bluuebunny/crossref_metadata_2025 huggingface dataset:
Ketanserin and the cardiovascular system
Authors: GRIFFITHS H. B. A. , WHITWAM J. G.
Published: February 2007

A double‐blind study was performed on 19 patients undergoing myocardial revascularisation. Routine anaesthetic and cardiopulmonary bypass procedures were used. Nine patients received ketanserin by continuous infusion and ten received an equal infusion rate of placebo. Arterial blood pressure was controlled with sodium nitroprusside. The ketanserin group had a signijicantly higher cardiac index and a lower peripheral vascular resistance during the first 2 hours after bypass.
Pupil response to alfentanil and fentanyl
Authors: ASBURY A. J.
Published: February 2007

The pupillary response to alfentanil, fentanyl and a saline placebo was measured in patients anaesthetised in a standard manner with halothane, to determine whether the pupil diameters changed in a way which could be distinguished from background activity. Measurements were made to the nearest 0.1 mm using a purpose‐built pupillometer. The response to the drugs can be clearly distinguished from the background activity seen in the placebo group. The time courses of constriction caused by the two drugs are significantly different from the placebo group responses. The time to maximum to response with alfentanil is 4 minutes compared with 8 minutes for fentanyl. Both drugs produced at least 35% reduction in mean pupil diameter compared with the placebo group. The duration of the response to alfentanil was 25 minutes, whereas the fentanyl response lasted more than one hour.
Plasma morphine levels produced by continuous infusion in children
Authors: Bray R.J. , Beeton C. , Hinton W. , Seviour J.A.
Published: February 2007

Blood samples were taken from six children aged between I0 months and 15 years. at intervals over a period of 40 hours while they were receiving continuous morphine infusions. The plasma morphine values obtained showed similar and consistent levels 15–30 minutes after starting the infusions.
Spinal anaesthesia with hyperbaric lignocaine for elective Caesarean section
Authors: BEMBRIDGE M. , MACDONALD ROSEMARY , LYONS G.
Published: February 2007

This study was carried out in 30 patients undergoing elective Caesarean section to assess the predictability and reliability of spinal anaesthesia with 5% hyperbaric lignocaine, with a view to incorporating the technique in our failed intubation drill. The spinal was performed with a 25‐gauge needle in either the sitting (15 patients) or left lateral position (15 patients). The speed of onset of anaesthesia to T6 was significantly faster (p < 0.01) in the lateral group. but the duration of action was similar in both groups. Twelve patients had hypotension and four developed severe postspinal headaches. The block progressed to the C2 dermatome in four patients and was associated with dysphagia. This was totally unpredictable and may be due to altered cerebrospinal fluid dynamics in late pregnancy. Therefore, the use of spinal anaesthesia with heavy lignocaine may be inadvisable in obstetric patients, especially following failed intubation.
Postoperative nitrous oxide analgesia
Authors: GODDARD J.M.
Published: February 2007

Nitrous oxide is occasionally used as an analgesic agent in the postoperative period. The feasibility of administering a known concentration from an air entrainment oxygen mask, using a primary flow of Entonox, (50% oxygen/50% nitrous oxide) was investigated. Accurox (C.R. Bard Canada Znc.) blenders, disconnected from their facemasks, were studied using a primary flow of Entonox. An increase in air entrainment of approximately 13% was demonstrated. Concentrations of about 20% nitrous oxide in oxygen enriched air, appropriate for postoperative analgesia, can be produced, but the methods are extravagant in the use of Entonox and are likely to be slightly unreliable.
Status epilepticus following enflurane anaesthesia
Authors: NICOLL J. M. V.
Published: February 2007

Two patients had generalised convulsions which occurred several hours afer anaesthesia supplemented with enpurane. One patient had to be treated for life threatening status epilepticus 7 hours after anaesthesia and the other had a myoclonic convulsion 17 hours after recovery from anaesthesia. Neither had any relevant pre‐operative history of epilepsy or convulsions. Possible synergistic roles of the metabolite of atracurium. laudanosine, as well as of cephazolin and photic stimulation, are discussed.
Schwannoma of the vagus nerve
Authors: Wood B. M. , Mcneil W. T.
Published: February 2007

