bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of baclofen on gastro‐oesophageal reflux, lower oesophageal sphincter function and reflux symptoms in patients with reflux disease
Authors: Van Herwaarden M. A. , Samsom M. , Rydholm H. , Smout A. J. P. M.
Published: March 2003

Background : Baclofen decreases gastro‐oesophageal reflux episodes in healthy subjects by reducing the incidence of transient lower oesophageal sphincter relaxations.

Aim : To investigate the effect of baclofen on reflux symptoms, oesophageal pH and lower oesophageal sphincter manometry in patients with gastro‐oesophageal reflux disease.

Methods : A double‐blind, placebo‐controlled, two‐way crossover design was used to study the effect of baclofen on heartburn and regurgitation 3 h after a provocation test meal in 37 patients with gastro‐oesophageal reflux disease. Additionally, in 20 of these patients, the effect of baclofen on oesophageal pH, transient lower oesophageal sphincter relaxations and basal lower oesophageal sphincter pressure was studied.

Results : Baclofen significantly decreased the acid reflux time and the incidence of gastro‐oesophageal reflux episodes (8.3 ± 8.8% vs. 12.4 ± 12.0%, P = 0.03 and 10.9 ± 7.3 per 3 h vs. 18.7 ± 12.4 per 3 h). The incidence of transient lower oesophageal sphincter relaxations was significantly lower with baclofen than with placebo (15.1 ± 6.4 per 3 h vs. 22.8 ± 5.4 per 3 h, P < 0.0001). Lower oesophageal sphincter pressure and the percentage of transient lower oesophageal sphincter relaxations associated with reflux were not affected by baclofen. No significant effect on symptom scores was observed.

Conclusions : Baclofen decreases post‐prandial acid reflux in patients with gastro‐oesophageal reflux disease by reducing the incidence of transient lower oesophageal sphincter relaxations. No effect of a single dose of baclofen on reflux symptoms could be demonstrated in this 3‐h post‐prandial study.
Colonic delivery of 4‐aminosalicylic acid using amylose–ethylcellulose‐coated hydroxypropylmethylcellulose capsules
Authors: Tuleu C. , Basit A. W. , Waddington W. A. , Ell P. J. , Newton J. M.
Published: March 2003

Background : 4‐Aminosalicylic acid has the potential for use in the treatment of diseases of the colon.

Aim : To assess the feasibility of delivering 4‐aminosalicylic acid directly to the colon using a hydroxypropylmethylcellulose capsule coated with a mixture of amylose, a polysaccharide metabolized by bacterial enzymes in the colon, and ethylcellulose.

Methods : Seven healthy male volunteers received, on three separate occasions, an uncoated or amylose–ethylcellulose‐coated hydroxypropylmethylcellulose capsule containing 4‐aminosalicylic acid Na (550 mg), or an intravenous injection of 4‐aminosalicylic acid Na (135 mg). The capsules were radiolabelled with 99mTc to allow their positions in the gastrointestinal tract to be followed using a gamma camera. Plasma and urine samples were collected and assayed for 4‐aminosalicylic acid and metabolite concentrations.

Results : The uncoated capsules broke down within 10 min in the stomach, allowing rapid and complete absorption of the drug. The coated capsules remained intact in the upper gastrointestinal tract, and had a median gastric emptying time of 61 min (interquartile range, 77 min) and a median colon arrival time of 363 min (interquartile range, 185 min). For the coated capsules, only the metabolite was detected in the plasma and/or urine after the capsules had reached the colon.

Conclusions : The specific coating protected the drug until the capsule reached the colon, where 4‐aminosalicylic acid was slowly released and absorbed. Thus, such a formulation has the potential for use in the treatment of inflammatory bowel disease.
The effect of Helicobacter pylori infection on nonsteroidal anti‐inflammatory drug‐induced upper gastrointestinal tract injury
Authors: Laine L.
Published: March 2003

Helicobacter pylori and nonsteroidal anti‐inflammatory drugs (NSAIDs) are the two major causes of peptic ulcers. This article reviews the interaction of H. pylori and NSAIDs on the development of gastric mucosal histological changes, endoscopically confirmed ulcers, and ulcer complications, and assesses whether underlying H. pylori infection potentiates (or mitigates) the development of NSAID‐induced ulcer disease. The weight of evidence does not suggest that H. pylori infection potentiates the risk of ulcer formation or ulcer complications in NSAID users. If such an effect occurs, it is likely to be relatively small. Some data even suggest that H. pylori may be protective against NSAID‐induced gastric ulcers. Limited data raise the possibility that H. pylori infection, however, may potentiate the effect of low‐dose aspirin with respect to ulcer bleeding. Both NSAIDs and H. pylori are independent risk factors for ulcer disease. Therefore, in an individual patient with an ulcer, one cannot be certain which factor is responsible for the ulcer, and both risks should be removed if possible.
Terlipressin in acute oesophageal variceal haemorrhage
Authors: Ioannou G. N. , Doust J. , Rockey D. C.
Published: March 2003

Background : Controversy exists surrounding pharmacological therapy in acute variceal bleeding.

Aim : To determine the efficacy and safety of terlipressin.

Methods : Randomized trials were identified and duplicate, independent, review identified 20 randomized trials involving 1609 patients that compared terlipressin with placebo, balloon tamponade, endoscopic treatment, octreotide, somatostatin or vasopressin for treatment of acute oesophageal variceal haemorrhage.

