bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between anaesthetic uptake and cardiac output
Authors: WATT S. J. , COOK L. B. , OHRI S. , LOCKWOOD G. G.
Published: February 2007

The hypothesis that anaesthetic uptake during maintenance of anaesthesia is related to cardiac output was tested on 21 patients undergoing cardiac surgery. Using a computer‐controlled closed breathing system, enflurane was administered to maintain an end‐expired concentration of 1%. Cardiac output was measured by thermodilution using a pulmonary artery catheter. A clear qualitative but not quantitative relationship was demonstrated. Changes in anaesthetic requirements at a constant end‐expired concentration are a better guide to changes in cardiac output than changes in end‐expired carbon dioxide with constant ventilation in patients undergoing cardiac surgery.
The effect of epidural blockade on gastric intramucosal pH in the peri‐operative period
Authors: SUTCLIFFE N. P. , MOSTAFA S. M. , GANNON J. , HARPER S. J.
Published: February 2007

Patients undergoing major surgery are at risk of developing gut ischaemia and multiple organ failure. The gastric tonometer provides a relatively non‐invasive method of assessing the adequacy of gut blood flow. Patients who develop repeated episodes of splanchnic ischaemia in the postoperative period, as evidenced by a low gastric intramucosal pH, have a higher mortality than those who do not. This randomised, controlled study was conducted to assess the effect of epidural blockade with bupivacaine on gastric intramucosal pH measurements in patients undergoing major surgery. A significantly lower proportion of patients with epidural blockade developed gastric intramucosal pH values < 7.32 postoperatively compared to controls (3/15 versus 13/16, p < 0.001). The significance of these results is discussed.
Learning fibreoptic skills in ear, nose and throat clinics
Authors: Burke L. P. , Osborn N. A. , Smith J. E. , Reid A. P.
Published: February 2007

We have compared the progress of anaesthetists taught fibreoptic techniques on awake patients in ear, nose and throat clinics with that of anaesthetists taught by traditional methods. Twelve anaesthetists participated in the study and were randomly allocated to the ear, nose and throat group or to the traditional training group. Each individual in the ear, nose and throat group attended the outpatient clinic and performed ten nasendoscopies on awake patients, whose upper airway had been anaesthetised with cocaine, under the supervision of an ear, nose and throat surgeon. Each individual in the traditional group performed ten nasendoscopies on anaesthetised oral surgery inpatients under the supervision of an anaesthetist. To assess the effectiveness of the two training methods, each anaesthetist in each group then attempted ten fibreoptic nasotracheal intubations on anaesthetised oral surgery patients. There was no significant difference between either the success rates or mean successful tracheoscopy times between the two groups. Nasendoscopy training in the ear, nose and throat clinic appears to be a good way of learning fibreoptic skills, which can then be readily applied to fibreoptic tracheal intubation in anaesthetic practice.
Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness
Authors: DAVIES F. W. , MANTZARIDIS H. , KENNY G. N. C. , FISHER A. C.
Published: February 2007

We have investigated the relationship between changes in the middle latency auditory evoked potentials during alternating periods of consciousness and unconsciousness produced by propofol infusion combined with spinal anaesthesia for total knee replacement. Eleven patients completed the study, of whom two had recollection of events after the onset of the anaesthetic. There were no significant differences in heart rate or systolic arterial pressure between any conscious and unconscious period. With the first change from consciousness to unconsciousness, latencies of Na, Pa and Nb increased from mean (SD) starting values of 20.0 (1.4), 31.7 (1.0) and 42.8 (1.6)ms to 22.5 (2.0), 39.3 (2.1) and 57.8 (4.4)ms, respectively. During successive transitions from unconsciousness to consciousness, awake latencies were slightly higher than those of baseline awake, whereas anaesthetised latencies were similar to the ones obtained during the first period of unconsciousness. The consistent changes demonstrated, suggest that the auditory evoked potentials could represent a reliable indicator of potential awareness during anaesthesia.
Effects of topical benzocaine and lignocaine on upper airway reflex sensitivity
Authors: RAPHAEL J. H. , STANLEY G. D. , LANGTON J. A.
Published: February 2007

We studied the degree and duration of effect on upper airway reflex sensitivity of oral benzocaine lozenges, nebulised lignocaine and lignocaine sprayed onto the vocal cords under direct vision, using low concentrations of ammonia as a stimulus to upper airway receptors. Ten minutes after the administration of oral benzocaine 20 mg the threshold response of the upper airway to ammonia (NH3TR) had risen significantly from baseline mean (SEM) of 680 (95) to 975 (109)ppm of ammonia with a return to baseline values after 25min (n = 8, p < 0.05, repeated measures of ANOVA; p < 0.001, t‐test). A direct spray of lignocaine 100mg onto the vocal cords resulted in a significant elevation in NH3TR from a baseline mean (SEM) of 665 (81) to a maximum of 1600 (88)ppm of ammonia with a significant elevation in the threshold persisting for 100min (n = 7, p < 0.001, repeated measures of AN OVA; p < 0.05, t‐test). The application of 4% nebulised lignocaine 4ml significantly increased NH3 T R from a baseline mean (SEM) of 770 (56) to a maximum of 1190 (63)ppm of ammonia with a significant elevation in the threshold persisting for 30 min (n = 8, p < 0.001, repeated measures of ANOVA; p < 0.05, t‐test). The maximum elevations in NH3TR with the two methods of lignocaine delivery were significantly different (p < 0.01, 2‐way A NOVA).
Thoracic paravertebral space location
Authors: RICHARDSON J. , CHEEMA S. P. S. , HAWKINS J. , SABANATHAN S.
Published: February 2007

