bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaesthetic problems in ex situ resection of the liver
Authors: GROSSE H. , PICHLMAYR R. , HAUSEN B. , LÜBBE N. , KIRCHNER E.
Published: February 2007

Ex‐situ resection of the liver is a new surgical technique for treatment of liver tumours not amenable to conventional surgery. This paper describes the cardiovascular and metabolic changes that occurred in nine consecutive such patients. No severe haemodynamic or pulmonary complications occurred. Specific problems were encountered during the prolonged anhepatic period, which lasted an average of 5.96 (SD 1.46) hours. Significant metabolic and coagulation disorders occurred 2 to 3 hours after hepatectomy because of complete loss of hepatic function. The predominant findings during the anhepatic period were hypoglycaemia and severe metabolic acidosis, mainly from increased levels of lactic acid. Exogenous administration of dextrose 5% at an average rate of 188 ml/hour was necessary to maintain normoglycaemia, while correction of metabolic acidosis required 403 (SD 159.79) mmol of sodium bicarbonate, supplemented by hyperventilation. Tris‐hydroxymethylaminomethane was used when sodium overload was thought to be a problem. There was a marked decrease of Factor V and fibrinogen, a moderate thrombocytopenia and fibrinolysis. The severity of these alterations was dependent on the duration of the anhepatic period and the primary function of the re‐implanted liver.
Resistance to fluid flow through two spinal needles
Authors: TOOMEY P. J.
Published: February 2007

A new needle, 120 mm long and 26 gauge in diameter, has been introduced for subarachnoid anaesthesia. The resistance to flow through the needle was measured using a pressure monitor infusion pump and compared with the resistance to flow through a 90‐mm 26‐gauge needle; there was a threefold increase in resistance in the 120‐mm needle compared to the 90‐mm needle, which could not be explained by the difference in length alone and must reflect a decrease in the internal diameter of the long needle. This results in difficulty in identifying the subarachnoid space by backflow of cerebrospinal fluid.
Attenuation of suxamethonium myalgias. Effect of midazolam and vecuronium
Authors: MINGUS M. L. , HERLICH A. , EISENKRAFT J. B.
Published: February 2007

We studied the incidence of fasciculations and postoperative myalgias in 100 female outpatients who had laparoscopy under thiopentone, N2O, isoflurane anaesthesia. Four groups of 20 patients each were pretreated with saline (group 1), tubocurarine 0.05 mg/kg (group 2), vecuronium 0.006 mg/kg (group 3), or midazolam 0.025 mg/kg (group 4), followed by suxamethonium 1.5 mg/kg. Group 5 received only vecuronium 0.1 mg/kg as relaxant (no suxamethonium). Fasciculations were graded, and postoperative myalgias rated on the first and third postoperative days. In groups 1–5 the incidence of fasciculations was 95, 15, 25, 95 and 0%; the incidence of myalgias on the first day after operation was 70, 45, 65, 75 and 60%, and on the third day after operation 20, 5, 20, 20, and 5%, respectively. We conclude that pretreatment with vecuronium, but not midazolam, decreases the incidence of fasciculations after suxamethonium (p < 0.05) and that in this patient population, postoperative myalgias appear to be unrelated to the use of suxamethonium.
Adverse haemodynamic effects of high‐dose aprotinin in a paediatric cardiac surgical patient
Authors: BÖHRER H. , BACH A. , FLEISCHER F. , LANG J.
Published: February 2007

High‐dose aprotinin for reduction of intra‐ and postoperative blood loss was associated with profound hypotension and flushing in a 3.5‐year‐old child who underwent cardiac surgery. Treatment with noradrenaline and intravenous fluid was required. Cardiovascular stability was restored after 10 minutes.
Embolism during Caesarean section
Authors: Matthews N. C. , Greer G.
Published: February 2007

We investigated the occurrence of gas embolism during Caesarean section using a Doppler ultrasound probe and found that it occurs between uterine incision and delivery. Embolism is less common during general anaesthesia than has been reported during regional anaesthesia. Both ruptured membranes and a protracted uterine incision to delivery interval predispose to embolism.
Isolated lung transplantation for pulmonary fibrosis
Authors: Conacher I. D. , Dark J. , Hilton C. J. , Corris P.
Published: February 2007

The peri‐operative anaesthetic management of 11 patients with pulmonary fibrosis undergoing single‐lung transplantation is presented. Intra‐operative problems, the early postoperative phase of recovery and intensive care, and other incidents in which general anaesthesia was required for the management of complications, are featured. Results, both short‐ and long‐term, are mentioned. Major intra‐operative events that cause concern appear to be related to the severity of the presenting illness and the development of respiratory failure. Others have reported the development of intra‐operative cardiac failure. All cases were successfully managed operatively using conventional one‐lung anaesthesia, although resort to partial cardiopulmonary bypass may have been indicated in some. The indications and attitudes to utilising cardiopulmonary bypass in the evolution of techniques for facilitating single‐lung transplantation are reviewed.
Pregnanolone emulsion A preliminary pharmacokinetic and pharmacodynamic study of a new intravenous anaesthetic agent
Authors: CARL P. , HØGSKILDE S. , NIELSEN J. W. , SØRENSEN M. B. , LINDHOLM M. , KARLEN B. , BÄCKSTRØ T.
Published: February 2007