Results : Meta‐analysis showed that compared to placebo, terlipressin reduced mortality (relative risk 0.66, 95% CI 0.49–0.88), failure of haemostasis (relative risk 0.63, 95% CI 0.45–0.89) and the number of emergency procedures per patient required for uncontrolled bleeding or rebleeding (relative risk 0.72, 95% CI 0.55–0.93). When used as an adjuvant to endoscopic sclerotherapy, terlipressin reduced failure of haemostasis (relative risk 0.75, 95% CI 0.58–0.96), and had an effect on reducing mortality that approached statistical significance (relative risk 0.74, 95% CI 0.53–1.04). No significant difference was demonstrated between terlipressin and endoscopic sclerotherapy, balloon tamponade, somatostatin or vasopressin. Haemostasis was achieved more frequently with octreotide compared to terlipressin (relative risk 1.62, 95% CI 1.05–2.50), but this result was based on unblinded studies. Adverse events were similar between terlipressin and the other comparison groups except for vasopressin, which caused more withdrawals due to adverse events.

Conclusions : Terlipressin is a safe and effective treatment for acute oesophageal variceal bleeding, with or without adjuvant endoscopic sclerotherapy. Terlipressin appears to reduce mortality in acute oesophageal variceal bleeding compared to placebo, and is the only pharmacological agent shown to do so. Future studies will be required to detect potential mortality differences between terlipressin and other therapeutic approaches.
The pharmacokinetic profiles of oral mesalazine formulations and mesalazine pro‐drugs used in the management of ulcerative colitis
Authors: Sandborn W. J. , Hanauer S. B.
Published: March 2003

Aim : To quantify through systematic review the pharmacokinetic profiles of the oral delayed release and sustained release mesalazine (5‐aminosalicylate, 5ASA) formulations (Asacol, Salofalk, Mesasal, Claversal, Pentasa) and pro‐drugs (sulfasalazine, olsalazine, balsalazide) used in the management of ulcerative colitis.

Methods : Selected articles had: (1) adult healthy volunteers or patients with ulcerative colitis and (2) quantification of pharmacokinetic data to include, at a minimum, urinary excretion of total 5ASA [5ASA plus N‐Acetyl‐5ASA (N‐Ac‐5ASA)].

Data collection and analysis : Pharmacokinetic data (Tmax, Cmax, AUC, urinary excretion, faecal excretion) of 5ASA, its major metabolite N‐Acetyl‐5ASA, total 5ASA, and the parent pro‐drug compounds was extracted.

Main results : The summary results for urinary excretion of total 5ASA over 24–96 h in all subjects (either mean or median) were: sulfasalazine mean 11–33% or median 22%; olsalazine mean 14–31% or median 16–27%; balsalazide mean 12–35% or median 20%; Asacol mean 10–35% or median 18–40%; Pentasa mean 15–53% or median 23–34%; Salofalk, Mesasal and Claversal mean 27–56% or median 31–44%. The summary results for faecal excretion of total 5ASA over 24–96 h in all subjects (either mean or median) were: sulfasalazine mean 23–75% or median 38%; olsalazine mean 47–50% or median 17–36%; balsalazide mean 46% or median 22%; Asacol mean 40–64% or median 20–56%; Pentasa mean 12–51% or median 39–59%; Salofalk, Mesasal and Claversal mean 37–44% or median 23–35%.

Conclusions : The systemic exposure to 5ASA, as measured by urinary excretion of total 5ASA, and the faecal excretion of total 5ASA is comparable for all oral mesalazine formulations and pro‐drugs. Thus, selection of a mesalazine therapy for the treatment of ulcerative colitis should be based on other factors such as efficacy, dose–response, toxicity of the parent compound and its metabolites, compliance issues related to dose forms and dosing schedules, and costs.
Infusion reactions to infliximab in children and adolescents: frequency, outcome and a predictive model
Authors: Crandall W. V. , Mackner L. M.
Published: March 2003

Background : Crohn's disease commonly affects children and adolescents, however the majority of research into the safety and efficacy of therapies for inflammatory bowel disease, including infliximab, has occurred only in adults.

Aim : To determine the rate of reactions in children following infliximab infusions, and to identify variables that might be predictive of those reactions.

Methods : We performed a retrospective review of all infliximab infusions performed at Columbus Children's Hospital from December 1998 through September 2001.

Results : Fifty‐seven children received 361 infusions. Three hundred and fifty‐five of the 361 infusions (98.3%) were completed. Fifty children had 304 repeat infusions. There were a total of 35 infusion related reactions. Female gender and the use of immunosuppressive medications for less than 4 months were risk factors for a reaction to infusion number 2. A reaction to infusion 2 and immunosuppressive use for less than 4 months were risk factors for infusion number 3.

Conclusions : The rate of infusion reactions in children receiving infliximab is similar to that in adults. Female gender, immunosuppressive use for less than 4 months and prior infusion reactions may be risk factors for subsequent infusion reactions in children.
A pharmacoscintigraphic evaluation of oral budesonide given as controlled‐release (Entocort) capsules
Authors: Edsbäcker S. , Bengtsson B. , Larsson P. , Lundin P. , Nilsson Å. , Ulmius J. , Wollmer P.
Published: March 2003

Aims : To investigate the gastrointestinal pharmacokinetics of controlled‐release (Entocort) and standard budesonide capsules.

Methods : Six Crohn's disease patients and eight healthy controls were given controlled‐release capsules containing budesonide and an inert 111In label, following breakfast. In the patients, a standard capsule containing deuterium‐labelled budesonide was given simultaneously. In the controls, on a separate occasion, the controlled‐release capsules were given in the fasting state. Gastrointestinal transit was recorded by a gamma camera. Plasma budesonide and deuterium‐labelled budesonide were used to estimate drug release, and urine cortisol was used to assess systemic effects.

