bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression and anxiety in pain clinic patients, Rapid assessment by microcomputer
Authors: Hanks G.W. , Lloyd J.W. , Evans P.J.D. , Ancill R.J.
Published: February 2007

Computer administered depression and anxiety rating scales were used in a pilot study to screen patients attending a regional pain relief unit. Patients found the procedure acceptable and helpful. There was a poor correlation between the computer assessments and doctors' ratings, with in general a much greater degree of morbid depression and anxiety revealed by the computer. Computer administered rating scales may be useful as a screening tool in pain clinic patients to identify those at risk of signficant psychiatric morbidity.
Analgesia following femoral neck surgery. Lateral cutaneous nerve block as an alternative to narcotics in the elderly
Authors: Jones S.F. , White A.
Published: February 2007

In a prospective controlled randomised trial on patients undergoing operative repair of fractured neck of femur via a lateral incision, the postoperative analgesic requirements of one group of patients who received a lateral cutaneous nerve block were compared with a second group who received no block. The former group were found to need significantly less intramuscular pethidine in the first 24 hours, and 44% required no supplementary analgesia whatsoever during this period. The time to first dose of opioid in ihe remainder was greatly increased. No untoward sequelae associated with the nerve block were seen.
Malignant hyperthermia—or not?
Authors: Moxon M. Ann
Published: February 2007

Some of the problems of diagnosis and management of malignant hyperthermia are discussed as illustrated by three case reports.
Epidural meptazinol for pain relief after lower abdominal surgery
Authors: RAO U. , CAMPBELL I. T. , CATLEY D. M. , SUTHERST J. R.
Published: February 2007

A preliminary investigation is reported into the use of epidural meptazinol for pain relief in 20 patients after major lower abdominal (gynaecological) surgery. Analgesia was rapid in onset (15 minutes), had a median duration of 124 minutes (interquartile range 85‐212 minutes) after a single dose of 30 mg and a median duration of 122.5 minutes (interquartile range 70–127 minutes) after a single dose of 60 mg. Overall pain relief, as judged by the patients themselves, was satisfactory in 19 out of the 20 cases. At 30 minutes and 45 minutes pain relief was significantly better with the 60 mg than the 30 mg dose (p < 0.02). No drug‐related adverse events were observed during the study.
Influence of plasma proteins on the onset of hypnotic action of intravenous midazolam
Authors: HALLIDAY N. J. , DUNDEE J. W. , COLLIER P. S. , LOUGHRAN P. G. , HARPER K. W.
Published: February 2007

The action of midazolam is influenced by serum protein binding as seen in the relationship between the time of onset of action of a fixed dose of the drug and the plasma albumin. Pretreatment with intravenous aspirin produces a decrease in the in vitro binding of midazolam. In vivo this is manifest as an increase in the rapidity of action of the benzodiazepines. Probenecid pretreatment will also cause a decrease in the onset time of midazolam. However this is not due to altered plasma protein binding of the sedative.
Extracranial surgery—intracerebral tumour
Authors: MILLAR S. W. , HENSHER R.
Published: February 2007

A case is described in which localising neurological signs developed on the first day following general anaesthesia for insertion of a silastic implant over a frontal fracture. Despite prompt appropriate investigation seven weeks elapsed before the correct diagnosis was made. Aspects of the management of patients who develop a neurological deficit soon after general anaesthesia are discussed.
Severe hypertension during anaesthesia for dacryocystorhinostomy
Authors: EL‐DIN A. S. M. A. K. , MOSTAFA S. M.
Published: February 2007

A healthy 82‐year‐old woman presented for dacryocystorhinostomy under general anaesthesia. Following the application of intranasal cocaine and subcutaneous injection of felypressin she developed severe hypertension. multiple ventricular ectopic beats and depression of the ST segment on the electrocardiogram. A drug interaction is suspected.
The Penlon Bromsgrove high frequency jet ventilator for adult and paediatric use
Authors: SMITH B. E.
Published: February 2007

The Penlon Bromsgrove is a new high frequency jet ventilator, suitable for use in both adults and children. The jet stream is humidified by means of an integral in‐line Bernoulli nebuliser. The self‐recharging nebuliser can also convey drugs directly to the airways in the form of an aerosol. Alarms and fail‐safe systems are incorporated. A pressure gauge continuously displays the jet drive pressure. There are two digital LED displays; one shows jet frequency in breaths per minute; the other, the jet drive pressure, minimum, maximum and mean patient airway pressures. Two fail‐safe systems ensure that these pressures do not become excessive. Both audible and visual alarms are provided. The prototype has proved to be quiet and completely reliable over more than 4000 hours use, with no bronchoscopic or histological evidence of ineffective humidification.
Variability of fentanyl pharmacokinetics in man
Authors: REILLY C. S. , WOOD A. J. J. , WOOD M.
Published: February 2007