Pregnanolone emulsion, a new steroid anaesthetic agent, was administered intravenously as bolus doses to six young healthy male volunteers in a preliminary pharmacokinetic and pharmacodynamic study. The plasma concentration‐time curves fitted a two‐compartment model. The elimination half‐life was between 0.9 and 1.4 hours, volume of central compartment between 0.95 and 2.10 litres/kg, volume of distribution between 3.75 and 5.58 litres/kg and total body clearance between 1.80 and 3.07 (litres/hour)/kg. The excretion in urine of unchanged pregnanolone was less than 0.1%. The pharmacodynamic properties were found to be similar to those of Althesin, with immediate induction of anaesthesia of short duration. The anaesthetic affected haemodynamics only slightly; minor depression of ventilation, with an increase in Paco2, occurred in several of the subjects. Excitation of short duration occurred in one subject during induction of sleep and slight involuntary muscle movements in another subject during sleep. It is impossible to draw any clear conclusions of the clinical efficacy and tolerance from this limited normal subject trial, but pregnanolone emulsion seems worthy of further clinical trial.
Contralateral tension pneumothorax during thoracotomy for lung resection
Authors: GABBOTT D. A. , CARTER J. A.
Published: February 2007

A patient underwent right thoracotomy and upper lobectomy for a mass found on routine chest radiography. He became profoundly cyanosed with a bradycardia and severe reduction in oxygen saturation at completion of surgery. The diagnosis of tension pneumothorax on the contralateral side to surgery was made and treatment instituted. The causes, treatment and implications of such an event during general anaesthesia for lung resection are discussed.
Minimum airway pressure weaning Weaning from mechanical ventilation at 50 breaths/minute by reduction of inflation pressure using a pressure generator
Authors: TAN P. S. K. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

Ten patients, whose lungs were ventilated initially with intermittent positive pressure ventilation at conventional rates after myocardial revascularisation or cardiac valvular surgery, were weaned using a valveless high frequency jet ventilator at a constant rate of 50 breaths/minute. The withdrawal of ventilation was achieved, when clinical criteria permitted, by reduction of the tidal volume preset on the jet ventilator in successive stages; this was effected by stepwise decreases in the jet driving pressure. This new mode of weaning at a constant rate of 50 breaths/minute is associated with minimum peak airway pressures. Synchronisation of the patient's breathing with the valveless ventilator is not required and weaning is tolerated well by the patient. Arterial oxygen tension and saturation were maintained throughout weaning and did not decline after extubation of the trachea.
Postoperative sore throat A comparison after premedication with papaveretum/hyoscine or temazepam
Authors: VALENTINE S. , McVEY F. K. , COE A.
Published: February 2007

A randomised double‐blind trial was conducted to study the use of two commonly used premedication regimens and the subsequent incidence of sore throat. Fifty adult patients who underwent routine surgery were anaesthetised in a standard fashion after premedication with papaveretum and scopolamine or temazepam, and interviewed after operation to assess the presence of sore throat. A significantly higher incidence of sore throat was associated with the use of papaveretum and scopolamine.
Meningitis after obstetric spinal anaesthesia
Authors: ROBERTS S. P. , PETTS H. V.
Published: February 2007

A case of meningitis after obstetric spinal anaesthesia is reported. The possible aetiological causes of postspinal meningitis are discussed and the difficulty in differentiation between aseptic and bacterial meningitis noted. Ways to reduce the risk of bacterial contamination of cerebrospinal fluid are mentioned. The patient in this case made a full recovery, but the use of spinal anaesthesia in these patients is open to question.
Opisthotonus and other unusual neurological sequelae after outpatient anaesthesia
Authors: SAUNDERS P. R. I. , HARRIS M. N. E.
Published: February 2007

Four patients who developed unusual neurological sequelae after outpatient anaesthesia are described. Propofol is strongly implicated as the cause. All four patients were female with no previous history of psychiatric disorder or neurological disease, unpremedicated, and had procedures of duration less than 20 minutes. Hyperreflexia and hypertonicity were present postoperatively and the reactions appeared to be triggered by an external stimulus. Three patients were examined by a neurologist and had a normal electroencephalograph. Two patients were on the same operating list; quality control was carried out on the anaesthetic agents used, and blood samples sent for toxicology showed no abnormalities. Mechanisms underlying these reactions are discussed.
Maintenance of body temperature in elderly patients who have joint replacement surgery A comparison between the heat and moisture exchanger and heated humidifier
Authors: Yam P. C. Ip , Carli F.
Published: February 2007

The effect of a heat and moisture exchanger on intra‐operative aural canal (core) and mean skin temperatures was investigated in elderly patients who had elective total hip arthroplasty under general anaesthesia with artificial ventilation of the lungs. Group 1 (n = 20) did not receive any form of artificial humidification while in group 2 (n = 20) a heat and moisture exchanger was inserted in the breathing system and in group 3 (n = 20) the inspired gases were humidified and warmed at 40°C by means of a heated humidifier. Time of surgery, intravenous fluid administration and operating theatre temperature were standardised. Mean (SD) aural canal (core) temperature decreased significantly in groups 1 and 2 (p < 0.001), while there was a fall of 0.3°C(0.6) in group 3, which was not significant. Mean skin temperature decreased during anaesthesia and surgery in both groups 1 and 2 (p < 0.05), while it increased in group 3. There was a significantly greater loss of body heat in groups 1 and 2 compared with group 3 intra‐operatively (p < 0.001). We conclude that a heat and moisture exchanger did not prevent the decrease in intra‐operative body temperature in elderly patients.
Prevention of TUR syndrome by detection of trace ethanol in the expired breath
Authors: Hahn R. G.
Published: February 2007

