bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum glutathione S‐transferase concentrations and creatinine clearance after sevoflurane anaesthesia
Authors: Darling J. R. , Murray J. M. , McBride D. R. , Trinick T. R. , Fee J. P. H.
Published: January 2004

The effects of sevoflurane and isoflurane on serum glutathione S‐transferase concentrations and creatinine clearance were compared in 50 ASA I–III patients aged over 18 years undergoing body surface surgery of 1–3 h predicted duration. Patients randomly received sevoflurane (n = 24) or isoflurane (n = 26) in nitrous oxide and oxygen (FIO2 = 0.4) via a nonrebreathing system. Fluids were standardised and patient’s lungs ventilated to normocapnia. Expired concentration of anaesthetic agent was adjusted to maintain systolic arterial pressure between 70 and 100% of baseline. Patients received significantly less (p < 0.05) sevoflurane (1.0 MAC‐h) than isoflurane (1.5 MAC‐h). Using serum glutathione S‐transferase concentrations and creatinine clearance as markers of hepatic and renal function respectively, no statistically significant differences were identified between the groups.
The first structure–function approach to drug design in anaesthesiaDr David S. Savage and pancuronium bromide
Authors: Brown D. L. , Brock‐Utne J. G.
Published: January 2004

This is the story of the development of pancuronium bromide and David S. Savage's enormous contribution to the first rational structure–function approach to the design of a pharmaceutically useful drug.
An epidural abscess due to resistant Staphylococcus aureus following epidural catheterisation
Authors: Yuste M. , Canet J. , Garcia M. , Gil M. A. , Vidal F.
Published: January 2004

We report a case of abscess formation after epidural analgesia, a rare complication that developed in our patient 13 days after placement of a thoracic epidural catheter for patient controlled analgesia. Culture of the pus grew methicillin‐resistant Staphylococcus aureus. Although early diagnosis and rapid management have been reported to yield a satisfactory outcome, the case we describe ended in severe sequelae.
Central airway compression Anaesthetic and intensive care consequences
Authors: McMahon C. C. , Rainey L. , Fulton B. , Conacher I. D.
Published: January 2004

We present the case of a 32‐year‐old woman with compression of the central airway, in whom airway control was lost on two separate occasions, regained using a rigid bronchoscope and whose subsequent intensive care management was complicated by dynamic hyperinflation.
Fentanyl and the interleukin‐6 response to surgery
Authors: Taylor N. M. , Lacoumenta S. , Hall G. M.
Published: January 2004

It has been suggested that large doses of opioids may suppress the interleukin‐6 response to surgery. We examined the effects of the supplementation of inhalational anaesthesia with either 3 or 15 μg.kg−1 fentanyl on the circulating interleukin‐6, interleukin‐8, C‐reactive protein, cortisol and glucose concentrations in 16 patients undergoing pelvic surgery. In both groups, surgery evoked the expected glucose, cortisol and interleukin‐6 response but no increase in interleukin‐8 was detected. There were no significant differences between the two groups. We conclude that the supplementation of inhalational anaesthesia with conventional doses of opioids does not modify the cytokine response to surgery.
An unusual complication of emergency tracheal intubation
Authors: Ooi G. C. , Irwin M. G. , Lam L. K. , Cheng S. W. K.
Published: January 2004

A 68‐year‐old woman presented with dyspnoea having undergone a short period of tracheal intubation during an episode of congestive cardiac failure 10 days earlier. On the fourth day of admission, she suddenly developed acute respiratory distress followed by a cardiac arrest and was found to have an enlarging neck mass. Following intubation and resuscitation, computerised tomography was carried out and surgical exploration revealed a retropharyngeal abscess and a pseudo‐aneurysm of the common carotid artery resulting from pharyngeal rupture which most probably occurred as a complication of the original tracheal intubation.
Morphine blood concentrations in elderly postoperative patients following administration via an indwelling subcutaneous cannula
Authors: Semple T. J. , Upton R. N. , Macintyre P. E. , Runciman W. B. , Mather L. E.
Published: January 2004

The pharmacokinetics of morphine in venous blood after a 5 mg bolus dose via an indwelling subcutaneous cannula were characterised in 22 elderly patients undergoing elective major surgery. In a subgroup of seven patients, the kinetics were also characterised after a second 5 mg dose of morphine administered 180 min after the first dose. Blood morphine concentrations following the single dose were highly variable — the coefficients of variation of Cmax, Tmax and the AUC up to 180 min (AUC180) were 54, 37 and 39%, respectively, with mean values of 86.6 ng.ml−1, 15.9 min and 3954 ng.ml−1, respectively. These mean values for the second dose were not statistically different to those of the first dose but were more variable. It was concluded that the injection of morphine via an indwelling subcutaneous cannula results in blood concentrations that are comparable to, and as variable as, those arising from intramuscular injection.
The effects of single‐handed and bimanual cricoid pressure on the view at laryngoscopy
Authors: Yentis S. M.
Published: January 2004