The derived pharmacokinetic data for the intravenous administration of fentanyl obtained from seven previous studies were compared using computer simulation of predicted plasma concentrations following three intravenous dosage regimens. There was wide discrepancy between the reported calculated pharmacokinetic constants from the various studies, such that the volume of distribution ranged from 4.4 to 59.7 litres, estimates of terminal elimination half‐life ranged from 141 to 853 minutes while total body clearance values ranged from 160 to 1530 ml/minute. The differences in predicted plasma concentrations were marked. The peak concentration following a bolus of 500 pg ranged from 8.4–113.6 ng/ml and took from 2.9 to 18.9 hours to fall to 0.5 ng/ml. The steady state plasma concentration reached with an infusion of 0.3 μg/kg/minute varied from 12.2–119.9 ng/ml and the plateau level attained with a two‐rate infusion (2.7 μg/kg/minute for 20 minutes then 0.3 μg/kg/minute) ranged from 10.6–50.8 ng/ml. The aim of descriptive pharmacokinetics is to allow the clinician to predict the plasma concentration achieved by a given dose and to facilitate dosage choice and adjustment. Recent interest has centred on the use of pharmacokinetics to calculate continuous intravenous infusion dosage regimens. The clinical application of current pharmacokinetic data for fentanyl is questionable.
The potencies of edrophonium and neostigmine as antagonists of pancuronium
Authors: BREEN P. J. , DOHERTY W. G. , DONATI F. , BEVAN D. R.
Published: February 2007

Dose response curves were constructed for edrophonium and neostigmine when used to antagonise pancuronium, 0.07 mg/kg during thiopentone‐nitrous oxide‐halothane anaesthesia. The antagonist was given when 10% twitch height had been restored and the effect was measured 10 minutes later. Recoveries to 50% and 90% twitch height were achieved with 167 and 828 μg/kg of edrophonium, and 10.5 and 51 μg/kg of neostigmine. The dose response curves were parallel and neostigmine was 16 times more potent than edrophonium. Combinations of equipotent doses of edrophonium and neostigmine were also administered and produced additive but not synergistic effects. It is concluded that either edrophonium or neostigmine may be used for the reversal of pancuronium neuromuscular blockade, but the combination of the two offers no advantage.
Biochemical changes following suxamethonium
Authors: LAURENCE A. S.
Published: February 2007

Forty patients were investigated for serum myoglobin changes following induction of anaesthesia but before the commencement of surgery. Blood was drawn for potassium, creatinine kinase and serum myoglobin immediately prior to and 5, 10 and 20 minutes after administration of thiopentone 4 mg/kg and suxamethonium 1.2 mg/kg. Twenty patients were given either 2 mg alcuronium or 20 mg gallamine as pretreatment 2 to 3 minutes before the suxamethonium to reduce the fasciculations. Anaesthesia was maintained with artificial ventilation and alcuronium, or spontaneous ventilation with halothane. Serum myoglobin was assayed by radioimmunoassay.

All pre‐induction rnyoglobin levels were within the normal range. Of the 20 patients who were not pretreated, six showed a marked rise of serum myoglobin within 5 minutes, increasing to 150–200 μg/litre at 20 minutes. The remaining 14 patients had no such rise. No patients in the pretreatment group had any significant rise in serum myoglobin, suggesting that although the fasciculations were not completely abolished, there was protection against one of the effects of suxamethonium on the muscle. Although there was no clear relationship between intensity of fasciculations and increase in serum myoglobin, there was no marked rise in serum myoglobin values in any patient who did not have muscle fasciculations. There were no consistent changes in potassium or creatinine kinase in any group during the period of study.
A new site for the adjustable pressure limiting valve on a circle absorber
Authors: PURI G. D. , VARMA Y. S.
Published: February 2007

A new site for the adjustable pressure limiting valve has been suggested which will result in the most efficient utilisation of soda lime using typical flows with a circle absorber system. It will permit economy of fresh gases using old models of circle absorbers in which the adjustable pressure limiting valve and fresh gas inlet are both situated upstream of the inspiratory unidirectional valve. The cost of the new attachment is small
C‐reactive protein in patients undergoing cardiac surgery
Authors: BORALESSA H. , DE BEER F. C. , MANCHIE A. , WHITWAM J. G. , PEPYS M. B.
Published: February 2007

Among 25 patients undergoing cardiac surgery with the aid of cardiopulmonary bypass, 13 who recovered uneventfully all had normal (< 2 mg/litre) levels of serum C‐reactive protein pre‐operatively. In contrast, 10 of the 12 patients who suffered from various postoperative complications, including two who died, had abnormally raised levels of C‐reactive protein pre‐operatively. AN patients showed a major acute phase response to surgery with peak C‐reactive protein levels at about 46 hours but, whereas the uncomplicated cases showed a characteristic smooth biphasic pattern of declining levels thereafter, the complicated cases all exhibited significant alterations of this pattern. The occurrence during the postoperative period of a secondary rise in C‐reactive protein or the failure of the level to continue falling, generally preceded clinical evidence of intercurrent infection. Pre‐operative measurement of serum C‐reactive protein may thus make a valuable contribution to the assessment of patients requiring elective cardiac surgery; regular postoperative monitoring can provide early warning of serious complications.
Intramuscular midazolam premedication in small children
Authors: TAYLOR M. B. , VINE P. R. , HATCH D. J.
Published: February 2007

Midazolam 0.2 mg/kg was compared as an intramuscular premedication in small children with papaveretum and hyoscine 0.4 and 0.008 mg/kg. Midazolam produced satisfactory sedation and anxiolysis and in the early postoperative period patients were significantly more awake 0,<0.05).
Detection of neurological damage during cardiopulmonary bypass
Authors: BOLSIN S. N. C.
Published: February 2007

