US study) of patients treated with ondansetron 16 mg, the most effective dose. Similarly, 22% (European study) and 19% (US study) of placebo‐treated patients experienced no nausea compared with 42% (European study) and 34% (US study) of ondansetron 16mg‐treated patients. All ondansetron doses in both studies were statistically superior to placebo (emesis p ≤ 0.007; nausea p ≤ 0.033). Slightly lower percentage differences in complete response between placebo and ondansetron for both nausea and emesis were observed for patients with a previous history of postoperative nausea and emesis compared with patients with no previous history, with ondansetron 16 mg being the most effective dose for both patient groups. In the US study, a slightly greater percentage of patients undergoing non‐gynaecological surgery had no nausea and no emesis compared with patients undergoing gynaecological surgery in both the placebo and ondansetron treatment groups. Again, ondansetron 16 mg was the most effective dose in both surgery types. Ondansetron was well tolerated, with only headache being reported as a significant problem in both studies. Overall, ondansetron 16 mg was the most effective dose in patients with and without a previous history of postoperative nausea and emesis undergoing both gynaecological and non‐gynaecological surgery.
Comparative effects of laryngeal mask and tracheal tube on total respiratory resistance in anaesthetised patients
Authors: BOISSON‐BERTRAND D. , HANNHART B. , ROUSSELOT J. M. , DUVIVIER C. , QUILICI N. , PESLIN R.
Published: February 2007

We compared the effects of the laryngeal mask and tracheal tube on total respiratory resistance in 10 anaesthetised, mechanically ventilated patients undergoing otological microsurgery. The subjects were randomly divided into two groups. In the first group, the tracheal tube (Rüsch) was inserted for the first series of measurements. This was then replaced by a laryngeal mask (Intavent) and a second series of measurements was made during the first hour of operation. In the second group, the same protocol was applied with inverse order in the use of the devices. From the measurement of respiratory flow and pressure at the airway opening, total respiratory resistance was calculated by multiple linear regression. The data were corrected to eliminate the previously determined nonlinear resistance of the two devices. Arterial blood pressure, electrocardiogram, oxygen saturation and end‐tidal carbon dioxide concentration were continuously monitored. With the laryngeal mask and the tracheal tube, mean (SE) minute ventilation was 9.4(0.9)l.min‐1 and 8.1 (0.9)l.min‐l, respectively for end‐tidal carbon dioxide concentrations between 3.6 and 4.1%. Although the glottic resistance was included in the measurement performed with the laryngeal mask but not with the tracheal tube, mean (SE) total respiratory resistance was not significantly different with the two devices (0.61(0.32) and 0.69(0.35) kPa.l‐1.s, respectively). Leakage was avoided with the laryngeal mask because the insufflation pressure never exceeded 1.7 kPa except in one patient suffering from severe chronic obstructive pulmonary disease who had a total respiratory resistance of 1.45kPa.l‐1.s. During the first hour of the operation all respiratory variables remained stable irrespective of the device used.
Plasma concentrations of alfentanil following epidural administration
Authors: van der LELY F. HAAK , BURM A. G. L. , van KLEEF J. W. , BOVILL J. G. , VLETTER A. A.
Published: February 2007

The plasma concentration‐time profile of alfentanil following epidural administration was determined in eight patients undergoing lower abdominal surgery under nitrous oxide (66%)‐oxygen (33%)‐halothane (0.3%) anaesthesia, supplemented with intravenous sufentanil. Alfentanil (1 mg) was administered epidurally before induction of general anaesthesia. Blood samples for the determination of plasma alfentanil concentrations by capillary gas chromatography were collected at intervals until 12h after the epidural injection. Peak plasma concentrations [mean (SD)] were 9.7 (2.3)ng.ml‐1, and were attained in a median (range) time of 90 (30‐120) min. The results suggest that alfentanil is slowly absorbed from the epidural space into the general circulation.
Inhalation anaesthesia and the Kearns‐Sayre syndrome
Authors: LAUWERS M. H. , VAN LERSBERGHE C. , CAMU F.
Published: February 2007

Kearns‐Sayre syndrome is an extremely rare mitochondrial myopathy, characterised by retinitis pigmentosa associated with progressive external ophthalmoplegia. Cardiac conduction abnormalities are common and range from bundle branch block to third degree atrioventricular block. Generalised degeneration of the central nervous system has also been reported. We describe the anaesthetic management of a child afflicted by this syndrome. The major anaesthetic complication in this disease is sudden third degree atrioventricular block which may lead to death in the absence of an artificial cardiac pacemaker.
Mediastinitis and sepsis syndrome following intubation
Authors: GAMLIN F. , CALDICOTT L. D. , SHAH M. V.
Published: February 2007

A patient developed sepsis syndrome with shock 7 h after an anaesthetic for a shoulder replacement. Tracheal intubation had been difficult and required the use of a stylet and gum‐elastic bougies. A gastrografin swallow subsequently demonstrated an oesophageal perforation and mediastinitis was diagnosed at surgical exploration. She survived after a prolonged period of intensive care treatment.
The SMART needle
Authors: VUCEVIC M. , TEHAN B. , GAMLIN F. , BERRIDGE J. C. , BOYLAN M.
Published: February 2007

Central venous access is an essential part of patient management in many clinical settings. Traditionally this has been achieved by a blind, external landmark guided technique which may not correlate exactly with the location of the vessel. We have prospectively evaluated the SMART needle, a new Doppler ultrasound guided vascular access device, in 40patients, to evaluate whether it can improve on the standard technique. The SMART needle was easy to use and reliably distinguished between arterial and venous signals. No advantage was demonstrated in‘easy’internal jugular vein cannulations. Although ease of cannulation in difficult cases was subjectively improved, the differences in time to cannulation and number of passes between the groups failed to reach statistical significance and the complication rates were similar. However, the use of the SMART needle on two occasions enabled avoidance of carotid artery puncture by correctly distinguishing the artery from the vein, so that it may have a rôle in patients in whom difficult internal jugular venous cannulation is anticipated.
Circulating fluoride changes and hepatorenal function following sevoflurane anaesthesia
Authors: NEWMAN P. J. , QUINN A. C. , HALL G. M. , GROUNDS R. M.
Published: February 2007

Sevoflurane, a new volatile inhalational agent, undergoes biotransformation to fluoride which is potentially nephrotoxic. We compared the effects of sevoflurane or isoflurane anaesthesia on hepatorenal function and serum fluoride concentrations in 50 ASA 1‐3patients undergoing major intra‐abdominal surgery. No patient developed renal or hepatic dysfunction. Mean (SEM) peak fluoride concentrations were 23.1 (1.5) μmol.l‐1for sevoflurane and 5.4 (0.4) μmol.l‐1 for isoflurane (p < 0.001). There was a significant correlation in the sevoflurane group between the total dose of agent (MAC h), the total fluoride production (r = 0 78, p = 0.0001) and peak fluoride concentration (r = 0.57, p = 0.003). There was no correlation between these variables in the isoflurane group.