bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupuncture and transcutaneous stimulation analgesia in comparison with moderate‐dose fentanyl anaesthesia in major surgery
Authors: Kho H. G. , Eijk R. J. R. , Kapteijns W. M. M. J. , van Egmond J.
Published: February 2007

The efficacy of acupuncture and transcutaneous stimulation analgesia, supplemented by small doses of fentanyl (mean 1.2 μg/kg, SD 1.7) was compared with moderate‐dose fentanyl anaesthesia (mean 22.9 μg/kg, SD 2.8) in 29 patients who underwent surgery for retroperitoneal lymph node dissection. The present study describes the anaesthetic techniques and comparison of haemodynamics, demand for analgesies after surgery, recovery and blood gases, restoration of urinary and bowel functions, convalescence in terms of self‐reliance and the postoperative course in respect of fatigue and morbidity. A more rapid return of consciousness, an absence of hypercapnia and a smaller decrease in pH were observed in patients who received acupuncture and transcutaneous stimulation (p < 0.05). No clinically relevant disadvantages attributable to the method were demonstrated.
A district‐wide anaesthetic audit
Authors: Verma R.
Published: February 2007

A district‐wide anaesthetic audit has been implemented by the Derby anaesthetic department. Data for every anaesthetic are collected on a specially designed audit form which is read into a computerised database using an optical mark reader. The implementation of the audit, problems encountered and some benefits realised are described.
Examination of cardiorespiratory changes during upper gastrointestinal endoscopy
Authors: MURRAY A. W. , MORRAN C. G. , KENNY G. N. C. , MACFARLANE P. , ANDERSON J. R.
Published: February 2007

Critical events including hypoxaemia, arrhythmias and myocardial ischaemia may occur more frequently during endoscopic procedures than during anaesthesia. A study was undertaken to assess the cardiovascular changes and to evaluate suitable monitoring techniques to detect critical events during sedation and endoscopy. Twenty patients scheduled to undergo a prolonged endoscopic procedure which required deep sedation were studied. Continuous recordings of electrocardiogram, heart rate and arterial oxygen saturation were made and arterial pressure was recorded at one‐minute intervals. The study commenced immediately before administration of sedatives, continued for the duration of the examination and for one hour following the examination. Oxygen saturation decreased in all patients during the examination to a mean of 82.9% (SD 11.9), and remained below baseline for the duration of the examination and into the recovery period. Statistically significant increases and reductions of systolic arterial pressure and rate‐pressure product were found during the procedures compared with baseline values recorded before administration of sedatives. Sixteen of the 20 patients developed tachycardia during the examination. Ten patients developed ectopic foci which were supraventricular, ventricular or both in origin. Electrocardiogram changes resolved during the recovery period. Myocardial ischaemia was assessed by S‐T segment depression and a significant correlation was found between S‐T segment depression and hypoxaemia, although the magnitude of the S‐T depression was small and may not have been detected clinically. No correlation was found between S‐T segment depression and arterial pressure, heart rate or rate‐pressure product. Regular and frequent assessments of arterial pressure and heart rate are desirable but the results confirm the importance of monitoring arterial oxygen saturation in addition to arterial pressure and the electrocardiogram.
The effect of the Trendelenburg position on lower oesophageal sphincter tone
Authors: HEIJKE S. A. M. , SMITH G. , KEY A.
Published: February 2007

Measurements were made of gastric, lower oesophageal and barrier pressures in the supine, moderate and steep Trendelenburg positions in 10 healthy female patients during balanced anaesthesia. Adoption of the Trendelenburg position resulted in no significant changes in any measurement, with the exception of a small increase (0.1 kPa) in intragastric pressure in the steep head‐down position. We conclude that the steep Trendelenburg position should not predispose to regurgitation in healthy patients.
Posthypoxic myoclonus (the Lance‐Adams syndrome) in the intensive care unit
Authors: HARPER S. J. , WILKES R. G.
Published: February 2007

The neurological assessment of patients admitted to the intensive care unit after successful resusitation from cardiopulmonary arrest may be difficult. We describe the cases of two patients who developed myoclonus within 24 hours of hypoxic respiratory and cardiac arrest. Initially, the clonic movements were thought to be generalised convulsions and were treated as such, until it became evident that the patients were aware and distressed. Posthypoxic myoclonus is a rare complication of successful cardiopulmonary resusitation. Recognition depends on the awareness that the syndrome exists, and is important so that correct therapy can be instituted. There may be important prognostic implications. Both our patients had normal intellectual recovery with moderate residual neurological disability from their movement disorder.
Oxygen concentrators offer cost savings for developing countries
Authors: Dobson M.B.
Published: February 2007

The costs of supplying oxygen to different sizes of hospital in Papua New Guinea have been calculated; the use of oxygen concentrators in this country would reduce the cost of oxygen supplies by between 25% and 75%.
Traumatic pneumocephalus following head injury
Authors: FINCH M. D. , MORGAN G. A. R.
Published: February 2007

A 17‐year‐old patient who developed a tension pneumocephalus following a general anaesthetic 29 days after a severe head injury is described.
A coaxial technique for facilitating one‐lung ventilation
Authors: CONACHER I. D.
Published: February 2007

