bluuebunny/crossref_metadata_2025 huggingface dataset:
Postspinal headache in young and elderly patients
Authors: RASMUSSEN B. S. , BLOM L. , HANSEN P. , MIKKELSEN S. S.
Published: February 2007

In two randomised, double‐blind studies of elderly patients with a mean age of 68.9 (range 21–88) years and young patients, mean age 29.4 (range 20–40) years, the effect of needle size on the incidence of postspinal headache was compared. The two needle groups, 20‐ and 25‐gauge, were comparable in both studies with regard to number, sex, age and type of surgery. The incidence of postspinal headache in young patients was 27.6% when a 20‐gauge needle was used and 12.6% with a 25‐gauge needle. There was no significant dzzerence in either the incidence of headache in the elderly patients (10.8% and 7.8%, respectively) or between the sexes. It is concluded that it does not matter if a 20‐ or a 25‐gauge needle is used for spinal analgesia in elderly patients with regard to postspinal headache, but if spinal analgesia is indicated in young patients a fine needle is preferred.
A comparison between open‐end (single hole) and closed‐end (three lateral holes) epidural catheters
Authors: MICHAEL S. , RICHMOND M. N. , BIRKS R. J. S.
Published: February 2007

A randomised, single‐blind study was conducted on 802 parturient women who required epidural analgesia, to compare open‐end (single hole) with closed‐end (three lateral holes) epidural catheters. The complication rate after catheter insertion was not statistically drferent between the two groups, but the number of unsatisfactory blocks was significantfy higher in the open‐end group (p < 0.001). The closed‐end catheters were easier and less painful to place, but gave a higher incidence of bloody taps. The open‐end catheters caused sensory blockade to be more frequently unilateral and more frequently missed sensory segments. This resulted in a significantly higher number of open‐end catheters that required replacement (p < 0.001). Open‐end catheters despite their theoretical advantages in the detection of intravenous and subarachnoid placement caused an unacceptably high incidence of unsatisfactory sensory blockade.
Giant false aneurysm of the subclavian artery
Authors: HUDDY S. P. J. , McEWAN A. , SABBAT J. , PARKER D. J.
Published: February 2007

A false aneurysm with a diameter of 15 cm developed in the wall of the subclavian artery after attempted internal jugular cannulation. This potentially lethal complication, its diagnosis and treatment are described.
Fluid deprivation before operation
Authors: AGARWAL A. , CHARI P. , SINGH H.
Published: February 2007

The effect of oral fluids before operation, followed by intramuscular morphine, on gastric volume and pH was examined in 150 elective surgical patients, ASA physical status 1 and 2, who were randomly assigned to one of the three groups of 50 each. Group 1 (control) continued their overnight fast; patients in Groups 2 and 3 received 150 ml water 2 hours before the scheduled time of surgery. Patients in Group 3 received intramuscular morphine 0.15 mg/kg and promethazine 0.5 mg/kg one hour before operation. The residual gastric volume was obtained by suction and its volume and pH measured immediately after induction of anaesthesia. Statistically significant (p < 0.05) decrease in residual gastric volume was observed in Groups 2 and 3 as compared to Group 1. However, the difference between these two groups was not statistically significant. There was no statistically significant difference in pH among the three groups. Overnight fluid fasting is not justified in elective surgical patients. Morphine can be safely given one hour before surgery in patients who have received water (150 ml) 2 hours before operation.
Pneumothorax caused by minitracheotomy
Authors: SILK J. M. , MARSH A. M.
Published: February 2007

We describe a case in which misplacement of a minitracheotomy tube produced a pneumothorax, a complication which has not been reported previously. Methods to identify correct placement of the minitracheotomy tube are discussed.
The Brain laryngeal mask airway An alternative to emergency tracheal intubation
Authors: CALDER I. , ORDMAN A. J. , JACKOWSKI A. , CROCKARD H. A.
Published: February 2007

The laryngeal mask airway was used to resuscitate a patient in whom direct and fibreoptic laryngoscopy were impossible because of cervical pathology and pulmonary oedema. The laryngeal mask airway may be an alternative to tracheal intubation in emergency resuscitation.
The nature of pre‐operative anxiety
Authors: McCleane G. J. , Cooper R.
Published: February 2007

In a study of 247 patients who had general anaesthesia for dental procedures, the incidence of individual anxieties was noted using a questionnaire completed by the patient. The most common anxieties related to the period before transfer to the operating theatre, intra‐operative awareness and postoperative pain. These anxieties were present in over half the patients questioned. The follow‐up questionnaire was completed by 207 patients in order to indicate which anxieties they would expect to have if they needed anaesthesia in the future. All anxieties were less frequent than found before operation.
Pre‐induction behaviour of children A review of placebo‐controlled trials of sedatives
Authors: MORGAN‐HUGHES J. O. , BANGHAM J. A.
Published: February 2007

Placebo‐controlled trials of sedative premedication in children are reviewed in an attempt to determine which drugs have been shown to reduce the frequency with which children cry or appear apprehensive. Small samples and inappropriate statistical methods limit the value of many of the studies. Most of the drugs tested will, in sufficient dose, increase the proportion of children who are asleep. Only intramuscular opioid analgesics, either alone or in combination with other drugs, have been shown repeatedly to increase the frequency of calm behaviour in those who are awake. There is some evidence, however, that intramuscular placebo controls have a lower frequency of calm behaviour than oral placebo controls.
Flumazenil in the outpatient A study following midazolam as sedation for upper gastrointestinal endoscopy
Authors: ANDREWS P. J. D. , WRIGHT D. J. , LAMONT M. C.
Published: February 2007