Previous studies suggest that severe symptoms of the ‘TUR syndrome’ occur from transurethral prostatic resection only when the volume of irrigant absorbed exceeds 2000 ml. An ethanol‐containing irrigating fluid was used in this study of 100 transurethral resections so that the irrigant absorption could be monitored by measuring ethanol in expired air. Fluid absorption was found in 41 patients, and in nine of them the volume of irrigant absorbed exceeded 1000 ml. Four of these operations were terminated promptly when the ethanol monitoring indicated rapid massive absorption that threatened to exceed 2000 ml. There were few and only mild adverse effects of the irrigant by following this regimen. It is concluded that ethanol monitoring makes it possible to prevent the TUR syndrome by selective termination of those operations in which large amounts of irrigant is absorbed.
Effect of glyceryl trinitrate and ice on dilation of hand veins
Authors: WILLIAMS S. , HECKER J. F.
Published: February 2007

Application of glyceryl trinitrate to a finger produced significant dilation of superficial hand veins. Gently rubbing ice over these veins for one minute slightly reduced this dilation, whereas rubbing ice over veins without glyceryl trinitrate caused significant venoconstriction. These results indicate that application of glyceryl trinitrate followed by local cooling may provide a simple and painless means of assisting venepuncture.
Rupture of the oesophagus during cricoid pressure
Authors: RALPH S. J. , WAREHAM C. A.
Published: February 2007

Rupture of the oesophagus occurred during the application of cricoid pressure at induction of anaesthesia when the patient vomited. The patient, who was bleeding from a gastric ulcer, was found to have a lower oesophageal tear which, although repaired at operation, resulted in a fatal mediastinitis.
Modification of pain on injection of propofol—a comparison between lignocaine and procaine
Authors: Nicol M. E. , Moriarty J. , Edwards J. , Robbie D. S. , A'Hern R. P.
Published: February 2007

Pain on injection of propofol was assessed in a controlled, randomised study of 273 patients. They received either lignocaine 10 mg, procaine 10 mg or isotonic saline 0.5 ml, 15 seconds before the injection of propofol into a vein on the back of the hand. The incidence of pain on injection in the'control group (51%) was comparable with other studies. Lignocaine and procaine both significantly reduced the pain (35% and 34% respectively, p < 0.05) but there was no statistical difference between these two groups.
Pulmonary air embolism during laparoscopic laser cholecystectomy
Authors: GREVILLE A. C. , CLEMENTS E. A. F. , ERWIN D. C. , McMILLAN D. L. , WELLWOOD J. McK.
Published: February 2007

We describe a case of pulmonary air embolism that occurred during laparoscopic cholecystectomy using the neodymium: yttrium‐aluminium‐garnet laser.
Anaesthesia for Proteus syndrome
Authors: PENNANT J. H. , HARRIS M. F.
Published: February 2007

A 14‐year‐old boy with Proteus syndrome presented for orthopaedic surgery to his legs. No report in the literature exists on anaesthesia for this condition. Our patient posed airway problems that were managed by tracheal intubation under sedation using a fibreoptic bronchoscope. Anaesthesia was induced with thiopentone and maintained with nitrous oxide and isoflurane in oxygen. His lungs were ventilated mechanically throughout surgery, which was uneventful.
The alkalinisation of bupivacaine for intercostal nerve blockade
Authors: SWANN D. G. , ARMSTRONG P. J. , DOUGLAS E. , BROCKWAY M. , BOWLER G. M. R.
Published: February 2007

A double‐blind randomised study was performed to investigate the effect of pH adjustment of bupivacaine, with adrenaline 1: 200 000, on the duration of block and pain relief after intercostal nerve blockade following thoracotomy. One group (n = 10) received bupivacaine with adrenaline 1: 200 000 (pH = 4.1) and the other (n = 10) received alkalinised bupivacaine with adrenaline 1: 200 000 (pH = 6.9). There was no significant difference in block duration (mean 23.9 and 26.4 hours respectively) visual analogue pain scores or morphine usage. Patients were more likely to have a block during the first 12 hours if they received alkalinised bupivacaine (p < 0.01, Chi‐squared test). A progressive regression of block, not previously described, was observed, explicable by means of spread of local anaesthesia to adjacent intercostal nerves. Alkalinisation of bupivacaine with adrenaline for intercostal nerve blockade has little clinical benefit.
General anaesthesia and undrained pneumothorax
Authors: CROFTS S. L. , HUTCHISON G. L.
Published: February 2007

A patient who required pleurectomy had a 30% pneumothorax when she was presented for anaesthesia. She had refused to have this drained, and it had not responded to conservative management. She was anaesthetised using a computer‐controlled propofol infusion system, without the use of nitrous oxide, and a chest drain was inserted before the institution of positive pressure ventilation. This technique reduces the hazards associated with general anaesthesia in the presence of an undrained pneumothorax. It may be a safe alternative method of induction of anaesthesia in other conditions in which positive pressure ventilation must be avoided, such as bronchopleural fistula.
The neuromuscular blocking effect of Org 9426
Authors: BOOIJ L. H. D. J. , KNAPE H. T. A.
Published: February 2007

