bluuebunny/crossref_metadata_2025 huggingface dataset:
Alfentanil in daycase anaesthesia
Authors: BAGSHAW O. N. T. , SINGH P. , AITKENHEAD A. R.
Published: February 2007

The effect of the addition of a single dose of 7 μg.kg−1 of alfentanil to a propofol/enflurane anaesthetic on the quality of anaesthesia and recovery was assessed. A total of 53 ASA grade 1 or 2 patients who underwent daycase dental surgery were allocated randomly to receive either alfentanil or saline. The study was blinded so that neither the anaesthetist nor the assessor was aware of which solution had been given. Patients in the alfentanil group took signficantly longer to recommence spontaneous ventilation (p = 0.035). Both techniques provided good quality of anaesthesia. Postoperative morbidity was common (45% of patients), but there was no difference between the groups. The rate of recovery was similar in the two groups and no patient required hospital admission after the final assessment at 3 h. Drowsiness was only mild to moderate in both groups at 24 h. A single dose of alfentanil can be administered safely as part of a daycase anaesthetic without increasing morbidity, although there appears to be little advantage in doing so.
The metabolic and hormonal response to cataract surgery
Authors: BARKER J. P. , VAFIDIS G. C. , ROBINSON P. N. , BURRIN J. M. , HALL G. M.
Published: February 2007

We studied the metabolic and hormonal responses of 30 elderly patients undergoing routine cataract surgery who were allocated randomly to receive either general anaesthesia, or local anaesthesia by means of either retrobulbar or peribulbar blockade. Both forms of local anaesthesia successfully prevented the increases in circulating cortisol and glucose concentrations seen in those patients who received general anaesthesia, there being no significant differences between retrobulbar and peribulbar blockade. The results show that the newer, and now more commonly performed peribulbar block, confers the same metabolic and hormonal stability as seen with the more traditional retrobulbar block.
The influence of diamorphine on spinal anaesthesia induced with isobaric 0.5% bupivacaine
Authors: ABUZAID H. , PRYS‐ROBERTS C. , WILKINS D. G. , TERRY D.M.S.
Published: February 2007

In a randomised, double‐blind study, the effect of addition of 1 mg of diamorphine to 4 ml of 0.5% bupivacaine for spinal anaesthesia was studied in two groups each of 30 patients presenting for either transurethral genito‐urinary surgery, or for lower limb arterial surgery or inguinal herniorrhaphy. Addition of 1 mg diamorphine to intrathecal 0.5% bupivacaine produced a prolonged and satisfactory analgesia in more than half the patients undergoing lower limb arterial or inguinal surgery, and the analgesic requirements of the remainder during the first postoperative 24 h were much less than those who received bupivacaine alone. In the urological surgery set there were no significant differences between the group who received bupivacaine and diamophine, and the group who received bupivacaine alone. The mixture of diamorphine I mg in 4 ml 0.5% bupivacaine was slightly less hypobaric (0.9981 at 37°C) than bupivacaine alone.
Atracurium after an anticholinesterase
Authors: Shorten G.D. , Ali H.A.
Published: February 2007

This study documents the response to atracurium (75 μg.kg−1) administered 30 min after a pancuronium‐ or tubocurarine‐ induced neuromuscular block has been reversed with either neostigmine (50 μg.kg−1) or edrophonium (0.5 μg.kg−1). Twenty‐one ASA 1 or 2 patients were studied, of whom H received neostigmine and 10 edrophonium. The degree of neuromuscular block was measured electromyographically from the first dorsal interosseous muscle of the hand using train‐of‐four stimulation of the ulnar nerve. When atracrium was administered, the single twitch response compared with control was 100% in all patients and the mean train‐of‐four ratios were 91% and 65% in the neostigmine and edrophonium groups respectively. After atracurium (75 μg.kg−1), minimum values for the single twitch response compared with control were 52% and 66% in the neostigmine and edrophonium groups respectively. Prior administration of atracurium appears to potentiate the neuromuscular blocking effects of atracurium administered 30 min later.
Evaluation of an alternative method of blood sampling from arterial cannulae
Authors: Alford A. M. , Kirton C. B. , Peacock J. E.
Published: February 2007

A new system for sampling from arterial cannulae has been designed which avoids the need to aspirate flushing solution before taking a sample and limits blood loss. The new system was compared with a standard sampling system and direct arterial sampling using in vitro models. A series of haemoglobin concentrations wen‐ prepared and sampled using the three sampling methods. There were no clinically significant differences in the values obtained with the different sampling techniques.
A comparison of diclofenac and ketorolac for postoperative analgesia following day‐case arthroscopy of the knee joint
Authors: MORROW B. C. , BUNTING H. , MILLIGAN K. R.
Published: February 2007

Seventy‐one patients presenting for day‐case arthroscopy were randomly allocated to receive either intramuscular diclofenac 75 mg or ketorolac 30 mg immediately after induction of anaesthesia. One hour after operation visual analogue pain scores were significantly lower in the ketorolac group compared with those receiving diclofenac. Pain scores at 2 and 4 h postoperatively were not significantly different between the two groups although six of those receiving diclofenac required opioid analgesia compared with only one in the ketorolac group. Discomfort in the operated knee was similar for both groups on the day following surgery, but pain from the intramuscular injection site was significantly greater in the diclofenac group. Intramuscular ketorolac 30 mg provided better postoperative analgesia and less pain at the injection site than diclofenac 75 mg.
Vecuronium block in the myasthenic patient
Authors: BARAKA A. , TAHA S. , YAZBECK V. , RIZKALLAH P.
Published: February 2007