A tube for bronchial intubation is described. A long (48 cm), small bore (5.0 mm internal diameter), cuffed, bronchial plastic tube is inserted coaxially within a large bore tracheal tube (10.0 mm) used for ventilation. The inner tube is designed primarily as a blocker to be inserted with a fibreoptic or optical bronchoscope, but can be effected blindly with a stylet. Several methods of inserting the inner tube and ensuring correct placement were used in 10 males undergoing thoracic surgery. If the bronchial cuff is inflated the tube can be used either as a blocker or as a conduit for suction and conventional and differential ventilatory techniques. Early clinical experience suggests that the technique is an alternative method of facilitating one‐lung ventilation.
Midazolam‐droperidol premedication for cardiac surgery A comparison with papaveretum and hyoscine
Authors: Antrobus J. H. L. , Abbott P. , Carr C. M. E. , Chatrath R. R.
Published: February 2007

A combination of midazolam and droperidol given intramuscularly was compared with papaveretum and hyoscine for premedication of patients about to undergo cardiac surgery. Midazolam and droperidol proved to be a very satisfactory combination, producing superior sedation and anxiolysis with good cardiovascular stability.
Patients' desire for information about anaesthesia Scottish and Canadian attitudes
Authors: Lonsdale M. , Hutchison G. L.
Published: February 2007

Patients in Canada and Scotland were asked to complete a pre‐operative questionnaire examining their desire for information relating to anaesthesia. In both Canada and Scotland, patients under the age of 50 years had a greater wish to receive information than those who were older (p < 0.0001). In Canada, female patients were found to be more keen to receive pre‐operative information than males of the same age group (p < 0.05). The priority given to individual pieces of information was remarkably similar in both countries. Details of dangerous complications of anaesthesia and surgery were consistently rated of low priority, with high priority going to postoperative landmarks such as eating and drinking. Both countries rated meeting the anaesthetist before surgery as the highest priority of all.
Comparison of high and low doses of suxamethonium
Authors: STEWART K. G. , HOPKINS P. M. , DEAN S. G.
Published: February 2007

In a double‐blind study, 67 young adult patients undergoing anaesthesia for dental extractions were allocated at random to receive either 0.5 mg/kg or 1.5 mg/kg suxamethonium. A greater increase in arterial pressure was seen following induction in the 1.5 mg/kg group, although overall intubating conditions were similar in the two groups. Suxamethonium‐associated muscle pains were significantly more common in the group which received the larger dose (p>0.05).
Effect of sufentanil on intracranial pressure in neurosurgical patients
Authors: WEINSTABL C. , MAYER N. , RICHLING B. , CZECH T. , SPISS C. K.
Published: February 2007

The effects of sufentanil on intracranial pressure, mean arterial pressure, cerebral perfusion pressure and heart rate were studied in 20 neurosurgical intensive care unit patients. Epidural intracranial pressure probes were implanted in patients who suffered head injury, intracerebral haemorrhage or underwent tumour resection. Sufentanil was given intravenously in sequential doses of 0.5, 1.0 and 2.0 μg/kg. Fifteen minutes elapsed after each dose. The patients were allocated to either group 1 (baseline intracranial pressure < 20 mmHg) or group 2 (baseline intracranial pressure > 20mmHg). Intracranial pressure did not change significantly in either group. Therefore the falls in mean arterial pressure with the highest dose in both groups and with 1.0 μg/kg in group 2, closely reflect corresponding reductions in cerebral perfusion pressure. As sufentanil in itself exerts no effects on intracranial pressure, concomitant haemodynamic changes are the critical factor for an adequate cerebral perfusion pressure.
Postoperative obstructive sleep apnoea
Authors: REEDER M. K. , GOLDMAN M. D. , LOH L. , MUIR A. D. , CASEY K. R. , GITLIN D. A.
Published: February 2007

A 74‐year‐old man presenting for aortic reconstructive surgery showed severe, previously undiagnosed obstructive sleep apnoea during overnight oximetry monitoring before operation. Postoperatively, in the first 4 hours following extubation, he suffered 238 episodes of respiratory obstruction. These events were associated with frequent arousals, large fluctuations in systolic and diastolic blood pressure. Administration of nasal continuous positive airways pressure abolished the obstructions and allowed an uninterrupted night's sleep, with a significantly reduced blood pressure. Subsequent dips in oxygen saturation as a result of respiratory obstruction recurred on the fifth postoperative night. We conclude that pre‐operative overnight oximetry may be useful in identifying those patients at risk of postoperative upper airway obstruction. Use of nasal continuous positive airway pressure may prevent the occurrence of early postoperative obstruction and the associated haemodynamic changes.
Acute airway obstruction as a result of minitracheotomy
Authors: CAMPBELL A. M. , O'LEARY A.
Published: February 2007

We describe two cases of airway obstruction due to bleeding following minitracheotomy and discuss the indications for minitracheotomy and management of this complication.
Exaggerated epidural blockade resulting from unusual spread of bupivacaine in a patient with low back pain
Authors: POPAT M. T. , JADAD A. R. , GLYNN C. J.
Published: February 2007