The major drawback of paravertebral space location using the traditional method of loss of resistance to air or saline is a failure rate of at least 10%. We investigated whether pressure measurement during needle advancement could improve reliability. Twenty‐nine blocks in 14 awake adult patients undergoing treatment for chronically painful neuralgic conditions of the chest or abdominal wall were studied. In erector spinae, the mean inspiratory pressure (29.5mmHg, SD 14.2), exceeded the expiratory pressure (19.4mmHg, SD 9.7). However, upon traversing the superior costo‐transverse ligament, there was a sudden lowering of pressures and the mean expiratory pressure (7.6 mmHg, SD 3.7) exceeded the inspiratory pressure (3.3 mmHg, SD 2.9). No negative pressures were recorded. Correct needle placement was confirmed by A ‘ray screening and contrast injection. All blocks were successful and uncomplicated. Location of the paravertebral space by this objective method of'pressure inversion’improves sensitivity and specificity and should lead to an improvement in the success rate of thoracic paravertebral analgesia.
Interactions of calcium channel blockers with non‐depolarising muscle relaxants in vitro
Authors: SEKERCI S. , TULUNAY M.
Published: February 2007

The effects of two calcium channel blockers (verapamil and nicardipine) on indirectly elicited muscle twitch and possible interactions between these drugs and non‐depolarising muscle relaxants (vecuronium, atracurium, pancuronium) were investigated using isolated rat phrenic nerve‐hemidiaphragm preparations. Both verapamil 10‐5 M and nicardipine 10‐6 M caused significant depression of twitch amplitude. Verapamil significantly increased vecuronium‐ and atracurium‐induced neuromuscular block, but not that produced by pancuronium. Nicardipine potentiated atracurium‐induced neuromuscular block but had no effect on pancuronium‐ and vecuronium‐induced twitch depression. Neostigmine 10‐6 M did not produce any significant changes in the maximal recovery of twitch depression induced with calcium channel blockers and muscle relaxants combinations; also, neostigmine had no effect on maximal recovery time of twitch depression.
A novel device for patient‐controlled sedation: laboratory and clinical evaluation of the Baxter Intermate LV250 infusor and patient‐control module
Authors: HAMID S. K. , WONG P. K. , CARMICHAEL F. , WHITE K. , ASBURY A. J.
Published: February 2007

The Baxter Intermate LV250 infusor is a large capacity, high flow mechanical infusor, designed to deliver viscous solutions and suspensions. The objective of the laboratory study was to evaluate the LV250 infusor when used with either 0.9% sodium chloride solution or an emulsion, propofol 1%. Following this, the LV250 infusor with the patient‐control module was assessed in the clinical setting as to its suitability for use in patient‐controlled sedation with a propofol and lignocaine mixture. Between reservoir volumes of 250 and 55 ml, the L V250 infusor was found to infuse a propofol 1% and lignocaine mixture at a lower flow compared with the sodium chloride solution, 170ml.h‐1 and 260ml.h‐1 respectively. The lower flow with the propofol mixture may be a result of its higher viscosity. All patients using the LV250 infusor for patient‐controlled sedation found it easy to use and stated that they were able to achieve their desired level of sedation. All patients maintained arterial oxygen saturations above 95%. The LV250 infusor performed reliably and with little inter‐device variation, and with the patient‐control module could be used as an alternative to electronic devices for providing patient‐controlled sedation. Compared with electronic infusors, its advantages include compactness and simplicity of design.
Doctor Dee's ether apparatus
Authors: SUDARSHAN G. , SONI A. K. , WELSH B.
Published: February 2007

In the early 1940s, Dr M. H. Armstrong‐Davison devised an apparatus for inhalational anaesthesia. The apparatus was essentially a combination of Water's to‐and‐fro soda‐lime canister and Hewitt's ether inhaler. The description of the apparatus is followed by a brief historical note on Dr Armstrong‐Davison.
Subdural or epidural?
Authors: Ralph C. J. , Williams M. P.
Published: February 2007

An epidural performed for obstetric analgesia was initially characteristic of a subdural block but subsequently behaved as a normal epidural. Radiological confirmation of the catheter having been subdural was established by performing a magnetic resonance imaging scan.
Pre‐operative anxiety
Authors: PANDA N. , BAJAJ A. , PERSHAD D. , YADDANAPUDI L. N. , CHARI P.
Published: February 2007

The influence of the relative position on the operating list on pre‐operative anxiety was studied in 60 adult female ASA 1 patients undergoing major surgery. Thirty patients were placed first on the operating list (group 1) and 30 were given a time 4–5 h later (group 2). Each patient was visited on the evening prior to surgery and again on the morning of surgery. Anxiety was measured at each visit by objective criteria and part 1 of the State‐Trait Anxiety Inventory questionnaire. The pulse rate, systolic blood pressure and the State‐Trait Anxiety Inventory questionnaire scores were higher on the second visit than on the first (p< 0.001) in all patients. This increase was greater in group 2 than in group 1 (p<0.05). The evening anxiety scores were not correlated with those on the morning visit and could not predict them.
Doxacurium pharmacodynamics in children during volatile and opioid‐based anaesthesia
Authors: KERN C. , TASSONYI E. , ROUGE J.‐C. , WILDER‐SMITH O. H. G. , PITTET J.‐F.
Published: February 2007