A case is described in which severe bradycardia complicated removal of a Schwannoma of the vagus nerve in the parapharyngeal space. The presentation of this rare tumour is discussed.
The effects on gas exchange of a large mediastinal tumour
Authors: Fletcher R. , Nordstrom L.
Published: February 2007

A 14‐year‐old boy with a mediastinal tumour large enough to cause dyspnoea at rest was anaesthetised for a biopsy. The tumour was believed to compress the tracheal bifurcation. After tracheal intubation, the expiratory breath sounds were heard to be intermittent. The expiratory flow pattern showed irregularities synchronous with the electrocardiogram. With constant flow inflation, the inspiratory pressure profile was suggestive of mechanical obstruction with a resistance which decreased during inspiration. The airway dead space was greatly reduced, suggesting that the obstruction was near the tracheal tube opening and that there was pooling of carbon dioxide behind this obstruction. The alveolar deadspace fraction was increased and the shape of the carbon dioxide single breath test suggested severe airway obstruction. These findings can be explained on the basis of large airway obstruction, partly intermittent because of the heart's movement, and also reduced lung volume and uneven gas distribution caused by the tumour and pleural fluid.
Benzodiazepine antagonist Ro 15‐1788
Authors: Kirkegaard L. , Knudsen L. , Jensen S. , Kruse A.
Published: February 2007

In a double‐blind, randomised trial the efficacy and safety of Ro 15‐1788, a new benzodiazepine antagonist, was assessed in forty adults undergoing gastroscopy under diazepam sedation. Criteria of efficacy were the degree of sedation and anterograde amnesia. There was a significantly faster recovery of the patients after the injection of 0.61.0 mg of Ro 15‐1788 than after placebo. Patients were awake shortly after Ro 15‐1788, but remained drowsy or asleep after placebo administration. There were no side effects of note.
Glycine and transurethral resection
Authors: Alexander J.P. , Polland A. , Gillespie I.A.
Published: February 2007

Fifty patients undergoing transurethral resection of the prostate were studied for evidence of glycine absorption and haemodilution. Plasma glycine levels increased substantially in nine patients and, in five, calculated irrigant, fluid absorption ranged from 619–1582 ml; another patient had absorbed 1360 ml fluid with only a small rise in plasma glycine. Two illustrative case histories are presented. The role of glycine us an inhibitory neurotransmitter is discussed and the possibility of toxic mechanisms other than dilational hyponatraemia is mentioned. Intravenous diuretics, hypertonic saline, and perhaps calcium salts, are recommended for the overt transurethral resection syndrome.
Combination treatment with ranitidine and sodium bicarbonate prior to obstetric anaesthesia
Authors: MATHEWS H. M. L. , WILSON C. M. , THOMPSON E. M. , MOORE J.
Published: February 2007

The gastric pH and volume were measured in 175 patients undergoing elective, and 313 undergoing emergency, obstetric procedures. Ranitidine 150 mg was administered orally every 6 hours in labour and at least 2 hours before elective Caesarean section. Patients received20 ml of8.4% sodium bicarbonate orally immediately prior to induction of anaesthesia. The combination of ranitidine and sodium bicarbonate produced marked alkalinisation of gastric contents (mean pH 8.9). The administration of sodium bicarbonate pre‐operatively in patients who received ranitidine less than 2 hours before operation led to satisfactory elevation of gastric pH. Only four patients had a gastric pH < 2.5, one patient refused any medication, two received only ranitidine and one patient had a long interval from administration of bicarbonate to aspiration of gastric contents. Gastric volumes were high in labouring patients (mean 84 ml) despite administration of ranitidine. The effectiveness of sodium bicarbonate as a single dose antacid therapy prior to obstetric anaesthesia requires further study.
The influence of nitrous oxide on oxyhaemoglobin dissociation and measurement of oxygen tension
Authors: SHAH M. V. , ANDERSON L. K. , BERGMAN N. A.
Published: February 2007