The effects of two different methods of cricoid pressure on laryngoscopic view were studied in 94 healthy women presenting for routine gynaecological surgery. Laryngoscopy was performed with either single‐handed or bimanual cricoid pressure; after grading of the view obtained, the other method was used and a second grading performed. Laryngoscopic view was better with the bimanual than with the single‐handed technique (p = 0.016). In 21 cases, a better laryngoscopic view was obtained with the bimanual technique; in eight cases it was better with the single‐handed technique; and in 65 cases, the method of cricoid pressure made no difference. Age, weight, Mallampatti score and thyromental distance did not differ between patients in these three groups. Bimanual cricoid pressure should be the initial technique of choice during rapid sequence induction but, in a minority of cases, switching to a single‐handed technique may improve the laryngoscopic view. The technique of cricoid pressure which produces the best laryngoscopic view in an individual patient cannot be predicted from the physical features studied.
Postoperative ‘minor’ complications
Authors: Myles P. S. , Hunt J. O. , Moloney J. T.
Published: January 2004

We compared the incidence of postoperative complications in women (vs. men) in 4173 patients. Overall, women were almost twice as likely to report any postoperative complication (RR = 1.92, p < 0.0005). Specifically, they were 2.6 times more likely to report nausea and vomiting (p < 0.0005), 1.5 times more likely to report sore throat (p = 0.0001), 2.3 times more likely to report headache (p < 0.0005) and 2.4 times more likely to report backache (p = 0.0036). Whether these gender differences are due to a reporting bias, or whether in fact women are at greater risk of such complications, remains to be determined.
Guidelines and cardiac anaesthetists
Authors: Alston R. P.
Published: January 2004

Guidelines for cardiac anaesthesia could reduce irrational variation in practice and so improve cardiac surgical outcome. In October 1994, a postal survey was undertaken to determine the views and attitudes of consultant cardiac anaesthetists in the United Kingdom towards guidelines. One hundred and forty correctly completed questionnaires were returned (minimum response rate 64%). Eighty‐nine per cent believed that guidelines were of value in medicine whilst only 21% wanted national guidelines for cardiac anaesthesia. Responses to other parts of the questionnaire showed that those against guidelines for cardiac anaesthesia were less positive towards their advantages and more negative to their disadvantages compared with those in their favour. The majority of cardiac anaesthetists, although believing them to be valuable in medicine, do not want guidelines for cardiac anaesthesia because they are concerned that guidelines would be inflexible and would neither reduce variation in, nor improve the quality of, cardiac anaesthesia.
A new combined spinal–epidural apparatus: measurement of the distance to the epidural and subarachnoid spaces
Authors: Hoffmann V. L. H. , Vercauteren M. P. , Buczkowski P. W. , Vanspringel G. L. J.
Published: January 2004

A new combined spinal–epidural anaesthesia apparatus with a 27G lockable spinal needle was used in 151 patients. Two groups could be created, based on whether dural perforation was felt or not (group 1: with dural click; group 2: no dural click). Measurements of the epidural space depth and of the protrusion of the spinal needle from the epidural needle (tip‐to‐tip distance) were made. The mean depth of the epidural space was 5.59 cm. Correlations were found with body weight, weight‐to‐height ratio and body mass index (p < 0.001). The mean tip‐to‐tip distance measured was 7.0 mm in the patients of group 1, whereas in group 2 a distance of 8.9 mm was found. This difference was statistically significant. Correlations were found between the epidural space width and the patient's height, weight‐to‐height ratio and body mass index. Four patients felt paraesthesia during placement of the spinal needle and, in another four patients, aspiration was necessary to detect cerebrospinal fluid. Two patients needed epidural top‐ups due to insufficient level of anaesthesia. The lockable spinal needle provides safe and stable conditions during injection and a high rate of success in reaching the subarachnoid space.
Deliberate self‐poisoning with dapsone
Authors: Ferguson A. J. , Lavery G. G.
Published: January 2004

We report the case of a 14‐year‐old girl who deliberately ingested 8–9 g of dapsone and presented with severe methaemoglobinaemia and altered mental status. Prompt treatment with repeated doses of methylene blue and organ support brought about control of the methaemoglobinaemia and averted organ failure.
Dental mirror for difficult nasotracheal intubation
Authors: Matot I. , Hevron I. , Katzenelson R.
Published: January 2004

A patient with a previous surgical history of a cleft lip and palate repair and a pharyngeal flap pharyngoplasty was admitted for repair of mandibular prognathism. Following induction of anaesthesia, it was impossible to advance the nasotracheal tube into the oropharynx. Using a dental mirror and retrograde tracheal intubation equipment, under direct vision, the nasotracheal tube was finally advanced into the oropharynx.
New agents, the circle system and short procedures
Authors: Nel M. R. , Ooi R. , Lee D. J. H. , Soni N.
Published: January 2004

Sevoflurane, desflurane and isoflurane were compared using a circle system in 97 patients undergoing short surgical procedures. Using initial high flows, the time intervals to equilibration between inspired and end‐expired agent concentrations were measured; equilibration was defined as FE/F1 =0.8. The mean (SD) times obtained for sevoflurane, desflurane and isoflurane were 8.2 (2.1) min, 3.8 (0.7) min and 19.7 (6.5) min, respectively. These times were significantly different from each other (p <0.0001). After equilibration total flows were reduced to 500 ml.min−1; at these flows the initial decline in end‐expired agent concentration was minimal with desflurane, intermediate with sevoflurane and greatest with isoflurane. Both desflurane and sevoflurane are appropriate for efficient use of the circle system during short anaesthetics.
Current practice in the pre‐operative assessment of patients for elective repair of abdominal aortic aneurysm
Authors: Pullman M. D. , Edwards N. D.
Published: January 2004