Fifty outpatients who underwent upper gastrointestinal endoscopy under midazolam sedation were allocated randomly into two equal groups of 25 in this double‐blind study. After the endoscopy, and 30 minutes after administration of the sedative, patients in one group received flumazenil 0.5 mg; those in the other group received a similar volume of vehicle only. Assessments of memory function, psychomotor performance and coordination were carried out and these were repeated 3.5 hours later. Flumazenil produced a significant improvement (p < 0.0001) immediately but no difference could be detected between flumazenil and placebo at 3.5 hours. However, patients in the flumazenil group reported, by means of linear analogue scales, a subjective feeling of alertness at the time of discharge, which was greater than that reported by those in the placebo group (p < 0.005).
Variables of patient‐controlled analgesia. 3: test of an infusion‐demand system using alfentanil
Authors: OWEN H. , BROSE W. G. , PLUMMER J. L. , MATHER L. E.
Published: February 2007

Patient‐controlled infusion‐demand analgesia was studied using alfentanil. We were unable to identify an optimal dose and administration rate; doses required range from 100 to 900 μg alfentanil. The mean concentration of alfentanil in blood associated with return of pain (i.e. immediately before demand) was 58 ng/ml on day 1 and 37 ng/ml on day 2. This difference was despite similar drug consumption on both days.
Guillain–Barré syndrome mimicking brainstem death
Authors: COAD N. R. , BYRNE A. J.
Published: February 2007

There must be a defined, predisposing condition to fulfil the criteria of brainstem death in the UK. A patient presented recently in coma and with absent brainstem reflexes, but no diagnosis was initially obvious. A subsequent diagnosis of Guillain–Barré syndrome was made, and the patient made a full recovery.
Internal jugular catheterisation Case report of a potentially fatal hazard
Authors: POWELL H. , BEECHEY A. P. G.
Published: February 2007

A case is presented of acute life‐threatening haemorrhage caused by laceration of the subclavian artery as a result of attempted cannulation of the internal jugular vein. This sequence of events has not been reported previously, and probably resulted from use of a cannula‐over‐needle system.
Rate‐responsive pacemakers and anaesthesia A consideration of possible implications
Authors: ANDERSEN C. , MADSEN G. M.
Published: February 2007

A new generation of pacemakers has been developed in recent years which adjust the pacing rate according to changes in physiological variables. The selected parameters are affected during physical activity that involves an increased heart rate in healthy humans. The variables include body movements, QT interval, breathing, temperature, myocardial contractility, oxygen saturation and changes in blood pH which may be influenced during general anaesthesia, and can lead to unphysiological, high, pacing rates. It is important to be familiar with the pacemaker and its functions before administration of anaesthesia in order to prevent complications. Rate‐responsive pacemakers in such situations should be programmed to exclude the rate‐responsive function.
Acupuncture anaesthesia Observations on its use for removal of thyroid adenomata and influence on recovery and morbidity in a Chinese hospital
Authors: Kho H. G. , van Egmond J. , Zhuang C. F. , Lin G. F. , Zhang G. L.
Published: February 2007

Acupuncture anaesthesia, supplemented by small doses of pethidine, was evaluated in 20 patients who had surgery for removal of a thyroid adenoma. There were significant increases in mean arterial pressure and respiratory rate during surgery, but no significant change in heart rate. The mean dose of pethidine given during surgery was 45 mg (SD 8.9). Postoperative recovery was rapid and complication free. Acupuncture anaesthesia did not provide complete analgesia, but was safe and preferable to general anaesthesia where there was a shortage of facilities.
Cholinesterase deficiency and the Churg–Strauss syndrome
Authors: TAYLOR B. L. , WHITTAKER M. , HEERDEN V. VAN , BRITTEN J.
Published: February 2007

We report two patients with the Churg–Strauss syndrome who were found to have decreased cholinesterase activity despite normal phenotypes. Suspicion of abnormal sensitivity to suxamethonium in the first case was raised after prolonged paralysis under anaesthesia. The findings in the second were incidental during the course of intensive care treatment. Both patients received immunosuppressive therapy. Differentiation between the effects of this and the disease process itself cannot be established.
Sprotte needle for intrathecal anaesthesia for Caesarean section: incidence of postdural puncture headache
Authors: CESARINI M. , TORRIELLI R. , LAHAYE F. , MENE J. M. , CABIRO C.
Published: February 2007

Caesarean section was performed under spinal anaesthesia in 55 women using a 25‐gauge diamond‐tipped needle and in a further 55 mothers with a 24‐gauge Sprotte needle. Eight patients (14.5%) developed a headache in the former group, five of whom required a blood patch. There were no headaches reported in the Sprotte group.
Effects of famotidine and cimetidine on plasma levels of epidurally administered lignocaine
Authors: KISHIKAWA K. , NAMIKI A. , MIYASHITA K. , SAITOH K.
Published: February 2007