The neuromuscular block of vecuronium was investigated in two myasthenic patients undergoing thymectomy. The first patient had no pre‐operative anticholinesterase therapy, the second patient was given pyridostigmine 60 mg 4 hourly, continued until the morning of surgery. In the two patients, neuromuscular block of vecuronium was monitored by electromyography. The results suggest that the neuromuscular block of vecuronium may be decreased by pre‐operative preparation of the myasthenic patient by pyridostigmine.
The Finapres 2300e finger cuff
Authors: JONES R. D. M. , KORNBERG J. P. , ROULSON C. J. , VISRAM A. R. , IRWIN M. G.
Published: February 2007

Blood pressure measurements associated with malapplication of a finger cuff were compared with contemporaneous intra‐arterial pressure data in seven volunteers to determine the influence of cuff application on the accuracy of the Finapres 2300e. Systolic readings in all cuff positions differed from arterial line data by more than the recommended standard and tight and loose cuff applications under and over‐read respectively, in all subjects. The results show the Finapres to be sensitive to small degrees of finger cuff malapplication which contribute to the bias on direct arterial comparison and limit the reliability of the instrument in clinical practice.
A comparison of two systems for assessing cerebral venous oxyhaemoglobin saturation during cardiopulmonary bypass in humans
Authors: BROWN R. , WRIGHT G. , ROYSTON D.
Published: February 2007

The Somanetics Invos 3100 cerebral oximeter is a new noninvasive device which measures the regional oxygen saturation of haemoglobin within the cerebral microvasculature by infrared spectroscopy. It was used in nine patients undergoing elective cardiac surgery and its results were compared with measurements of jugular venous bulb saturations obtained by the Oximetrix Opticath oximetry system. The index value of jugular venous bulb saturation was obtained by analysis of jugular bulb blood in an 11282 cooximeter. The cerebral oximeter was less accurate and precise (standard deviation of difference 14.1%) than the Oximetrix system (standard deviation of the difference 2.65%) and also demonstrated a systematic error in bias unrelated to cerebral per fusion pressure. The cerebral oximeter may therefore be less useful than jugular venous bulb saturation in the clinical management of patients undergoing cardiopulmonary bypass.
An audit of extradural infusion analgesia in children using bupivacaine and diamorphine
Authors: Wilson P. T. J. , Lloyd‐Thomas A. R.
Published: February 2007

One hundred and fifty extradural infusions of diamorphine and bupivacaine after major surgery in children were audited over a 15 month period. The majority of the children (69%) were less than 5 years of age. Analgesia was assessed or selfrated as‘very good' in over 75% of patients. Urinary retention was seen in 11% of patients and pruritis in 10%. Respiratory depression requiring intervention was only seen in one patient–a premature infant of 39 weeks postconceptual age. Technical complications resulted in the early loss of 16.7% of the infusions. Although analgesia was good the complexity of the extradural infusion technique demanded significant medical and nursing time especially to overcome technical problems.
The influence of the H1 and H2 receptor antagonists, terfenadine and ranitidine on the hypotensive and gastric pH effects of the histamine releasing drugs, morphine and tubocurarine
Authors: TREUREN B. C. , GALLETLY D. C. , ROBINSON B. J. , SHORT T. G. , URE R. W.
Published: February 2007

Morphine and tubocurarine may release histamine by direct mast cell degranulation which may result in systemic effects such as cutaneous flushing, local wheal and flare formation and hypotension. This randomised, double‐blind study examined whether pre‐operative combined oral terfenadine (60 mg) and ranitidine (150 mg) attenuates the reduction in blood pressure and cutaneous flushing after the administration of tubocurarine and morphine in 60 patients undergoing elective gynaecological surgery. In addition, investigation was made of whether tubocurarine and morphine cause a significant decrease in gastric pH in comparison to the nonhistamine‐releasing agents fentanyl and vecuronium. Patients were randomly assigned to one of three groups receiving either pre‐operative terfenadine and ranitidine and intra‐operative tubocurarine and morphine (group A); pre‐operative placebo and intra‐operative tubocurarine and morphine (group B); pre‐operative placebo and intra‐operative fentanyl and vecuronium (group C). Compared to group B, group A had less hypotension and tachycardia but no significant decrease in cutaneous flushing immediately following morphine and tubocurarine (p > 0.05). There were no significant differences in haemodynamic changes between the groups A and C. In those patients not pretreated with terfenadine and ranitidine (groups B and C), gastric pH decreased between 5 and 10 min following bolus administration of morphine and tubocurarine (group B), whereas patients receiving fentanyl and vecuronium (group C) had an increase in gastric pH. This suggests that histamine release following administration of morphine and tubocurarine is sufficient to increase gastric acidity. These results indicate that for routine prophylaxis of high risk patients and for patients who have had a previous anaesthetic anaphylactoid reaction, oral premedication with the newer H1 and H2 receptor antagonists may be useful. Furthermore, systemic liberation of histamine may cause a significant decrease in gastric pH with the attendant risk of aspiration pneumonitis.
Creatinine and 51Cr‐EDTA clearance after liver transplantation
Authors: BURNS A. M. , HUE D. P. , WRAIGHT E. P. , PARK G. R.
Published: February 2007