The interaction between doxacurium and halothane, isoflurane or alfentanil has not been studied in children. Using the cumulative dose‐response technique and electromyography, we determined ED 50 and ED90 of doxacurium during halothane (n = 9), isoflurane (n= 12) or alfentanil (n = 9) based anaesthesia in children aged 2–10 years. Both isoflurane and halothane potentiated the effects of doxacurium compared to alfentanil. The ED50for doxacurium/halothane was 23.9μg.kg‐1 compared to 32.7 μg.kg‐1 for doxacurium/alfentanil. The ED90, for doxacurium j isoflurane was 32.7 μg.kg‐1 compared to 48.2 μg.kg‐1 doxacurium/alfentanil (p<0.05). There were no significant time course differences between the groups. When equipotent doses of doxacurium were used to provide muscle relaxation the duration of the neuromuscular block was similar in children who received qflentanil, halothane or isoflurane supplementation of N2O/O2 anaesthesia.
Respiratory pattern and rebreathing in the Mapleson A, C and D breathing systems with spontaneous ventilation
Authors: COOK L. B.
Published: February 2007

A theoretical analysis is presented of the Mapleson A, C and D breathing systems when used in spontaneous respiration. The influence of the respiratory pattern is explained diagrammatically. Simple equations are derived, predicting the fresh gas flow required to prevent rebreathing with different respiratory patterns. Further equations allow the degree of rebreathing caused by inadequate fresh gas flow to be quantified. These are used to examine the effects of different respiratory patterns on the efficiency of the three systems. It is demonstrated that the single most important determinant of efficiency is the duration of the expiratory pause. The nature of the inspiratory and expiratory waveforms is less important and the I:E ratio far less important. The analysis suggests that the Mapleson A system will always be the most efficient of the three systems. The Mapleson C system will be efficient if inspiration is long and the expiratory pause is minimal. The Mapleson D system will be efficient if the expiratory pause is sufficiently long.
Leg and back pain after spinal anaesthesia involving hyperbaric 5% lignocaine
Authors: Salmela L. , Aromaa U. , Cozanitis D. A.
Published: February 2007

Fifty‐four patients, aged 27–90 years, who were given lignocaine 5% in 6.8% glucose solution for spinal anaesthesia were studied. Thirteen of these patients experienced pain in the legs and/or back after recovery from anaesthesia. The patients affected were younger (p<0.05) and the site of the dural puncture was higher (p <0.01) than those individuals without pain. Five of the 13 patients (38%) with pain and seven of the 41 patients (17%) without pain admitted to a high alcohol intake, which might be a contributing factor. Leg and/or hack pain is associated with the intrathecal use of hyperbaric 5% lignocaine.
Acid‐base management during cardiopulmonary bypass
Authors: Goldsack C. , Berridge J. C.
Published: February 2007

Controversy exists over which method of acid‐base management should be used during hypothermie cardiopulmonary bypass: the alpha‐stat method or the pH‐stat method. We surveyed 40 centres in the United Kingdom to assess current practice; whether practice has changed recently; and if so, why. Ten years ago, 31 centres (77.5%) used pH‐stat and seven (17.5%) used alpha‐stat. Currently nine centres (22.5%) are using pH‐stat, 25 (62.5%) are using alpha‐stat and four (10%) are using both. One centre (2.5%) has always used a modified pH‐stat technique, and one continues to use alpha‐stat in children and pH‐stat in adults. Twenty‐one of the 22 centres which have changed their practice did so because of increasing reports incriminating pH‐stat in postoperative morbidity, particularly cerebral dysfunction. Our results show a marked trend towards using alpha‐stat methods rather than the more traditional pH‐stat approach.
Endothelin‐1 concentrations and optimisation of arterial oxygenation and venous admixture by selective pulmonary artery infusion of prostaglandin E1 during thoracotomy
Authors: CHEN T.‐L. , LEE Y.‐T. , WANG M.‐J. , LEE J.‐M. , LEE Y.‐C. , CHU S.‐H.
Published: February 2007

In order to improve arterial oxygenation and venous admixture during one lung ventilation, the effect of selective infusion of prostaglandin Ei into the pulmonary artery of the ventilated lung was investigated in 12 adult patients undergoing thoracotomy. Patients’bronchi were intubated with a Mallinckrodt bronchial tube and ventilated with 66% oxygen in air. Cardiopulmonary factors such as systemic and pulmonary arterial pressures, pulmonary vascular resistance, blood gas analyses, cardiac output and airway pressure were measured before and during one‐lung ventilation; venous admixture (Qs/Qt) was calculated. Serial blood samples were taken from the pulmonary artery of the ventilated lung for endothelin‐1 estimation. One lung ventilation reduced the mean Pao2 from 42.1 (2.3)kPa to 11.8 (1.4)kPa (p < 0.001) and increased Qs/Qt from 10.8 (3.2)% to 39.2(4.7)% (p < 0.001). Pulmonary vascular resistance also increased from 167 (24) dyne.s.cm‐5 to 262 (38) dyne.s.cm‐5 (p < 0.05) with a corresponding increase of plasma endothelin‐1 (p < 0.05). After 30min of one lung ventilation, PGE, was infused continuously into the pulmonary artery of the ventilated lung at a rate which increased incrementally from 0.04–0.10 μg.kg‐1.min‐1. Pao2 increased to 20.7 (2.6) kPa (p < 0.01) and Qs/Qt decreased to 30.6 (3.5)% (p < 0.05). During the infusion, pulmonary vascular resistance reduced to 173 (30) dyne.s.cm‐5 (p < 0.01). The plasma endothelin‐1 concentration reached a plateau between the end of one lung ventilation (before closing the thorax) and 6h postoperatively. This correlated inversely with the pre‐operative forced expiratory volume in one second (r =— 0.68, p < 0.005), declining to normal values 72 h after operation. The selective infusion of PGEi into the pulmonary artery of the ventilated lung corrected pulmonary vasoconstriction and improved both arterial oxygenation and venous admixture during one lung ventilation for thoracotomy.
Patient‐controlled alfentanil
Authors: IRWIN M. G. , JONES R. D. M. , VISRAM A. R. , KENNY G. N. C.
Published: February 2007