Results : Budesonide delivery to the ileo‐colonic region was significantly greater after the intake of the controlled‐release capsules [69%; 95% confidence interval (CI), 54–84] than after the standard capsules (30%; 95% CI, 15–45) (P = 0.005). Fasting had little impact on uptake. The transit and pharmacokinetics of budesonide were similar in both subject groups, although systemic availability was higher in patients (21%; 95% CI, 13–33) than in controls (12%; 95% CI, 10–14) (P = 0.009). Urinary cortisol was, however, similar in both groups.

Conclusions : A major fraction of budesonide is released in the ileum and throughout the colon, the intended target for the controlled‐release formulation. The prandial state has little effect on budesonide uptake.
A randomized, double‐blind trial of the efficacy and safety of 10 or 20 mg rabeprazole compared with 20 mg omeprazole in the maintenance of gastro‐oesophageal reflux disease over 5 years
Authors: Thjodleifsson B. , Rindi G. , Fiocca R. , Humphries T. J. , Morocutti A. , Miller N. , Bardhan K. D. ,   FOR THE EUROPEAN RABEPRAZOLE STUDY GROUP
Published: March 2003

Background : Gastro‐oesophageal reflux disease has a chronic course, and often requires long‐term treatment. Proton pump inhibitors are the treatment of choice for both acute and maintenance treatment, but little is known from randomized controlled trials of their effects beyond 1 year.

Aim : To compare the efficacy and safety of two doses of rabeprazole with 20 mg omeprazole in the maintenance treatment of erosive gastro‐oesophageal reflux disease over 5 years.

Methods : Two hundred and forty‐three patients who had previously responded to acute treatment for erosive gastro‐oesophageal reflux disease were prospectively randomized to receive 5 years of treatment with rabeprazole (10 or 20 mg daily) or omeprazole (20 mg daily). The primary outcome measure was endoscopically confirmed relapse of erosive gastro‐oesophageal reflux disease.

Results : One hundred and twenty‐three patients (51%) completed all 5 years of the study, with similar completion rates in the three groups. Relapses occurred in nine of 78 (11.5%), eight of 82 (9.8%) and 11 of 83 (13.3%) patients in the rabeprazole 20 mg, rabeprazole 10 mg and omeprazole 20 mg groups, respectively. Gastric biopsy showed no evidence of any harmful effects. All treatments were well tolerated.

Conclusions : Rabeprazole 10 mg, rabeprazole 20 mg and omeprazole 20 mg all had similar efficacy in the maintenance treatment of gastro‐oesophageal reflux disease. All three were safe and well tolerated during 5 years of treatment.
Comparative pharmacokinetics and safety of lansoprazole oral capsules and orally disintegrating tablets in healthy subjects
Authors: Freston J. W. , Chiu Y.‐L. , Mulford D. J. , Ballard II E. D.
Published: March 2003

Background : Many individuals with acid‐related gastrointestinal disorders have difficulty in swallowing oral agents.

Aim : To compare the bio‐availability of a single dose of lansoprazole orally disintegrating tablet with that of an intact capsule.

Methods : One hundred and twenty healthy subjects participated in two prospective, Phase I, open‐label, two‐period cross‐over studies to receive lansoprazole, 15 mg or 30 mg. Within each study, subjects were randomized into two parallel cohorts consisting of 30 subjects per regimen, dispensed in opposing sequence over two periods separated by a 7‐day washout period. Blood samples were collected on day 1 of both periods to determine the pharmacokinetic parameters.

Results : Tmax occurred at 1.8 and 2.0 h with the 15‐mg and 30‐mg tablets, respectively. Dose proportional increases in Cmax, AUCt and AUC∞ were observed in the 15‐mg and 30‐mg groups. The terminal elimination half‐lives (t1/2) were identical in both dose groups (1.18 h). Lansoprazole administered as the orally disintegrating tablet was bio‐equivalent to the intact capsule formulation with respect to Cmax, AUCt and AUC∞.

Conclusions : Lansoprazole orally disintegrating tablets, 15 mg and 30 mg, are bio‐equivalent to the respective dose administered as the intact capsule. This novel dosage formulation represents an option for patients who have difficulty in swallowing oral agents.
How would patients prefer to spend the waiting time before their operations?
Authors: Hyde R. , Bryden F. , Asbury A. J.
Published: March 2003

Many surgical patients are anxious while waiting to go to the operating theatre in spite of the best preparation with drugs, information and reassurance. It is possible that patients could be more comfortable if allowed a choice of activities before operations. The objective of this study was to find out how pre‐operative patients might prefer to occupy their time. We distributed 200 questionnaires to elective surgery patients and 184 (92%) were available for analysis. Of the respondents, 54.1% wanted to be slightly sleepy, 72.0% preferred not to be fast asleep and 57.2% preferred not to be wide awake. Reading (56.8%), listening to music (57.1%) and chatting with other patients (39.9%) were preferred activities. It might be appropriate to ask patients how sedated they would wish to be before their surgery and perhaps have alternatives to sedation available.
The aetiology and prevention of peri‐operative corneal abrasions
Authors: White E. , Crosse M. M.
Published: March 2003