We have compared glomerular filtration rate measured by creatinine clearance with that measured by 51Cr‐EDTA clearance after liver transplantation. Fourteen pairs of values were obtained from seven patients on the first and second days after operation. There were wide discrepancies between the values for glomerular filtration rate measured by the two methods, with a regression co‐efficient of 0.43 (p = 0.12). Both methods assume a steady state, with no change of extracellular fluid volume or in the rates of exchange between physiological compartments, that does not apply in the immediate period after operation. The results show the difficulties of using clearance techniques to assess renal function after major surgery. Since drug therapy may be based on these measurements, we suggest that in this group of patients isolated clearance values should not be used.
Intra‐arterial versus intravenous regional analgesia for hand surgery
Authors: KOSCIELNIAK‐NIELSEN Z. J. , HORN A.
Published: February 2007

Twenty‐six adult patients participated in this study of intra‐arterial and intravenous regional analgesia. The radial or the brachial artery was cannulated in patients randomised to receive intra‐arterial regional analgesia and a hand vein was cannulated in patients randomised to receive intravenous regional analgesia, with a 22‐G cannula. A double cuffed tourniquet and Esmarch's bandage were used. Lignocaine 0.5%, (1.5 mg.kg−1 intra‐arterially, and 3.0 mg.kg−1 intravenously) was injected over 3 min. There were two failures (one in each group). Intra‐arterial injection of lignocaine was more painful than intravenous injection. Onset and offset of analgesia, surgical and tourniquet pain scores, motor blockade, and bruising after cannulations were similar. Surgical conditions were good in all patients having intra‐arterial regional analgesia, fair and poor in five having intravenous regional analgesia (ns). Three of the intravenous regional analgesia patients had transient adverse affects after tourniquet release (ns). No permanent sequelae of cannulations were observed. It is concluded that intra‐arterial regional analgesia with lignocaine 0.5%, 1.5 mg.kg−1 has similar onset, offset, quality, failure rate and patient acceptance, as intravenous regional analgesia with lignocaine 0.5%, 3.0 mg.kg−1.
A preliminary assessment of epidural chloroprocaine for day procedures
Authors: ALLEN R. W. , FEE J.P.H. , MOORE J.
Published: February 2007

Twenty‐five patients underwent epidural anaesthesia with a new formulation of chloroprocaine 3% (1.0–1.5 ml. 10 cm body height−1) for a variety of day procedures. The mean (range) duration of surgery was 17 (5–35) min. The mean (range) time taken to establish maximal block was 16 (15–21) min and the mean (range) time to ambulation was 78 (55–95) min after administration of chloroprocaine. Twenty‐three patients experienced a decrease in systolic arterial blood pressure of up to 15% of baseline values with another two decreasing by up to 25%. Two patients complained of severe backache immediately after operation and a further 16 and four patients reported mild or moderate backache respectively. Operating conditions were excellent in all but one patient and 23 patients said they would be happy to have the same anaesthetic again.
A blind nasal intubation using a laryngeal mask airway
Authors: THOMSON K. D.
Published: February 2007

Successful blind nasal intubation was achieved with the aid of a laryngeal mask airway before surgery for correction of severe micrognathism.
Noninvasive blood pressure measurements with single and twin‐hose systems—do mixtures matter?
Authors: AMOORE J. N. , SCOTT D. H. T.
Published: February 2007

Noninvasive blood pressure monitors which use twin‐ and single‐hose cuffs complicate the movement of patients between bed spaces with different cuff‐hose systems. We assessed, using a commercially available noninvasive blood pressure monitor function analyser, the use of single‐hose cuffs coupled via a Y‐piece adaptor to the twin‐hose of noninvasive monitors designed for use with twin‐hose cuffs. Assessments were made at three simulated pressures (200/150 mmHg, 120/80 mmHg, and 60/30 mmHg) and at normal and weak arterial pulsations. The use of a single‐hose cuff attached with the Y‐piece adaptor did not adversely affect the performance of the monitors.
The effectiveness of pre‐operative advice to stop smoking: a prospective controlled trial
Authors: Munday I. T. , Desai P. M. , Marshall C. A. , Jones R. M. , Phillips M.‐L. , Rosen M.
Published: February 2007

Patients who smoke cigarettes suffer increased postoperative morbidity. A prospective, controlled trial was designed to evaluate the effectiveness of written pre‐operative advice to stop smoking before admission for elective surgery and to record the duration of abstinence immediately before the operation. Although the advice was ineffective in persuading patients to stop smoking, it was associated with a reduction in the amount of tobacco consumed. Nicotine and carbon monoxide have important short‐term adverse effects but 15% of all patients continued to smoke within an hour of surgery. If patients are unable to give up cigarette smoking completely, it is still worthwhile stopping on admission to hospital.
A comparison of the 2% and 1% formulations of propofol during anaesthesia for craniotomy
Authors: DEWANDRE J. , VAN BOS R. , VAN HEMELRIJCK J. , VAN AKEN H.
Published: February 2007