The effects of two H2‐receptor antagonists, famotidine and cimetidine, on the plasma levels of epidurally administered lignocaine were studied. Group A (n = 20) received famotidine 20 mg orally the night before surgery and 20 mg intramuscularly 60 minutes before induction of anaesthesia. Group B (n = 15) received cimetidine 200 mg orally the night before the surgery and 400 mg orally 60 minutes before the anaesthetic induction. Group C (n = 20) received neither famotidine nor cimetidine and served as controls. Twelve millilitres of 2.0% lignocaine with adrenaline 1:200 000 was injected into the epidural space in all patients, after the establishment of general anaesthesia with nitrous oxide, oxygen, and enflurane (0.3–0.5%). The patients who received cimetidine showed significantly higher plasma concentrations of lignocaine compared with either group A or group C at all investigation times (p < 0.01). The mean peak plasma concentrations were 2.4 (SEM 0.1), 3.2 (SEM 0.2) and 2.3 (SEM 0.1) μg/ml in group A, B, and C, respectively. This study suggests that famotidine is preferable to cimetidine for control of gastric acidity before the use of lignocaine as the epidural anaesthetic.
The Trilite inhaler. An historical review and performance assessment
Authors: TWEEDIE I. E. , SNOWDON S. L.
Published: February 2007

The Trilite inhaler was developed for use in World War II. Its efficient performance is confirmed and a brief biography of its inventor is also given.
Intravenous diclofenac sodium Does its administration before operation suppress postoperative pain?
Authors: Campbell W. I. , Kendrick R.
Published: February 2007

Intravenous diclofenac sodium was evaluated in a double‐blind randomised trial relative to intramuscular diclofenac, intravenous fentanyl, and intramuscular placebo in 160 patients undergoing extraction of impacted lower third molar teeth. The test drug was administered before operation in an attempt to alleviate postoperative pain. A 10‐cm visual analogue scale was used to assess pain at 30 minutes and one day after surgery, if the patients stayed overnight. Patients who received intravenous diclofenac had significantly less pain than the other groups 30 minutes after operation. They also had significantly less pain one day after surgery than the placebo or opioid groups, but not less than the intramuscular diclofenac group. Capillary bleeding time, in comparison with placebo, was significantly prolonged after the use of intramuscular diclofenac, and a similar but nonsignificant trend was observed in the intravenous diclofenac group. No problems were encountered with excessive bleeding in any group.
Intrathecal anaesthesia for day‐care surgery A retrospective study of 160 cases using 25‐ and 26‐gauge spinal needles
Authors: Sarma V. J. , Boström U.
Published: February 2007

The records of 160 day‐care surgical patients who received intrathecal anaesthesia were reviewed. No major complications were recorded. The incidence of postspinal headache after puncture with a 25‐gauge spinal needle was nearly four times more frequent compared to a 26‐gauge needle. The occurrence of postspinal headache in patients over the age of 45 years was significantly less frequent (p < 0.05) than in younger patients. Intrathecal anaesthesia was acceptable to 91% of outpatients in this group.
Acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom
Authors: Tordoff S. G. , Sweeney B. P.
Published: February 2007

The choice of drugs for acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom was determined by questionnaire. The results are compared with a similar survey of anaesthetic departments 5 years ago. The prescription of sodium citrate and the H2 receptor antagonist ranitidine has superseded that of Mist, magnesium trisilicate.
Accidents, near accidents and complications during anaesthesia A retrospective analysis of a 10‐year period in a teaching hospital
Authors: CHOPRA V. , BOVILL J. G. , SPIERDIJK J.
Published: February 2007

A retrospective analysis is presented of all reports of faults, accidents, near accidents and complications associated with anaesthesia in one hospital from 1978 to 1987. 113074 anaesthetics were administered in that period, of which 97496 were for noncardiac procedures. There were 148 reports; 39 were of dental damage. Peri‐operative cardiac arrests during noncardiac surgery were reported 29 times. Sixteen of these were fatal. Anaesthesia was thought to have played an important role in 13 cardiac arrests (1 per 7500 anaesthetics) and six were not successfully resuscitated (1 per 16 250 anaesthetics). There were 12 reports of postoperative peripheral neuropathies (1 per 9422 anaesthetics). Failure to check, lack of vigilance and inattention or carelessness were the most frequently associated factors with the rest of the reports.
Local anaesthesia for eye surgery The peri‐ocular technique
Authors: FRY R. A. , HENDERSON J.
Published: February 2007

A technique of peri‐ocular infiltration of local anaesthetic for eye surgery is described. The ease of administration of this form of local blockade is highlighted and its low propensity for complication compared with retrobulbar blockade. The involvement of anaesthetists in the performance of local anaesthesia for ophthalmic surgery that utilises this technique is encouraged.
Cardiac arrest after isoflurane anaesthesia in a patient with Duchenne's muscular dystrophy
Authors: CHALKIADIS G. A. , BRANCH K. G.
Published: February 2007

An 8‐year‐old boy known to have Duchenne's muscular dystrophy suffered a cardiac arrest 10 minutes after he regained consciousness after isoflurane anaesthesia for an orchidopexy procedure. Resuscitation was successful 2 hours after the star of external cardiac compression and after correction of hyperkalaemia and the administration of dantrolene. He later developed myoglobinuria, elevated creatine kinase and a metabolic and respiratory acidosis. He demonstrated a delayed increase in rectal temperature.
Effect of metoprolol and diazepam on pre‐operative anxiety
Authors: Jakobsen C.‐J. , Blom L. , Brondbjerg M. , Lenler‐Petersen P.
Published: February 2007