There are conflicting reports of the effect of nitrous oxide on the oxyhaemoglobin dissociation curve. We have therefore determined P50 of haemoglobin in the presence of either nitrous oxide or nitrogen and studied the upper portion of the curve in greater detail. No significant differences in the oxyhaemoglobin dissociation curve were observed when nitrous oxide was substituted for nitrogen. The oxygen tensions measured in gas mixtures were not significantly different when determined simultaneously with a polarographic oxygen electrode and the mass spectrometer when nitrous oxide was used instead of nitrogen.
Peri–operative management of carcinoid syndrome using ketanserin
Authors: HOUGHTON K. , CARTER J. A.
Published: February 2007

This report describes the successful use of ketanserin, a 5–HT2 receptor antagonist, for the acute control of systemic blood pressure in a patient with the carcinoid syndrome. undergoing hepatic artery embolisation. Serial measurements of plasma 5–hydroxyindoles. platelet 5–hydroxytryptamine and plasma cate–cholamines are also given.
Acute rhabdomyolysis following surgery for burns
Authors: PFEIFER P. M.
Published: February 2007

A case is reported of acute rhabdomyolytic renal failure following surgery for minor superficial skin burns. Rhabdomyolysis apparently started peri‐operatively. Possible initiating causes are discussed, notably tourniquet ischaemia. The pathophysiology, diagnosis and treatment are reviewed.
Intensive care aspects of severe Legionella pneumonia
Authors: POWER K.J. , BOWEN D.J.
Published: February 2007

A case of extensive Legionella pneumonia is presented. The patient required an extended period of artificial ventilation, notably punctuated by episodes of dysrhythmia and severe haemodynamic instability, but who nevertheless eventually recovered. Intensive care aspects of Legionnaires' disease are discussed.
A new double lumen tube adaptor
Authors: SIBAI A. N. , BARAKA A.
Published: February 2007

The report describes a new double lumen tube adaptor which provides selective one lung ventilation without external clamping. It also facilitates, without disconnexion and remantling, both correct bronchial cuff inflation and continuous positive airway pressure administration using an underwater seal chest bottle. Oxygenation can be kept optimal during one lung anaesthesia by applying 1.0 kPa continuous positive airway pressure to the nonventilated lung using an oxygen flow of 1–2 litres/minute.
The work of the Leeds Malignant Hyperpyrexia Unit, 1971–84
Authors: ELLIS F. R. , HALSALL P. J. , HARRIMAN D. G. F.
Published: February 2007

A detailed account of the procedure of muscle biopsy for screening patients suspected of being susceptible to malignant hyperpyrexia is given, together with a review of the results obtained from 1127 patients screened over the last 14 years. The information should help anaesthetists to discuss the investigation fully with probands and other members of their families before referral for further specific investigation.
Accidental subdural catheterisation
Authors: LEE A. , DODD K. W.
Published: February 2007

A case of accidental subdural catheterisation is presented, and its course is compared with previously reported subdural injections of local anaesthetic agents. The importance of obtaining proof of the site of malposition of an epidural catheter is stressed.
Tumours of the glomus jugulare
Authors: MATHER S. P. , WEBSTER N. R.
Published: February 2007

Two cases are reported using a two stage procedure for the excision of glomus jugulare tumours. The anaesthetic problems which this may produce are discussed, and recommendations are made regarding the anaesthetic conduct for this procedure. A two stage, combined procedure is suggested to reduce anaesthetic morbidity.
New syringes for arterial blood sampling
Authors: WISBORG T. , BAKKE P. , GULSVIK A.
Published: February 2007

Two new syringes for arterial blood sampling were compared. Fifty syringes of each type were randomly tested in awake patients and no signifcant differences were found regarding time taken to collect samples, or the pain experienced by the patient. Air bubbles were found in, and blood leaked, from the Pulsator syringes signijcantly more often than from the Radiometer B 129 syringes (p < 0.00s).
Anaphylactoid reaction complicating neonatal anaesthesia
Authors: Pollock E. M. M. , Macleod A. D. , Mcnicol L. R.
Published: February 2007