Three cases of neurological damage, which occurred during cardiopulmonary bypass, and which were detected by the cerebra1, function analysing monitor, are reported. A fourth case, which had similar changes on the cerebral function analysing monitor but no neurological damage, is also described. The importance of changes in frequency of the cerebral electrical activity in the early detection and accurate prediction of severity of neurological damage is emphasised. The advantages of this instrument over other displays of the electroencephalogram are discussed.
Pulse oximetry
Authors: Clapham M. C. C. , Mackie A. M.
Published: February 2007

The applications of a pulse oximeter were studied in dental day case surgery using nasal mask anaesthesia. Changes in arterial oxygen saturation were sensitively and rapidly detected, in the absence of cyanosis. Impaired oxygenation can be detected before cyanosis develops.
Intubating conditions following pre‐induction priming with alcuronium
Authors: HARROP‐GRIFFITHS A. W. , GROUNDS R. M. , MOORE M.
Published: February 2007

Three priming doses of alcuronium have been investigated and, using a logistic transformation technique, the priming dose required to produce adequate intubating conditions in 99% of patients at 60 seconds following the second dose of alcuronium has been deduced. This dose, 106.5 μg/kg is extremely high and may be unsafe if used, since 30% of our patients complained of side effects when given a priming dose of only 50 μg/kg.
Anaesthesia for Friedreich's ataxia
Authors: BELL C. F. , KELLY J. M. , JONES R. S.
Published: February 2007

A patient with Friedreich's ataxia was anaesthetised on two occasions. The neuromuscular blocking agent was atracurium 0.5 mg/kg on the first occasion and tubocurarine 0.5 mg/kg on the second. The effect of each was monitored using the train‐ofifour twitch technique. Friedreich's ataxia has been reported to cause a marked sensitivity to non‐depolarising muscle relaxants and hyperkalaemia, with resulting cardiac dysrhythmias after suxamethonium. This patient did not demonstrate an abnormal response to either relaxant; the operating conditions were satisfactory and recovery was not delayed. These drugs may be safely used in this condition provided that monitoring is adequate.
Halothane and trichloroethylene
Authors: HOLLIS N.
Published: February 2007

The vapour pressures of static mixtures of halothane and trichloroethylene and the output of the two vapours from an Oxford Miniature Vaporizer filled with mixtures of the two liquids have been studied. In a small pilot study, a mixture of halothane and trichloroethylene was used for drawover anaesthesia in patients having minor surgery; this seems to work satisfactorily and may have some limited applications.
Respiratory depression after morphine in the elderly
Authors: DAYKIN A. P. , BOWEN D. J. , SAUNDERS D. A. , NORMAN J.
Published: February 2007

The effects of intravenous morphine (10 mg/70 kg) on the ventilatory response to CO2 were studied in two groups of subjects, young (18‐29 years) and old (66‐85 years), prior to elective surgery. In both groups morphine caused a signijcant depression of respiration as judged by a reduction in the slope of the CO2 response curve. a reduction in the calculated ventilation at an end tidal CO2 tension of 7.3 kPa, a rise in resting end tidal CO2 and a rise in the CO2 threshold. There were no significant differences between the two groups in the changes produced by the drug, suggesting that acute respiratory depression after a single intravenous injection of morphine is similar in old and young people.
Nebulised adrenaline 1:1000 in the treatment of croup
Authors: REMINGTON SHIRLEY , MEAKIN GEORGE
Published: February 2007

A case of infective croup is described which was successfully treated using nebulised adrenaline 1:1000. The diagnosis of croup and the basis for the use of nebulised adrenaline are discussed.
Minitracheotomy
Authors: LEWIS G. A. , HOPKINSON R. B. , MATTHEWS H. R.
Published: February 2007

Minitracheotomy is a simple percutaneous technique of tracheal cannulation using a small bore tube. It allows efficient tracheobronchial toilet while preserving glottic function. Examples of its use in the intensive therapy unit are described.
Acute poisoning with gold cyanide
Authors: Wright I. H. , Vesey C. J.
Published: February 2007

A case of deliberate ingest ion of an electroplating solution containing gold cyanide is described. Despite the use of an antidote, and supportive treatment for cyanide poisoning, the patient died after 13 hours. Sublethal cyanide and high red blood cell gold levels suggest acute gold toxicity as the most likely cause of death. Evidence for this is discussed and recommendations are made for the treatment of cyanide poisoning.
Distribution of evoked paraesthesiae and effectiveness of brachial plexus block
Authors: Smith B. E.
Published: February 2007

The distribution of paraesthesiae evoked by a low power nerve stimulator during performance of supraclavicular brachial plexus block was studied in 120 patients. Evoked paraesthesiae in the distribution of the median nerve was associated with a significant improvement in effectiveness of the block when compared with evoked paraesthesiae in the ulnar and radial distributions. A possible explanation for this funding is proposed.
Potentiation of epidural opioids with epidural droperidol
Authors: Bach V. , Carl P. , Ravlo O. , Crawford M. E. , Werner M.
Published: February 2007

During a period of one year, 119 patients with chronic pain received injections of opioids via a catheter inserted in the lumbar epidural space. Twenty‐three patients (19%) showed evidence of tolerance and were given droperidol 1.25–5.0 mg epidurally. In 20 patients in this study, there was a significant reduction in the number of epidural opioid injections. Six patients complained of excessive sedation, which disappeared when the dose of droperidol was reduced, although this did not affect the analgesia. One patient given an accidental overdose of droperidol developed reversible Parkinsonism. It is concluded that epidural administration of the dopamine antagonist droperidol may be beneficial as supplementary medication to epidural opioids when tolerance develops.
Can epidural catheters penetrate dura mater? An anatomical study
Authors: Hardy P.A.J.
Published: February 2007