A double‐blind study of 98 patients who underwent elective hysterectomy or orthopaedic surgery was conducted to evaluate the effect of metoprolol or placebo combined with diazepam given 1–3 hours before surgery. Evaluation was by anaesthetists and by visual analogue scoring by the patients. The anaesthetists found that patients who received metoprolol were significantly less anxious (p < 0.005) and better sedated (p < 0.001) before induction of anaesthesia. The patients who received metoprolol found themselves more calm compared with placebo patients. Arterial blood pressure and heart rate were reduced by metoprolol compared to placebo. Metoprolol may be a valuable drug for premedication.
A jet nebuliser for delivery of topical anaesthesia to the respiratory tract A comparison with cricothyroid puncture and direct spraying for fibreoptic bronchoscopy
Authors: Isaac P. A. , Barry J. E. , Vaughan R. S. , Rosen M.
Published: February 2007

Topical anaesthesia of the respiratory tract for fibreoptic bronchoscopy was compared, in a single‐blind study, inhaled from a simple and inexpensive jet nebuliser, administered by cricothyroid injection or by a ‘spray‐as‐you‐go technique’. Each technique was supplemented by spraying lignocaine through the fibrescope and intravenous fentanyl‐droperidol sedation. Inhaled nebulisation was successfully used for 96% (46 of 48) of patients, was safe, effective and acceptable to the patient and bronchoscopist. The cricothyroid injection method produced better conditions than nebulisation in patients who had diagnostic bronchoscopy. The nebuliser technique is as satisfactory as the spraying technique in patients for diagnostic bronchial lavage in whom bleeding from a cricothyroid puncture is unacceptable. Patients who used the nebuliser were more satisfied. This technique may also be a useful method for ‘awake’ intubation.
Local application of EMLA and glyceryl trinitrate ointment before venepuncture
Authors: Gunawardene R. D. , Davenport H. T.
Published: February 2007

One hundred unpremedicated fit day surgery patients aged between 27 and 68 years were allocated randomly into one of four groups and EMLA, glyceryl trinitrate, EMLA and glyceryl trinitrate or a placebo ointment was applied to the dorsum of a hand. The pain and ease of venepuncture were determined at induction of anaesthesia 60 minutes later. Pain scores were also reassessed 1–2 hours after operation. Lower pain scores and easier venepuncture occurred when EMLA and glyceryl trinitrate ointment was applied to the dorsum of the hand.
Quality of life after intensive care
Authors: RIDLEY S. A. , WALLACE P. G. M.
Published: February 2007

An important aspect of effectiveness of intensive care services is change in the quality of life of survivors after critical illness. A questionnaire was compiled using established methods for assessment of quality of life and sent to all known survivors of a regional intensive care unit. Each patient's quality of life was then quantified using disability categories. The results show that patients with a good premorbid quality of life suffered a significant decline after critical illness. Similar important decreases in quality of life were found in younger patients and trauma victims. Quality of life may be a valuable consideration in determining the appropriateness of intensive care management.
Spinal catheter anaesthesia for Caesarean section in a patient with spina bifida
Authors: NUYTEN F. , GIELEN M.
Published: February 2007

A patient with grossly deformed vertebral anatomy, scheduled for elective Caesarean section, expressed her wish to stay fully awake during the procedure. Epidural anaesthesia was considered to be impracticable, while dural puncture appeared possible only at thoracic level. Spinal anaesthesia using a subarachnoid catheter placed at T7‐8 was employed successfully.
Severe hypotension due to intramyometrial injection of prostaglandin E2
Authors: KILPATRICK A. W. A. , THORBURN J.
Published: February 2007

Treatment of postpartum haemorrhage because of uterine atony with intramyometrial prostaglandin E2 1 mg, in an anaesthetised patient resulted in life‐threatening hypotension. Anaesthetists should be aware of the potential cardiovascular side effects of prostaglandins.
Laryngeal oedema from a neck haematoma A complication of internal jugular vein cannulation
Authors: RANDALLS B. , TOOMEY P. J.
Published: February 2007

Laryngeal oedema occurred after formation of a neck haematoma after attempted internal jugular vein cannulation. This resulted in complete respiratory obstruction and respiratory arrest and it was impossible to ventilate her lungs manually or intubate her trachea. Oxygenation of the patient was only possible using transtracheal ventilation.
Minitracheotomy: complications and follow‐up with fibreoptic tracheoscopy
Authors: Randell T. , Kalli I. , Lindgren L.
Published: February 2007

Complications and changes in tracheal mucosa after minitracheotomy were evaluated in 28 patients. Tracheal mucosa was inspected fibreoptically after the insertion of a minitracheotomy cannula, and then at 3‐day intervals until the cannula was removed. Thereafter, assessments were made every third day until the mucosa was considered normal. Three significant complications occurred: mediastinal puncture, paratracheal entrance of the cannula and subcutaneous emphysema. Difficulties at insertion of the minitracheotomy cannula were encountered in 15 of 28 patients (54%). Air flow detected through the cannula in one patient, and lack of air flow in another patient, were misleading signs of the position of the cannula. Passing a suction catheter in three patients and a normal end‐tidal carbon dioxide tracing in one patient, were also found to be misleading. The correct position and possible complications could be verified only by fibreoptic tracheoscopy. Changes in the tracheal mucosa were independent of the duration of minitracheotomy therapy.
Recovery after day‐case anaesthesia. A 24‐hour comparison of recovery after thiopentone or propofol anaesthesia
Authors: HEATH P. J. , OGG T. W. , GILKS W. R.
Published: February 2007