Corneal abrasion is the most frequent ocular complication to occur during the peri‐operative period. This review describes the aetiology of corneal abrasions and evaluates the current methods of prevention. Most abrasions are caused by lagophthalmos (failure of the eyelids to close fully) during general anaesthesia, resulting in corneal drying. General anaesthesia reduces both the production and the stability of tears and therefore increases the incidence of this painful condition. Taping the eyelids closed, soft contact lenses, the instillation of aqueous gels or paraffin‐based ointments are all effective in preventing corneal abrasions, but ointments are associated with significant morbidity.
Pericardial placement of a pulmonary artery catheter
Authors: Cardwell M. E. , Winter B.
Published: March 2003

Extravascular placement of a pulmonary artery catheter occurred when it was passed down an in situ sheath, the side arm of which had already been used for administration of fluids without any problems. The case emphasises that complications occur with the use of invasive monitoring and a correctly placed line may become extravascular even in a short time.
Dutch case‐control study of anaesthesia‐related morbidity and mortalityRationale and methods
Authors: Arbous M. S. , Grobbee D. E. , Van Kleef J. W. , Meursing A. E. E.
Published: March 2003

To date, anaesthesia‐related mortality, morbidity and risk factors have almost exclusively been studied qualitatively rather than quantitatively. Therefore, knowledge of the relative risk associated with many anaesthesia‐related factors is still lacking. Recently, a quantitative study of the determinants and prevention of morbidity and mortality in anaesthesia was started in the Netherlands. Its objective is to study severe peri‐operative morbidity and mortality as a function of anaesthesia‐related risk factors. The study is designed as a case‐control study within a prospectively defined cohort. The cohort comprises all patients undergoing an anaesthetic procedure, either general, regional or a combination, in one of 61 hospitals between 1 January 1995 and 1 January 1997. A ‘case’ is a patient who dies within 24 h of undergoing an anaesthetic procedure or who remains comatose 24 h after an anaesthetic procedure. A ‘control’ patient is a randomly chosen patient who has undergone anaesthesia and is matched for gender and age. The present report discusses the study protocol.
Respiratory complications associated with tracheal extubationTiming of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia
Authors: Koga K. , Asai T. , Vaughan R. S. , Latto I. P.
Published: March 2003

Sixty patients were randomly allocated to one of three groups and the incidences of respiratory complications which occurred during emergence from anaesthesia were compared under the following three circumstances: tracheal extubation after the patient had regained consciousness (awake group); tracheal extubation while the patient was still anaesthetised (anaesthetised group); and the use of the laryngeal mask during emergence from anaesthesia (mask group). In the mask group, the laryngeal mask was inserted under deep anaesthesia before tracheal extubation and the lungs were ventilated through the laryngeal mask after tracheal extubation. In the awake group, straining (bucking) occurred in 18 patients and desaturation (arterial oxygen haemoglobin saturation < 95%) in two patients. In the anaesthetised group, airway obstruction occurred in 17 patients and desaturation in one of these patients. In the mask group, ventilation through the laryngeal mask was temporarily difficult immediately after tracheal extubation in one patient and coughing occurred before removal of the mask in three patients. No respiratory complications occurred in two patients in the awake group, three patients in the anaesthetised group and 16 patients in the mask group. The incidence of respiratory complications during recovery from anaesthesia was significantly lower in the mask group than in the other two groups (pooled) (p << 0.001). Therefore, the use of the laryngeal mask after tracheal extubation decreases the incidence of respiratory complications during recovery from anaesthesia.
Postoperative outcome in high‐risk infants undergoing herniorrhaphy: comparison between spinal and general anaesthesia
Authors: Somri M. , Gaitini L. , Vaida S. , Collins G. , Sabo E. , Mogilner G.
Published: March 2003

The incidence of inguinal hernia is higher in premature infants, particularly in low birth weight neonates. This latter group may also incur increased postoperative respiratory complications and inpatient admissions. The purpose of this study was to compare the effects of general and spinal anaesthesia on postoperative respiratory morbidity and on the length of hospital stay in high‐risk infants undergoing inguinal herniorrhaphy. Forty patients, all high‐risk infants who underwent unilateral or bilateral herniorrhaphies, were randomly assigned to receive general anaesthesia (n = 20) or spinal anaesthesia (n = 20). There was a significant difference in respiratory morbidity between the two groups, as well as a significant difference in the inpatient hospital stay. The present study suggests that spinal anaesthesia can be used safely for high‐risk infants, preterm or formerly preterm, undergoing inguinal hernia repair.
Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation
Authors: Ho B. Y. M. , Skinner H. J. , Mahajan R. P.
Published: March 2003

This study aimed to evaluate whether or not the use of intermittent positive pressure ventilation via the laryngeal mask airway is associated with a higher risk of gastro‐oesophageal reflux when compared with intermittent positive pressure ventilation via a tracheal tube in patients undergoing day case gynaecological laparoscopy in the head down position. Sixty healthy women were randomly allocated to receive either the laryngeal mask or cuffed tracheal tube for intra‐operative airway maintenance. Using continuous oesophageal pH monitoring, four patients in the tracheal tube group and none in the laryngeal mask group had evidence of gastro‐oesophageal reflux (as indicated by a decrease in oesophageal pH to below 4). The difference in the incidence of reflux did not achieve statistical significance (p = 0.11). In conclusion, we found no evidence to suggest that the use of intermittent positive pressure ventilation via the laryngeal mask increases the risk of gastro‐oesophageal reflux in patients undergoing elective day case gynaecological laparoscopy.
HypophosphataemiaPathophysiology, effects and management on the intensive care unit
Authors: Bugg N. C. , Jones J. A.
Published: March 2003