A three‐week‐old girl presented for surgery for congenital pyloric stenosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with atracurium. The administration of these drugs was followed within 2–3 minutes by oedema of the eyelids and epiglottis, reduced peripheral circulation and central cyanosis.
An evaluation of the Datex Normac anaesthetic agent monitor
Authors: Colquhoun A. D. , Gray W. M. , Asbury A. J.
Published: February 2007

A new monitor for volatile anaesthetics, the Datex Normac, was assessed in the laboratory and operating theatre. The instrument had a warm up time of 90 minutes from cold, but only 5 minutes from standby. Zero drift was less than 0.01% over 7 hours, and repeated measurements of gain showed a coefficient of variation of less than 1%. However, gain drift of 6% occurred when the instrument was switched off between periods of use. Signal noise was less than 0.02 vol % on a new instrument, but was about six times greater on an instrument that had been in use for a year. The response time of 550 ms is short enough to allow breath by breath monitoring. When the instrument was calibrated on the enjurane setting, measurements made on the enflurane, halothane and isojlurane settings were accurate to within 6% of the reading. This is satisfactory for clinical purposes, but not for more demanding applications. Calibration canisters are available, and two that we tested were accurate to better than 0.1 vol %. Nitrous oxide, carbon dioxide and water vapour have very small effects on the monitor. The instrument provided trouble‐free monitoring in theatre.
Vecuronium induced neuromuscular blockade
Authors: CASSON W. R. , JONES R. M.
Published: February 2007

The speed of onset of neuromuscular blockade was measured for increasing doses of vecuronium. Onset times were found to be shorter with larger doses, up to a limit of ED95× 3 (0.15 mg/kg). Thereafter, increasing the dose, even up to ED95× 8 (0.4 mg/kg), did not appreciably shorten the time to full neuromuscular blockade. The clinical implications of, and pharmacokinetic basis for, these findings are discussed.
Carcinoid syndrome with myasthenia gravis
Authors: KEENS S. J. , DESMOND M. J. , UTTING J. E.
Published: February 2007

The anaesthetic management of a patient suffering from carcinoid syndrome and myasthenia gravis is described including the successful treatment of a carcinoid attack with intravenous aprotonin. The differences between myasthenia gravis and the myasthenic (Eaton‐Lambert) syndrome are considered and the rationale for the choice of vecuronium as the muscle relaxant is discussed.
The use of antacids as a prophylaxis against Mendelson's syndrome in the United Kingdom. A survey
Authors: Sweeney B. , Wright I.
Published: February 2007

Maternal mortality from aspiration of gastric contents still remains unacceptably high, despite various recommended prophylactic measures. In order to establish which jorms of antacid prophylaxis are currently being used, a questionnaire was sent to anaesthetists working in obstetric units in the United Kingdom. Despite its limitations. magnesium trisilicate remains the most popular antacid during labour and before Caesarean section.
Intravenous feeding with medium chain triglycerides. Effect on blood gases and the complement system in critically ill patients
Authors: Ball M. J. , Sear J. W.
Published: February 2007

Critically ill patients are usually in a catabolic state and may require total parenteral nutrition; this often includes lipid emulsions. Any adverse effects of constituents on pulmonary function, white cell function or the haemocoagulation system could have disastrous consequences in such patients. We have investigated the effects of a new intravenous lipid preparation containing medium chain triglyceriks, which, in severely ill malnourished patients are theoretically a preferable energy source to conventional drug chain triglycerides. In a pilot study 17 critically ill patients whose lungs were artificially ventilated were given this lipid emulsion; no adverse eflects were observed. Arterial oxygen and carbon dioxide tensions, ratio of inspired oxygen fractional concentration to arterial oxygen tension. platelet and white cell counts all remained constant and the complement system was not activated.
Single breath induction of anaesthesia, using a vital capacity breath of halothane, nitrous oxide and oxygen
Authors: WILTON N. C. T. , THOMAS V. L.
Published: February 2007