Sixty patients who presented for day‐case dilatation and curettage were allocated randomly to receive either thiopentone or propofol for induction and maintenance of anaesthesia. One anaesthetist administered all the anaesthetics whilst all assessments were made by one other. The results indicate that early recovery of memory function, critical flicker fusion frequency and subjective feelings of tiredness, drowsiness and alertness were superior in the propofol group. There was a significant difference in subjective feelings of tiredness and drowsiness recorded by the two study groups at 24 hours. Memory function assessed by Wechsler logical memory function passages at 24 hours was impaired in the propofol group in comparison to a group of ’reference’ subjects.
Anaesthesia for laparoscopic cholecystectomy using the Nd:Yag laser. The implications for a district general hospital
Authors: GREVILLE A. C. , CLEMENTS E. A. F.
Published: February 2007

We describe the anaesthetic management of the first reported cholecystectomy by laparoscopic laser in the United Kingdom. The implications of the development of laser surgery in a district general hospital are discussed.
The use of diazepam in chloroquine poisoning
Authors: RAJAH A.
Published: February 2007

A 39‐year‐old patient was found to be unconscious after having taken 2.5 g of chloroquine. Treatment consisted mainly of gastric lavage and diazepam. Experimental and clinical evidence is presented to show that diazepam in varying doses significantly decreases the mortality rate.
Caesarean section in a patient with haemoglobin SC disease and a phaeochromocytoma
Authors: PATTISON J. , HARROP‐GRIFFITHS A. W. , WHITLOCK J. E. , ROBERTS J. C.
Published: February 2007

The anaesthetic management of a patient with haemoglobin SC disease for lower segment Caesarean section and excision of a phaeochromocytoma is described. The patient was given a general anaesthetic for the surgical procedure after exchange transfusion had achieved an haemoglobin A concentration of greater than 50%. A live infant was delivered and a suprarenal phaeochromocytoma was excised during a 6.5 hour procedure. The patient's postoperative recovery was uneventful.
Postoperative sore throat: topical hydrocortisone
Authors: Stride P.C.
Published: February 2007

Forty patients undergoing tracheal intubation and controlled ventilation of the lungs for elective surgical procedures were studied. They were allocated randomly into one of two groups. The tracheal tubes used for group A patients were lubricated before insertion with water‐soluble 1% hydrocortisone cream. Those for group B patients were lubricated with KY jelly. The incidence of postoperative sore throat was found to be significantly greater in group A. Topical 1% hydrocortisone cream is therefore ineffective in the prevention of postoperative sore throat.
Was CEPOD right?
Authors: Ruiz K. , Aitkenhead A. R.
Published: February 2007

This retrospective study found that the long‐term (greater than 6 months) postoperative survival in ASA 4E and 5E patients was 41% and 21% respectively, in 1986. This supports the Confidential Enquiry into Peri‐operative Deaths’ recommendation that life‐saving surgery should not be withheld from patients who present in so serious a condition that they are unlikely to survive surgery.
Intravenous propofol anaesthesia using a computerised infusion system
Authors: WHITE M. , KENNY G. N. C.
Published: February 2007

Propofol offers many advantages as a total intravenous anaesthetic agent compared with other agents. However, considerable experience is necessary in order to give an uncomplicated anaesthetic. A mathematical model which describes the pharmacokinetic behaviour of the drug was incorporated into a computerised delivery system which enables the anaesthetist to achieve and maintain a target blood concentration of propofol and to manipulate this at will. The system was used to provide general anaesthesia for 33 healthy patients who underwent general surgery. A strong statistical relationship was found between measured blood propofol concentrations and the corresponding computer predictions (y =−0.50+1.36x). No significant differences in this relationship were found between patients who breathed spontaneously (y =−0.71x+1.43x) and those who received intermittent positive pressure ventilation (y =−0.33+1.32x).
An epidural injection simulator
Authors: DAYKIN A. P. , BACON R. J.
Published: February 2007

The construction and function of a teaching aid for the insertion of epidural injections is described.
Epidural fentanyl and 0.5% bupivacaine for elective Caesarean section
Authors: KING M. J. , BOWDEN M. I. , COOPER G. M.
Published: February 2007

Either 100 μg fentanyl or 2 ml saline was added to 0.5% bupivacaine administered epidurally for elective Caesarean section in 30 patients, in a double‐blind randomised study. Bupivacaine 0.5% was administered until a complete sensory block was established extending to the 4th thoracic dermatome. One of the patients who received epidural fentanyl required intravenous alfentanil and Entonox and another, Entonox only briefly during surgery, compared with seven in the control group who required intravenous alfentanil and Entonox and one who required Entonox only. Postoperative analgesia was of longer duration in those who received epidural fentanyl (p < 0.01). There were no deleterious effects on neonatal or maternal outcome.
The effect of diltiazem on the cardiovascular response to tracheal intubation
Authors: MIKAWA K. , IKEGAKI J. , MAEKAWA N. , GOTO R. , KAETSU H. , OBARA H.
Published: February 2007