Org 9426, a new steroidal non‐depolarising muscle relaxant, which is stable in solution, was studied in 30 anaesthetised (thiopentone, fentanyl, nitrous oxide) male patients, ASA 1 or 2. A dose‐response curve for Org 9426 was constructed and the ED90, mean (SD), was found to be 0.36 (0.031) mg/kg. The onset of action was 3.8 (1.8) minutes, the clinical duration 17.4 (3.2) minutes, the total duration of action 31.9 (6.2) minutes and the recovery time 9.96 (3.2) minutes. No signs of histamine release or cardiovascular effects were observed. Org 9426 thus has a faster onset of action than vecuronium bromide or atracurium dibesylate.
The effect of prophylactic fentanyl on shivering in elective Caesarean section under epidural analgesia
Authors: LIU W. H. D. , LUXTON M. C.
Published: February 2007

The aims of this randomised double‐blind study were to investigate whether 25 μg of fentanyl administered prophylactically by the epidural route would influence the incidence of shivering in parturients who underwent elective Caesarean section under epidural analgesia and whether it would affect the axillary and calf temperatures. There was a 50% reduction (p < 0.05) in the overall incidence of shivering in patients who received fentanyl and there was some evidence to suggest that low‐dose epidural fentanyl might reduce shivering by an influence on thermoregulation.
Monitoring of irrigating fluid absorption during transurethral prostatectomy
Authors: HULTÉN J. , SARMA V. J. , HJERTBERG H. , PALMQUIST B.
Published: February 2007

A simple, reliable method to detect absorption of irrigating fluid during transurethral prostatectomy is to tag irrigating fluids with 1% ethanol and monitor expired breath ethanol concentrations. This method correlated well (n = 0.79) with other existing methods of absorption monitoring in 20 anaesthetised patients. Ethanol (1%) tagging does not alter the optical quality of the irrigating fluid and is harmless to the patient. The technique is non‐invasive, repeatable, cheap and gives instant results. It can be used in anaesthetised or awake patients and can detect absorption of as little as 100–150 ml in any 10‐minute period.
Airway protection by the laryngeal mask
Authors: JOHN R. E. , HILL S. , HUGHES T. J.
Published: February 2007

Methylene blue was placed in the pharynx of 64 patients undergoing anaesthesia with the laryngeal mask. No leak of dye into the larynx was detected on fibreoptic inspection of the inside of the mask in any subject. The use of the laryngeal mask as a means of protecting the airway during procedures such as minor nasal operations is therefore supported.
Flumazenil in intensive care The duration of arousal after an assessment dose
Authors: Fisher G. C. , Clapham M. C. C. , Hutton P.
Published: February 2007

The effect of an assessment dose of the benzodiazepine antagonist flumazenil was studied in 20 patients in an intensive care unit. The patients had been sedated with alfentanil and midazolam, and were ready to be weaned from mechanical ventilation. In 10 patients flumazenil was titrated just to produce full arousal whilst the midazolam infusion was continued; flumazenil administration was repeated one hour later after the infusion of midazolam had been stopped. In another 10 patients, flumazenil was administered only once, coinciding with the cessation of sedation. The duration of full arousal in both groups was less than 15 minutes in 75% of patients given a single dose of flumazenil (median dose 0.4 mg) although some effect persisted for up to 60 minutes. The cardiovascular effects of arousal were transient and probably not clinically significant. A brief duration of action is advantageous if the patient is found still to require sedation.
Cross‐sectional study of complications of inhalational anaesthesia in 16995 patients
Authors: LEW J. K. L. , SPENCE A. A. , ELTON R. A.
Published: February 2007

Patients undergoing anaesthesia in which halothane, enflurane or isoflurane were used, were surveyed with reference to 16 unwanted effects selected by the nominal group method. A simple record card was completed at the time of anaesthetic administration. The overall incidence of complications was 13.9%. One complication was reported in 10.8% of the cases, and more than one in 3.1%. Complications were more frequent in the obese, the elderly and those patients receiving isoflurane, but in view of the small overall use of this agent, the anaesthetists involved may still have been on a learning curve.
A comparison of azapropazone and aspirin for pain relief following dental extractions
Authors: GARRIOCH M. A. , WARDALL G. J. , FITCH W.
Published: February 2007

Eighty patients received one of three treatments after elective dental surgery involving multiple extractions. Group A received aspirin 600 mg, group B azapropazone 300 mg and group C azapropazone 600 mg. All drugs were administered in a double‐blind fashion. Quality of analgesia was unsatisfactory for all treatments; over 30% of patients required supplementary analgesia with an opioid. In addition there were a large number of withdrawals from the study. There were no significant differences in analgesic efficacy between groups.
Paraplegia following coeliac plexus block
Authors: VAN DONGEN R. T. M. , CRUL B. J. P.
Published: February 2007

A case is described in which a coeliac plexus block with alcohol 48%, performed under X ray control, resulted in paraplegia. Ischaemia of the spinal cord, due to damage to the arterial blood supply, was thought to be the cause.
The oesophageal detector device
Authors: WEE M. Y. K. , WALKER A. K. Y.
Published: February 2007

In 100 children between the ages of 1–10 years, observers of differing experience reliably and rapidly detected 50 oesophageal and 50 tracheal intubations in a randomised single‐blind trial using the original oesophageal detector device. However, only two children under the age of 2 years were tested and no conclusions can be drawn for this age group from this study.
Topical glyceryl trinitrate and eutectic mixture of local anaesthetics in children A randomised controlled trial on choice of site and ease of venous cannulation
Authors: Teillol‐Foo W. L. M. , Kassab J. Y.
Published: February 2007