A 75‐year‐old woman with chronic low back pain was given bupivacaine and methylprednisolone epidurally through a catheter in the L1–L2 interspace. An unusual spread of bupivacaine resulted in a block from the C4 to the L1 dermatome with no relief of back pain. Injection of a radiopaque dye and subsequent X rays showed a similar spread. The possible causes are discussed.
Life‐saving use of extracorporeal membrane gas exchange in severe, acute respiratory failure
Authors: FISHER A. P. , JAYAWARDENE B. , RAMSTEAD K. D. , FISHER A. R.
Published: February 2007

A 41‐year‐old man developed acute respiratory failure in association with thoracotomy and decortication for a persisting pleural collection secondary to a stab injury. The use of veno‐venous extracorporeal membrane gas exchange proved life‐saving.
Chemical meningism after lumbar facet joint block with local anaesthetic and steroids
Authors: THOMSON S. J. , LOMAX D. M. , COLLETT B.‐J.
Published: February 2007

A case is reported in which chemical meningism occurred after lumbar facet joint block with methylprednisolone acetate and bupivacaine. This complication was probably due to inadvertent dural puncture. The use of steroids in facet joint injections is questioned.
Thoracic epidural analgesia in a patient with bilateral phaeochromocytoma undergoing coronary artery bypass grafting
Authors: LIEM T. H. , MOLL J. E. , BOOIJ L. H. D. J.
Published: February 2007

A patient suffering from phaeochromocytoma and coronary artery stenoses needed coronary artery bypass grafting before adrenalectomy. High thoracic epidural analgesia (T1‐T2) with bupivacaine and sufentanil in combination with general anaesthesia was used. Plasma adrenaline and noradrenaline concentrations decreased during the period before bypass grafting compared to the baseline value and no important haemodynamic changes were seen during this period. Thoracic epidural analgesia failed to suppress the release of catecholamine during the bypass period. After the operation, the plasma catecholamine concentrations returned to the baseline value. Excellent analgesia (visual analogue scale = 1‐2) was achieved with a postoperative epidural, but the plasma catecholamine concentration increased considerably.
Use of the Inspiron nebuliser during continuous positive airway pressure ventilation
Authors: HARDWICK M. , DICKSON G. , CLUTTON‐BROCK T.
Published: February 2007

The Inspiron Nebuliser 002305 with air entrainment was assessed as a gas delivery device in a continuous positive airway pressure system. Inspired oxygen concentrations, total gas flows and pressures within the system were measured over a range of settings, with and without positive end expiratory pressure. Inspired oxygen concentrations and total flows were completely disrupted when a positive end expiratory pressure valve was applied, and the system failed to generate continuous positive airway pressure. We would not therefore recommend the Inspiron nebuliser as a gas delivery system for continuous positive airway pressure.
Cardiovascular effects of nasotracheal intubation
Authors: Smith J. E. , Grewal M. S.
Published: February 2007

Intubation time, arterial pressure, heart rate and arterial oxygen saturation during nasotracheal intubation effected with the Macintosh laryngoscope blade were compared with those during orotracheal intubation. The 60 patients studied received a standardised general anaesthetic and were randomly allocated to one of two groups immediately before tracheal intubation. The mean nasal intubation time (33.2 seconds) was significantly greater than mean oral intubation time (14.8 seconds). The mean arterial pressure changes in the nasal group were significantly greater and more prolonged than in the oral group. The mean heart rate in the nasal group was significantly lower than in the oral group during the first minute after intubation, after which heart rates were similar. There were no significant differences between the two groups with regard to arterial oxygen saturation levels at any stage.
Plasma etomidate levels in mother and fetus
Authors: GREGORY M. A. , DAVIDSON D. G.
Published: February 2007

The most commonly used induction agent in anaesthesia for Caesarean section is still thiopentone. The increasing incidence of Caesarean section for delivery of premature babies from a hostile environment may call in question the assumption that the dose of thiopentone received by the neonate will not cause depression in the hours following birth. Previous studies on thiopentone for Caesarean section have shown inconsistency in umbilical vein/maternal vein ratios. We have studied plasma etomidate levels in maternal and umbilical blood at the time of delivery to see whether equilibrium, occurs with this agent. We were able to demonstrate an umbilical/maternal vein etomidate ratio of 0.5 (SD 0.18), with no relation to time in the range encountered. Also, the uterine artery/uterine vein etomidate ratio was 0.86 (SD 0.33), suggesting that etomidate uptake into the fetus is effectively complete. Further, in all cases the neonatal plasma etomidate levels were less than half those measured at recovery of consciousness in adults in other studies, despite a larger induction dose than is usually used.
A survey of secondary transfers of head injured patients in the south of England
Authors: VYVYAN H. A. L. , KEE S. , BRISTOW A.
Published: February 2007

A survey by questionnare was carried out to look into the provision of facilities for the secondary transfer of head injured patients, as well as difficulties encountered. An 84.6% response rate was achieved from 110 hospitals in six regions in the south of England. The results showed that 21% of hospitals had been unable to make a transfer in the previous year, and delays were commonly experienced by 23.7% of hospitals. The nursing attendance during transfer was satisfactory, but the quality of medical escort was poor, and the standard of monitoring equipment available was unacceptable. Methods of improving the situation include implementation of the recommendations of the Royal College of Surgeons, as well as the Association of Anaesthetists’recommendations for standards of monitoring and provision of intensive care.
The automatic implantable cardioverter‐defibrillator
Authors: CARR C. M. E. , WHITELEY S. M.
Published: February 2007