Theefficacy of diltiazem in the attenuation of the cardiovascular response to laryngoscopy and tracheal intubation was studied in patients who received 0.2 or 0.3 mg/kg diltiazem 60 seconds before the start of laryngoscopy. These data were compared with a control group who received saline. Each group consisted of 10 patients who had elective surgery. Patients who received saline showed a significant increase in mean arterial pressure and rate pressure product associated with tracheal intubation. These increases after tracheal intubation were reduced in diltiazem‐treated patients compared with those of the control group (p < 0.05). The data suggest that a bolus injection of diltiazem is a simple, practical and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.
A low flow open circle system for anaesthesia Part I: Laboratory evaluation at normal and high frequencies
Authors: CHAKRABARTI M. K. , STACEY R. G. W. , HOLDCROFT A. , WHITWAM J. G.
Published: February 2007

A circle breathing system was connected by deadspace tubing to an open system valveless ventilator. The minimum volume of this tubing, required to prevent dilution of anaesthetic gas in the breathing system by the driving gas of the ventilator, was determined at frequencies of 15, 30, 60, 100 and 150 breaths/minute, with tidal volumes that ranged from 100 to 1100 ml and a fresh gas supply to the circle system of 1, 2 and 4 litres/minute. At 15 breaths/minute, tidal volumes equal to or less than the deadspace volume could be used safely without any mixing with the ventilator driving gas, when a fresh gas flow of 2 litres/minute or above is supplied to the circle system. At 1 litre/minute of fresh gas flow, mixing occurred at tidal volumes less than the deadspace volume. Mixing of gas occurred in the system at frequencies greater than 30 breaths/minute even when the tidal volume was much less than the deadspace volume. However, at high frequencies of ventilation, since the tidal volume requirement decreases, deadspace tubing with a safe internal volume, that is greater than 600 ml, may be used up to 100 breaths/minute.
A low flow open circle system for anaesthesia Part 2: Clinical evaluation
Authors: HOLDCROFT A. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

A prototype valveless ventilator was attached by open deadspace tubing to a circle system and used to ventilate the lungs of 12 patients with low flows of anaesthetic gases for periods between 60 and 120 minutes during intra‐abdominal surgery. Anaesthesia was induced with thiopentone and maintained with nitrous oxide 50% in oxygen and enflurane. This was reduced to 2 litres/minute after a 10‐minute period of nitrogen wash out and stabilisation of anaesthetic gas concentration, with an initial anaesthetic gas flow of 6 litres/minute. The concentration of oxygen, carbon dioxide, nitrous oxide and enflurane were measured in the outflow from both the anaesthetic machine and the inspiratory limb of the circle system. The measured mean inspired oxygen and nitrous oxide concentrations showed no significant variation throughout the low flow period of the study. This new low flow open circle ventilation system appears to offer some advantages in terms of safety and versatility over other systems which are discussed.
Propofol sedation after open heart surgery A clinical and pharmacokinetic study
Authors: McMurray T. J. , Collier P. S. , Carson I. W. , Lyons S. M. , Elliott P.
Published: February 2007

One hundred adult patients who required mechanical ventilation after open heart surgery for coronary revascularisation were studied. All received a standard premedication and a high dose opioid anaesthetic. On arrival in the intensive care unit they were allocated randomly to receive either propofol or midazolam to maintain sedation within a predetermined range. Patients who received propofol underwent extubation of the trachea, using standard criteria, after a mean time (log‐transformed) of 7.6 minutes after sedation for approximately 17 hours. The corresponding time was 125 minutes in those given midazolam. There were significantly higher morphine requirements during sedation, and higher arterial carbon dioxide tensions 30 minutes after extubation of the trachea, in patients who received midazolam. Pharmacokinetic analysis in 20 patients showed that the elimination half‐life of propofol was prolonged (470 minutes) and clearance was reduced (1.14 litres/minute) compared with subjects who had not undergone cardiopulmonary bypass. The rapid clinical recovery was reflected in a rapid redistribution half‐life (13.4 minutes), but this was also longer than the redistribution time of 2–4 minutes in other patients.
Electro‐acupuncture and postoperative emesis
Authors: Ho R. T. , Jawan B , Fung S. T. , Cheung H. K. , Lee J. H.
Published: February 2007

One hundred unpremedicated female patients of ASA grade 1 or 2 who underwent laparoscopy as outpatients were allocated randomly to one of four groups. All patients received general anaesthesia withfentanyl, thiopentone, halothane, nitrous oxide and oxygen; suxamethonium was given to facilitate tracheal intubation. In the recovery room, group I (control) received no treatment; group 2 received electro‐acupuncture at the P6 point (Neiguan) on the right side for 15 minutes, group 3 received transcutaneous electrical nerve stimulation at the P6 point on the right side for 15 minutes and group 4 received prochlorperazine 5 mg intravenously. Any act of vomiting, including dry retching, during the first 3 postoperative hours was regarded as postoperative emesis. The incidence of postoperative emesis was 11/25 (44%) in group 1, 3/25 (12%, p > 0.05) in group 2, 9/25 (36%) in group 3, and 3/25 (12%, p < 0.05) in group 4. Our results suggest that electro‐acupuncture is as effective as prochlorperazine, and may be better than transcutaneous electrical nerve stimulation, in reducing postoperative emesis.
The effect of diclofenac and nefopam on postoperative dental pain
Authors: Goucke C. R. , Keaveny J. P. , Kay B , Healy T. E. J. , Ryan M.
Published: February 2007

Eighty‐two outpatients who received general anaesthesia for surgical removal of maxillary or mandibular third molars were given either diclofenac 75 mg or nefopam 20 mg intramuscularly for postoperative pain control. They and the control group were also allowed oral paracetamol as required. The results showed that there was no significant pain relief from these single intramuscular injections.
Propofol for long‐term sedation in the intensive care unit* A comparison with papaveretum and midazolam
Authors: HARRIS C. E. , GROUNDS R. M. , MURRAY A. M. , LUMLEY J. , ROYSTON D. , MORGAN M.
Published: February 2007