We have compared the opioid effects of a patient‐demand, target‐controlled infusion of alfentanil (n = 10), with patient‐controlled bolus administration of morphine (n = 10) following major spinal surgery in Chinese patients aged from 11 to 67 years. The same general anaesthesia regimen was used in all patients. One group of patients were given intra‐operative morphine analgesia followed by postoperative intravenous morphine patient‐controlled analgesia, while the other group received an intra‐operative target‐controlled infusion of alfentanil. Following surgery, the alfentanil group were given control of a handset and were able to increase the target alfentanil plasma level in 5ng.ml‐1 increments with a 2‐min lockout interval. If analgesia was not demanded within a 15‐min period, the computer reduced the target concentration by 5ng.ml‐1. All patients had continuous pulse oximetry monitoring and hourly recording of pain, sedation, nausea scores and respiratory rate. Patients receiving alfentanil had the target concentration noted hourly and four blood samples taken during the first 24 h for measurement of plasma alfentanil concentrations by high performance liquid chromatography. The alfentanil infusion system was equally effective as an analgesic technique when compared with morphine patient‐controlled analgesia. There were no hypoxaemic episodes (oxygen saturation <94%), no difference in sedation scores and the incidence of nausea (30%) was the same in both groups. There was a significantly (p < 0.001) lower respiratory rate in the alfentanil group compared with patients receiving morphine at, clinically assessed, equianalgesia. The predicted plasma alfentanil concentrations increased rapidly from about 30ng.ml‐1 during the first 4 h to around 100ng.ml‐1 at the end of the 24‐h study period. The precision of the target‐controlled infusion system was 75.4% and the mean prediction error (bias) 58.1%, suggesting an underestimation of the measured alfentanil concentrations by the alfentanil infusion system in these Chinese patients.
Low pressure leakage in anaesthetic machines
Authors: SOMPRAKIT P. , SOONTRANAN P.
Published: February 2007

Positive and negative pressure tests for checking the low pressure section of 36 anaesthetic machines in order to detect gas leaks were prospectively compared. The low pressure section was checked by the soap bubble test as a‘gold standard‘. The leakage rate was 86.1%. The sensitivity and specificity of the positive pressure tests were 92% and 100% respectively, whilst the sensitivity and specificity of the negative pressure test were both 100%. However, seven machines revealed a leak which was only detected by the positive pressure test: this problem arose through defects in the emergency oxygen flush devices which allowed oxygen to leak around the valve even though it was in the‘off’position. This might reduce the specificity of the negative pressure test to 41.7%. For security, both tests should be carried out in series; the positive pressure test followed by the negative pressure test. The possibility of gaseous leakage around the oxygen flush device is not generally recognised. This study emphasises the need for skilled servicing of anaesthetic machines on a regular basis.
Topical ibuprofen for skin analgesia prior to venepuncture
Authors: Smith A. J. , Eggers K. A. , Stacey M. R. W. , Power I.
Published: February 2007

The analgesic effect of topical ibuprofen was investigated in ten volunteers. There were no significant differences in visual analogue scale pain scores for pinprick after 15 and 60 mm of application of ibuprofen, placebo and EM LA cream. Comparison of visual analogue scale scores for venous cannulation after similar durations of ibuprofen and EMLA creams found significantly (p < 0.014) lower scores for EMLA at 60min. We do not consider ibuprofen cream to be clinically useful for venous cannulation.
The effect of temperature upon pain during injection of propofol
Authors: Fletcher G. C. , Gillespie J. A. , Davidson J. A. H.
Published: February 2007

Propofol has been shown to cause pain on injection. This study investigated the effect of warming propofol to 37°C on the pain of intravenous injection. One hundred and one women on outpatient gynaecology lists were allocated to receive propofol either at room temperature or at 37°C. Warming propofol decreased the incidence of pain on injection by 37% (p < 0.001), and also decreased the severity of pain reported by patients (p < 0.001). We conclude that warming propofol to 37°C provides a simple and safe method of reducing the incidence of pain on injection without the addition of other agents.
Sevoflurane degradation by soda lime in a circle breathing system
Authors: MUNDAY I. T. , WARD P. M. , FODEN N. D. , JONES R. M. , F. N. A. M. VAN PELT PhD  , KENNA J. G.
Published: February 2007

Sevoflurane is degraded by soda lime to a vinyl ether commonly referred to as compound A. We measured the concentration of compound A in the circle breathing system of 31 patients receiving sevoflurane anaesthesia. fnspiratory and expiratory gas samples were analysed using gas chromatography and flame ionisation detection. The end‐tidal sevoflurane concentration and soda lime temperature were recorded. The peak compound A concentration ranged between 10 to 32ppm in the inspiratory limb and 7 to 26 ppm in the expiratory limb. There was a positive correlation between the peak compound A concentration and the end‐tidal sevoflurane concentration (r2= 0.545, p < 0.0001) and the soda lime temperature (r2= 0.301, p = 0.0014). We conclude that the end‐tidal concentration of sevoflurane and the temperature of the soda lime are important variables in determining concentration of compound A in a circle system.
The influence of three deflation techniques Optimal shape of the laryngeal mask cuff
Authors: BRIMACOMBE J. , FFARCSI A. BRAIN , BRANAGAN H. , SPRY M. , SCHOFIELD J.
Published: February 2007