A postal survey of 100 hospitals throughout the United Kingdom and Ireland was conducted to assess current practice in the pre‐operative assessment and use of pulmonary artery catheters in patients undergoing elective abdominal aortic aneurysm repair. Seventy‐four completed questionnaires were received. The survey revealed that 53% of respondents hold designated pre‐operative assessment clinics, attended by anaesthetists in 54% and cardiologists in 26%. However, only 4% of respondents have a written protocol for stratifying patients and assessing peri‐operative risk. By far the commonest investigation of choice for further cardiological assessment is transthoracic echocardiography (67%). Other investigations of choice are multiple update gated acquisition (MUGA) scan (13%), dipyridamole thallium imaging (9%), exercise ECG (6%), stress echocardiography (1%) and stress MUGA (1%). Two units (3%) never undertook further investigation. Pulmonary artery flotation catheters are used as a routine by 9% of respondents, dependent upon left ventricular ejection fraction by 65%, dependent on other factors by 7% and not used at all by 19%. The survey reveals widespread variation in pre‐operative assessment of patients undergoing elective repair of abdominal aortic aneurysm.
The effect of clonidine on sevoflurane requirements for anaesthesia and hypnosis
Authors: Katoh T. , Ikeda K.
Published: January 2004

We evaluated the effects of clonidine given orally on sevoflurane requirements for anaesthesia and hypnosis. Patients received either clonidine (5 μg.kg−1) by mouth (n =21) 90 min before surgery or no premedication (n =21) by random allocation. MAC was calculated using repeated tetanic nerve stimulation with end‐tidal sevoflurane concentration increased or decreased by 0.3 vol.% depending on the previous response. MAC awake was calculated according to the response to verbal command. The mean (SD) MAC in the clonidine‐treated patients was 1.53 (0.20)% compared with 1.83 (0.15)% in the control group (p <0.001). Similarly, MAC awake was reduced in the clonidine group (0.50 (0.08)% compared with 0.60 (0.07)% in the control group) (p <0.001). We conclude that clonidine 5 μg.kg−1 orally administered pre‐operatively reduces sevoflurane requirements for anaesthesia and hypnosis.
Co‐induction and laryngeal mask insertion# A comparison of thiopentone versus propofol
Authors: Driver I. , Wilson C. , Wiltshire S. , Mills P. , Howard‐Griffin R.
Published: January 2004

Conditions for insertion of the laryngeal mask airway were assessed in 70 unpremedicated patients comparing the co‐induction with midazolam‐alfentanil‐thiopentone and midazolam–alfentanil–propofol. Following pre‐induction doses of midazolam 0.04 mg.kg−1 and alfentanil 10 μg.kg−1, patients received equipotent doses of either thiopentone or propofol. Whilst jaw relaxation and ease of laryngeal mask insertion were similar between the two groups, patients receiving propofol were less likely to have undesired responses requiring additional boluses of induction agent (p < 0.05). We conclude that, using these doses, propofol is superior to thiopentone for laryngeal mask airway insertion when using a co‐induction technique.
Choice of tracheal tube size for children: finger size or age‐related formula?
Authors: Van Den Berg A. A. , Mphanza T.
Published: January 2004

A study was undertaken to compare the size of tracheal tube used for paediatric anaesthesia derived from either the diameter of the distal phalanx of the little or index finger, or from a standard formula (age in years/4 + 4.5 mm). The results showed that the diameter of the terminal phalanx was a poor predictor of the external diameter of the tube that provided the best fit. The mean (SD) diameters were 9.34 (1.02), 10.24 (1.23) and 7.56 (0.97) mm for the little finger, index finger and tracheal tube providing ‘best fit’, respectively. The formula provided a better correlation with the internal diameter of the chosen tracheal tube. The mean (SD) figures were 5.61 (0.75) and 5.70 (0.67) mm for the formula and the chosen tracheal tube, respectively. The use of the diameter of the terminal phalanx of either the little or the index finger is an unreliable measurement for the prediction of tracheal tube size in paediatrics.
Spontaneous remission of left bundle branch block during anaesthesia
Authors: Garcia E. J. , Kumar C. M. , Lawler P. G. P. , Newnam P. T. F.
Published: January 2004

Routine pre‐operative evaluation of a 58‐year‐old man scheduled for repair of an inguinal hernia, disclosed a blood pressure of 200/100 mmHg. This decreased to 150/100 mmHg after a period of rest. An electrocardiogram taken as a result of this chance finding showed left bundle branch block. There were no other cardiovascular symptoms or signs. Soon after induction of general anaesthesia, the conduction defect disappeared. The return to sinus rhythm was sudden and sustained and was not related to changes in heart rate or blood pressure. One month later, his electrocardiograph remained normal.
An unusual presentation in a patient with metachromatic leukodystrophy
Authors: Malde A. D. , Naik L. D. , Pantvaidya S. H. , Oak S. N.
Published: January 2004