A study using postmortem dura mater and arachnoid mater showed that catheter perforation of dura did not occur. In contrast, perforation of arachnoid proved easy.
Intravenous regional anaesthesia below the knee
Authors: Valli H. , Rosenberg P. H.
Published: February 2007

The quality of anaesthesia provided by three dosages of prilocaine. 40 ml 0.5%. 20 ml 1%, or 40 ml 1%. administered in random order, for intravenous regional anaesthesia of the lower extremity below the knee was compared in six volunteers. Limited sensory blockade was achieved in the groups with 40 ml 0.5% and 20 ml I% during the 30‐minute test period. One subject was not fully anaesthetised with any of the dosages used. Recovery was rapid (mean 12–13 minutes) in these two groups. In two subjects given 40 ml of 1%. complete recovery took 90 minutes. At 30 minutes, the degree of flexion remaining in the great toe (control 100%) was 4% in the groups who received 40 ml Of 0.5% and 1 %, but 34% in those who received 20 ml of I% respectively. Full motor recovery was achieved in 8–9 minutes. Five of six volunteers who received the 400‐mg dose experienced subjective signs of central nervous system side effects when the cuff was released. In this group, the mean plasma level of prilocaine at 2 minutes was 1.22 μg/ml. maximum 2.12 μg/ml. In a radiological examination, no leak of contrast medium under the tourniquet cuff (300 mmHg) was detected. The development of anaesthesia was fastest following the largest dose, but the large number of central side effects makes that dosage less suitable for clinical work.
Obstetric epidural test doses
Authors: PRINCE G. , MCGREGOR D.
Published: February 2007

A number of obstetric fatalities related to epidural anaesthesia have been reported recently. In each case catheter or needle misplacement had resulted in a lethal intrathecal or intravascular injection. In this review these cases and a number of other similar but nonfatal reports are examined. In many cases, essential safety checks such as the aspiration test and the test dose had not been performed before the epidural injection, but in others one or both of these tests had been used and had failed to predict the complication. Safety test failures generally occurred because ineffective tests were used or because effective tests were inadequately interpreted. This is not surprising because although textbooks recommend a bewildering variety of test doses, they seldom give precise details as to how they should be conducted. A detailed test dose protocol is recommended, which will safely warn of epidural catheter and needle misplacement in the most effective manner possible. If the protocol is used, accidental subarachnoid and intravascular injections can be reduced to a minimum, but they will still occur. It is emphasised that these complications should not cause fatalities if trained personnel and adequate resuscitation facilities are available.
Intravenous anaesthesia with propofol and alfentanil. The influence of age and weight
Authors: Hilton P. , Dev V.J. , Major E.
Published: February 2007

Sixty healthy patients undergoing body surface surgery were anaesthetised with continuous infusions of propofol (200 μ/kg/minute) and alfentanil (0.25 μ/kg/minute). Additional bolus doses of propofol (20 mg) were given if movement occurred. The incidence of patient movement in response to skin incision was significantly less in patients over 45 years of age than in those below 45 years (p < 0.05). Maintenance dosage of propofol sufficient to abolish movement decreased with increasing age (p < 0.001). Systolic blood pressure decreased in most patients over the first 10 minutes of anaesthesia and the magnitude of this decrease increased with age (p < 0.0001). These parameters did not correlate strongly with body weight. Dose requirements of propofol are not the same for patients of all ages and strongly suggest that young and old patients should not he treated as a homogeneous group, either for investigative or clinical purposes.
Treatment of near drowning—a review of 130 cases
Authors: Simcock A.D.
Published: February 2007

This paper reviews the management and clinical course of patients after rescue from near drowning. Those with adequate ventilation on arrival at hospital had an excellent prognosis. The prognosis of those patients with inadequate ventilation, or who have suffered cardiac arrest, depends on rapid assessment and the institution of vigorous resuscitative measures. The medical management of all types of patients is reviewed in detail. the results tabulated and complications discussed.
Ventilatory effects of propofol during induction of anaesthesia
Authors: TAYLOR M. B. , GROUNDS R. M. , MULROONEY P. D. , MORGAN M.
Published: February 2007

The ventilatory effects of induction of anaesthesia with either propofol 2.5 mg/kg or thiopentone 4.0 mg/kg have been observed in patients premedicated with either atropine alone or papaveretum and hyoscine. Induction of anaesthesia with propofol was accompanied by a greater degree of ventilatory depression which was of longer duration than following thiopentone. The effect was accentuated by the opioid premedication.
Intercostal neuralgia following stellate ganglion block
Authors: McCALLUM M. I. D. , GLYNN C.J.
Published: February 2007

The case is described of a 78‐year‐old female patient who experienced temporary but severe chest wall pain following stellate ganglion block. The possible mechanisms and treatment of this complication are discussed.
Management of a glomus jugulare tumour with internal carotid artery involvement
Authors: BRAUDE B. M. , HOCKMAN R. , McINTOSH W. A. , HAGEN D.
Published: February 2007

A previously healthy 40–year‐old female presentedfor surgical resection of a large glomus jugulare tumour with extensive involvement of the carotid siphon and intracranial extension. Conduct of anaesthesia with specijic reference to cerebral protection is discussed. A combination of induced hypothermia, barbiturate therapy, normotension, normocarbia and prior clamping of the distal internal carotid artery was chosen. The role of barbiturates as a therapeutic intervention is debated.
Pretreatment with opioids
Authors: Dundee J. W. , Halliday N. J. , Mcmurray T. J. , Harper K. W.
Published: February 2007