A randomised, single‐blinded, controlled trial was conducted to determine if a new laryngeal mask deflation tool offered any advantages over manual or free deflation. Ten laryngeal mask airways were tested and the deflation tool provided a significantly superior and more consistent shape than either hand manipulation or the free deflation, but did not offer any benefits in terms of residual volume. The deflator tool should encourage wider use of the standard recommended insertion technique. It can be used as a backup when manual deflation cannot provide the correct shape and may be useful for researchers studying laryngeal mask airway placement.
Contralateral pneumothorax following thoracotomy for vertebrectomy
Authors: Spears F. D. , Jardine A.
Published: February 2007

A 21‐year‐old woman underwent correction of congenital thoracic kyphoscoliosis. The procedure was completed in two stages. The first stage involved right thoracotomy and anterior vertebrectomy. Following positional obstruction of her right‐sided chest drain she developed a very large, left‐sided pneumothorax in the immediate postoperative period. No attempt at central venous line placement had been made on the left side. Breach of the midline at vertebrectomy may allow pleural gas to cross and cause a contralateral pneumothorax.
A comparison of epidural infusions of fentanyl or pethidine with bupivacaine in the management of postoperative pain
Authors: Cox C. R. , Serpell M. G. , Bannister J. , Coventry D.M. , Williams D. R.
Published: February 2007

A double‐blind randomised clinical trial was undertaken in 40 patients undergoing major abdominal surgery. Postoperative pain relief was provided using epidural infusions of 0.06% bupivacaine with fentanyl 4 μg.ml‐1 (n = 20) (group F) or with pethidine 1.5 mg.ml‐1 (n = 20) (group P). Postoperative pain scores using a visual analogue scale (0–100mm) were not significantly different between the two groups. Median pain scores were 0–19 mm at all times of assessment indicating that good analgesia was provided by both regimens. There was no significant difference between the epidural infusion rates in the two groups. The side effects and effect on pulmonary function were similar in each group. Nine patients were withdrawn from the study (four from group F, five from group P) due to failure of the epidural technique or other complications. Fourteen patients, equally distributed, required a total of 24 epidural‘top‐ups’by an anaesthetist because of inadequate analgesia. We demonstrated no advantage with epidural pethidine over fentanyl when used by infusion in combination with bupivacaine in the management of postoperative pain.
Oxygen saturation of patients recovering from electroconvulsive therapy
Authors: McCormick A. S. M. , Saunders D. A.
Published: February 2007

Oxygen saturation was measured by pulse oximetry in 33 psychiatric patients breathing air during recovery from 60 episodes of electroconvulsive therapy. Desaturation to less than 90% occurred in 17% of patients. Oxygen saturation values in recovery were significantly lower than pre‐operative saturations (p = 0.0014 using ANOVA), with a significant difference (p = 0.001) for up to 5min in recovery.
Mortality predicted by APACHE II
Authors: GOLDHILL D.R. , WITHINGTON P. STUART
Published: February 2007

The contribution of physiological values to the APACHE II score was determined by retrospective analysis of 11 348 patients undergoing intensive care. Eleven physiological variables contributed a mean of 8.9 points, 54% of the total APACHE II score. The mortality ratio (observed hospital mortality/hospital mortality predicted by APACHE II) was 1.13. We altered the APA CHE II scores and post‐intensive care hospital mortality in order to examine the effect on the mortality ratio of these changes. Increasing scores by two or four points decreased mortality ratios to 1.00 and 0.89 respectively: decreasing scores by two or four points to a minimum of zero increased mortality ratios to 1.27 and 1.44 respectively. A 25% increase or decrease in post‐intensive care hospital mortality changed mortality ratios to 1.21 and 1.05 respectively. Physiological values vary with the timing of collection and accuracy of recording. Small consistent differences in scores cause potentially important changes in the mortality ratio. Unless data collection and the effect of management before and after intensive care are standardised, using mortality ratios to compare intensive care units is likely to be inaccurate and misleading.
Postoperative pain
Authors: NAY P. G. , ELLIOTT S. M. , HARROP‐GRIFFITHS A. W.
Published: February 2007

A study of 43 patients undergoing coronary artery bypass grafting was conducted in order to compare pre‐operative expectation of pain severity and duration to actual postoperative experience. As judged by linear visual analogue scores, patients expected more pain than they experienced (p = 0.0359). For the majority of patients, pain duration was less than expected. Eighty‐four per cent of patients reported that their pain was better or the same as expected. Ninety‐five per cent of patients were satisfied or very satisfied with postoperative analgesia. The authors conclude that, although the standard of postoperative analgesia after coronary artery bypass grafting remains objectively poor (the median postoperative pain score was 4 on a 10 cm linear visual analogue pain score), patients are usually satisfied with their pain relief. The authors suggest that this may be related to patients’pre‐operative overestimation of postoperative pain severity. The authors caution against giving patients unrealistic expectations of the quality of postoperative analgesia.
Control of end‐tidal carbon dioxide during IPPV
Authors: SCOTT P. V. , HADEN R. M. , JONES R. P.
Published: February 2007