A 2‐year‐old child was admitted with bilateral bronchopneumonia. During convalescence he sustained sudden respiratory arrest for which he required ventilatory support. He had undergone cholecystectomy 1 month prior to the above episode. The pathological examination of the gall bladder mass had revealed the features of metachromatic leukodystrophy. Gastro‐oesophageal reflux, which is associated with this neurological disorder, was suspected to be the cause of this sudden respiratory arrest and its presence was confirmed by barium swallow examination.
The feasibility, safety and cost of infiltration anaesthesia for hernia repair
Authors: Callesen T. , Bech K. , Kehlet H.
Published: January 2004

Data from 400 consecutive elective ambulatory operations for inguinal hernia under unmonitored local anaesthesia with limited pre‐operative testing were prospectively obtained by the use of standardised files and questionnaires to assess the feasibility, patient satisfaction and potential cost reductions for such a technique. The median age of the patients was 59 years, and 29 operations were performed in ASA group III patients. The median postoperative hospital stay was 85 min. Conversion to general anaesthesia was necessary only in two cases, and nine patients needed overnight admission. One week postoperative morbidity was low with one case of transient cerebral ischaemia and one case of pneumonia, but no case of urinary retention. On follow‐up, 88% were satisfied with the procedure, including unmonitored local anaesthesia. The cost reduction was at least £160 per patient compared with general/regional anaesthesia. We conclude that elective inguinal herniorrhaphy may be performed routinely under unmonitored local anaesthesia with a low postoperative morbidity, a high satisfaction rate and significant cost reductions.
SHO training in anaesthetics. How good is it?
Authors: Bunch G. A. , Bahrami J. , Macdonald R.
Published: January 2004

All senior house officer posts in the Yorkshire Deanery have been assessed against five parameters. Posts in anaesthesia were among the best with excellent consultant support, good exposure to clinical practice and well‐structured education and training. Anaesthetic posts were almost unique in satisfying the ‘New Deal’ on junior doctors hours though intensity of work was something of a problem for the on‐call senior house officer. Appraisal is a new educational tool which is being used to a greater degree in anaesthetics than in any other specialty. The deficiencies found in anaesthetic posts could be corrected by the universal use of appraisal and solving the recruitment problems that have compromised the delivery of good training in some districts.
Pain on injection of propofol. A comparison of cold propofol with propofol premixed with lignocaine
Authors: Parmar A. K. , Koay C. K.
Published: January 2004

Propofol is frequently associated with pain on injection. Previous studies have suggested that chilling of the propofol decreases pain significantly. This prospective, randomised, double‐blind trial was designed to assess the effectiveness of cold propofol compared with propofol premixed with lignocaine in minimising pain on injection. Patients were allocated to one of four groups: propofol + lignocaine 0.1 mg.kg−1, propofol + lignocaine 0.2 mg.kg−1, cold propofol and a control group consisting of propofol premixed with normal saline and maintained at room temperature. The results of this study show that cold propofol is associated with a very high incidence of injection pain while lignocaine 0.1 mg.kg−1 premixed with propofol significantly decreases the incidence of pain (p < 0.001). Increasing the dosage of lignocaine above 0.1 mg.kg−1, however, does not significantly decrease the incidence of pain further. The addition of lignocaine also significantly decreases the incidence of excitatory side‐effects.
Failed intubation and emergency percutaneous tracheostomy
Authors: Dob D. P. , McLure H. A. , Soni N.
Published: January 2004

Failed intubation associated with difficulty with ventilation is rare. Cricothyrotomy may provide a means of oxygenating the patient, but in practice it may be difficult to perform and does not establish a definitive airway. We report two patients in whom percutaneous tracheostomy was used as an emergency procedure. In both cases placement was extremely rapid and salvaged the situation, leaving a definitive airway.
Interaction of vecuronium and atracurium during halothane anaesthesia in children
Authors: Sloan M. H. , Bissonnette B. , Lerman J.
Published: January 2004

The combination of vecuronium and atracurium was studied in 60 children of ASA physical status 1 or 2. In part I, the dose–response relationships were determined in 30 children who were randomly assigned to receive a single bolus of 0.02, 0.025 or 0.03 mgkg−1 of vecuronium or 0.075, 0.01 or 0.0125 mgkg−1 of atracurium. The evoked electromyogram of the adductor pollicis brevis muscle to train‐of‐four stimulation was monitored. The speed of onset of the neuromuscular blockade was determined by a 95% depression of the train‐of‐four whereas the recovery index was established at 75% recovery of T1. In part II, 30 children were randomly assigned to receive 2 × ED95 of vecuronium, 2 × ED95 of atracurium, or a combination of 1 × ED95 of vecuronium + 1 × ED95 of atracurium. This study showed that the ED50 and ED95 for vecuronium were 0.021 mgkg−1 and 0.037 mgkg−1 and for atracurium 0.11 mgkg−1 and 0.30 mgkg−1, respectively. The slopes of the dose–response relationships were significantly different (p < 0.001). With vecuronium alone, the speed of onset of neuromuscular blockade was significantly slower (p < 0.001) and the duration of action less (p < 0.001) than that with atracurium alone or with the combination. There were no differences between atracurium and the combination of both medications. The recovery index was similar for all groups. We conclude that the dose–response relationships of vecuronium and atracurium in children undergoing halothane anaesthesia are not parallel and the neuromuscular effects of vecuronium and atracurium are neither additive nor synergistic. While vecuronium has a shorter duration of action than atracurium, this feature is not apparent when it is combined with atracurium in equipotent doses. Recovery is rapid and not prolonged when these two drugs are combined.
A comparison of near‐infrared spectroscopy and jugular bulb oximetry in comatose patients resuscitated from a cardiac arrest
Authors: Buunk G. , Van Der Hoeven J. G. , Meinders A. E.
Published: January 2004