Inhalational induction of anaesthesia. using a single vital capacity breath of 4% halothane in 66% nitrous oxide and 33% oxygen was evaluated in 100 unpremedicated outpatients. The technique was found to be acceptable to most (91%) of the patients studied, with a mean (SD) induction time (measured from beginning of inspiration to loss of‘eyelash reflex? of 83(21) seconds. Relative cardiovascular stability was a notable finding of the technique. with a slight decrease in the mean arterial pressure of only 10%. Anaesthetic induction time was unaffected by age, weight or smoking habits. The technique of single breath induction is therefore proposed as a safe and acceptable alternative to intravenous induction in co‐operative adult patients.
Influence of ketanserin pretreatment on the haemodynamic responses to sternotomy
Authors: CASHMAN J. N. , THOMPSON M. A. , BENNETT A.
Published: February 2007

The effect of intravenous ketanserin on the pressor response to sternotomy was studied in 36 patients undergoing coronary artery surgery. Two doses of the drug (10 mg and20 mg) were compared with a placebo injection of saline. After induction of anaesthesia, haemodynamic variables were measured until the institution of cardiopulmonary bypass. Plasma and platelet 5‐hydroxyindoles and 5‐hydroxytryptamine were measured in a subset of 13 patients. Ketanserin induced a dose‐dependent amelioration of the pressor response to sternotomy. Plasma 5‐hydroxyindoles and platelet 5‐hydroxytryptamine levels did not correlate with clinical response. The increased effectiveness of the higher dose of ketanserin may be due to an effect other than serotonin antagonism.
Selective bronchial intubation for one lung anaesthesia in thoracic surgery
Authors: NAZARI S. , TRAZZI R. , MONCALVO F. , ZONTA A. , CAMPANI M.
Published: February 2007

Anew method for one lung anaesthesia in thoracic surgery is described. Separate lung ventilation is obtained with selective main bronchus intubation. by means of an appropriate cuffed tube inserted through a standard orotracheal tube. Ventilation is carried out separately through the bronchial tube on one side and the residual tracheal tube lumen on the other side. This method greatly simplifies the technique of bronchial intubation and offers many advantages over commercially available double–lumen tubes.
A comparison of five heat and moisture exchangers
Authors: SHELLY MAIRE , BETHUNE D. W. , LATIMER R. D.
Published: February 2007

Five heat and moisture exchangers were investigated to compare their efficiency of humidification, their ability to filter bacterial spores and their various physical properties. The results are presented and the various mechanisms of heat and moisture exchange are reviewed. The Pall Ultipor BB50. because of its hydrophobic properties, has a slightly different action from heat and moisture exchangers already in use. The place of the Pall Ultipor BB50 in clinical practice is discussed.
Pethidine compared with meptazinol during labour
Authors: MORRISON C. E. , DUTTON D. , HOWIE H. , GILMOUR H.
Published: February 2007

A randomised double‐blind comparison of pethidine and meptazinol used as analgesics in labour was carried out in 1100 consecutive women who would normally have received intramuscular pethidine. Pain assessments at 30‐minute intervals were made independently by patients and midwives. Maternal and neonatal side effects were noted. The babies' requirements for resuscitation and weight changes in the first 5 days were studied. There was no difference in the analgesia provided by the two drugs; the pattern of side effects was similar, but the incidence of vomiting was greater following meptazinol administration. The babies in the two groups were similar with respect to resuscitation received, weight gains or losses and the incidence of clinical neonatal jaundice. The most striking findings were the poor quality of pain relief experienced by both groups following parenteral analgesics and the high incidence of side effects.
Insertion of intratracheal stents
Authors: SHERRY K. M. , KEELING P. A. , JONES H. M. , AVELING W.
Published: February 2007

The case histories of two patients who required the insertion of intratracheal stents are presented. The peroperative anaesthetic management of one case included the use of high frequency jet ventilation of the lungs; in the other case, partial cardiopulmonary bypass was used. The advantages and disadvantages of these two methods are discussed.
Morbidity and early retirement among anaesthetists and other specialists
Authors: McNAMEE R. , KEEN R. I. , CORKILL C. M.
Published: February 2007