Routine detection and treatment of hypophosphataemia on the intensive care unit is commonplace. Hypophosphataemia has been associated with a multitude of clinical effects and there are many associations between correction of hypophosphataemia and improvement in symptoms. However, there is no evidence at present to support the routine correction of hypophosphataemia in the absence of clinical symptoms or signs.
The effect of low‐dose ketamine on fentanyl‐induced respiratory depression
Authors: Mildh L. , Taittonen M. , Leino K. , Kirvelä O.
Published: March 2003

This study evaluated if adding low‐dose ketamine to fentanyl could offer a haemodynamically stable drug combination with little respiratory side‐effects. Eight healthy, consenting male volunteers received in a random, cross‐over and double‐blind fashion both fentanyl 2 μgkg−1 + ketamine 0.25 mgkg−1 and fentanyl 2 μgkg−1 + placebo. The fentanyl and placebo reduced minute ventilation, alveolar ventilation and oxygen consumption ( p < 0.05), with little effect on haemodynamics. After fentanyl and ketamine, the decrease in minute ventilation and alveolar ventilation was attenuated compared to the placebo‐containing combination ( p < 0.05), but with a simultaneous increase in oxygen consumption ( p < 0.05) and stimulation of haemodynamics ( p < 0.05). Both treatments decreased oxygen saturation and arterial oxygen pressure similarly. Ketamine thus attenuated the fentanyl‐induced reduction in ventilation without preventing the decrease in blood oxygenation. In conclusion, combining low‐dose ketamine to fentanyl offers no benefits in terms of preventing respiratory depression.
The impact of a high‐dependency unit on the workload of an intensive care unit
Authors: Dhond G. , Ridley S. , Palmer M.
Published: March 2003

While there has been recent support for high‐dependency unit development, there are few data reporting the impact of such development on existing critical care facilities. Therefore the aim of this study was to examine the workload and capacity constraints of an adult general intensive care unit before and after the development of an adjacent high‐dependency unit. Following the opening of the high‐dependency unit, the total number of patients admitted increased by 49%. On the high‐dependency unit, more elderly patients were admitted for longer and more frequently following midweek elective surgery. On the intensive care unit, patients' initial severity of illness was lower and their duration of admission decreased; fewer patients were admitted directly from the general wards. The financial benefits of high dependency care may be eroded by the increased use of the critical care services.
Prophylactic anti‐emetic efficacy of ondansetron in laparoscopic cholecystectomy under total intravenous anaesthesiaA randomised, double‐blind comparison with droperidol, metoclopramide and placebo
Authors: Helmy S. A. K.
Published: March 2003

The prophylactic anti‐emetic efficacy and safety of pre‐operative intravenous ondansetron was evaluated in a randomised, double‐blind, comparison with droperidol, metoclopramide and placebo in 160 ASA grade 1 and 2 patients undergoing laparoscopic cholecystectomy under total intravenous anaesthesia. The patients were randomly allocated to receive ondansetron (4 mg), droperidol (1.25 mg), metoclopramide (10 mg) or placebo given as a single intravenous dose immediately before induction of a standardised general anaesthetic. There were no significant differences between the four study groups with regard to the demographic and anaesthetic data, postoperative analgesia, postoperative sedation scores, duration of postoperative hospital stay and incidence of adverse events. The incidence of nausea and vomiting was significantly lower (p < 0.05) between 1 h and 4 h after surgery in the ondansetron group compared with the droperidol, metoclopramide and placebo groups. The incidence of nausea was similar in the four groups in the other study periods: 0–1 h and 4–24 h. The incidence of vomiting was lower in the ondansetron, droperidol and metoclopramide groups than in the placebo group between 1 and 4 h but was the same between 4 and 24 h. As a result of the lower incidence of nausea and vomiting between 1 h and 4 h in the ondansetron group, the overall incidence of nausea and vomiting was lower during the first 24 h after surgery in this group than in the other three groups.
Diagnosing brain death: the importance of documenting clinical test results
Authors: Keogh A. T. , Akhtar T. M.
Published: March 2003

Eighty‐three cases of brain stem death referred to the South Thames Transplant Co‐ordination Service were audited to determine the quality of brain stem death test records. Documentation of brain stem death tests were complete in only 41 (44%) cases at the time of referral. There was no significant difference in completeness, whether documentation was in patient's notes or on a designated checklist (p = 0.14). There were a greater number of omissions when the tests were documented in patient's notes rather than on a form (p = 0.01). There is a necessity to improve the quality of brain stem death test documentation in order to facilitate organ donation and safeguard the integrity of brain stem death testing. This requires a commitment by clinicians to improve the quality of documentation, which can be accomplished by recording all aspects of brain stem death tests, including the conclusion on a single designated checklist.
Ethical considerations in anaesthesia journals
Authors: Asai T. , Shingu K.
Published: March 2003

It has been shown that instructions to authors in nonanaesthesia biomedical journals often fail to require authors to state that the study was approved by an ethics committee and informed consent obtained from participants; articles also often omit mentioning these points. We examined 11 English‐language journals, which are listed in the ‘Anesthesiology’ category of 1995 SCI Journal Citation Reports, to see whether the instructions to authors of anaesthesia journals mention the following ethical factors: approval of the study by an ethics committee, informed consent, redundant publication, fraud, authorship, conflict of interest and protection of patients' privacy. We also examined 673 articles which appeared in these anaesthesia journals ( July to December issues of 1996) to see whether they stated acquirement of ethics committee approval and informed consent. All journals addressed the avoidance of redundant publications and unjustifiable authorship. Ten journals required approval of studies and signatures from all authors, eight journals mentioned informed consent. Only seven required the disclosure of any conflict of interest and the protection of patients' privacy. More than 90% of the articles stated that the study was approved and informed consent obtained.
A case of ventricular fibrillation in the prone position during back stabilisation surgery in a boy with Duchenne's muscular dystrophy
Authors: Reid J. M. , Appleton P. J.
Published: March 2003