One cause of cerebral damage in comatose patients resuscitated from a cardiac arrest is cerebral ischaemia occurring during the postresuscitation period. Near‐infrared spectroscopy has been advocated as a useful monitor of brain oxygenation, but data on clinical use in comatose postarrest patients are not available. Therefore, we compared regional oxygen saturation measured with the INVOS 3100 with global oxygen saturation measured using jugular bulb oximetry in 10 comatose patients successfully resuscitated from an out‐of‐hospital cardiac arrest. Our data show that, in most patients, there is a significant difference between the two methods. The INVOS 3100 over‐read at low jugular bulb saturations (< 60%) and under‐read at high jugular bulb saturations (≥ 60%). During hypoventilation we found a significant increase in regional oxygen saturation. This increase was significantly correlated with the rise in cerebral blood flow and cardiac index, indicating that regional oxygen saturation is influenced by both cerebral and extracerebral components. We conclude that regional cerebral oxygen saturation measured with the INVOS 3100 cannot be compared with global cerebral oxygen saturation measured with jugular bulb oximetry in comatose patients resuscitated from a cardiac arrest. This may be due to characteristics of the INVOS 3100 or to the distribution of cerebral blood flow after cardiac arrest.
The laryngeal mask as an antipollution device
Authors: O'hare K. , Kerr W. J.
Published: January 2004

Anaesthetic pollution is still a problem and recent UK Control of Substances Hazardous to Health (COSHH) recommendations require employers to attempt to control the risk. Fifteen day‐case urology operating lists were studied to compare the level of nitrous oxide exposure using face mask or laryngeal mask anaesthesia. Nitrous oxide was avoided in one group until the laryngeal mask was inserted. The use of the laryngeal mask airway showed a significant reduction in the level of pollution, such that recent COSHH recommendations were attained. However, (US) NIOSH levels were only reliably attained by avoiding nitrous oxide until the laryngeal mask was inserted. The laryngeal mask was therefore shown to be a reliable antipollution device.
Haemodilution tolerance in patients with mitral regurgitation
Authors: Spahn D. R. , Seifert B. , Pasch T. , Schmid E. R.
Published: January 2004

Haemodynamic parameters and oxygen consumption were determined in 20 patients with mitral regurgitation before and after a 12 mlkg−1 isovolaemic exchange of blood for 6% hydroxyethyl starch. During haemodilution, mean (SEM) haemoglobin concentration decreased from 13.0 (0.4) to 10.3 (0.4) gdl−1 (p = 0.001). With cardiac filling pressures maintained at predilution levels, cardiac index increased from 1.84 (0.08) to 1.94 (0.08) l.min−1.m−2 (p = 0.025) while systemic vascular resistance decreased from 1556 (86) to 1425 (83) dynescm−5 (p = 0.002) and oxygen extraction increased from 31.7 (1.1) to 37.3 (1.4)% (p = 0.001) resulting in an unchanged oxygen consumption. The haemodynamic response to haemodilution was not affected by the patients' cardiac rhythm, i.e. whether it was sinus rhythm or atrial fibrillation. In conclusion, isovolaemic haemodilution to a haemoglobin of 10.3 gdl−1 is well tolerated in patients with mitral regurgitation. Compensatory mechanisms include both an increase in cardiac index and an increase in oxygen extraction.
Dose–response and time‐course of the effect of rocuronium bromide during sevoflurane anaesthesia
Authors: Xue F. S. , Liao X. , Tong S. Y. , Liu J. H. , An G. , Luo L. K.
Published: January 2004

To evaluate the influence of sevoflurane on the dose–response relationship and on the time‐course of the effect of rocuronium, 60 adult patients undergoing elective plastic surgery were randomly allocated to either the control or the sevoflurane group. Anaesthesia was maintained with 60% nitrous oxide in oxygen and thiopentone in the control group and with 60% nitrous oxide in oxygen and an end‐tidal concentration of 1.75% sevoflurane in the sevoflurane group. Neuromuscular function was assessed mechanomyographically with train‐of‐four stimulation at the wrist every 12 s and the percentage depression of the first twitch of the train‐of‐four was used as the study parameter. The dose–response relationship of rocuronium in the two groups was determined by the cumulative dose–response technique. The dose–response curve of rocuronium in the sevoflurane group was shifted to the left compared to the control group, indicating a potentiation of rocuronium‐induced neuromuscular block. The effective doses of rocuronium required to produce 50%, 90% and 95% twitch depression in the sevoflurane group were decreased by 30.5%, 26.7% and 25.2%, respectively, compared to the control group. Following the administration of a total dose of rocuronium of 400 μgkg−1, the duration of action of, and the recovery from, rocuronium were both significantly prolonged by sevoflurane. There were significant differences in the duration of peak effect, clinical duration, recovery index and the total duration of action between the control and the sevoflurane groups.
Clinical usefulness of the bispectral index for titrating propofol target effect‐site concentration
Authors: Struys M. , Versichelen L. , Byttebier G. , Mortier E. , Moerman A. , Rolly G.
Published: January 2004