We have described a method for control of end‐tidal carbon dioxide tension during intermittent positive pressure ventilation in a model lung and in 19 adults during general anaesthesia supplemented by central or peripheral neural blockade. The inspiratory and expiratory limbs of an open or a circle anaesthesia system were interconnected and ventilated simultaneously in a variable manner during inspiration. The flow of mixed‐expired gas, normally one‐way, became to‐and‐fro (variable functional apparatus deadspace, or‘virtual’deadspace). At minute volume ventilation > = 100 ml.kg ‐1.min‐1 (patients), the value of end‐tidal carbon dioxide tension was varied reproducibly within the range 4.1–6.5 (SD 0.1) kPa independently of fresh gas flow or other prescribed patterns of ventilation. At a steady state, stable nominated values of end‐tidal carbon dioxide tension within the range were attained. By how much any given intra‐operative value of end‐tidal carbon dioxide tension may be said to affect peri‐operative outcome is debatable, but during surgery any change in a nominated value may usefully indicate a change in the steady state.
Lumbar epidurography with multi‐orifice and single orifice epidural catheters
Authors: MAGIDES A. D. , SPRIGG A. , RICHMOND M. N.
Published: February 2007

The spread of iohexol in the epidural space was studied using two types of epidural catheter. Twenty pre‐menopausal women undergoing hysterectomy received lumbar epidural analgesia via either multi‐orifice or single orifice catheters. Twenty‐four hours after surgery, iohexol was injected before catheter removal with the patient lying supine. Whereas there was no significant difference in the total number of vertebral segments covered by dye or the total number of segments reached above or below the level of epidural insertion, spread was more even to the right and left of midline using the single orifice catheters. Sacral spread of dye was only observed when a single orifice catheter was used. Epidural catheter design affects the distribution of solutions in the epidural space, with single orifice epidural catheters producing more even distribution of dye with sacral extension.
Induction of anaesthesia with midazolam and a target‐controlled propofol infusion
Authors: TZABAR Y. , BRYDON C. , GILLIES G. W. A.
Published: February 2007

Eighty patients premedicated with temazepam were allocated randomly to receive an intravenous bolus of midazolam (either 0, 1, 2 or 4mg) 4min before a propofol infusion using a system designed to maintain a target blood concentration of 3 μg.ml‐1. Anaesthesia was successfully induced within 3 min of starting the infusion in 45% of patients receiving no midazolam. This rose to 70%, 85% and 95% in the groups receiving 1, 2 and 4 mg midazolam boluses respectively (p < 0.005). There were reductions in arterial blood pressure 3 min after starting the infusion in all groups but there was no significant difference between the groups. Apnoea was rare. Small doses of midazolam usefully enhance the effect of a propofol infusion administered at a dose which by itself would not induce anaesthesia in a majority of patients.
The delivery of oxygen by a Venturi T piece
Authors: CAMPBELL D. J. , FAIRFIELD M. C.
Published: February 2007

We have evaluated the performance of the Intersurgical 40% Oxygen Recovery T‐Kit in ten healthy volunteers, Inspired oxygen and end‐tidal carbon dioxide. concentrations were measured during normal respiration and with variations in respiratory rate and depth. The performance of the device was then studied after modifications to the inspiratory limb, the expiratory, limb and the arrangement of the attachments to the T ‐piece. The standard arrangement of the T piece was associated with inadequate inspired oxygen concentration (31.9±0.6%), independent of respiratory rate and depth. All three modifications increased the inspired oxygen concentration, the longer expiratory limb to 34.6% (p < 0.01)and the altered T piece arrangement to 37.3% (p < 0.01). The highest inspired oxygen concentration of 40.3% (p < 0.01)was obtained by increasing the length of the inspiratory limb.
Arnold‐Chiari malformation in pregnancy
Authors: Semple D. A. , McClure J. H. , Wallace E. M.
Published: February 2007

We report the case of a 30‐year‐old pregnant woman with an Arnold‐Chiari malformation, who presented with severe pregnancy‐induced hypertension at 30 weeks gestation. She was known to have had a difficult tracheal intubation during a previous general anaesthetic. Caesarean section was performed under an incremental epidural anaesthetic block.
Anaesthesia for electroconvulsive therapy Personnel and facilities
Authors: Lee D. , Kenny M. , Harrop‐Griffiths W.
Published: February 2007

In order to compare the anaesthetic staffing and facilities provided for patients undergoing electroconvulsive therapy with those provided for patients undergoing elective cystoscopy, a confidential telephone enquiry was conducted. An anaesthetist in each of the 40 hospitals where clectroconvulsive therapy is performed in three Health Regions chosen at random was questioned. The results show that a high standard of care is provided for patients undergoing elective cystoscopy in terms of pre‐operative assessment anaesthetic assistance, intra‐operative monitoring and postoperative recovery facilities. The standards of care and of facilities for patients undergoing electroconvulsive therapy are substantially inferior and commonly fall short of accepted national guidelines.
The effect of ondansetron on the pharmacokinetics and pharmacodynamics of temazepam
Authors: PRESTON G. C. , KEENE O. N. , PALMER J. L.
Published: February 2007