An historically prospective study of the rates of early retirement due to permanent ill health, early retirement between 60 and 64 years of age for other reasons, and deaths while in post, among consultant anaesthetists in England was carried out. The control group comprised consultants in four other hospital specialty groups. Approximately two‐thirds of all consultants employed in the five specialties at National Health Service hospitals in England during 1966–83 were included in the study. Ill‐health retirements among male anaesthetists were more than twice those expected on the basis of rates in the control group (p < 0.001). The number of other early retirements between 60 and 64 was a third higher than expected (p < 0.005). The number of deaths in post was also raised. For the smaller group of female anaesthetists there was not a statistically significant excess of ill‐health retirements, but the number of early retirements between 60 and 64 was significantly greater than expected (p < 0.005), as was the number of deaths in post (p < 0.001). Possible causes of these excesses are discussed.
Spurious central venous pressure
Authors: BARROWCLIFFE M. P.
Published: February 2007

A patient is described in whom two different sites of cannulation of central veins produced markedly different pressures with potentially dangerous consequences. Falsely elevated pressures recorded from a catheter inserted via the subclavian vein were related to the patency in the arm of an arteriovenous shunt. The likely cause of this phenomenon is discussed.
Nausea and vomiting after prostaglandins in day case termination of pregnancy The efficacy of low dose droperidol
Authors: MILLAR J. M. , HALL P. J.
Published: February 2007

The antiemetic effects of low dose droperidol (0.25 and 0.5 mg) and a placebo were compared in patients who had received prostaglandin for day case termination of pregnancy. The incidence of nausea and vomiting was high. Low dose droperidol significantly reduced postoperative nausea and vomiting without any delay in immediate recovery or discharge home (p < 0.05). Droperidol 0.25 mg was equally effective as an antiemetic, as 0.5 mg.
Recovery from propofol infusion as the main agent for outpatient arthroscopy
Authors: ZUURMOND W. W. A. , VAN LEEUWEN L. , HELMERS J. H. J. H.
Published: February 2007

Propofol by continuous intravenous infusion has been compared with isoflurane as the main anaesthetic agent for outpatient arthroscopy of the knee. In 40 unpremedicated patients, anaesthesia was induced with propofol 2 mg/kg and vecuronium bromide 0.1 mg/kg and maintained after tracheal intubation with nitrous oxide 66% in oxygen. One group received 3% isoflurane prior to intubation and 0.9% during maintenance, while the other received a continuous intravenous infusion of propofol at a rate of 10 mg/kg/hour. Recovery was assessed by the time to opening eyes, to be able to answer five questions correctly, to recovery of ocular balance (Maddox Wing test) and by comparing pre‐ and postoperative performance in a paper and pencil test (the p‐deletion test). After 3 hours all the patients were fit for discharge. Recovery tests showed no differences between the groups. All patients were satisfied with the anaesthesia. Full recovery took on average 1.5 days (range between I hour and 14 days) in both groups. Patients' opinion 1 month after the procedure should be included in every study concerning recovery. Anaesthesia by continuous propofol infusion results in quick recovery comparable with that following isoflurane anaesthesia.
The loading dose for continuous infusion epidural analgesia
Authors: MACLEOD D. M. , TEY H. K. , BYERS G. F. , DOLLERY W. C. , TUNSTALL M. E.
Published: February 2007

The effects of 0.08% and 0.5% bupivacaine, given in equal volumes as the loading dose prior to continuous infusion epidural analgesia, were compared. The incidence of hypotension, as well as the height of sensory blockade. was markedly lowered by reducing the loading dose of bupivacaine. However, the efficacy of the epidural analgesia was maintained by using the same volume for the loading dose. The mean onset of analgesia was delayed from 9.1 to 13.6 minutes. There were fewer calls for intervention consequent upon the reduction in adverse effects. The use of 8 ml 0.08% bupivacaine for the loading dose or for subsequent top‐ups is recommended. The concept of a liquid sleeve of local anaesthetic in the epidural space is further supported.
Ondine's curse and the anaesthetist
Authors: MATHER S. J.
Published: February 2007