The bispectral index, a new processed electroencephalographic parameter which may give information on depth of anaesthesia, was used in 58 patients undergoing outpatient gynaecological surgery in order to study if the addition of bispectral index monitoring to standard clinical monitoring could improve the titration of target propofol concentration when using effect‐site target‐controlled propofol infusion for sedation. In Group 1 (n = 30), the bispectral index was recorded but the anaesthetist was unaware of the readings and therefore only classical signs of depth of anaesthesia were used to guide the anaesthetist in controlling the effect‐site concentration. In Group 2 (n = 28), bispectral index readings were available to the anaesthetist and effect‐site concentration was adjusted to ensure that bispectral index was maintained between 40 and 60. Similar propofol induction and maintenance doses, blood and effect‐site concentrations and mean bispectral index were found in the two groups. A greater percentage of bispectral index readings lying outside the target range (i.e. < 40 or > 60) and more movement at incision and during maintenance were found in Group 1. There was a trend towards more implicit awareness in patients in Group 1. Bispectral index was found to be useful for measuring depth of sedation when using propofol target‐controlled infusion. Propofol dosage could not be decreased but a more consistent level of sedation could be maintained due to a more satisfactory titration of target effect‐site concentration.
Failure of chest X‐rays to diagnose pneumothoraces after blunt trauma
Authors: Collins J. A. , Samra G. S.
Published: January 2004

We report four cases of occult pneumothorax in patients who had suffered blunt trauma. In each case supine chest X‐rays failed to diagnose an anterior pneumothorax. Subsequent spiral computerised tomography scans of the chest showed anterior pneumothoraces in all cases. In two of the cases anterior pneumothoraces were present in spite of a chest drain having been placed in the pleural cavity. We recommend the insertion of anteriorly positioned chest drains to relieve pneumothoraces in severely injured trauma patients.
Small tubes revisited
Authors: Koh K. F. , Hare J. D. , Calder I.
Published: January 2004

We measured the peak inflation and end expiratory pressure at the proximal and distal ends of two sizes of tracheal tube in men and women receiving positive pressure ventilation. There was a statistically significant increase in proximal inflation pressure when the smaller size of tube (6.5 mm for men, 6.0 mm for women) was used. There was no increase in distal inflation or end expiratory pressures. Clinically satisfactory positive pressure ventilation was obtained when 6.0 and 6.5 mm tracheal tubes were used. The advantages and disadvantages of using small sizes of tracheal tube are discussed.
Research Review: Risk and protection in the context of services for children in need
Authors: Little Michael , Axford Nick , Morpeth Louise
Published: January 2004

The paper summarizes the evidence and provides definitions of risk, protective factors, resilience, coping strategies and need in the context of children in need. Definitions are offered for children in need and children's services. The way in which individual interpretation can alter objective assessment of risk is explored. A method for recording evidence relevant to clinical practice on behalf of children in need is offered. Implications for policy and practice are discussed.
The effectiveness of selected interventions for previous maltreatment: enhancing the well‐being of children who live at home
Authors: Dufour Sarah , Chamberland Claire
Published: January 2004

The authors critically assessed reviews of the literature published between 1984 and 2002 to describe the state‐of‐knowledge about the effectiveness of interventions aimed at protecting or improving the welfare of child victims of maltreatment and who remain in the family home. The interventions studied target children, parents or families. They chiefly involve cases of sexual abuse, physical abuse or neglect; very few concern psychological abuse or exposure to violence. For the most part, the intervention effectiveness indicators measure changes in parents’ and children's knowledge (e.g. better knowledge of child development), attitude (e.g. gains in enthusiasm), emotion (e.g. decreased anxiety) and behaviour (e.g. decreased rates of aversive behaviours). Few assessments follow up on participants to determine whether the changes are lasting. The small number of evaluative studies, methodological limitations and disparities in the content and the carrying out of interventions make it difficult to draw sound conclusions about the effectiveness of interventions, even for interventions most often and most favourably assessed, such as behavioural and cognitive‐behavioural interventions with maltreating parents. Implications for practice, research and policy are underlined.
Using the case study approach for improved programme evaluations
Authors: Spath Robin , Pine Barbara A
Published: January 2004

This paper discusses the case study approach to programme evaluation in the human services and its multiple benefits to the evaluator and to the various stakeholders in the programme being evaluated. Of particular importance is the use of a case study to examine programme processes which then inform the design of the outcome study of programme effects. Following a brief overview of the case study approach in research and its applications, the authors delineate its benefits and illustrate these using the evaluation of a model programme designed to reunify families separated by a child's placement in foster care. The results of the case study more clearly defined the programme's processes for both the researchers and the programme staff, and illuminated the desired outcomes which then were delineated in measurable terms. The result was a design for an outcome evaluation that was consistent with programme goals, processes, and intended benefits. The case study also facilitated communication and collaboration between the researchers and the programme's stakeholders, provided important information for agency decision‐makers, and contributed greatly to the potential for the success of the overall evaluation.
Parental mental health: disruptions to parenting and outcomes for children
Authors: Smith Marjorie
Published: January 2004