Pretreatment with small doses of fentanyl (fO0 jig) or alfentanil (300 pg) was found significantly to reduce the induction dose of thiopentone. Fentany 150 μp and alfentanil 150 pg also signifcantly reduced the onset time and increased the consistency of action of midazolam. Respiratory depression was not a problem when 50 pg fentanyl or 150 pg alfentanil were used.
Amiodarone, phaeochromocytoma and cardiomyopathy
Authors: Solares G. , Ramos F. , Martin‐Duran R. , SAN‐Jose J. M. , Buitrago M.
Published: February 2007

The anaesthetic management of a patient with a phaeochromocytoma and cardiomyopathy is described. The control of dysrhythmias was the major problem. Ventricular dysrhythmias were treated with lignocaine, and intravenous amiodarone was used to control the supraventricular rhythm disturbances.
Local complications following intravenous benzodiazepines in the dorsum of the hand. A comparison between midazolam and Diazemuls in sedation for dentistry
Authors: Margary J. J. , Rosenbaum N.L. , Partridge M. , Shankar S.
Published: February 2007

Two hundred patients requiring sedation for minor oral surgery were randomly allocated to receive either midazolam or diazepam as Diazemuls intravenously through a 23‐gauge indwelling needle in the dorsum of the hand. The site of injection was inspected at 7 days and 14 days post injection and assessed for pain, tenderness, redness, induration, painless thrombosis, and thromhophlebitis. The mean dose administered was 0.119 mg/kg of midazolam and 0.298 mg/kg of Diazemuls. At 7 days there was no significant difference in venous complications. At the 14 day follow up, the midazolam group had a significantly greater incidence of tenderness and redness (p < 0.001 and p < 0.05 respectively using Chi squared test). The incidence of thrombophlebitis in the midazolam group was 2% at 7 days and 1% at 14 days, the corresponding figures in those given Diazemuls being none und 1% respectively. We conclude that the dorsum of the hand is a satisfactory site of injection for administration of these drugs. The higher incidence of minor complications at 14 days following midazolam was offset by its more reliable amnesic properties.
Accidental spinal anaesthesia following intrathoracic intercostal nerve blockade
Authors: SURY M. R. J. , BINGHAM R. M.
Published: February 2007

A case of high spinal anaesthesia following intrathoracic intercostal nerve blockade is described and the possible causative mechanisms are discussed.
Multiple complications after internal jugular vein catheterisation
Authors: GAMULIN Z. , BRÜCKNER J.‐C. , FORSTER A. , SIMONET F. , ROUGE J.‐C.
Published: February 2007

We report a case of a young female who developed multiple life threatening complications after a single internal jugular vein catheterisation. They consisted of pleural misplacement of the catheter. massive haemorrhage with cardiovascular collapse following catheter removal, and development of arteriovenous fistula, diagnosed 18 months later.
The prevention of renal impairment in patients undergoing orthotopic liver grafting by infusion of low dose dopamine
Authors: POLSON R. J. , PARK G. R. , LINDOP M. J. , FARMAN J. V. , CALNE R.Y. , WILLIAMS R.
Published: February 2007

Administration of low dose dopamine (2.0 μg/kg/minute) begun before surgery in patients undergoing liver transplantation decreases the incidence of postoperative renal impairment. Thirty‐four consecutive patients in the Cambridge/King's College Hospital liver transplantation series were studied. Nineteen patients (21 transplant operations) received prophylactic low dose dopamine throughout the operative and early postoperative period, while 15 patients (15 transplant operations) received dopamine only when clinically indicated for incipient renal failure or as an inotropic agent. In the prophylactic dopamine group, only two transplant operations (9.5%) were complicated by renal impairment, whereas in the other group, 10 patients (67%) developed renal impairment (p = 0.001); of these, four developed acute renal failure (27%). Comparison of seven pairs of patients, matched for age, sex, diagnosis, operative blood loss and operative hypotension (one group receiving dopamine, the other not), revealed a significantly higher urine output in the first 24 hours and creatinine clearance 24—48 hours after surgery (p < 0.05) in those treated prophylactically. In view of these findings, we would recommend that consideration be given to the prophylactic use of dopamine in patients undergoing orthotopic liver transplantation.
Continuous display of plasma potassium during cardiac surgery
Authors: DRAKE H. F. , TREASURE T. , SMITH B.
Published: February 2007

We have evaluated the use of an intravascular ion‐selective electrode for continuous plasma potassium monitoring in patients during and after cardiac surgery. Potassium estimations from the indwelling electrode provided a rapid and sensitive, but only moderately reliable, indicator of potassium as confirmed by blood samples. Several significant changes in the plasma potassium were found to occur in the period studied and using this continuous monitor, the precise time course of these changes was recorded.
A prospective study of 200 consecutive twin deliveries
Authors: CRAWFORD J. S.
Published: February 2007