This paper describes the anaesthetic management of a patient who had an automatic implantable cardioverter‐defibrillator. The working principles of the device, the indications for its insertion and the postoperative complications, are discussed. An increasing number of cardioverter‐defibrillators are being implanted in the UK. At least two general anaesthetics are required for each patient; one for implantation of the device and a second for testing its efficiency in terminating ventricular tachycardia and ventricular fibrillation. In future, the number of patients presenting for noncardiac surgical procedures is likely to increase, therefore every anaesthetist should be aware of the problems involved in management.
Extracorporeal circulation in the management of massive propanolol overdose
Authors: MCVEY F. K. , CORKE C. F.
Published: February 2007

A case of refractory hypotension following propanolol overdose is reported. Management included isoprenaline, glucagon and extracorporeal circulatory support using femoral vein‐femoral artery bypass. The unreliability of neurological observations, especially unreactive pupils, in the presence of drug overdose is reiterated.
The use of the Penlon Nuffield 200 in a monoplace hyperbaric oxygen chamber
Authors: LEWIS R. P. , SZAFRANSKI J. , BRADFORD R. H. , SMITH H. S. , CRABBE G. G.
Published: February 2007

We modified a Penlon Nuffield 200 for use in a monoplace hyperbaric oxygen chamber by feeding back the chamber pressure to the reducing valve of the Nuffield 200. This provides a compensating mechanism, allowing the ventilator to deliver adequate tidal volumes at pressures of up to 3 atmospheres. We report the laboratory testing of the ventilator and our experience of ventilating two patients with carbon monoxide poisoning. Although compensation is not complete the modification is adequate for short‐term clinical use in patients in whom the airway is compromised but who need hyperbaric oxygen therapy.
Comparison of propofol and thiopentone for laryngeal mask insertion
Authors: Brown G. W. , Patel N. , Ellis F. R.
Published: February 2007

Conditions for insertion of the laryngeal mask were assessed following induction of anaesthesia with either propofol 2.5 mg/kg or thiopentone 4.0 mg/kg in 80 patients premedicated with diazepam 10 mg. Insertion following induction with thiopentone resulted in a greater incidence of gagging (p < 0.01). The use of additional induction agent, where necessary, resulted in no ultimate significant difference between the groups for the provision of satisfactory conditions.
Haemodynamic effects of propofol in children
Authors: Short S. M. , Aun C. S. T.
Published: February 2007

The haemodynamic effects of induction of anaesthesia with propofol in children were studied. Two hundred and sixteen children (ASA 1) were randomly allocated to receive one of six different doses of propofol, from 1.6 mg/kg to 2.6 mg/kg, in 0.2 mg/kg increments. Noninvasive measurement of blood pressure showed that mean arterial pressure was reduced by approximately 15% after 1 minute, and by 30% after 5 minutes. The reduction in pulse rate over a 5‐minute period was approximately 17%. These changes were similar in each group, regardless of the dose administered. The propofol was mixed with lignocaine, 0.5 mg/ml, and the incidence of pain on injection into a vein on the dorsum of the hand was 24%. We conclude that, within the dose range of our study, the haemodynamic disturbance after induction of anaesthesia with propofol in children is not dose related.
Hysteria
Authors: ADAMS A. P. , GOROSZENIUK T.
Published: February 2007

Hysteria as a cause of failure to recover consciousness following general anaesthesia is a rare event. This case report describes such an instance in a young, healthy 22‐year‐old female suffering severe dental phobia who was undergoing dental conservation. The literature is reviewed and a summary of the possible physiological mechanisms involved is given.
Reversible renal failure following opioid administration
Authors: HILL S. A. , QUINN K. , SHELLY M. P. , PARK G. R.
Published: February 2007

A patient who received intravenous papaveretum during and after operation developed anuria and biochemical evidence of impaired renal function in the first 6 hours after surgery. Administration of naloxone 0.4 mg was associated with a sustained improvement in urine output. Mean arterial pressure did not change significantly. The impairment of renal function may have been related to high plasma concentrations of codeine, one of the constituents of papaveretum.
Environmental contamination during tracheal suction
Authors: COBLEY M. , ATKINS M. , JONES P. L.
Published: February 2007

The extent of airborne environmental bacterial contamination which occurs following tracheal suction has been investigated in patients undergoing intermittent positive pressure ventilation in the intensive therapy unit. Two methods of performing suction, one using a conventional open technique and one using a closed system (Stericath), have been compared. Significantly lower levels of environmental contamination were observed when the closed system was used.
Inhaled nebulised fentanyl for postoperative analgesia
Authors: Higgins M.J. , Asbury A.J. , Brodie M.J.
Published: February 2007

The effects of three concentrations of inhaled nebulised fentanyl citrate solution given for postoperative pain relief were studied. Each of 30 patients inhaled one dose of 3 ml of solution nebulised over 9 min. A combined analysis of pain relief, time to further analgesia and effect on respiratory frequency showed the highest concentration (318 μg/ml fentanyl base) to be more effective (p < 0.01) than the two lower concentrations (159 μg/ml and 64 μg/ml) which were indistinguishable from each other. There were no major side effects. This study provides evidence for the efficacy and safety of inhaled fentanyl for postoperative analgesia. Estimation of the delivered doses did not support the hypothesis that fentanyl is more effective by this route compared with other parenteral routes. Further studies are required to improve the method of delivery and investigate the pharmacodynamic features of this technique.
Parents in the anaesthetic room
Authors: Ryder I. G. , Spargo P. M.
Published: February 2007