This study investigated the pharmacodynamic and pharmacokinetic equivalence of 1% and 2% propofol emulsions when used for total intravenous anaesthesia for intracranial surgery. The same infusion rate (6.7 mg.kg‐1.h‐1) of the two preparations was administered. Induction doses, recovery times, and haemodynamic profiles were identical. Similar propofol concentration profiles were produced and total body clearance of propofol was identical. Both preparations were associated with a similar incidence of injection pain but neither resulted in venous thrombosis or thrombophlebitis at 24 h. Plasma triglyceride concentrations were significantly higher with the 1% solution, but there were no differences in cholesterol concentrations. The 1% and 2% emulsions appeared to be pharmacologically equivalent with similar minor effects on arterial blood pressure and heart rate. Two percent propofol may be preferable to the 1% solution for maintenance of anaesthesia in patients in whom a large lipid load might be considered undesirable.
The effects of Entonox and epidural analgesia on arterial oxygen saturation of women in labour
Authors: ARFEEN Z. , ARMSTRONG P. J. , WHITFIELD A.
Published: February 2007

The arterial oxygen saturation of 40 mothers in the first stage of labour was monitored using pulse oximetry. Half the mothers received epidural analgesia and the rest inhaled Entonox for pain relief. Eight mothers in the Entonox group and six in the epidural group had at least one episode of significant hypoxia (saturation < 90%). There was little difference in the number of hypoxic episodes experienced by either group (29 in the Entonox and 21 in the epidural) although their mean duration and severity was greater in the Entonox group. Women in labour who inhale Entonox have an appreciable incidence of arterial desaturation. Epidural analgesia reduces the severity of hypoxic episodes although it does not eliminate them.
A comparison of postoperative analgesia following spinal or epidural anaesthesia for Caesarean section
Authors: Lam F. Y. , Broome I. J. , Matthews P. J.
Published: February 2007

Postoperative analgesia, using a patient‐controlled analgesia system, was studied in 32 women after elective Caesarean section performed under either spinal or epidural anaesthesia. Patients who had spinal anaesthesia had significantly higher pain scores and morphine consumption during the first 4 h postoperatively than patients who had epidural anaesthesia. This situation was reversed between 4 to 8 h postoperatively with patients who had had epidurals having significantly higher pain scores despite higher morphine consumption. After 8 h there was little difference in pain scores or morphine use between the two groups. Total morphine consumption in the first 24 h postoperatively was not significantly different between the two groups.
The EMLA patch—a new type of local anaesthetic application for dermal analgesia in children
Authors: Nilsson A. , Boman I. , Wallin B. , Rotstein A.
Published: February 2007

The skin application of EMLA cream under a Tegaderm dressing was compared in children with a new combined dressing/local anaesthetic patch—the EMLA patch. The analgesic effect during venepuncture was assessed using a visual analogue scale (patients) and a verbal rating scale (investigator). Skin adhesiveness and incidence of local skin reactions with the two types of application were also studied. The study was designed as an open randomised trial with two parallel groups. Sixty children, aged between 5 and 15 years were evaluated. After a minimum application time of 60 min an intravenous cannula was inserted. There was no difference in analgesia as assessed by the patients or the investigators. Mild discomfort at removal of the occlusive dressing/patch was observed in a few patients, but there was no difference in the adhesiveness of the Tegaderm dressing and the EMLA patch. Only mild local skin reactions (with paleness in the anaesthetised skin area) were observed in both groups. It was concluded that both the EMLA patch and the Tegaderm/EMLA cream dressing provide effective dermal analgesia for venepuncture with a 0.8 mm (outer diameter) cannula. The two types of application were indistinguishable but the ease of application of the patch is a distinct advantage.
Reducing smoking
Authors: HUGHES J. A. , SANDERS L. D. , DUNNE J. A. , TARPEY J. , VICKERS M. D.
Published: February 2007

In a double‐blind randomised trial, 122 female smokers undergoing elective surgery were allocated to receive one of two prerecorded messages while fully anaesthetised. The active message was designed to encourage them to give up smoking whilst the control message was the same voice counting numbers. No patient could recall hearing the tape. Patients were asked about their postoperative smoking behaviour one month later. Significantly more of those who had received the active tape had stopped or reduced their smoking (p < 0.01). This would suggest a level of preconscious processing of information.
Anaphylactic/anaphylactoid reactions to anaesthetic and associated agents Skin prick tests in aetiological diagnosis
Authors: PEPYS J. , PEPYS E. O. , BALDO B. A. , WHITWAM J. G.
Published: February 2007

Fifty‐one patients were referred in one year (1992) for investigation of immediate type anaphylactic/anaphylactoid reactions during anaesthesia. Skin prick tests were made with 23 anaesthetic and associated agents in the concentrations used clinically. Definite or probable causes were identified by immediate type wealing reactions, supported by the clinical history in 36 of the 46 in whom a diagnosis of anaphylaxis was made. These comprised mainly the neuromuscular relaxants, chiefly suxamethonium (18); atracurium (6); gallamine (2); one each alcuronium; pancuronium; vecuronium and tubocurarine, as well as alfentanil (1); Gelofusine (2); cefuroxime (1) and latex (2). The materials for performing the skin prick test are readily available and it can be very helpful in making important aetiological diagnoses.
Motor signs of wakefulness during general anaesthesia with propofol, isoflurane and flunitrazepam/fentanyl and midlatency auditory evoked potentials
Authors: SCHWENDER D. , FABER‐ZÜLLIG E. , KLASING S. , PÖPPEL E. , PETER K.
Published: February 2007