One hundred and four children aged between 1 and 11 years were studied in a double‐blind randomised controlled trial of glyceryl trinitrate ointment versus placebo, when used in addition to standard eutectic mixture of local anaesthetics cream. Each child received glyceryl trinitrate ointment on one hand and placebo on the other, and thus acted as his/her own control. A group of 30 children who received only the eutectic mixture on both hands (60 measurements) was also studied. The choice of site and ease of cannulation was scored. Skin colour and venous dilatation under the eutectic mixture were scored on a visual analogue scale. The addition of topical glyceryl trinitrate ointment to the standard eutectic mixture positively affected venous dilatation (p < G.01), choice of cannulation site (p < 0.001), and ease of cannulation (p < 0.001) of topical anaesthetic‐treated skin.
A double‐blind study of the speed of onset of analgesia following intramuscular administration of ketorolac tromethamine in comparison to intramuscular morphine and placebo
Authors: RICE A. S. C. , LLOYD J. , MILLER C. G. , BULLINGHAM R. E. , O'SULLIVAN G. M.
Published: February 2007

A double‐blind, randomised, parallel group, placebo‐controlled study was performed in 85 patients to compare the speed of onset of analgesia following the intramuscular administration of a single dose of 30 mg of ketorolac tromethamine, 10 mg of morphine or placebo. A new, sensitive, method was used to measure the latency of analgesia. The onset of analgesia was defined by the time taken for the pain intensity score to reach a specified percentage of the baseline value. Twenty‐five percent of patients achieving a 50% reduction in baseline pain intensity score appears to be the most appropriate parameter to assess the speed of onset of analgesia of ketorolac and morphine in the postoperative setting. Paired comparison demonstrated that ketorolac had a significantly faster onset of analgesia (p = 0.03) when compared to placebo, whilst comparison of morphine to placebo analgesic latency (p = 0.06) just failed to reach significance. There was no significant difference between the analgesic onset time of ketorolac and morphine (p = 0.73). Intramuscular ketorolac and intramuscular morphine have comparable analgesic onset times in the postoperative pain context. However, the sensitive method of measuring onset of analgesia described, highlights the slow onset of analgesia when analgesics of known efficacy are given by the intramuscular route in the postoperative period. More attention should be given to the speed of onset of analgesia in future assessments of analgesics.
Percutaneous dilational tracheostomy
Authors: BODENHAM A. , DIAMENT R. , COHEN A. , WEBSTER N.
Published: February 2007

Tracheostomy is performed commonly to aid weaning from assisted ventilation in patients who require intensive care. The procedure carries a significant mortality and morbidity, in part due to problems in moving unstable patients. We report the use of a bedside percutaneous tracheostomy technique for use in adult patients who require intensive care. The procedure was successful in 19 of 20 cases. The one failure, in the first case, resulted from transection of a superficial midline vein. The lack of significant haemorrhage was notable in all other cases. The procedure has proved to be efficient and cost‐effective in this unit and has now replaced conventional surgical tracheostomy in this group of patients.
Induction and recovery characteristics of desflurane in day case patients: A comparison with propofol
Authors: WRIGLEY S. R. , FAIRFIELD J. E. , JONES R. M. , BLACK A. E.
Published: February 2007

Desflurane is an ether halogenated exclusively with fluorine. It has a blood/gas partition coefficient of 0.42 (of. isoflurane 1.40 and nitrous oxide 0.46). This characteristic suggests that it should provide both a fast induction of anaesthesia and a rapid recovery from anaesthesia. To assess this, 60 patients were entered into a study and allocated at random to one of four groups receiving either desflurane or propofol for induction and maintenance of anaesthesia. Desflurane caused loss of consciousness in approximately 2 minutes during gaseous inductions. The psychomotor scores in the patients who received propofol for induction and maintenance of anaesthesia were significantly worse compared with those who were given desflurane for either induction and maintenance or for maintenance only. There was also a tendency for other recovery parameters to be faster in the patients receiving desflurane although this did not reach statistical significance. This suggests that desflurane would be a suitable agent for day case anaesthesia providing for a rapid recovery.
Spondyloepiphyseal dysplasia congenital
Authors: RODNEY G. E. , CALLANDER C. C. , HARMER M.
Published: February 2007

Spondyloepiphyseal dysplasia congenita is a rare condition with several features of concern to the anaesthetist. The patients are of extremely short stature and the presence of kyphoscoliosis may lead to significant respiratory impairment. Cervical vertebral body changes can result in spinal cord compression and laryngotracheal stenosis may be present. The management of such a patient presenting for elective Caesarean section under epidural anaesthesia is described.
A prospective study of liver function in infants and children exposed to daily isoflurane for several weeks
Authors: Jones R. M. , Diamond J. G. , Power S. J. , Bajorek P. K. , Munday I.
Published: February 2007