One hundred and forty‐one parents were asked to complete a questionnaire about their reactions after accompanying their child during induction of anaesthesia. Of 139 respondents, 99% believed that their presence was of benefit to their child, and 95% believed that they helped the anaesthetist. The degree of anxiety experienced by the parent did not significantly affect this view, nor was the degree of anxiety affected by the method of induction chosen by the anaesthetist.
Low‐flow anaesthesia
Authors: COTTER S. M. , PETROS A. J. , DORÉ C. J. , BARBER N. D. , WHITE D. C.
Published: February 2007

An 8‐week survey was conducted to determine whether the introduction of low‐flow anaesthesia (a fresh gas flow of 4 litres/minute or less) into routine use would be acceptable to members of a representative anaesthetic department and if the consequent reduction in use of volatile anaesthetics would result in financial savings. The hourly consumption of the volatile agents was measured during anaesthesia conducted using either conventional or low fresh gas flows. Anaesthetists' acceptance of low‐flow anaesthesia was assessed using a questionnaire. Data were gathered on 286 patients undergoing inhalational anaesthesia for routine operative procedures. A 54.7% reduction in the consumption of isoflurane and a 55.9% reduction in that of enflurane was found. Of the 28 anaesthetists at the hospital, 21 would use low‐flow anaesthesia routinely. The routine use of low‐flow anaesthesia would therefore be acceptable and could result in annual savings of £26870 at Northwick Park Hospital.
Gastric emptying following Caesarean section and the effect of epidural fentanyl
Authors: GEDDES S. M. , THORBURN J. , LOGAN R. W.
Published: February 2007

The rate of absorption of paracetamol following oral administration was used as an indirect measure of the rate of gastric emptying. This was to determine the effect on gastric motility of the addition of fentanyl to a solution of local anaesthetic given into the epidural space to provide pain relief following Caesarean section. Thirty subjects were randomly allocated to receive either bupivacaine plus fentanyl or bupivacaine alone. The area under the curve of the graph of plasma paracetamol concentration versus time was calculated for each subject at 45 and 90 minutes after administration of the epidural injection, and this value was used as an index of the rate of gastric emptying. This study demonstrated that gastric emptying may be normal immediately following Caesarean section under epidural anaesthesia, but that if fentanyl is added to the epidural solution, gastric emptying is significantly slower in the first 45 minutes following surgery (p < 0.05).
Stressful pre‐operative preparation procedures
Authors: COBLEY M. , DUNNE J. A. , SANDERS L. D.
Published: February 2007

One hundred and twenty‐four patients (76 women and 48 men) were interviewed within the first 36 hours after operation. Fifty per cent of those studied were denture wearers. They were asked to fill in a questionnaire which registered their levels of distress about the various pre‐operative preparation procedures. The most common factors contributing to pre‐operative distress were waiting for transfer to the operating theatre, the prohibition of fluids and the removal of dentures.
A serious complication of minitracheotomy
Authors: McEWAN A. I. , FRANCIS G. A. , CLARKE J. T.
Published: February 2007

A previously unreported complication of minitracheotomy is described. The minitracheotomy introducer was lost into the pleural cavity and a thoracotomy was required to remove it.
Effect of prior administration of cold saline on pain during propofol injection
Authors: Barker P. , Langton J. A. , Murphy P. , Rowbotham D. J.
Published: February 2007

A single‐blind, randomised, controlled study was undertaken to compare the efficacy of three methods of preventing pain during injection of propofol on induction of anaesthesia. Patients were allocated randomly to receive unmodified propofol, propofol with 0.05% lignocaine, propofol at 4°C and unmodified propofol preceded by 10 ml of 0.9% saline at 4°C. Prior injection of cold saline reduced the incidence of pain and discomfort significantly (22%) compared with unmodified propofol (75%; p < 0.005) and was similar to that after cold propofol (33%) and propofol with lignocaine (44%). There was no significant difference between the treatment groups.
Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement
Authors: SERPELL M. G. , MILLAR F. A. , THOMSON M. F.
Published: February 2007

A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200 000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.
Milrinone, a bridge to heart transplantation
Authors: WATSON D. M. , SHERRY K. M. , WESTON G. A.
Published: February 2007

We describe the use of a milrinone infusion as a bridge to heart transplantation in the treatment of severe congestive cardiac failure secondary to viral cardiomyopathy. The clinical improvement that occurred when milrinone was commenced made it possible to wean the patient from conventional cardiovascular support with an intra‐aortic balloon pump and dobutamine. There was an improvement in organ perfusion.
Potential errors in pulse oximetry III: Effects of interference, dyes, dyshaemoglobins and other pigments*
Authors: RALSTON A. C. , WEBB R. K. , RUNCIMAN W. B.
Published: February 2007