Auditory evoked potentials have been used as an indicator of awareness. In the present study we combined epidural analgesia with three techniques of general anaesthesia. Motor signs of intra‐operative wakefulness were documented and assessed along with cardiovascular changes and with midlatency auditory evoked potentials. Thirty patients undergoing elective laparotomy were studied as follows: first continuous epidural analgesia was used in all patients to block painful sensation to the level of T5. Intravenous general anaesthesia was induced with propofol (2.5 mg.kg‐1 b.w., group 1, n = 10), thiopentone (5 mg.kg‐1 b.w., group 2, n = 10) or etomidate (0.2 mg.kg‐1 b.w., group 3, n = 10) and maintained with a propofol (3–5 mg.kg‐1, group 1), isoflurane (0.4‐0.8 Vol%, group 2), flunitrazepam and fentanyl (0.005 mg.kg‐1 b.w.) bolus injection every 20 to 30 s (group 3). Heart rate and arterial pressure were recorded continuously. Purposeful movements of the limbs, eye‐opening or other movements as well as coughing were documented as motor signs of intra‐operative wakefulness. Auditory evoked potentials were recorded in the awake state, after induction and during maintenance of general anaesthesia. Motor signs of intra‐operative wakefulness occurred statistically significantly more often in the patients of the flunitrazepam/fentanyl group than in those of the propofol and isoflurane group. There was no correlation between wakefulness and cardiocirculatory parameters. In the awake patients midlatency auditory evoked potentials had high peak to peak amplitudes and a periodic waveform. After induction of general anaesthesia with propofol, thiopentone and etomidate as well as during maintenance of general anaesthesia with propofol and isoflurane, midlatency auditory evoked potentials were severely attenuated or abolished. In contrast, during maintenance of general anaesthesia with flunitrazepam/fentanyl midlatency auditory evoked potentials reestablished high peak to peak amplitudes. The persistence of midlatency auditory evoked potentials coincides with a high incidence of motor signs of wakefulness. During the combination of regional and general anaesthesia, isoflurane and propofol seem to provide better suppression of motor signs of wakefulness than the intermittent bolus injection of flunitrazepam/fentanyl.
The subjective effects of low‐dose propofol A double‐blind study to evaluate dimensions of sedation and consciousness with low‐dose propofol
Authors: WHITEHEAD C. , SANDERS L. D. , OLDROYD G. , HAYNES T. K. , MARSHALL R. W. , ROSEN M. , ROBINSON J. O.
Published: February 2007

In this study the subjective effects (sedation and mood) of subanaesthetic doses of propofol were examined in 28 healthy male volunteers. A computer model was used to predict the infusion profiles necessary to obtain steady state propofol plasma concentrations of0.3μg.ml‐1, 0.6 μg.ml‐1, 0.9 μg.ml‐1. Objective measures of sedation from saccadic eye movement and choice reaction time gave significant dose responses at each level but a battery of psychometric tests failed to show dose‐related subjective responses. Of particular note in the subjective data is the lack of a difference between groups or even of a consistent trend within the data. This suggests that a low concentration of propofol in plasma does not induce euphoria or a sense of well‐being. The anecdotal evidence available for mood changes with propofol therefore remains unsubstantiated.
The effect of oral omeprazole on the disposition of lignocaine
Authors: NOBLE D. W. , BANNISTER J. , LAMONT M. , ANDERSSON T. , SCOTT D. B.
Published: February 2007

The effects of the gastric antisecretory drug, omeprazole, on the disposition of lignocaine were studied in 10 healthy male volunteers in a double‐blind, randomised, placebo‐controlled, two‐period crossover trial. Omeprazole 40 mg or placebo was taken daily for one week before administration of lignocaine 1 mg.kg‐1 (3.7 μmol.kg‐1) given intravenously over 10 min. Venous concentrations of lignocaine and its metabolite monoethylglycinexylidine were measured in plasma with reversed phase liquid chromatography. The mean (95% CI) areas under the curve at infinity for lignocaine after pretreatment with omeprazole or placebo were 6.67 (4.90–8.45) μmol.h.l‐1 and 6.14 (5.05‐7.23) μmol.h.l‐1, respectively (p = 0.44). The respective areas for monoethylglycinexylidine were 1.85 (1.25‐2.45) μmol.h.l‐1 and 1.79 (1.44‐2.14) μmol.h.r‐1 (p = 0.78). Similarly, omeprazole had no significant effect on the half‐lives of lignocaine or methylglycinexylidine.
Nitric oxide: basic science and clinical applications
Authors: KAM P. C. A. , GOVENDER G.
Published: February 2007

Nitric oxide is now considered an important endogenous mediator for neurotransmission, vasodilatation, nerve function and immune defence. Improved understanding of the physiology and pharmacology of nitric oxide could lead to important applications especially in the treatment of septic shock and pulmonary hypertension or vasoconstriction.
Grading of direct laryngoscopy A survey of current practice
Authors: Cohen A. M. , Fleming B. G. , Wace J. R.
Published: February 2007