Eleven infants and children presenting for daily radiotherapy for a period of at least 2 weeks were anaesthetised with isoflurane in 33% oxygen and nitrous oxide. They were unpremedicated and given no other agents to supplement anaesthesia. The average number of exposures was 24 (SD 11; range 10–39) and the total anaesthetic time per exposure varied between 15 and 30 minutes. Liver function was assessed by determining serum total bilirubin, aspartate amino transferase, gamma glutamyl transferase and alkaline phosphatase before the start of treatment and at 5‐daily intervals thereafter. There was no measurable change in any of these determinants of liver function. All children accepted daily induction of anaesthesia with isoflurane. Induction, maintenance and recovery from anaesthesia were uncomplicated.
Removal of a laryngeal foreign body using high frequency jet ventilation
Authors: TAN S. S. , DHARA S. S. , SIM C. K.
Published: February 2007

Aspiration of a foreign body into the respiratory tract is a common and serious accident in childhood. Laryngotracheal foreign bodies, although less common than bronchial foreign bodies, are potentially more dangerous. Removal is commonly achieved using a rigid ventilating bronchoscope. We report a 16‐month‐old boy who had an open safety pin impacted in his larynx. This was removed through a tracheostomy, using high frequency jet ventilation to maintain gaseous exchange. We believe that this is the first case in which this method of removal has been reported.
Propofol: bolus or continuous infusion
Authors: Brownlie G. S. , Baker J. A. , Ogg T. W.
Published: February 2007

Forty patients undergoing vaginal termination of pregnancy were randomly allocated to receive a propofol anaesthetic using either a repeat bolus or infusion technique. The Ohmeda 9000 Infusion Pump was used in the study. Patients in the infusion group recorded significantly longer induction times, greater maintenance doses and prolonged immediate recovery characteristics. Both techniques offered cardiovascular stability but no advantages were demonstrated for the infusion technique over a conventional repeat bolus method.
Effects of epidural diamorphine on the somatosensory evoked potential to posterior tibial nerve stimulation
Authors: LOUGHNAN B. A. , YAU K. W. , RANSFORD A. O. , HALL G. M.
Published: February 2007

We have studied the effects of the epidural administration of diamorphine 0.1 mg/kg at the L3–4 interspace on somatosensory evoked potentials in the cervical epidural space before corrective surgery for idiopathic adolescent scoliosis. A further eight patients in whom anaesthesia was maintained with a propofol infusion acted as a control group. Epidural diamorphine had no effect on the latency or amplitude of the evoked potentials. We conclude that epidural diamorphine is a suitable technique to use in scoliosis surgery because of its lack of effect on neurophysiological variables, although the potential respiratory problems need investigation.
Double‐blind testing fails to confirm analgesic response to extradural morphine
Authors: JADAD A. R. , POPAT M. T. , GLYNN C. J. , McQUAY H. J.
Published: February 2007

We report two patients with chronic non‐malignant pain in whom morphine given intravenously via a patient‐controlled analgesia system produced partial pain relief but was accompanied by severe side effects. Open administration of epidural morphine resulted in complete pain relief with minimal side effects and the patients were considered as candidates for implanted opioid delivery systems. However, when the epidural morphine was given in a double‐blind and placebo‐controlled manner, morphine did not produce greater analgesia than placebo and no dose‐response relationship was seen. These cases show that careful investigation is necessary before proceeding to implanted systems and that changing the route did not improve the analgesia: side effect balance for morphine in these patients.
Extradural analgesia and previous spinal surgery
Authors: CALLEJA M. A.
Published: February 2007

Extradural block was performed in a nulliparous patient with previous spinal surgery. Epidurographic evidence explains the rapid onset and extensive sensory block obtained.
Acid aspiration prophylaxis in morbidly obese patients: famotidine vs. ranitidine
Authors: Vila P. , Vallès J. , Canet J. , Melero A. , Vidal F.
Published: February 2007

Famotidine and ranitidine were compared as agents for the prevention of acid aspiration syndrome in 32 morbidly obese patients undergoing vertical banded gastroplasty. Single‐dose oral famotidine or double‐dose oral ranitidine were administered on a random basis before surgery. Gastric contents were aspirated through a gastric tube, manually aided by the surgeon with the abdomen open. Mean (SD) gastric volumes were 13.8 ml (6.7) and 12.1 ml (13.0) for the famotidine and ranitidine groups, respectively. Mean (SD) gastric pH values were 6.2 (1.5) and 6.8 (1.5), respectively. There were no significant differences between the groups and no patient was considered‘at risk’ (pH < 2.5 and gastric volume > 25 ml). We conclude that single‐dose oral famotidine and double‐dose oral ranitidine are equally effective for preventing acid aspiration syndrome in morbidly obese patients.
Diamorphine analgesia after Caesarean section
Authors: Smith I. D. , Klubien K. E. , Wood M. L. B. , Macrae D. J. , Carli F.
Published: February 2007

In a randomised double‐blind study, the efficacy, duration of action and side effects of five diamorphine analgesia regimens following Caesarean section are described. The time to next analgesia was shorter in the 5 mg intramuscular group (3.53 hours) than in any of the four epidural groups: 5 mg (5.7 hours, p = 0.007), 2.5 mg (4.76 hours, p = 0.103), 5 mg with adrenaline 1/200 000 (7.2 hours, p = 0.001) and 2.5 mg with adrenaline 1/200 000 (6.05 hours, p = 0.007). Multiple regression analysis showed that the addition of adrenaline significantly increased the duration of action of epidural diamorphine (p < 0.05). The 5 mg dose with adrenaline showed no advantage when compared with 2.5 mg with adrenaline (p = 0.16). No serious side effects were reported in any group.
Septic a trial thrombus
Authors: JOSHI P. , BULLINGHAM A. , SONI N.
Published: February 2007