Electrosurgery, patient motion and some types of lighting can cause errors in saturation readout; it is recommended that probes should be shielded from ambient lighting. Intravenous dyes can introduce gross but transient errors, which may also be present in in vitro measurements. Carboxyhaemoglobin causes overestimation of fractional saturation by an amount less than, but possibly close to, the percent of carboxyhaemoglobin present. Methaemoglobin causes the pulse oximeter readout to tend towards 85%. Fetal haemoglobin and bilirubin introduce no significant error, although they may interfere with in vitro measurements. Skin pigmentation can result in a slight decrease in accuracy. Nail polish may cause up to 6% underestimation of saturation; it is recommended that probes should be mounted sideways on fingers with nail polish or long nails. Adhesive tape or a vinyl glove across the probe has no demonstrable effect on accuracy. A blood sample should be analysed by a multiwavelength in vitro oximeter when an erroneous pulse oximeter reading is suspected, although errors may be introduced in the in vitro reading by fetal haemoglobin, bilirubin and intravenous dyes.
Francis Percival de Caux (1892–1965)
Authors: WILKINSON D. J.
Published: February 2007

All doctors practice medicine within the confines of what is termed ‘acceptable practice’. This acceptable practice is delineated by medical ethics, the actions of one's colleagues, social custom, and the laws of the country. Failure to conform to any or all of these constraints may result in professional ostracism or even loss of liberty. The life and work of Frances Percival de Caux clearly shows these effects in their most damaging manner.
A comparison of lignocaine with prilocaine in axillary brachial plexus anaesthesia
Authors: McCoy E.P. , Wilson C.M.
Published: February 2007

Twenty patients received either lignocaine 1.5% with 1/200000 adrenaline (group L), or prilocaine 1.5% plain (group P) as a brachial plexus block for surgery to the upper limb, in a randomised double‐blind study. The two groups were comparable in age, weight and duration of surgery and there were no significant differences between the two groups with regard to onset, pattern or degree of sensory loss. The degree of motor loss was also comparable. The group L patients had a statistically significant longer duration of sensory loss than those in group P. All the blocks were performed using the same technique and provided complete surgical anaesthesia. Prilocaine 1.5% plain provides adequate sensory and motor blockade for brachial plexus anaesthesia and is a suitable agent for medium duration surgery to the upper limb.
Incidence of awareness with recall during general anaesthesia
Authors: LIU W. H. D. , THORP T. A. S. , GRAHAM S. G. , AITKENHEAD A. R.
Published: February 2007

One thousand patients who were anaesthetised between February and April 1990 at University Hospital, Nottingham were interviewed between 20 and 36 hours after their operation. Patients under 16 years of age, those who had undergone obstetric or intracranial surgery, those who were unable to communicate and patients who were discharged from hospital before the postoperative visit were not interviewed. A standard set of questions was used to determine the incidences of recall of events and dreams during the operation. These incidences were 0.2% and 0.9% respectively, considerably lower than reported in previous comparable studies.
Comparison of extradural and intravenous diamorphine as a supplement to extradural bupivacaine
Authors: LEE A. , McKEOWN D. , BROCKWAY M. , BANNISTER J. , WILDSMITH J. A. W.
Published: February 2007

The influence of route of administration (extradural as compared with intravenous) of diamorphine 0.5 mg/hour as a supplement to extradural bupivacaine (0.125% at 15 ml/hour) was investigated in two groups of 20 patients who underwent major abdominal gynaecological surgery. Significantly more patients in the intravenous group withdrew because of inadequate analgesia (p < 0.05). Those in the extradural group were significantly more drowsy throughout the study (p < 0.01), but no major side effects were encountered.
Myoclonic spasms after epidural diamorphine infusion
Authors: JAYAWARDENA B. , HILL D. J.
Published: February 2007

A case is presented in which myoclonus occurred after epidural diamorphine infusion. Reports of this phenomenon following other epidural drugs and possible mechanisms are discussed.
Evaluation of the Lamtec anaesthetic agent monitor
Authors: HUMPHREY S. J. E. , LUFF N. P. , WHITE D. C.
Published: February 2007

The Lamtec agent monitor is a compact anaesthetic analyser designed to measure halothane, isoflurane and enflurane. It shows good linearity and stability. The faster model can be used for end‐tidal measurements up to 25 breaths per minute. Calibration using a standard of the gas to be measured is recommended.
Antagonism of atracurium with neostigmine
Authors: Goldhill D. R. , Carter J. A. , Suresh D. , Whitehead J. P. , Flynn P. J.
Published: February 2007

In 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium‐induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 μg/kg, 35 μg/kg, 55 μg/kg or 75 μg/kg). The recovery times to a train‐of‐four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average TI of between 8.8% and 14.9%. There was no difference in the recovery times between the patients given neostigmine 35 μg/kg, 55 μg/kg or 75 μg/kg. Recovery after neostigmine 15 μg/kg was significantly slower than after the higher doses. One patient given neostigmine 75 μg/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 μg/kg of neostogmine as a single bolus.
Colloid solutions in the critically ill
Authors: STOCKWELL M. A. , SONI N. , RILEY B.
Published: February 2007