One hundred and twenty anaesthetists (30 of each grade), from three separate regions, were interviewed as to how they recorded the appearance of laryngeal structures at direct laryngoscopy and about their knowledge of the commonly used numerical grading system. About two‐thirds of anaesthetists surveyed (69.2%) used the numerical grading system, but of these, over half could not identify a‘grade 2’laryngoscopic appearance correctly. Of anaesthetists who did not use the numerical method, over half could not correctly state the difference between a‘grade 2’and a‘grade 3’laryngoscopic appearance. Over 40% of anaesthetists stated incorrectly that the grading should be made on the initial view, even when laryngeal pressure had been needed. Junior anaesthetists were more likely to use the numerical method of recording. The results show that there is unacceptable uncertainty and inaccuracy in the use of the numerical grading system by users as well as non‐users, which makes the current routine clinical use of the numerical grading system unsatisfactory.
The physiology and pharmacology of postoperative nausea and vomiting
Authors: NAYLOR R. J. , INALL F. C.
Published: February 2007

The main function of emesis is to remove toxins from the body. The emetic response will also be triggered by cancer chemotherapy and radiotherapy or surgery under general anaesthesia. The mechanism of activation of the vomiting system is dependent on stimulation of gastrointestinal (mechanoreceptors and chemoreceptors) and/or central pathways which activate the chemoreceptor trigger zone in the area postrema. Postoperative emesis is activated by a range of factors before, during and after anaesthesia. The precise mechanism of action of any one of the influencing factors can only be speculated as there has been very little basic research into this area, due largely to the lack of an appropriate model for postoperative nausea and vomiting. The range of agents used in the prevention and treatment of emesis are effective to varying degrees, but some are associated with poor side effect profiles making them particularly unsuitable for prophylactic use. Newer antiemetics, which selectively antagonise 5‐HT3 receptors, have proved effective and well tolerated in the treatment of chemotherapy‐induced emesis and postoperative nausea and vomiting.
The oesophageal detector device
Authors: DONAHUE P. L.
Published: February 2007

Accuracy, ease and speed of recognition of tracheal tube position were assessed using the oesophageal detector device in a series of 40 tests on 29 patients. A single blind method was used, with each paramedic performing a single test on each patient. The tests were randomly split between two groups consisting of those tests performed on the tracheal or oesophageal tube respectively. Of the 40 tests performed, 21 were on tracheal tubes and 19 on oesophageal tubes. Correct placement was diagnosed with 100% accuracy by the paramedics, none of whom had previously used the oesophageal detector device. Each paramedic also graded speed of recognition of position and ease of use of the device. Recognition of position was graded as instant in 37 out of 40 tests. Use of the oesophageal detector device by previously inexperienced paramedics has thus been shown to be accurate, rapid and easy to learn.
Respiratory complications due to inadequate analgesia following thoracotomy in a neonate
Authors: CASS L. J. , HOWARD R. F.
Published: February 2007

We present a case in which a 2‐day‐old infant suffered respiratory complications shortly following premature termination of a postoperative extradural infusion. Restoration of analgesia led to a marked clinical improvement.
Differential lung ventilation as an alternative to one‐lung ventilation during thoracotomy
Authors: BARAKA A.
Published: February 2007

Investigation was carried out on three elderly patients undergoing thoracotomy. During one‐lung ventilation using a Robertshaw double‐lumen tube, the PaO2 decreased below 11·7 kPa despite ventilation of the dependent lung with 100% oxygen. Differential lung ventilation was then initiated by partial occlusion of the adapter limb to the nondependent lung, whilst maintaining unrestricted ventilation of the dependent lung. In the three patients, differential lung ventilation increased the PaO2 to 15–37.2 kPa. The increased Pao2 may be attributed to diffusion oxygenation via the partially inflated, nondependent lung. Differential lung ventilation can be used during thoracotomy whenever one‐lung ventilation is followed by hypoxaemia, despite adequate ventilation of the dependent lung with 100% oxygen.
The need for quality control in measurement of mixed venous oxygen saturation
Authors: BEARDS S. C. , EDWARDS J. D. , NIGHTINGALE P.
Published: February 2007

We investigated the variability of arterial, mixed venous and peripheral venous oxygen saturation readings in three co‐oximeters in regular use on two Intensive Care Units. Over a 2‐week period, 96 readings were obtained from each of the following machines; two AVL 912 co‐oxylite co‐oximeters (Machines A and B, Biomedical Instruments, Graz, Austria) and one IL‐282 (Machine C, Instrumentation Laboratories, Lexington, MA, USA). The coefficient of variation in the arterial oxygen saturations was extremely small on all three machines (<0.43%). The coefficient of variation in the mixed venous samples, however, ranged from 1.96 to 4.61% on machine A, and from 2.73 to 4.71% on machine B, but only from 0.17 to 1.47% on machine C. The variation in mixed venous saturations obtained from a single blood sample repeatedly analysed on machines A and B was large enough to influence clinical management.
Blood pressure measurement using oscillometric finger cuffs in children and young adults
Authors: LYEW M. A. , JAMIESON J. W.
Published: February 2007

Arterial blood pressure measurements (y) obtained from forefinger cuffs were compared with standard arm cuff readings (x) in 41 anaesthetised children and young adults. Mean (SD) differences between cuff measurements were –0.21 (9.15), –1.56 (10.2) and 1.23 (9.12) mmHg for the systolic, mean and diastolic pressures respectively. The correlation for systolic blood pressures (r = 0.85, y = 0.99x + 0.58, sy, x= 9.15) was better than that for mean or diastolic pressures. Oscillometric finger cuffs are suitable for monitoring the systolic blood pressure in children and young adults during general anaesthesia.
Spinal cord compression immediately following, but unrelated to, epidural analgesia
Authors: MILLS G. H. , HOWELL S. J. L. , RICHMOND M. N.
Published: February 2007