A 15‐year‐old boy with Duchenne's muscular dystrophy experienced prolonged cardiac arrest whilst in the prone position for spinal surgery. He was successfully resuscitated without apparent neurological sequelae by internal cardiac massage via a thoracotomy and external and internal direct current cardioversion. Recommendations are suggested for the pre‐ and peroperative management of such cases.
The effect of anaesthesia and surgery on plasma cytokine production
Authors: Helmy S. A. K. , Wahby M. A. M. , El‐Nawaway M.
Published: March 2003

The aim of this study was to investigate cytokine production in response to anaesthesia [total intravenous anaesthesia (TIVA) with propofol, sufentanil and atracurium] and surgery (laparoscopic vs. open cholecystectomy). Forty adult patients, ASA I–II, undergoing elective laparoscopic (group 1) or open (group 2) cholecystectomy were studied. Venous blood samples for measurement of interleukin (IL)‐1β, IL‐2, IL‐4, IL‐6, tumour necrosis factor‐α (TNF‐α) and interferon‐γ (IFN‐γ) were taken before the induction of anaesthesia, pre‐incisionaly, at the end of anaesthesia and surgery and 24‐h postoperatively. Pre‐incisionaly, in both groups, IL‐1β, IL‐4, IL‐6, TNF‐α and IFN‐γ did not show a significant change, whereas IL‐2 showed a significant decrease (p < 0.005 in group 1 and p < 0.001 in group 2) compared with pre‐induction levels. By the end of anaesthesia and surgery, IL‐1β, IL‐2, IL‐4, IL‐6 and TNF‐α showed a significant increase in group 2 (p < 0.005 for IL‐1β, IL‐2 and IL‐4, and p < 0.05 for IL‐6 and TNF‐α); while in group 1, only IL‐2 showed a significant increase (p < 0.01) and IFN‐γ showed a significant decrease (p < 0.05) compared with pre‐incisional levels. By 24‐h postoperatively, IL‐1β, IL‐4, IL‐6 and TNF‐α had decreased significantly in group 2 (p < 0.005 for IL‐4 and p < 0.05 for the others); whereas in group 1, IL‐2 and IFN‐γ showed a significant increase (p < 0.005) compared with the end of anaesthesia and surgery level. In conclusion, TIVA with propofol, sufentanil and atracurium does not seem to have a significant effect on IL‐1β, IL‐4, IL‐6, TNF‐α and IFN‐γ release. IL‐2 was the only cytokine to show a significant decrease due to the effect of anaesthesia alone in both groups. The cytokine response to open cholecystectomy stimulated both the pro‐inflammatory (IL‐1β, IL‐6 and TNF‐α) and the anti‐inflammatory (IL‐4) components, while this response was absent in laparoscopic cholecystectomy.
Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia
Authors: Smith I. , Thwaites A. J.
Published: March 2003

We compared target‐controlled propofol with sevoflurane in a randomised, double‐blind study in 61 day‐case patients. Anaesthesia was induced with a propofol target of 8 μg.ml−1 or 8% sevoflurane, reduced to 4 μg.ml−1 and 3%, respectively, after laryngeal mask insertion and subsequently titrated to clinical signs. Mean (SD) times to unconsciousness and laryngeal mask insertion were significantly shorter with propofol [50 (9) s and 116 (33) s, respectively] than with sevoflurane [73 (14) s and 146 (29) s; p < 0.0001 and p = 0.0003, respectively]; however, these differences were not apparent to the blinded observer. Propofol was associated with a higher incidence of intra‐operative movement (55 vs. 10%; p = 0.0003), necessitating more adjustments to the delivered anaesthetic. Emergence was faster after sevoflurane [5.3 (2.2) min vs. 7.1 (3.7) min; p = 0.027], but the inhaled anaesthetic was associated with more nausea and vomiting (30 vs. 3%; p = 0.006), which delayed discharge [258 (102) min vs. 193 (68) min; p = 0.005]. Direct costs were lower with sevoflurane but nausea would have increased indirect costs. Patient satisfaction was high (≥ 90%) with both techniques. In conclusion, both techniques had advantages and disadvantages for day‐case anaesthesia.
Critically ill medical patients, their demographics and outcome
Authors: Lam  , Ridley
Published: March 2003

There are few reports describing the demographic details and outcome of noncoronary medical patients on adult general intensive care units. It is not known how medical patients differ from other critically ill patients and how this may influence their outcome. Consequently, we recorded the demographic details of 374 critically ill medical patients and followed their survival for up to 3 years. Patients referred from medical specialties are younger, more severely ill and suffer a higher severity‐of‐illness‐adjusted intensive care unit mortality than other patients. The short‐term survival of medical patients is poor with a median survival of 40 days. Twenty per cent of medical patients die after discharge from intensive care but before 40 days. However, the long‐term survival of medical patients is better than other patients and almost as good as the general population. Further research is required to identify those patients who are likely to survive beyond 40 days.
Postoperative pseudostatusNot everything that shakes is epilepsy
Authors: Reuber M. , Enright S. M. , Goulding P. J.
Published: March 2003