A prospective study of consecutive series of 200 twin pregnancies has provided some definitive and some tentative conclusions. It has been shown that in any attempt to assess the value of form of clinical management, cases in which nuchal cord was present in either twin must be disregarded and that attention must be paid to the techniques of analgesia/anaesthesia provided for delivery. There is strong suggestion that the provision of an epidural for either Caesarean section or vaginal delivery is markedly beneficial to the second twin. There is also evidence to suggest that when vaginal delivery is conducted under an epidural, the acid‐base status of the second twin is very likely to be as good as, or better than, that of its sibling, where as that is most unlikely to be so among cases delivered without an epidural. Further benefit is conferred upon both twins if the bearing‐down reflex is abolished. Attention is drawn to an apparently increasing frequency of abdominal delivery of the second twin following vaginal delivery of the first and to the consequent demand which this must make upon anaesthetic cover.
The effect of pregnancy on pulmonary nitrogen washout
Authors: BYRNE F. , ODURO‐DOMINAH A. , KIPLING R.
Published: February 2007

Pre‐oxygenation times were studied in 30 fit pregnant women during the course of their pregnancy. The mothers were studied in the supine position with a left lateral tilt and breathing through a standard Magill system with an oxygen flow rate of 8 litres/minute. Between 13–26 weeks gestation and 26–42 weeks the times needed to achieve an end‐tidal nitrogen of 2% were 104 seconds (SD 30) and 80 seconds (SD 20), respectively. A control group of young women of similar age and weight needed 130 seconds (SD 30) to achieve the same end‐tidal nitrogen concentration. A gas‐tight mask was found to be essential to achieve effective denitrogenation (end‐tidal nitrogen concentration of 2%).
Anaphylactoid reaction to alcuronium
Authors: PUSEY J. M. , CHARLTON S.M. , SKINNER J. B. , ASSEM E. S. K.
Published: February 2007

A 67‐year‐old woman suffered cardiovascular collapse during induction of anaesthesia. This was later shown to be anaphylactic in origin; the causative agent was alcuronium. In vitro testing showed a highly specific sensitivity to alcuronium with minimal cross‐reactivity. Future anaesthesia with decreased risk was thereby assured. The clinical nature of this reaction and a review of the literature implicate the cardiovascular system as the principal target in this type of reaction to alcuronium and suggest that the heart is directly involved.
Respiratory depression after intrathecal opioids
Authors: KRANTZ T. , CHRISTENSEN C. B.
Published: February 2007

Morphine 20 mg and pethidine 50 mg were accidentally injected intrathecally in a patient who had received large doses of opioids epidurally for cancer pain and who had shown tolerance to their effects. The well established tolerance to spinal opioids did not protect the patient against a moderate degree of respiratory depression. Morphine concentrations 6.5 hours after the morphine injection were 103 500 ng/ml and 52 ng/ml in cerebrospinal fluid and serum, respectively.
Unilateral pulmonary oedema/atelectasis in the lateral decubitus position
Authors: BARAKA A. , MOGHRABI R. , YAZIGI A.
Published: February 2007

An obese male patient developed hypoxia, hyercarbia and radiological signs of pulmonary oedemal atelectasis in the dependent lung after surgery in the lateral decubitus position. This appears to have been due to ventilation‐perfusion mismatch, although other factors were considered. The patient recovered following 36 hours of intermittent positive pressure ventilation of the lungs.
Explosive anaesthetic agents. A regional survey on the use of ether and cyclopropane
Authors: Konarzewski W. H. , Richards G. , Thomson S. , Nash D.G.
Published: February 2007

A total of 156 consultant anaesthetists in the North East Thames Regional Health Authority were circulated with a questionnaire on their personal use of ether and cyclopropane and their attitudes towards restriction or withdrawal of these agents; 144 completed questionnaires were received (92% response). Four anaesthetists (3%) claimed to use ether regularly at least once a month and 27 anaesthetists (19%) fell that their anaesthetic practice would suffer if ether were withdrawn. Cyclopropane had 62 regular users (43%) and 65 anaesthetists (45%) felt that their practice would suffer if it were withdrawn. Ninety‐two anaesthetists (64%) were prepared to confine their use of explosive agents to either the anaesthetic room or the operating room; of these, three‐quarters favoured the anaesthetic room. There were few notable differences in the pattern of use of explosive agents between anaesthetists with more than 21 years in the specialty and those with less than 21 years.
Evoked potentials following diazepam or fentanyl
Authors: Loughnan B. L. , Sebel P. S. , Thomas D. , Rutherfoord C. F.
Published: February 2007

The effects of fentanyl or diazepam on somatosensory, visual and brainstem auditory evoked potentials were studied in 13 healthy patients scheduled for elective surgery. Following control recordings of evoked potentials, either diazepam 20 mg or fentanyl 200 μg was administered intravenously. Evoked potentials were then recorded twice in the subsequent hour. No significant changes occurred in the latency or amplitude of somatosensory, visual or brainstem auditory evoked potentials. Although dose‐related changes in evoked potential latencies and amplitudes have been demonstrated with both the inhalational and intravenous anaesthetics, these changes did not occur with diazepam or fentanyl used alone. An anaesthetic technique based on these two drugs would be suitable when intra‐operative evoked potential monitoring is required to assess ischaemia and preservation of evoked responses.
Premedication for day case surgery
Authors: RAYBOULD D. , BRADSHAW E. G.
Published: February 2007