The objective of this study was to determine the effects of ondansetron on the pharmacokinetics of temazepam and on pharmacodynamics relevant to its use as oral premedication. Twenty‐four healthy volunteers (12 of each sex) were administered the following oral treatments in a randomised, double‐blind crossover design: temazepam 20 mg plus placebo; or temazepam 20 mg plus ondansetron 8 mg. Blood samples were taken for plasma temazepam assay at intervals up to 32 h after administration. In addition, a brief battery of psychomotor tests was administered 1 h prior to dosing and 1 and 4 h after dosing. Analysis of the derived pharmacokinetic parameters showed no differences between the treatments described above. Analysis of data from the dynamic measures likewise showed no difference between the treatments. It was concluded that the co‐administration of ondansetron did not influence the pharmacokinetics or pharmacodynamic actions of temazepam.
The use of absorbent materials for the disposal of controlled drugs
Authors: TARLING M. M. , VAN DEN BERG N. , STRUNIN L. , WALTON A.
Published: February 2007

The Association of Anaesthetists of Great Britain and Ireland's most recent publication on controlled drugs notes that the Environmental Protection Act (1992) does not permit the disposal of controlled drugs into the water sewerage system. The Association suggests that, in order to conform to the Misuse of Drugs Regulations (1985). controlled drugs may best be disposed of using some sort of absorbent material, for example a small amount of cat litter or wallpaper paste, in the bottom of a sharps bin. The absorbent capacity of three types of cat litter, wallpaper paste and a commercial absorbent material were tested. Both the commercial absorbent and wallpaper paste displayed limited absorbent qualities unless the container was agitated. The cat litter, Snowflake, absorbed more controlled drug than the others (one‐way ANOVA, F2.12= 250.85, p < 0.01). The use of absorbent materials in sharps bins for the disposal of controlled drugs in clinical areas has limitations and may not be suitable. It is concluded, therefore, that small volumes of controlled drugs should be disposed of directly into clinical waste and that large volumes should be dealt with using a commercial absorbent in its own container.
Torsade de pointes ventricular tachycardia following coronary artery spasm during general anaesthesia
Authors: Mizutani K. , Toyoda Y. , Kubota H.
Published: February 2007

We present a patient who suffered two episodes of torsade de pointes ventricular tachycardia during general anaesthesia for abdominal surgery. The first occurred on suctioning of the tracheobronchial tree and the second while anaesthesia was light. Since ST segment elevation was in each case noted before the onset of torsade de pointes, coronary artery spasm was suspected to be the cause. An intravenous infusion of nitroglycerine was effective in treating and preventing these episodes. These findings suggest that coronary artery dilators such as nitroglycerine are indicated for initial treatment of torsade de pointes following coronary artery spasm in order to facilitate recovery from myocardial ischaemia.
The effect of posture on late postoperative oxygenation
Authors: MYNSTER T. , JENSEN L. M. , JENSEN F. G. , KEHLET H. , ROSENBERG J.
Published: February 2007

Twelve patients had their arterial oxygen saturation measured pre‐operatively and on days 1, 4 and 7 after laparotomy. Measurements were performed in the supine, sitting and standing positions on each day. Arterial oxygen saturation was significantly higher during sitting and standing on days 1 and 4 after operation compared with the supine position (p < 0.05). These results give further evidence for the benefits of patient mobilisation after major surgery.
The influence of cold on the recovery of three neuromuscular blocking agents in man
Authors: ENGLAND A. J. , WU X. , RICHARDS K. M. , REDAI I. , FELDMAN S. A.
Published: February 2007

The Arrhenius hypothesis suggests that change in temperature has a less marked effect on the rate of physical processes than on biological reactions. We have investigated the process underlying recovery from neuromuscular block in man by studying the effect of cooling on the rate of recovery from depolarising and non‐depolarising block. Vecuronium, rocuronium and decamethonium (C10) neuromuscular block were investigated using the isolated forearm technique on awake human volunteers. In these experiments, one arm was cooled whilst the other was used as control. Moderate hypothermia decreased the rate of recovery from all three agents, but this was significantly less marked with the depolarising drug. The mean Q10 (the anticipated change in rate of a reaction across a 10°C temperature gradient) of the rate of recovery for vecuronium was 3.21, rocuronium 2.86 and decamethonium 1.29. This suggests a different process in the recovery of these two types of drug. According to the Arrhenius hypothesis this would suggest that the recovery from non‐depolarising drugs is likely to involve a biochemical mechanism and that recovery from decamethonium is controlled by a physical process.
The effect of increasing the dose of buprenorphine on the haemodynamic response associated with tracheal intubation
Authors: Khan F. A. , Kamal R. S.
Published: February 2007

The effect of buprenorphine on the haemodynamic response to tracheal intubation was studied at two dose levels, 2.5 μg.kg‐1 and 5 μg.kg‐1, in a placebo‐controlled double‐blind trial in 75 patients undergoing laparoscopic cholecystectoniy. The study drugs were administered intravenously 8 min before induction of anaesthesia with thiopentone 5 mg.kg‐1 and vecuronium 0.1 mg/kg‐1. Buprenorphine 2.5 μg.kg‐1 caused 50% attenuation of the blood pressure response whereas 5 μg.kg‐1 caused 70% attenuation compared to the saline placebo. The maximum increase in heart rate was 14% of the control value after 2.5 μg.kg‐1 and 11% after 5 μg.kg‐1 of buprenorphine. A significant difference in heart rate was also observed between the two buprenorphine groups at 5 and 10 min after intubation. Blood pressure and heart rate both showed a significant fall from baseline values 10 min after intubation in both buprenorphine groups, with the changes being greater in the 5 μg.kg‐1 group. We recommend the use of 2.5 μg.kg‐1 buprenorphine for attenuation of the hypertensive response to intubation in major abdominal surgery.
Alternative splicing of pre‐mRNAs of Arabidopsis serine/arginine‐rich proteins: regulation by hormones and stresses
Authors: Palusa Saiprasad Goud , Ali Gul Shad , Reddy Anireddy S.N.
Published: February 2007