Postoperative epileptic seizures are recognised but rare. Psychogenic seizures and pseudostatus epilepticus are relatively common, particularly in the peri‐operative period. Our series of five cases of postoperative pseudostatus epilepticus demonstrates that the failure to recognise the psychogenic nature of this condition may cause anaesthetists to give inappropriate and potentially harmful treatment. Psychogenic ‘status’ is easy to diagnose once it has been considered. Convulsive episodes lasting longer than 90 s, closed eyes during a ‘tonic–clonic’ attack, retained pupillary response and resistance to eye opening are useful signs. Often there is a history of multiple admissions with ‘status epilepticus’ and of previous postoperative ‘status’.
Effect of clonidine premedication on haemodynamic responses to fibreoptic bronchoscopy
Authors: Matot I. , Kuras Y. , Kramer M. R.
Published: March 2003

The usual haemodynamic response to fibreoptic bronchoscopy is an increase in heart rate and blood pressure. We therefore compared, in a prospective, randomised, double‐blind study, the effect of two doses of oral clonidine premedication (150 μg or 300 μg) with placebo (control group) on the haemodynamic alterations in 62 patients who underwent elective fibreoptic bronchoscopy. Significant increases in blood pressure and heart rate were observed during fibreoptic bronchoscopy only in the control group. Clonidine 150 μg blunted the haemodynamic response to fibreoptic bronchoscopy (p < 0.05). Significant decreases in systolic blood pressure (< 90 mmHg) were observed in all patients premedicated with 300 μg clonidine. Throughout the study nine patients (75%) in the 300 μg clonidine group were treated at least once for hypotension. Compared with the control group, time to awakening was significantly longer only in patients premedicated with 300 μg clonidine. In conclusion, premedication with 150 μg oral clonidine attenuates haemodynamic responses to fibreoptic bronchoscopy, without causing excessive haemodynamic depression and sedation. These data encourage the administration of clonidine as premedication in patients undergoing fibreoptic bronchoscopy, particularly in those with, or at risk for, coronary artery disease.
Calcium and the anaesthetist
Authors: Aguilera I. M. , Vaughan R. S.
Published: March 2003

Calcium plays a central role in a large number of physiological actions that are essential for life. It is important therefore that the anaesthetist understands calcium pathophysiology. In this review, the physiology, regulation, clinical features, causes and treatment of alterations in circulating calcium will be discussed. In addition, the effects that acid–base status, massive blood transfusion and cardiopulmonary bypass may have on circulating calcium will be highlighted. Finally, the role that calcium plays in ischaemic/reperfusion injury and myocardial stunning will be summarised.
Reducing red blood cell transfusion in elective surgical patients: the role of audit and practice guidelines
Authors: Mallett S. V. , Peachey T. D. , Sanehi O. , Hazlehurst G. , Mehta A.
Published: March 2003

In 1996, we prospectively audited peri‐operative transfusion practice in elective surgical patients over a 3‐month period. Two‐unit transfusions represented 60% of all transfusions. Haemoglobin was measured infrequently prior to transfusion and the main ‘trigger’ for transfusion was an estimated blood loss in excess of 500 ml. Transfusion guidelines that required the haemoglobin level to be measured immediately before transfusion were introduced. The audit was repeated in 1998; transfusion ‘triggers’ and the number of transfusions for the two periods were compared. In the second audit, the total number of transfusions decreased by 43%. The mean estimated blood loss associated with a 2‐unit transfusion had increased from 608 (373) ml to 1320 (644) ml (p < 0.01) and the estimated haemoglobin concentration after transfusion had decreased from 12.4 (1.8) g.dl−1 to 9.9 (2.4) g.dl−1 (p < 0.01). These results suggest that transfusion guidelines can have a significant impact on clinical practice.
An assessment of the staffing level required for a high‐dependency unit
Authors: Garfield M. , Jeffrey R. , Ridley S.
Published: March 2003

High‐dependency units are increasing in number and becoming an ever more important part of a hospital's facilities. The optimum staffing ratio is unknown, but the Department of Health and the Intensive Care Society recommend a level of one nurse to two patients. We recorded Therapeutic Intervention Scoring System‐28 scores and Nurse Dependency Scores for all admissions to our adult, general high‐dependency unit over 7 months. We found a weak correlation between the nurse dependency score and the Therapeutic Intervention Scoring System‐28 score. The median Therapeutic Intervention Scoring System‐28 score was 23 points (interquartile range 19–26), and the median Nurse Dependency Score was 1.0. These results are approximately two‐thirds of those for European intensive care units. We conclude that a nurse‐to‐patient ratio of 1 : 2 may be insufficient for an adult general high‐dependency unit, and would recommend a nurse‐to‐patient ratio of 2 : 3.
Training in obstetric general anaesthesia: a vanishing art?
Authors: Johnson R. V. , Lyons G. R. , Wilson R. C. , Robinson A. P. C.
Published: March 2003

General anaesthesia in obstetric practice has largely been replaced by the use of regional techniques. We have studied this phenomenon and the subsequent impact on training in this technique both retrospectively and with a prospective audit. There has been a decline in the use of general anaesthesia for Caesarean section such that trainee anaesthetists are getting less practical exposure to this important procedure. Audit revealed a deficit with consultant involvement in training and heightened awareness has resulted in improved supervision. Possible implications for future consultant working practices are discussed.
Quantitative assessment of motor block in labouring women receiving epidural analgesia
Authors: Graham A. C. , McClure J. H.
Published: March 2003