Thirty‐seven patients with a wide range of illnesses were studied during mechanical ventilation of the lungs in an intensive care unit. Fifteen were sedated with a continuous propofol infusion, with analgesia provided by bolus doses of papaveretum. Twelve received a continuous infusion of papaveretum, supplemented by bolus doses of midazolam. The level of sedation was assessed every four hours and measurements were made of haemodynamic and respiratory variables. Levels of sedation were generally satisfactory in both groups. Six patients who received propofol required the use of muscle relaxants, because of their strong respiratory drives, to achieve synchronisation with the ventilator. There was no significant difference in respiratory or haemodynamic variables between the groups, but several patients required inotropic support because of their disease. There was no evidence of inhibition of adrenal steroidogenesis in the propofol group. Propofol can be a useful sedative agent in the intensive care unit, but sedative regimens should be tailored to individual patient requirements.
Peri‐operative care in restrictive respiratory disease
Authors: PATRICK J. A. , MEYER‐WITTING M. , REYNOLDS F. , SPENCER G. T.
Published: February 2007

A total of 139 of 473 severely disabled, mainly ventilator‐dependent patients required some form of surgery. Such patients require surgery more frequently than normal individuals, both because of their disability and because even minor unrelated disorders superimposed on permanent disability cause greater handicap. We report the peri‐operative management and postoperative complications of 142 operations on 83 patients between 1982 and 1987. A simple inhalational anaesthetic technique was used; opioids and muscle relaxants were seldom given. Negative pressure ventilation was employed in the postoperative period when appropriate, and was combined with vigorous chest physiotherapy. There were three peri‐operative deaths, but the overall death rate in the patients who underwent surgery was no greater throughout the study period than in those who did not require surgery. We believe that an aggressive surgical approach is appropriate in severely disabled, ventilator‐dependent patients.
A comparison of the effects of omeprazole and ranitidine on gastric secretion in women undergoing elective Caesarean section
Authors: EWART M. C. , YAU G. , GIN T. , KOTUR C. F. , OH T. E.
Published: February 2007

This study compares the efficacy of omeprazole and ranitidine at reducing gastric secretion in obstetric patients. Sixty‐five women scheduled to undergo elective Caesarean section under general anaesthesia were randomly allocated to receive either omeprazole 40 mg or ranitidine 150 mg orally at 2200 hours the night before and at 0600 hours on the morning of surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. All patients had gastric aspirates less than 25 ml. None of the omeprazole group had an aspirate of pH less than 3.5. Six patients (19%) in the ranitidine group had aspirates of pH less than 3.5, a significant difference from the omeprazole group (p < 0.05). Of these six, two (6%) had aspirates of pH less than 2.5. Hence this study showed that omeprazole was more effective and consistent than ranitidine at maintaining gastric pH greater than 3.5.
Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief
Authors: VERCAUTEREN M. , LAUWERS E. , MEERT T. , HERT S. DE , ADRIAENSEN H.
Published: February 2007

Sufentanil 25 μg plus clonidine 1 μg/kg administered epidurally was compared with epidural sufentanil 50 μg alone in a double‐blind fashion for pain relief in 40 patients after abdominal surgery. The duration of complete pain relief was significantly longer in those who received the mixture. Oxygen saturation was reduced 10 and 20 minutes after sufentanil alone, but remained stable after sufentanil and clonidine. There were significant decreases in arterial blood pressure in the latter group that were maximum between 20 and 120 minutes after administration.
Postoperative hypoxaemia: mechanisms and time course
Authors: JONES J. G. , SAPSFORD D. J. , WHEATLEY R. G.
Published: February 2007

Postoperative hypoxaemia results predominantly from two mechanisms. Gas exchange is impaired during anaesthesia as a result of reduced tone in the muscles of the chest wall and probably alterations in bronchomotor and vascular tone, and the resulting changes persist into the postoperative period. In addition, there is an abnormality of control of breathing, which results in episodic obstructive apnoea. These episodes continue for several days after operation and are related to sleep pattern and analgesic administration, although the precise effects of different analgesic regimens have not been evaluated. Oxygen administration is effect in reducing the degree of hypoxaemia.
Incidence and range of carboxyhaemoglobin in blood for transfusion
Authors: Freeman R. , Perks D.
Published: February 2007

No statistically significant difference was found between the levels of carboxyhaemoglobin detected in samples from 42 blood units and their sample side arms. A cooximeter was used. However, carboxyhaemoglobin in a range of 1.1–6.9% was found in 18 out of a further 100 side arm samples taken randomly from the blood bank.
Regional anaesthesia and cough effectiveness
Authors: HARROP‐GRIFFITHS A. W. , RAVALIA A. , BROWNE D. A. , ROBINSON P. N.
Published: February 2007