A double‐blind, between‐patient trial was used to assess midazolam 7.5 and 15 mg as oral premedication for day case surgery. Midazolam 7.5 mg did not produce significant anxiolysis or sedation in comparison to placebo as measured by patient self‐assessment linear analogue scales and observer scores. Midazolam 15 mg caused significant anxiolysis and sedation pre‐operatively but also at 2 hours following awakening. Psychomotor performance assessed by digital‐symbol substitution tests was significantly impaired by midazolam, in both doses, throughout the period of investigation. Midazolam 15 mg orally provides good premedication but the prolonged effects make it unsuitable for short‐stay patients.
Memory of cardiac anaesthesia
Authors: GOLDMANN L. , SHAH M. V. , HEBDEN M. W.
Published: February 2007

Thirty patients scheduled for elective cardiopulmonary bypass surgery were interviewed pre‐operatively and postoperatively to assess changes in their emotional state and recollections, both aware and unaware, of intra‐operative events. A random selection of patients heard a prerecorded audio tape towards the end of bypass after they were rewarmed to 37°C. The tape contained suggestions for patients to touch their chin during the postoperative interview, to remember three sentences and to recover quickly. The interviewers were blind to the experimental condition. The experimental group touched their chins significantly more often than the control group (p = 0.015). Sentence recognition did not reach significance and this may be due to the small numbers and low salience of the stimuli. Seven patients (23%) recalled intra‐operative events, five with the aid of hypnosis. Three reports (10%) were corroborated. Pre‐operative medication (p < 0.01) and postoperative anxiety (p < 0.05) were significant predictors of those patients who reported recall.
Cardiovascular collapse following epidural anaesthesia for Caesarean section in a patient with aortic incompetence
Authors: ALDERSON J. D.
Published: February 2007

A death following epidural anaesthesia for Caesarean section in a patient with aortic incompetence and pre‐eclampsia is described. Possible hazards of epidural anaesthesia in aortic incompetence are described and it is suggested that reduction of total peripheral resistance is contraindicated in such patients.
A comparison of propofol and methohexitone as induction agents for day case isoflurane anaesthesia
Authors: O'TOOLE D. P. , MILLIGAN K. R. , HOWE J. P. , McCOLLUM J. S. C. , DUNDEE J. W.
Published: February 2007

The induction and recovery characteristics of equivalent doses of propofol and methohexitone were compared in 50 patients undergoing day case isoflurane anaesthesia. Propofol induction was smoother but was associated with greater cardiorespiratory depression. Both the speed and quality of recovery were superior with propofol compared with methohexitone.
The effect of sufentanil on the cardiovascular responses to tracheal intubation
Authors: KAY B. , NOLAN D. , MAYALL R. , HEALY T. E. J.
Published: February 2007

The effects of sufentanil 0.5 or 1 μg/kg, given intravenously after induction of anaesthesia, on the cardiovascular responses to tracheal intubation were examined in a controlled, randomised, double‐blind investigation. The control group of patients exhibited significant rises in arteriat blood pressure and heart rate for 4 minutes after tracheal intubation. Heart rate exceeded 100 beats/minute and systolic pressure increased by over 20% in every patient. All patients moved or breathed within 10 minutes of the administration of suxamethonium. Sufentanil 0.5 μg|kg prevented increases in the me an values of heart rate and arterial blood pressure, although increases were observed in five patients. Significant falls in the mean values of heart rate and arterial pressure occurred from 4 minutes after intubation until observations ended 15 minutes after induction of anaesthesia. Two patients moved or breathed during this time, although movement in response to nerve stimulation occurred in all patients 10 minutes after administration of suxamethonium. Sufentanil 1 μg/kg was effective in suppressing a rise in heart rate or arterial pressure in every patient. Significant falls in these variables occurred from 2 minutes after tracheal intubation onwards. No patient moved or breathed for 15 minutes after induction of anaesthesia, although neuromuscular transmission was present 10 minutes after giving suxamethonium in each case.
Unexpected difficult intubation
Authors: MASON D. G. , WARK K. J.
Published: February 2007

Two cases of asymptomatic epiglottic cysts which presented as partial upper airway obstruction following induction of anaesthesia are described. The incidence, pathology and anaesthetic management are discussed.
Prolonged and biphasic respiratory depression following epidural buprenorphine
Authors: JENSEN F. MOLKE , JENSEN N.‐H. , HOLK I. K. , RAVNBORG M.
Published: February 2007

Ventilatory sensitivity to carbon dioxide was measured in six healthy volunteers before, and at various times up to 20 hours after, administration of epidural buprenorphine 0.15 mg with a modified Read rebreathing technique. The carbon dioxide response curves were depressed in a time‐dependent, prolonged and biphasic manner. Significant depression was seen in the intercept values at an end tidal carbon dioxide of 7.2 kPa. for mouth occlusion pressure (p < 0.01), tidal volume (p < 0.05) and minute ventilation (p < 0.05). A significant reduction of slope was obtained only for minute ventilation. Linear regression of respiratory rate changes during carbon dioxide stimulation, did not reach statistical significance. In conclusion, these data indicate that epidural buprenorphine, despite a high lipid solubility, causes respiratory depression to the same extent as epidural morphine. Surveillance of patients who receive epidural buprenorphine for postoperative pain relief is necessary.
Difficult tracheal intubation: a retrospective study
Authors: SAMSOON G. L. T. , YOUNG J. R. B.
Published: February 2007