A 77‐year‐old man underwent repair of a vesicocolic fistula following which he had a protracted stay in the intensive care unit due to recurrent septicaemia, which was initially caused by bowel anastomosis breakdown. Management included central venous cannulation and pulmonary artery catheter monitoring. A septic, mobile right atrial thrombus developed, which was successfully treated. The literature on this condition is reviewed.
Reversal of prolonged suxamethonium apnoea with fresh frozen plasma in a 6‐week‐old infant
Authors: GILL R. S. , O'CONNELL N. , SCOTT R. P. F.
Published: February 2007

A period of apnoea lasting 480 minutes following suxamethonium in a 6‐week‐old male infant is described. Neuromuscular function recovered following the administration of fresh frozen plasma. The infant was found to be homozygous for atypical cholinesterase (E1a E1a). This is believed to be the youngest reported case of suxamethonium apnoea.
Respiratory failure as presentation of achalasia of the oesophagus
Authors: KENDALL A. P. , LIN E.
Published: February 2007

A 68‐year‐old woman with a history of hiatus hernia developed aspiration pneumonia after operation for fractured neck of femur. After 8 days, acute respiratory failure was caused by massive retention of air and food in the oesophagus. This was relieved by aspiration, and treated by balloon dilation of the gastic cardia.
Continuous direct and indirect blood pressure measurement (Finapres) in the critically ill
Authors: FARQUHAR I. K.
Published: February 2007

Continuous noninvasive blood pressure measurement is of great potential use in the critically ill. This study was designed to find out whether measurements of blood pressure by a Finapres accurately represented intra‐arterial pressure. Comparisons were made between readings from a radial artery line and from a Finapres finger cuff in 10 critically ill patients. There was an unpredictable but usually stable difference between measurements from the two sources; this difference varied in magnitude and direction in individual patients. A t present the Finapres cannot be recommended as a substitute for intra‐arterial blood pressure measurement in the critically ill.
Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac
Authors: Edwards N. D. , Barclay K. , Catling S. J. , Martin D. G. , Morgan R. H.
Published: February 2007

A randomised, controlled study was undertaken to assess the postoperative pain and side effects experienced by patients undergoing day case diagnostic laparoscopy and laparoscopic sterilisation, and to evaluate the effectiveness in these patients of peroperative diclofenac. Patients undergoing laparoscopic sterilisation had significantly higher pain scores at one hour postoperatively, and at discharge, than patients undergoing diagnostic laparoscopy (p < 0.01) but there were no significant differences in pain scores 24 hours after discharge. The incidence of postoperative side effects following discharge from hospital was high, but there were no significant differences between the groups. Diclofenac had no significant effect in either group on the severity of postoperative pain, or the incidence of postoperative side effects.
Pulse oximeter probes A comparison between finger, nose, ear and forehead probes under conditions of poor perfusion*
Authors: CLAYTON D. G. , WEBB R. K. , RALSTON A. C. , DUTHIE D. , RUNCIMAN W. B.
Published: February 2007

The performances of 10 pulse oximeters using finger probes were compared with the same pulse oximeters using alternative probes (eight finger probes, two nose probes and a forehead probe) in poorly perfused patients. All readings were then compared with directly measured arterial blood oxygen saturations. The mean difference (bias, ‘accuracy’), standard deviation (precision) and ‘drop out’ rate for each pulse oximeter combination was determined. An overall ranking of performance of each pulse oximeter was calculated using five criteria (accuracy, precision, number of readings within 3% of standard, percentage of readings given within 3% of standard, expected overread limit in 95% of cases). Nose and forehead probes performed poorly. Some ear probes performed well compared to some finger probes, but the overall performance of probes in other sites compared to finger probes was worse, (p = 0.05). Two of eight ear probes and no nose or forehead probes would be expected to be within 4% of the reference value in 95% of readings. The use of finger probes rather than probes in other sites is recommended in the patient with poor peripheral perfusion.
Peri‐operative drug prescribing pattern and manufacturers' guidelines
Authors: KLUGER M. T. , GALE S. , PLUMMER J. L. , OWEN H.
Published: February 2007

Many patients admitted for surgery are receiving regular drug therapy. Adverse effects may occur, either as a result of these drugs being stopped suddenly or because staff are unaware of significant interactions between certain drugs and anaesthetic agents or techniques. This study aimed to find out how regular drug medication is actually given in the peri‐operative period. In addition, pharmaceutical companies were contacted and asked for information about the effects of sudden withdrawal of their products and potential interactions with anaesthetic agents. We found that many drugs were omitted peri‐operatively with potentially significant effects. Pharmaceutical companies do not seem to appreciate the importance of this problem and not all of them give clear recommendations relevant to practising anaesthetists.
Cardiac anaesthesia in a patient with myotonic dystrophy
Authors: TANAKA M. , TANAKA Y.
Published: February 2007

We describe a patient with myotonic dystrophy who required open‐heart surgery for an atrial septal defect. He also had a sick sinus syndrome and an abnormal myocardium on histological examination. Anaesthesia using fentanyl, droperidol, nitrous oxide and a low concentration of enflurane was uneventful. Atelectasis of the left lung developed on the first postoperative day after removal of the tracheal tube. This was successfully treated by fibreoptic bronchoscopy.
Occupational health and pollution from anaesthetics
Authors: HALSEY M. J.
Published: February 2007