All patients admitted to an Intensive Care Unit were randomised to receive all volume replacement fluid as either human albumin solution or a synthetic colloid. A total of 475 patients were admitted during the study period. Patients' age, sex, APACHE score and calculated risk of death were assessed on admission. Outcome was assessed as length of Intensive Care stay and mortality. There was no difference between the groups. Subgroups of patients with APACHE score greater than 10, calculated risk of death greater than 50% and length of stay greater than 5 days were also evaluated but no significant differences were found between treatment groups. The use of albumin rather than 3.5% polygeline for volume replacement in the Intensive Care Unit has no influence on outcome.
An evaluation of the Brüel and Kjær monitor 1304
Authors: McPEAK H. B. , PALAYIWA E. , ROBINSON G. C. , SYKES M. K.
Published: February 2007

A laboratory evaluation was performed on the Brüel and Kjœr multigas monitor 1304, incorporating a pulse oximeter. The instrument was tested for accuracy, stability, response and delay times, frequency response and the effects of water vapour, alcohol, cyclopropane and sevoflurane. The instrument's performance was found to be within or very close to the manufacturer's specifications for accuracy, stability and response and delay times. It was unaffected by water vapour and alcohol and the effect of cyclopropane on the vapour channel was lower than has been reported for other analysers. The response to sevoflurane was of the same order as that of the other vapours. A 90% response to square wave changes of gas composition was maintained up to 60 breaths.min−1 for CO2, O2, and N2O and up to 40 breaths.min−1 for the vapours when the nafion sampling tube was used.
The ‘whoosh’ test
Authors: Lewis M. P. N. , Thomas P. , Wilson L. F. , Mulholland R. C.
Published: February 2007

We describe a previously unreported test to confirm accurate needle placement in caudal epidurals. Of 26 patients undergoing caudal epidural, 19 (73%) had correct needle placement as determined by epidurography. All of these had a positive‘whoosh' test. There were no false positives.
Propofol and serum potassium
Authors: Fogarty D.J. , McCleane G.J.
Published: February 2007

The aim of this study was to examine the effect of propofol and propofol with suxamethonium on serum potassium concentration during induction of general anaesthesia. Forty patients were studied during elective surgery and serum electrolytes were measured before and after the induction of anaesthesia. Patients were allocated at random into two groups to receive either propofol alone or with suxamethonium. The serum potassium fell by 0.04 mmol.l−1 by 5 min after induction with propofol alone but had recovered to the pre‐induction level by 10 min. The serum potassium rose by 0.23 mmol.l−1 when a combination of propofol and suxamethonium was used for the induction of anaesthesia.
V̇o2 and V̇co2 following tourniquet deflation
Authors: Hoka S. , Yoshitake J. , Arakawa S. , Ohta K. , Yamaoka A. , Goto T.
Published: February 2007

We examined changes in O2 uptake, CO2 output, blood pressure and heart rate following tourniquet deflation in 23 patients undergoing orthopaedic surgery of the lower extremities. A pneumatic tourniquet was applied for periods ranging from 21 to 106 min (mean 51 min). Prerelease values of V̇o2 (O2 uptake at each min) and V̇co2 (CO2 output at each min) were 201 (37) and 174 (38) (mean (SD)) ml.min−1 respectively. Significantly, V̇o2 and V̇co2 increased by 55% and 80%, respectively, at 2 min after tourniquet release and returned to prerelease values within 8 min. The blood pressure fell significantly and the heart rate rose significantly. The increases in CO2 output and O2 uptake were dependent on the length of tourniquet inflation time; Y = 4.7 X (tourniquet time) +54, r = 0.88, (p < 0.001) for CO2, and Y = 1.3 X (tourniquet time) +99, r = 0.52, (p < 0.05) for O2. The slope of the increase in CO2 output as a function in inflation time was 3.6 times greater than that of O2 uptake. In conclusion, CO2 output and O2 uptake increased transiently after tourniquet deflation and the extent of the increase in CO2 output is more than threefold as compared with that in O2 uptake.
Upper oesophageal sphincter pressure and the effect of cricoid pressure
Authors: VANNER R. G. , O'DWYER J. P. , PRYLE B. J. , REYNOLDS F.
Published: February 2007

Upper oesophageal sphincter pressure has been measured in 24 patients with a sleeve device. The median sphincter pressure when awake was 38 mmHg. and when anaesthetised and paralysed was 6 mmHg. After tracheal intubation, cricoid pressure was applied at measured values between 5 and 50 N using a hand‐held cricoid yoke while the sphincter pressure was recorded in two head and neck positions: with and without a standard intubating pillow with neck support. A cricoid force of 40 N increased sphincter pressure to above 38 mmHg in all the patients and the use of the pillow did not alter this effect. With the application of cricoid pressure, operating department assistants raised sphincter pressure to above 38 mmHg in only 50% of patients. Laryngoscopy made little difference to the effect of cricoid pressure except in one patient in whom it reduced the sphincter pressure by 27 mmHg.
Ketorolac for postoperative analgesia in elderly patients
Authors: Smallman J. M. B. , Powell H. , Ewart M. C. , Morgan M.
Published: February 2007