A patient developed spinal cord compression following epidural analgesia. The diagnosis was made difficult by the presence of epidural analgesia, although the compression was not in fact related to the analgesic technique employed. This case highlights the need for close observation of patients in whom epidural analgesia is, or has recently been, employed and the need to consider alternative reasons for neurological deficit.
Elevated porphyrins following propofol anaesthesia in acute intermittent porphyria
Authors: ELCOCK D. , NORRIS A.
Published: February 2007

A patient with acute intermittent porphyria was anaesthetised with propofol for a minor orthopaedic procedure. Postoperative urinary porphyrins were markedly raised compared to pre‐operative values, although the patient remained clinically well. Caution should continue to be exercised when propofol is used in patients with acute porphyrias.
Phakomorphic glaucoma—an unusual cause of postoperative vomiting
Authors: GUPTA S. , CHARI P. , BALA I. , MURALIDHAR J.
Published: February 2007

A 60‐year‐old female patient receiving epidural buprenorphine for postoperative analgesia developed intractable nausea and vomiting not responding to antiemetics. Ophthalmic consultation for congestion of the left eye was sought and the patient was diagnosed as having phakomorphic glaucoma. Extracapsular extraction of the left lens was performed after primary anti‐oedema measures. Glaucoma as a cause of intractable postoperative nausea and vomiting should be considered in susceptible patients.
Noise pollution in the anaesthetic and intensive care environment
Authors: KAM P. C. A. , KAM A. C. , THOMPSON J. F.
Published: February 2007

Noise in the operating theatre, recovery room and intensive care unit is above internationally recommended levels. The psychological and physiological effects of noise are reviewed. Equipment and conversation among the staff are major sources of noise in these areas. Equipment design, modification of nursing care procedures, and increased awareness of noise created by the staff may be effective in reducing noise pollution in these areas.
The effect of clonidine on intra‐operative requirements of fentanyl during combined epidural/general anaesthesia
Authors: Murga G. , Samsó E. , Valles J. , Casanovas P. , Puig M. M.
Published: February 2007

The study evaluates the analgesic effects of epidural clonidine in patients undergoing abdominal hysterectomy under combined epidural/general anaesthesia. Forty ASA 1–2 patients were divided into two groups who received epidurally either clonidine 300 μg (group 1) or placebo (group 2). Anaesthesia was maintained with oxygen/nitrous oxide, a midazolam infusion, vecuronium, and boluses of fentanyl 100 μg administered as needed to maintain cardiovascular stability. The mean (SD) intra‐operative fentanyl requirements were 2.05 (0.18) and 3.66 (0.3) μg.kg‐1.h‐1 for groups 1 and 2 respectively (p < 0.001). Patients in Group 1 had a lower heart rate after tracheal intubation and surgical incision (p < 0.02). In the recovery room, pain intensity was lower in group 1 (p < 0.003) and the mean (SD) time until analgesia request was jincreased from 48.5 (8.4) min in group 2 to 235.7 (33.2) min in group 1 (p < 0.001). Our results demonstrate that epidural clonidine produces decreased fentanyl requirements, improved cardiovascular stability, reduced pain intensity and effective postoperative analgesia in the recovery room.
Age‐dependent haematological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of halothane and nitrous oxide
Authors: PERIĆ M. , PETROVEČKI M. , MARUŠIĆ M.
Published: February 2007

Anaesthetic staff chronically exposed to high occupational concentrations of halothane and nitrous oxide were tested for numerous haematological and cellular function parameters at the peak of the working season and after 3 weeks vacation. The analysis of data was performed to compare differences in subjects younger and older than the age of 40 years, respectively when compared with normal controls. The analysis revealed a higher recovery of erythrocyte’count in the blood of older staff, and stronger disturbance of leucocyte formation in younger staff. In contrast, monocytes appeared to be more stable in the younger staff as were the T and B lymphocyte counts. After stimulation with PHA, Con A and PWM mitogens, lymphocytes from the older age group incorporated a significantly higher amount of tritiated thymidine, but stimulation indices did not differ. Natural killer cell numbers appeared equally affected; natural killer cell activity was unaffected, but there was an increase in activity in the younger staff after the vacation. Serum immunoglobulin concentrations tended to be more affected in older individuals at the peak of the working season.
Cardiac tamponade in an infant
Authors: CHERNG Y‐G. , CHENG Y‐J. , CHEN T‐G. , WANG C‐M. , LIU C‐C.
Published: February 2007

A 2994g infant suffered cardiac tamponade from an infusion of total parenteral nutrition through an indwelling central venous catheter. The infant survived as a result of early diagnosis and aggressive therapeutic intervention. Cardiac tamponade secondary to central venous catheterisation is rare, but potentially lethal. Possible mechanisms are direct puncture by the catheter tip, or osmotic injury from the use of hypertonic solutions. To avoid this complication, the catheter tip should be prevented from entering the right atrium and its position should be checked periodically by chest X ray. Cardiac tamponade should be considered in any patient with a central venous catheter whose clinical condition deteriorates suddenly. Diagnostic or therapeutic pericardiocentesis should be employed as the first measure and time should not be wasted on other diagnostic procedures.
Traumatic pneumomyelogram
Authors: DAY C. J. E. , NOLAN J. P. , TARVER D.
Published: February 2007