This is a retrospective study of patients whose tracheas were impossible to intubate on a previous occasion. There is a correlation between the degree of difficulty and the anatomy of the oropharynx in the same patient. The study was initially on obstetric patients but was extended to nonobstetric surgical patients in order to increase the number of cases investigated. The incidence of failed intubations in the obstetric group over a 3‐year period was seven out of 1980 cases, whereas in the surgical group the results were six out of 13 380 patients. Any screening test which adds to our ability to predict difficulty in intubation must be welcomed, as failure to intubate can potentially lead to fatality.
Awareness under anaesthesia due to a defective gas‐loaded regulator
Authors: PURI G. D. , GEORGE M. A. , SINGH H. , BATRA Y. K.
Published: February 2007

Awareness under anaesthesia occurred in two patients due to a defect in an anaesthesic machine, which caused an inadequate supply of nitrous oxide. A defective fail‐safe gas‐loaded regulator was found to have caused communication between the pipelines for oxygen and nitrous oxide. This resulted in oxygen flow through the nitrous oxide flowmeter. A simple test to detect this type of defect is suggested.
Assessment of alfentanil by intravenous infusion as long‐term sedation in intensive care
Authors: Cohen A.T. , Kelly D.R.
Published: February 2007

The use of an alfentanil infusion for sedation of critically ill patients in intensive care was investigated in 16 patients who were entered consecutively into the study. The mean duration of stay was 8 days. Supplements of Diazemuls and muscle relaxants were administered if required. The success of the technique was judged by nursing and medical staff and, in particular, the wakefulness of patients was noted. No patient could recall events that occurred during their infusion. An outline protocol is described.
Suxamethonium apnoea in a 4‐month‐old twin
Authors: MEHTA Y. , HOLE P.
Published: February 2007

A case of one infant of twins who developed suxamethonium apnoea is described. Investigation of the family revealed him to be homozygous for atypical cholinesterase while the other twin was normal. Tissue HLA and blood typing indicated the twins to be identical.
Miller's syndrome
Authors: RICHARDS M.
Published: February 2007

A new case of Miller's syndrome is reported and the characteristic features are described along with a brief outline of related conditions. The anaesthetic management is discussed and the problems which may be encountered when dealing with this syndrome are highlighted.
Spontaneous retrobulbar haemorrhage following anaesthesia
Authors: GUNNING K. E. J. , COLLETT B. J.
Published: February 2007

A case is presented of retrobulbar haemorrhage following anaesthesia for the removal of a chicken bone from the pharynx of a patient with systemic lupus erythematosus. The aetiology and treatment are discussed.
A comparison of halothane and trichloroethylene with isoflurane. A study of drawover air anaesthesia with the Triservice anaesthetic apparatus
Authors: Tighe S. Q. M. , Pethybridge R. J.
Published: February 2007

Induction and recovery times were not significantly different between two groups that received halothane with trichloroethylene and isoflurane, respectively. Maintenance of anaesthesia and analgesia was also satisfactory. Isoflurane resulted in a higher heart rate (p < 0.01), a lower respiratory rate (p < 0.01) and a higher inspired oxygen concentration (p < 0.05). Respiration may be more efficient. Other potential advantages of isoflurane for anaesthesia in the field are discussed. Despite the fact that it is 15 times more expensive, the use of isoflurane as sole agent is recommended.
Analgesia from morphine and ketamine
Authors: OWEN H. , REEKIE R. M. , CLEMENTS J. A. , WATSON R. , NIMMO W.S.
Published: February 2007

Ketamine 4 μg/kg/minute produced pain relief similar to that from morphine 33 μg/minute in a doubleblind study that compared analgesia from constant‐rate intravenous infusions of the two drugs in 60 patients. The analgesic efficacy of the infusions, as assessed by pain scores and the requirement for supplementary self‐administered morphine, was poor. Ventilatory depression, the most significant side effect, occurred only in patients who received morphine infusion. The low dose ketamine infusion did not provide clinically useful analgesia even though adequate plasma concentrations were achieved.
Intravenous sedation for cataract surgery
Authors: GILBERT J. , HOLT J. E. , JOHNSTON J. , SABO B. A. , WEAVER J. S.
Published: February 2007

Fifty‐five unpremedicated outpatients scheduled for cataract surgery were randomly allocated to receive either a fixed dose of nalbuphine and methohexitone or fentanyl and diazepam administered in a dose adjusted to produce the required sedative effect. Statistical analysis revealed no difference between groups with regard to immediate side effects, intra‐ocular pressure or postoperative nausea or vomiting. Recovery time from administration of the sedative until compliance with simple commands was significantly longer in the nalbuphine/morphine group (89 vs 196 seconds) but this was not felt to be of clinical importance. This combination was better in terms of sedation at the time of insertion of the nerve blocks, lack of recall of insertion of the nerve block, incidence of intra‐operative complications, surgeon's assessment of operating conditions and patient acceptability. This fixed dose by weight drug combination for intravenous sedation should be applied widely.
Sir Ivan Magill
Authors: CONDON H. A.
Published: February 2007

Further annotated references to the life and work of Sir Ivan Magill are listed.
Epidural sufentanil versus intramuscular buprenorphine for postoperative analgesia
Authors: DONADONI R. , ROLLY G.
Published: February 2007

Epidural sufentanil 50 μg was compared with intramuscular buprenorphine 0.3 mg for postoperative pain relief. Patients were assigned randomly to one of two treatment groups and received both an intramuscular and epidural injection, one of which was a placebo. Onset of pain relief was faster and quality of analgesia superior during the first 2 hours in the patients who received epidural sufentanil but the duration of analgesia was longer in the buprenorphine group. Cardiovascular variables remained stable in all patients and no respiratory depression was observed. Side effects were more frequent following buprenorphine.