The assessment of motor block associated with epidural analgesia is traditionally performed using the modified Bromage Score. However, it is a qualitative and quantitative measurement of both spread and intensity of motor block in the lower limbs, and it has been adapted from Bromage's original use as an assessment of the adequacy of epidural anaesthesia for abdominal surgery. A number of quantitative assessment methods exist but these are either laboratory based and/or impracticable in the clinical situation of labour. We therefore set out to devise a quantitative assessment method which would be easy to use and acceptable to labouring women receiving epidural analgesia. A force transducer was modified to enable power of hip adduction to be assessed quantitatively before and after epidural analgesia was established. These results were compared with the modified Bromage Scale and an extended scale which further subdivided the scores between 0 and 1. Our results show that there is a large variation in the quantitative measurement of motor block (as measured by adductor strength) that may not be detected by the sole use of the modified Bromage Score. We suggest that future studies to assess motor block in the clinical setting use an additional quantitative method of assessment.
Cardiovascular effects of intravenous propofol administered at two infusion rates: a transthoracic echocardiographic study
Authors: Bilotta F. , Fiorani L. , La Rosa I. , Spinelli F. , Rosa G.
Published: March 2003

We assessed the haemodynamic changes after a propofol infusion at two rates in low‐risk unpremedicated patients (ASA I–II). To determine contractility changes and loading conditions, we measured the ejection fraction, end‐systolic quotient and fractional shortening on transthoracic echocardiograms. We studied 40 patients undergoing peripheral neurosurgical procedures under general anaesthesia induced by propofol alone (total dose 2.5 mg.kg−1). Patients were randomly assigned to receive propofol at an infusion rate of 10 mg.s−1; or 2 mg.s−1. Haemodynamic data were recorded simultaneously immediately before propofol infusion, at the end of infusion, and 5 and 10 min after the infusion ended. The higher infusion rate induced a larger decrease in mean arterial pressure than the lower infusion rate (− 20% vs. − 10% from baseline, p = 0.01). In both groups, global and segmental ventricular function remained unchanged throughout the study. In both groups, there were markedly reduced end‐systolic quotients – presumably related to diminished afterload, and in the higher infusion‐rate group a significant reduction in fractional shortening – presumably related principally to diminished preload.
Leakage of fluid around high‐volume, low‐pressure cuffs
Authors: Asai T. , Shingu K.
Published: March 2003

We studied the ability of high‐volume, low‐pressure tracheal tube cuffs (Portex Soft Seal®, Portex Profile®, Mallinckrodt Lo‐Contour® and Mallinckrodt Hi‐Lo® tubes) to prevent leakage of fluid into the airway, in a model trachea and lung. Five tubes (7.0 and 8.0 mm internal diameter) of each type were used. Each tube was inserted into the model trachea and the cuff inflated until the intracuff pressure reached either 20, 30 or 40 cmH2O. The model lung was ventilated with a tidal volume of 700 ml and respiratory rate of 14 breath.min−1 at a compliance of 20 cmH2O. Ten millilitres of 0.01% methylene blue solution were infused over the cuff and the volume of fluid leaking past the cuff over 5 min was measured. The leak volume for the Soft Seal tube was less than that for the Profile or Lo‐Contour tubes at all intracuff pressures (all p < 0.05). Compared with the Hi‐Lo tube, the volume leaking past the cuff for the Soft Seal tube was greater at an intracuff pressure of 20 cmH2O (p < 0.05), whereas there was no significant difference between these two tubes at an intracuff pressure of 30 or 40 cmH2O. We conclude that the cuff of the Portex Soft Seal tube prevented leakage of fluid significantly more than that of the Portex Profile or Mallinckrodt Lo‐Contour tubes, and to a similar degree to that of the Mallinckrodt Hi‐Lo tube.
Fat embolism
Authors: Mellor A. , Soni N.
Published: March 2003

Fat embolism syndrome is a collection of respiratory, haematological, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of the clinical syndrome is low (< 1% in retrospective reviews) whilst the embolisation of marrow fat appears to be an almost inevitable consequence of long bone fractures. There is debate over the pathogenesis of fat embolism syndrome and it seems a variety of factors interact to produce a spectrum of end organ damage. Many therapeutic interventions and prophylactic strategies have been tried with varying success. Current treatments are supportive and the condition is usually associated with a good outcome. The literature on fat embolism syndrome is extensive and this review aims to discuss the incidence, aetiology, pathophysiology, diagnosis and treatment of fat embolism.
Risk factors for postoperative anxiety in adults
Authors: Caumo W. , Schmidt A. P. , Schneider C. N. , Bergmann J. , Iwamoto C. W. , Adamatti L. C. , Bandeira D. , Ferreira M. B. C.
Published: March 2003

We identified risk factors for postoperative anxiety and quantified their effect on 712 adults between 18 and 60 years of age (ASA I–III physical status) undergoing elective surgery under general anaesthesia, neural blockade or both. The measuring instruments were a structured questionnaire, a pain visual analogue scale, the McGill Pain Questionnaire, the State‐Trait Anxiety Inventory, the Montgomery–Äsberg Depression Rating Scale, a Self‐Reporting Questionnaire‐20, and a Self‐Perception of Future Questionnaire. Multivariate conditional regression modelling taking into account the hierarchical relationship between risk factors revealed that postoperative anxiety was associated with ASA status III (OR = 1.48), history of smoking (1.62), moderate to intense postoperative pain (OR = 2.62) and high pain rating index (OR = 2.35), minor psychiatric disorders (OR = 1.87), pre‐operative state‐anxiety (OR = 2.65), and negative future perception (OR = 2.20). Neural block anaesthesia (OR = 0.72), systemic multimodal analgesia (OR = 0.62) and neuroaxial opioids with or without local anaesthesia (OR = 0.63) were found to be protective factors against postoperative anxiety.