Precursor mRNAs with introns can undergo alternative splicing (AS) to produce structurally and functionally different proteins from the same gene. Here, we show that the pre‐mRNAs of Arabidopsis genes that encode serine/arginine‐rich (SR) proteins, a conserved family of splicing regulators in eukaryotes, are extensively alternatively spliced. Remarkably about 95 transcripts are produced from only 15 genes, thereby increasing the complexity of the SR gene family transcriptome by six‐fold. The AS of some SR genes is controlled in a developmental and tissue‐specific manner. Interestingly, among the various hormones and abiotic stresses tested, temperature stress (cold and heat) dramatically altered the AS of pre‐mRNAs of several SR genes, whereas hormones altered the splicing of only three SR genes. These results indicate that abiotic stresses regulate the AS of the pre‐mRNAs of SR genes to produce different isoforms of SR proteins that are likely to have altered function(s) in pre‐mRNA splicing. Sequence analysis of splice variants revealed that predicted proteins from a majority of these variants either lack one or more modular domains or contain truncated domains. Because of the modular nature of the various domains in SR proteins, the proteins produced from splice variants are likely to have distinct functions. Together our results indicate that Arabidopsis SR genes generate surprisingly large transcriptome complexity, which is altered by stresses and hormones.
Centromere dynamics in the primitive red alga Cyanidioschyzon merolae
Authors: Maruyama Shinichiro , Kuroiwa Haruko , Miyagishima Shin‐ya , Tanaka Kan , Kuroiwa Tsuneyoshi
Published: February 2007

Centromeres are universally conserved functional units in eukaryotic linear chromosomes, but little is known about the structure and dynamics of the centromere in lower photosynthetic eukaryotes. Here we report the identification of a centromere marker protein CENH3 and visualization of centromere dynamics in the ultra‐small primitive red alga Cyanidioschyzon merolae. Immunoblotting and immunofluorescence microscopy showed that CENH3 increased rapidly during S phase, followed by a drastic reconstitution into two discrete foci adjacent to the spindle poles at metaphase, suggesting the cell‐cycle‐regulated expression of CENH3. Immunoelectron microscopy revealed that the CENH3 signals were associated with the nuclear envelope, implying interplay between the kinetochore complex and the nuclear envelope. These results demonstrate dynamic centromere reconstitution during the cell cycle in an organism in which the chromosomes do not condense at metaphase.
SOME TRENDS IN THE THEORY AND PRACTICE OF LISTENING COMPREHENSION
Authors: DIRVEN RENÉ
Published: February 2007

The present situation in most foreign‐language (FL) classes is, surely, that listening comprehension is under‐represented. Against this background it is astonishing that a number of writers, especially in the USA, claim absolute priority for listening comprehension and want to have speaking delayed, even believing early attempts at oral proficiency to be prejudicial to mastery of the foreign language. I do not share this rather extreme view and will rather plead for an integration of listening and speaking skills.
ORAL ASSESSMENT: A SCHEME FOR THE ASSESSMENT OF THE ORAL ENGLISH OF TRAINEE TEACHERS
Authors: HILL GUY
Published: February 2007

Assessment of the teaching ability of trainee teachers on teaching practice is, of course, common. Less common, perhaps, is the assessment of the oral proficiency in a teaching situation of non‐native speakers of English who are being trained to teach English and/or, in an ESL environment, other subjects in English.
FOCUSING ON QUESTIONS THROUGH ANSWERS
Authors: HAHN CORA
Published: February 2007

Students who have no difficulty with questions in practice drills sometimes get confused when they really have to ask a question. This confusion is often revealed during role‐play, dialogues, and similar activities, but attention is not usually drawn to it at the time because the aim of such activities is to give experience of communication, not the study of question form. There is thus a need for activities that focus on questions.
ENGLISH AS A FOREIGN LANGUAGE FOR 5–8 YEAR OLDS
Authors: SCHMID‐SCHÖNBEIN GISELA , FRÖHLICH‐WARD LEONORA
Published: February 2007

Writers of textbooks published since the beginning of 1978 are invited to submit 1000 word articles discussing the principles underlying their work and accompanied by two pages from the book in question. The articles should be problem‐based, not advertisements, and the extracts should be in a form for reproduction without redrawing. Writers will be responsible for obtaining all necessary permissions.
Discourse analysis, non‐native Englishes and second language acquisition research
Authors: KACHRU YAMUNA
Published: February 2007

ABSTRACT: Recent research in discourse analysis clearly demonstrates the relevance of shared sociocultural conventions in successful linguistic interactions. Most recent studies in Second Language Acquisition (SLA), however, ignore this aspect of language behavior completely. In general, researchers in SLA have been interested in evaluating and falsifying or corroborating hypotheses such as contrastive analysis, error analysis, interlanguage, critical period, similarity between first and second language acquisition, linguistic markedness, natural approach and monitor. Very little attention has been paid so far to the communicative needs of the second language learners who may not share the standards of communicative competence that the native speakers of the target language value. Recent studies of non‐native varieties of English establish beyond doubt the fact that these varieties differ from the native varieties of English precisely because their users have norms of communicative competence entirely different from those of native speakers of English. In this paper, evidence is presented to show that the development and institutionalization of nonnative varieties of English around the world pose a serious problem for all existing theories of SLA. The issues that need to be addressed in future research are clearly identified.