The association between parental mental health problems and negative outcomes for children has been long known. This paper addresses three issues in relation to this. First, the scale of the problem is outlined, in terms of both the prevalence of mental health problems in parents and the likelihood of children exhibiting negative outcomes in these circumstances. Secondly, the specificity, or lack of it, of particular outcomes in the child in relation to different parental mental health problems is explored. Thirdly, the paper focuses on the importance of disruptions to parenting as a mechanism in the transmission of mental health problems to negative impacts on the child. Examples are given of how parenting is disrupted in non‐clinical community populations, and the subsequent impacts on the child. The case is made for the preventative importance of parenting and family support in mediating between parental mental health problems and negative impacts on the child.
From policy to practice: the implementation of a new framework for social work assessments of children and families
Authors: Cleaver Hedy , Walker Stephen
Published: January 2004

This paper describes a two‐year study conducted in 24 English councils to evaluate the implementation of the Framework for the Assessment of Children in Need and their Families. The Framework promotes a holistic, multi‐agency approach towards the assessment of children in need. The study was carried out in two phases. Phase one explored how councils implemented the Framework and accompanying assessment records. Phase two used a variety of methods to assess the impact of the Framework on practice, including an audit of completed assessment records, postal questionnaires to practitioners and managers in social services and partner agencies, and a qualitative study of 52 cases which included interviews with parents, children over 10 and social workers. A time record was used to gather information on the time social workers spent on the various elements of the core assessment process. The study suggests that councils had to overcome a number of organizational and other barriers in order to implement the Framework. However, the Framework and supporting materials appear to have provided the foundations to improve the quality of social work recording and promote interagency working, and have strengthened the involvement of children and families in the assessment process.
Effective interventions to promote child and family wellness: a study of outcomes of intervention through Children's Family Centres
Authors: Fernandez Elizabeth
Published: January 2004

This paper reports research carried out in Australia designed to evaluate the impact of family support interventions by comparing the views of families and their caseworkers with respect to the perceived benefits and outcomes of the interventions in the context of changes in family functioning and parent–child relationships, and the extent to which changes led to reduced involvement in protective services. The intervention was monitored over a six‐month period using a pre‐ and post‐test design, incorporating quantitative and qualitative approaches in the methodology. The paper discusses: problem domains identified; changes in caregivers’ level of distress, problem solving and learning ability, bonding style and use of discipline; parents’ and children's cooperation with the programme; and implications of the findings for policy and research methodology.
Relating outcomes to objectives in child protection
Authors: Devaney John
Published: January 2004

With the introduction of the Children (Northern Ireland) Order 1995, Health and Social Care Trusts in Northern Ireland have been engaged in a refocusing of children's services, shifting resources and interventions towards supporting families at an earlier stage in order to reduce the likelihood of crisis, breakdown or abuse at a later stage. Alongside this development the Government wishes to see a clearer link between the objectives of the child protection system and the outcomes for children and their families. This paper critiques the current system of performance management in the child protection system. Using data from a study exploring the characteristics and careers of children in the children protection system in Northern Ireland it is argued that the current measurements of performance are too basic and are designed principally to monitor the operation of the system rather than the impact of services and interventions on the lives of children and their families.
Working with managers to improve services: changes in the role of research in social care
Authors: Ward Harriet
Published: January 2004

The setting of specific objectives for children's services and the identification of key outcome indicators, together with the development of a core information specification for children's services with its practical application in the implementation of the Integrated Children's System, all mean that substantially more data are now available to child welfare agencies. Not so long ago in the UK it was the role of research teams to collect and analyse such data. Now that so much of it is already available to agencies, are researchers who work in this area of applied social policy research becoming redundant?

Using data from the cohorts of looked after children being studied at the Centre for Child and Family Research, Loughborough University, the paper demonstrates how researchers can work in consultation with the managers of child welfare agencies to make better sense of the data at their disposal. It considers three issues: what additional variables need to be explored to help agencies better understand their performance; how groups of children could be identified who follow predictable pathways through social care; and how qualitative information is necessary to gain a true picture of what is happening. All of these examples demonstrate a fundamental role for researchers in working with social services personnel to identify how services can be improved.
Use of population measures and norms to identify resilient outcomes in young people in care: an exploratory study
Authors: Flynn Robert J. , Ghazal Hayat , Legault Louise , Vandermeulen Gail , Petrick Susan
Published: January 2004