We report the results of a study of the effects of spinal and epidural anaesthesia for Caesarean section on commonly used indicators of a patient's ability to cough effectively. Both spinal and epidural anaesthesia, after the achievement of a block adequate for surgery, were associated with statistically significant decreases (p < 0.05) in all the respiratory variables recorded: forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate and maximum expiratory pressure. We conclude that although the observed changes are unlikely to impair the normal patient's ability to cough effectively in these circumstances, there may be clinically significant impairment in the presence of an inadvertently high block or in a patient with pre‐existing pulmonary disease.
Ketamine as analgesic for total intravenous anaesthesia with propofol
Authors: GUIT J. B. M. , KONING H. M. , COSTER M. L. , NIEMEIJER R. P. E. , MACKIE D. P.
Published: February 2007

A prospective study of 18 patients who underwent noncardiac surgery was performed to study the use of ketamine as an analgesic during total intravenous anaesthesia with propofol. A comparison was made with the combination propofol/fentanyl. The propofol/ketamine combination resulted in haemodynamically stable anaesthesia without the need for additional analgesics. Postoperative behaviour was normal in all patients and none of the patients reported dreaming during or after the operation. Propofol seems to be effective in eliminating side effects of a subanaesthetic dose of ketamine in humans. We recommend the propofol/ketamine combination for total intravenous anaesthesia for surgery when stable haemodynamics are required.
Dr F. P. de Caux—the first user of curare for anaesthesia in England
Authors: WILKINSON D. J.
Published: February 2007

Curare was used in the 19th century in England by a wide variety of scientists, physicians and veterinarians. Their experiments indicated many of the properties of the drug, but its clinical usage remained very limited and was reserved for cases of tetanus, hydrophobia and strychnine poisoning. Griffith and Johnson are usually credited with the introduction of curare into clinical anaesthesia in 1942, but a Dr F.P. de Caux working at the North Middlesex Hospital, London, in 1928 utilised curare in a series of seven patients. His work was not widely publicised and this contribution to anaesthetic history has been overlooked by subsequent authors.
Intra‐operative patient‐controlled sedation
Authors: RUDKIN G. E. , OSBORNE G. A. , CURTIS N. J.
Published: February 2007

Patient‐controlled sedation using propofol is described in 23 ASA 1 patients undergoing surgical extraction of third molars. Cardiovascular and respiratory stability was maintained and sedation was no deeper than full eyelid closure with prompt response to verbal command. Amnesia for the extractions was common (70%), but there was no significant amnesia for recovery room events. Intra‐operative patient cooperation was good, postoperative patient satisfaction high and all patients stated they liked the self‐administration and would use the same technique again. Propofol dose was correlated with both procedure length (r = 0.587; p = 0.003) and surgical difficulty (rs= 0.550; p = 0.010).
Acute mercury poisoning
Authors: McLAUCHLAN G. A.
Published: February 2007

A case of deliberate self poisoning with approximately 7 g mercuric chloride (the lethal dose is about 1 g) is described. The patient died after 6 days despite the use of chelating agents, plasma exchange and intensive supportive therapy. The management of acute mercury toxicity is discussed.
Accidental injection of ether into the epidural space
Authors: MAPPES A. , SCHAER H. M.
Published: February 2007

Five ml diethyl ether was accidentally injected into the epidural space via an epidural catheter at the end of a Caesarean section. Immediately the patient felt a hot and burning pain in her legs that led to paraparesis, with a sensory level to T8. The patient showed bilateral recovery of both motor and sensory functions 4 hours after the accident.
Postoperative analgesia after triple nerve block for fractured neck of femur
Authors: Hood G. , Edbrooke D. L. , Gerrish S. P.
Published: February 2007

Fifty patients with fractured neck of femur that required surgical correction with either a compression screw or pin and plate device were randomly allocated to receive one of two anaesthetic techniques, general anaesthesia combined with either opioid supplementation or triple nerve block (three in one block) with subcostal nerve block. The nerve blocks significantly reduced the quantity of opioid administered after operation; 48% of these patients required no additional analgesia in the first 24 hours. Plasma prilocaine levels in these patients were well below the toxic threshold, and peak absorption occurred 20 minutes after the injection. No untoward sequelae were associated with the nerve blocks.
Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation
Authors: WILSON I. G. , MEIKLEJOHN B. H. , SMITH G.
Published: February 2007

We have studied the effect of varying the timing of a prior dose of intravenous lignocaine 1.5 mg/kg on the cardiovascular and catecholamine responses to tracheal intubation. Forty healthy patients were given an intravenous injection of either placebo or lignocaine 2, 3 or 4 minutes before tracheal intubation. There was a significant increase in heart rate of 21–26% in all groups. There was no significant increase in mean arterial pressure in response to intubation in any group of patients given lignocaine before intubation, but in the placebo group, mean arterial pressure increased by 19.1% compared to baseline values (p < 0.05).
Potential errors in pulse oximetry
Authors: RALSTON A. C. , WEBB R. K. , RUNCIMAN W. B.
Published: February 2007

There is no absolute reference for oxygen saturation, although multiwavelength in vitro oximeters are accepted as the ‘gold standard’. Regardless of whether fractional or functional saturation is used by manufacturers to calibrate their oximeters, evaluation against fractional saturation is recommended since this is the clinically relevant variable. The use of standard notation and comparisons based on bias and precision is recommended. The accuracy of pulse oximetry is intrinsically limited by the use of only two wavelengths, and is dependent on the initial calibration population. The empirical algorithms used to convert the signal to its ‘readout value’ and the quality control of hardware may both be important sources of variability between oximeters. Change in blood temperature may introduce errors in pulse oximeter and in vitro oximeter saturation readings, but these will be clinically insignificant. Changes in blood pH should not decrease pulse oximetry accuracy.