Ketorolac was compared with papaveretum followed by paracetamol plus dextropropoxyphene orally', for postoperative pain relief in elderly orthopaedic patients. Seventy‐two patients over the age of 65 years were entered into a double‐blind, randomised trial. Pain and pain relief were recorded during an intramuscular and an oral phase, lasting up to 8 days, and a global assessment was made at the end of the study. No difference was demonstrated between the two treatment groups. The incidence of side effects was similar in both groups. It was concluded that ketorolac could provide pain relief equivalent to papaveretum for many patients.
A comparison of two approaches to sciatic nerve block
Authors: Kilpatrick A. W. A. , Coventry D. M. , Todd J. G.
Published: February 2007

This study compared the posterior and popliteal fossa approaches for sciatic nerve block. Patients scheduled to undergo foot surgery were allocated randomly into one of two groups: group A (n = 20) received sciatic nerve block via the posterior approach and group B (n = 20) received a block using the popliteal fossa approach. All blocks were performed with the aid of a peripheral nerve stimulator and alkalinised 0.5% bupivacaine with 1 in 200 000 adrenaline was injected in a dose of 2 mg.kg Nineteen of 20 blocks in group A were successful compared with nine of 20 in group B (p < 0.01). There was no significant difference between the groups in respect of time to onset or duration of block. Patients in group B reported less discomfort during performance of the sciatic nerve block but required supplementary nerve blocks more frequently. We recommend the use of the posterior approach for sciatic nerve block.
Appropriate use of local anaesthetic for venous cannulation
Authors: HARRISON N. , LANGHAM B. T. , BOGOD D. G.
Published: February 2007

A departmental survey indicated that the large majority of anaesthetists believed that injection of local anaesthetic before insertion of an intravenous cannula was unnecessary if a cannula of 18 gauge or smaller was used, because injection of local anaesthetic would be more painful than insertion of the cannula. A study was undertaken to test this hypothesis. The results showed that intravenous cannulation with a cannula of 18, 20 or 22 gauge was significantly (p < 0.006) more painful than a subcutaneous injection of 1% lignocaine. We recommend that subcutaneous injection of local anaesthetic should be considered before insertion of any size of intravenous cannula.
Treatment of acute severe asthma assisted by hypothermia
Authors: BROWNING D. , GOODRUM D. T.
Published: February 2007

A 20‐year‐old woman in status asthmaticus who failed to respond to conventional therapy and ventilation of the lungs with 0.5–2.0% halothane, was cooled to 30°C for almost 5 days as the arterial carbon dioxide tension rose above 15 kPa. Halothane was not of immediate value, contrary to other reports. A reduction in carbon dioxide production by controlled hypothermia permitted more suitable ventilation parameters, but extensive muscle weakness caused by a steroid‐induced myopathy complicated weaning from respiratory support. Prospective measurement of serum creatinine phosphokinase concentration in patients given high dose corticosteroids may herald the onset of a myopathy.
The use of propofol and alfentanil by infusion in military anaesthesia
Authors: WILSON R. J. T. , RIDLEY S. A.
Published: February 2007

A total intravenous technique using propofol and alfentanil was used successfully in four battlefield casualties treated at a British Military Field Hospital during the recent Gulf conflict. All patients made a rapid recovery of adequate quality for prompt evacuation. We believe that the use of propofol and alfentanil as an induction and maintenance regimen for military anaesthesia merits further evaluation and comparison with established techniques.
Influence of converting enzyme inhibition on isoflurane‐induced hypotension for cerebral aneurysm surgery
Authors: Van Aken J. , Leusen I. , Lacroix E. , De Somer A. , Roily G. , Calliauw L.
Published: February 2007

Twenty‐five patients (aged 18 to 72 years), who recovered after the first bleed from a cerebral aneurysm, were operated on under neuroleptanaesthesia. Isqflurane was added to induce hypotension, ft was found that the required hypotension (51 (SEM 1) mmHg) could be obtained and maintained at much lower isoflurane concentrations (less than 1%) after blockade of the angiotensin converting enzyme activity by enalaprilat (2.5 mg i.v.) than without such inhibition. During the hypotension which lasted 78 (Sem 10) min, only minor adjustments of the isoflurane concentration (0.70 (0.04%) were needed. The desired level of hypotension was obtained with preservation of the cardiac output and without tachycardia. No resistance to the blood pressure lowering effect of isoflurane was observed. On recovery from anaesthesia, a small increase of blood pressure above control values was seen in 16 patients and was easily reversed by small doses of clonidine (mean total dose: 220 (61) μg). The operative conditions were excellent and the postoperative recovery was uneventful and complete in 23 patients.
Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction
Authors: Messent M. , Sullivan K. , Keogh B. F. , Morgan C. J. , Evans T. W.
Published: February 2007

The outcome of adult respiratory distress syndrome complicating cardiopulmonary bypass has changed little in recent years. A retrospective, case‐controlled study was designed to assess the incidence of the adult respiratory distress syndrome in these circumstances and the extent to which it could be linked with pre and peri‐operative predictive factors. Eleven patients who developed the syndrome out of 840 who underwent cardiopulmonary bypass over a 9 month period were compared with 53 controls matched for sex, operation and surgeon. The incidence of adult respiratory distress syndrome and its mortality were 1.3% and 53% respectively. Significant predictors were a high intra and postoperative intervention score, the total volume of blood pumped during bypass (>300 l) and age (>60 years). These risk factors should alert the clinician to the possibility of severe postoperative pulmonary complications.