A 70‐year‐old man sustained a severe head injury following a fall downstairs, which resulted in him being found in a head down position. In the accident and emergency department he was noted to have subarachnoid air on a lateral cervical spine radiograph. This drew attention to the presence of fractures in the middle cranial fossa and nitrous oxide was immediately discontinued. The presence of a traumatic pneumomyelogram implies a base of skull or middle cranial fossa fracture, and is almost certainly associated with intracranial subarachnoid air. Early recognition of the condition, and cessation of nitrous oxide, is essential to prevent dangerous increases in intracranial pressure secondary to the diffusion of gas into the air filled cavity.
A trial of pre‐emptive analgesia
Authors: Mansfield M. , Meikle R. , Miller C.
Published: February 2007

The influence of timing of administration of peroperative alfentanil on pain and analgesic requirements after surgery was studied in 60 patients undergoing total abdominal hysterectomy with or without bilateral salpingo‐oophorectomy. Thirty patients received alfentanil 7.5μg.kg‐1 on induction of anaesthesia, followed by alfentanil 7.5μg.kg‐1 90s before surgical incision (group A). Thirty control patients received alfentanil 15μg.kg‐1, 10 min after abdominal incision (group B). In addition, 10min after surgical incision both groups received morphine 0.2mg.kg‐1, given over a 10min period. The visual analogue scores (median, interquartile range) for pain 24 h after operation were 28.5 mm (11.25–47.0) in group A and 21.0 mm (10.5–47.5)in group B, p = 0.76. There were no differences in visual analogue scores at intermediate times. Morphine consumption in the first 24 h after surgery (median, interquartile range) was 53.5mg (37.25–60.0) in group A and 52.0mg (39.75–71.0) in group B, p = 0.52. We conclude that postoperative morphine consumption and pain scores are no different when alfentanil 15μg.kg‐1 is given before or after skin incision for abdominal hysterectomy.
Sensitivity to second dose of mivacurium
Authors: FELDMAN S. A. , HOOD J. R. , CAMPKIN N. T. A. , REHM S.
Published: February 2007

The sensitivity of patients to a second dose of mivacurium has been studied following complete recovery of the twitch response after > 95% neuromuscular block produced by a systemic bolus of the drug. In further experiments we have excluded one arm from the effect of a systemic bolus ED95 dose of mivacurium for 100 s so as to obtain two different levels of neuromuscular block in the two arms of the same patient. Upon recovery from the block in the paralysed arm the dose response of both arms to a second dose of mivacurium was studied in order to investigate the effect of the amount and duration of block upon second dose sensitivity. An approximately 50% diminution in the ED95 dose requirement of mivacurium was found following complete recovery from an ED95 dose in spite of the rapid plasma clearance of this drug. A similar increase in sensitivity was observed in the arm that had been excluded for 100 s from the peak effect of the drug. It was concluded that the second dose sensitivity was not due to a receptor effect or to residual drug in plasma.
An assessment of a blood warmer for high and low flows
Authors: JOHNSON A. L. M. , MORGAN M.
Published: February 2007

The Level 1 warmer (H‐250 model) with its new disposable set (D‐60HL) was found to be effective in warming fluids at flows between 1 and 500 ml.min‐1 or fluids at room temperature, and between 5 and 100 ml.min‐1 for fluids at 4–5°C.
Angiotensinamide in the treatment of probable anaphylaxis to succinylated gelatin (Gelofusine)
Authors: McKINNON R. P. , SINCLAIR C. J.
Published: February 2007

A patient undergoing anaesthesia for coronary artery bypass surgery developed a probable anaphylactic reaction to succinylated gelatin (Gelofusine). The principal feature of the reaction was one of cardiovascular depression. An infusion of the angiotensin analogue, angiotensinamide was successful in the treatment of the reaction and allowed completion of the surgery.
The application of Read Codes to anaesthesia
Authors: BANKS I. C.
Published: February 2007

The Anaesthetic Specialty Working Group of the Clinical Terms Project is creating a set of terms for anaesthesia. These terms can be used to describe the activities of an anaesthetist, and are designed for use in computerised systems such as automated anaesthetic record‐keeping systems. These terms will be coded as Read Codes, and will be introduced to the National Health Service in 1994. The method for, and the reasoning behind the creation of these terms, is discussed below. The way that these terms can be used in the field of anaesthesia is outlined.
Teaching fibreoptic intubation
Authors: Hartley M. , Morris S. , Vaughan R. S.
Published: February 2007

A technique for teaching fibreoptic orotracheal intubation in patients under general anaesthesia is described and evaluated. A standard general anaesthetic was administered to 60 patients presenting for elective gynaecological surgery. Patients were randomly assigned to receive either alfentanil 10 μg. Kg−1 or a placebo, and to be intubated either by a consultant experienced in the use of the fibreoptic bronchoscope or by an inexperienced trainee under instruction. Heart rate, arterial pressure and oxygen saturation were monitored continuously. The time to achieve tracheal intubation in the trainee group was significantly prolonged (p < 0.001), but no patient developed arterial desaturation. The hypertensive response to fibreoptic intubation was suppresed in those patients who received alfentanil (p < 0.001). The increase in heart rate was not suppressed, but was attenuated when these patients were compared with those who had received the placebo (p < 0.001). Alfentanil 10μ.kg−1 minimises the haemodynamic response when teaching fibreoptic orotracheal intubation under general anaesthesia.