The purposes of this study were to derive a new method for identifying resilience (i.e. positive adaptation in spite of serious adversity) among young people in care and to determine the percentage of the latter who experienced resilience on selected outcomes, as conceptualized from within the developmental approach of Looking After Children. The participants comprised two samples of young people who were living in out‐of‐home care (mainly foster care) in the province of Ontario, Canada, 340 aged 10–15 years and 132 aged 5–9 years. Virtually all had experienced severe adversity in their families of origin, such that in most cases the legal custody, care, and control of the young people had been permanently transferred from their parents to a local Children's Aid Society. Corresponding to each in‐care sample was a general‐population sample of the same age range that served as a normative comparison group and was drawn from the National Longitudinal Survey of Children and Youth (NLSCY). The NLSCY is an ongoing, long‐term social‐policy study of the development of a nationally representative sample of Canadian children into adolescence and early adulthood. The general‐population samples were composed, respectively, of 5539 young people aged 10–15 years and 11 858 children aged 5–9 years. Resilience among the young people in care was operationally defined, on each outcome variable, as average or above‐average functioning relative to that of the general‐population sample of the same age range. The percentage experiencing resilience was relatively high on the outcomes of health, self‐esteem, and pro‐social behaviour, moderate on the outcomes of relationship with friends and anxiety and emotional distress, and low on the outcome of academic performance. The implications of the findings are discussed.
Heterogeneity in intensive care units: fact or fiction?
Authors: Ridley S. , Burchett K. , Gunning K. , Burns A. , Kong A. , Wright M. , Hunt P. , Ross S.
Published: January 2004

Reports and guidelines concerning intensive care practice have been issued recently. However, the introduction of such centrally issued recommendations may be difficult because of marked heterogeneity between intensive care units. This study examined the facilities (number of beds, consultant sessions, nursing establishment), annual workload (number and types of patients admitted) and outcome (intensive care unit mortality) in the (old) Anglia Region. There were significant differences in the distribution of patients' ages, severities of illness, diagnoses, durations of admission and outcomes. Such heterogeneity may make multicentre trials more difficult to conduct and create problems when uniform measures designed to improve intensive care services are being planned.
Propofol anaesthesia and vomiting after myringoplasty in children
Authors: Habre W. , Sims C.
Published: January 2004

To determine whether propofol anaesthesia reduces the incidence of nausea and vomiting after ear surgery, 40 children aged 4–16 years were randomly assigned to receive either propofol or inhalational anaesthesia. Children in the propofol group had anaesthesia induced with propofol and maintained with propofol–nitrous oxide and those in the inhalational group had anaesthesia induced with thiopentone and maintained with isoflurane–nitrous oxide. Nausea and vomiting were recorded for 24 h after surgery and metoclopramide was offered to children who vomited more than twice. We found that 11 children (55%) who had propofol and 14 children (70%) who had inhalational anaesthesia vomited one or more times after surgery (difference not significant). The incidence of vomiting was lower in the propofol group during the first 2 h after surgery (0% and 25% propofol and inhalational groups, respectively) (p < 0.05) but was similar at all other time intervals. Rescue anti‐emetic was given to two (10%) and eight (40%) children in the propofol and inhalational groups, respectively (p < 0.05). We conclude that propofol anaesthesia alone is not an effective means of preventing vomiting after middle ear surgery in children.
Factors affecting neostigmine reversal of vecuronium block during sevoflurane anaesthesia
Authors: Morita T. , Kurosaki D. , Tsukagoshi H. , Shimada H. , Sato H. , Goto F.
Published: January 2004

We examined the influence of the concentration of sevoflurane and the degree of muscle block at the time of reversal on the activity of neostigmine. Ninety ASA 1–2 patients were anaesthetised with 0.2, 0.7 or 1.2 MAC of sevoflurane (30 patients each) in 66% nitrous oxide in oxygen. The electromyographic (EMG) response of the adductor digiti minimi was monitored at 20‐s intervals after train‐of‐four stimulation of the ulnar nerve. The initial neuromuscular block was produced by vecuronium 100 μg.kg−1. When the amplitude of the first response (T1) values had recovered to 10%, 25% or 40% of the control, neostigmine 40 μg.kg−1 was administered. The train‐of‐four ratio values were recorded at 1‐min intervals during the subsequent 15‐min period. Higher end‐tidal concentrations (p < 0.0001) and more pronounced block at the time of reversal (p < 0.0001) were associated with a delayed recovery in the train‐of‐four ratio. In addition, the train‐of‐four ratio 15 min after neostigmine administration was more dependent on the sevoflurane concentration than on the degree of block present (p < 0.0001). These results confirm that neostigmine (40 μg.kg−1) can reverse vecuronium‐induced but not sevoflurane‐induced neuromuscular block.
Body position and late postoperative nocturnal hypoxaemia
Authors: Rosenberg‐Adamsen S. , Stausholm K. , Edvardsen l. , Zwarts M. , Kehlet H. , Rosenberg J.
Published: January 2004

Thirteen patients were monitored for nocturnal body position (supine vs. side) and arterial oxygen saturation pre‐operatively and on the second postoperative night after major abdominal surgery. The number of positional changes were significantly decreased after operation (p < 0.05) with a trend towards more time spent in the supine position (p = 0.1). Individual mean arterial oxygen saturation decreased postoperatively (p < 0.05) but without a difference between the supine and side positions (p = 0.9). Pre‐operatively, episodic desaturations were significantly more frequent in the supine position than on the side (p < 0.05) but not postoperatively. Pain was the most frequent reason for decreased nocturnal movements.