The Control of Substances Hazardous to Health Regulations require employers in the United Kingdom to evaluate and control the risks to health for all their employees from exposure to hazardous substances at work. This applies to those working in hospital operating theatres who may be exposed to anaesthetic gas pollution. These legal requirements coupled with continuing concern about the effective localised control of anaesthetic pollution, the potential chemical interactions in the upper atmosphere, as well as the analysis of the prospective study in the United Kingdom on the health of women doctors, have prompted a reassessment of the topic. Some of the original fears are without foundation but the overall conclusion is that we can still not regard anaesthetic pollution as a problem solved.
Effects of nicardipine on the circulatory responses to tracheal intubation in normotensive and hypertensive patients
Authors: OMOTE K. , KIRITA A. , NAMIKI A. , IWASAKI H.
Published: February 2007

This study was undertaken to examine the effects of nicardipine on circulatory responses to laryngoscopy and tracheal incubation in normotensive (n = 39) and hypertensive (n = 36) patients. Laryngoscopy and tracheal intubation were performed after induction of anaesthesia with thiamylal, followed by administration of intravenous saline or nicardipine 20 or 30 μg.kg−1 and suxamethonium. Blood pressure and heart rate were recorded, and rate‐pressure product was calculated. Nicardipine 20 and 30 μg.kg−1 prevented the increase in mean arterial pressure after intubation in normotensive and hypertensive patients (p < 0.01 compared with saline). The changes in heart rate after intubation were significantly greater in normotensive patients than in hypertensive patients when 20 or 30 μg.kg−1 of nicardipine was given (p < 0.05 and p < 0.01 respectively). Rate‐pressure product increased significantly (p < 0.01) after intubation in normotensive patients whether nicardipine was administered or not, but the increase was suppressed completely by nicardipine 20 or 30 μg.kg−1 in hypertensive patients. We conclude that nicardipine is effective in preventing the circulatory responses to laryngoscopy and tracheal intubation in hypertensive patients.
Internal jugular catheterisation
Authors: PINA J. , MORUJÃO N. , CASTRO‐TAVARES J.
Published: February 2007

An internal jugular catheter, which was inserted into a patient with a traumatic haemopneumothorax, accidentally entered the pleural cavity. This was initially undetected because the two signs most frequently used to confirm correct placement, those of blood reflux and fluctuation of central venous pressure with respiration, were positive. A number of precautions are suggested which should be taken when central venous catheters are inserted in patients with thoracic trauma.
A comparison of omeprazole and ranitidine for prophylaxis against aspiration pneumonitis in emergency Caesarean section
Authors: YAU G. , KAN A. F. , GIN T. , OH T. E.
Published: February 2007

One hundred and sixty‐two Chinese women undergoing emergency Caesarean section were allocated at random on admission to the labour ward to receive one of three regimens for orally administered chemoprophylaxis against acid aspiration: ranitidine 150 mg 6 hourly with sodium citrate at induction of anaesthesia, omeprazole 40 mg 12 hourly with sodium citrate, or omeprazole 40 mg 12 hourly alone. Intragastric pH and volume were measured immediately after induction of anaesthesia. Ten patients (17%) in the omeprazole‐only group, three (6%) in the omeprazole and citrate group and one (2%) in the ranitidine group had an intragastric pH < 2.5 and volume > 25 ml (p < 0.05). The use of sodium citrate resulted in higher intragastric pH but larger intragastric volumes (p < 0.05). The sodium citrate and ranitidine regimen was the most cost‐effective among the three.
Late postoperative nocturnal dips in oxygen saturation in patients undergoing major abdominal vascular surgery
Authors: REEDER M. K. , GOLDMAN M. D. , LOH L. , MUIR A. D. , CASEY K. R. , LEHANE J. R.
Published: February 2007

Twenty‐four patients (23 male) who presented for aortic reconstructive surgery were studied with pulse oximetry on a pre‐operative night and during the first five postoperative nights. Patients with five or more dips in oxygen saturation of greater than 4% (with a prompt recovery back toward baseline of 3% or more) per hour of monitoring were classified as having a significant abnormality of respiration. Pre‐operatively, four of 24 patients (17%) demonstrated such an abnormality. Postoperatively, 12 patients (50%) met these criteria on at least one of the first five postoperative nights and six of these had two or more nights with severe episodic hypoxaemia. Frequent severe episodic dips in arterial oxygen saturation (to less than 85% saturation) occurred in the late postoperative period at a time when oxygen therapy would usually have been discontinued. Pre‐operative overnight pulse oximetry studies fail to predict the development of abnormal respiratory patterns in the postoperative period in the majority of patients.
Fatal pulmonary embolism following spinal anaesthesia for Caesarean section
Authors: McHALE S. P. , TILAK M. D. V. , ROBINSON P. N.
Published: February 2007

Pulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo‐embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be the first time this has been reported.
Alfentanil increases intracranial pressure when intracranial compliance is low
Authors: MOSS E.
Published: February 2007

Intracranial pressure increases following the administration of alfentanil 1 mg are reported in five patients with suspected normal pressure hydrocephalus who were undergoing infusion of saline into a lateral ventricle to measure cerebrospinal fluid outflow resistance. The increase in intracranial pressure was accompanied by a fall in mean arterial pressure. These observations show that, when the intracranial compliance is reduced, alfentanil can cause considerable increases in intracranial pressure and decreases in cerebral perfusion pressure.