The central hypoventilation syndrome (Ondine's curse) is reviewed and discussed with emphasis on the clinical features and treatment of the disorder. It is a rare syndrome, but the anaesthetist working in a paediatric centre or in intensive care should be aware of its existence since advice and assistance in management may be required.
Treatment of severe accidental hypothermia using the Clinitron bed
Authors: MILES J. M. , THOMPSON G. R.
Published: February 2007

Two cases of severe accidental hypothermia (core temperature (28°C) rewarmed employing the Clinitron system are described. The physiological changes during hypothermia and rewarming are discussed and the current concepts of rewarming (active external versus internal) outlined. It is suggested that severely hypothermic patients can be successfully treated by rapid external rewarming using the Clinitron heated fluidised‐bead bed. This method combines the advantages of rapid rewarming, minimal physiological disturbance and is non invasive.
A new ventilator for closed breathing systems
Authors: Twigley A. , Chakrabarti M. K. , Whitwam J. G.
Published: February 2007

A new electronic ventilator for application during closed breathing system anaesthesia is described (OAV7700, Ohmeda). It is easy to use and can be mounted on any conventional anaesthetic machine. It has several desirable features, such as a simple control and display panel, appropriate alarms and a patient breathing system that can be autoclaved. Observations were made on seven patients undergoing major surgery. Anaesthetic gases were introduced at 1, 2 and 4 litres/minute at three points in the breathing system, one conventionally in the closed system, one at the ventilator and one in the tracheal tube. Carbon dioxide homeostasis was maintained during this procedure. The application of fresh gas flows of 2 and 4 litres/minute in the tracheal tube allowed a small but significant reduction in the mean tidal volume. However, it was concluded that a fresh gas flow of 1 litre/minute applied conventionally either into the closed system or at the ventilator, provided optimal conditions.
The acute effects of intravenous isosorbide dinitrate during cardiac surgery
Authors: PARSONS R. S. , WETZEL R. C. , MOHANDAS K.
Published: February 2007

The acute effects of intravenous isosorbide dinitrate during open heart surgery were studied in 15 adult patients. Consistent and significant (p < 0.001) reductions in pulmonary vascular resistance (25% before. 23% after, cardiopulmonary bypass) and mean pulmonary artery pressure (14% before, 13% after, cardiopulmonary bypass) were observed in the absence of significant changes in cardiac index, mean systemic arterial pressures or right or left atrial filling pressures. These findings indicate that after cardiopulmonary bypass, when right ventricular dysfunction with raised pulmonary vascular resistance may occur, selective reduction of right ventricular afterload with isosorbide dinitrate may prove beneficial.
Pneumatic tourniquet paralysis following intravenous regional analgesia
Authors: LARSEN U. T. , HOMMELGAARD P.
Published: February 2007

A case of pneumatic tourniquet paralysis with permanent damage is presented. The importance of relating the cuff pressure to the cuff used, the arterial blood pressure and the shape of the arm is emphasised.
The use of bronchial stents in the management of bronchomalacia
Authors: GODDARD J. M. , BOOKER P. D.
Published: February 2007

A case is described in which the use of a bronchial stent proved very useful in the management of an infant with severe air trapping secondary to bronchomalacia.
Effects of benzodiazepines on laryngeal reflexes
Authors: GROVES N. D. , REES J. L. , ROSEN M.
Published: February 2007

Of 20 volunteers, five were given intravenous Diazemuls 15 mg over 15 seconds, and three groups of five were given lormetazepam 2 mg intravenously over 10, 20 and 60 seconds, respectively. Laryngeal reactivity and psychomotor function were tested at intervals from prior to injection until 4 hours after injection. For equivalent degrees of depression of psychomotor function, lormetazepam depressed the laryngeal reflex less than Diazemuls (p = 0.004). Lormetazepam given over 60 seconds depressed the laryngeal reflex more than when given over 10 seconds (p = 0.008) or over 20 seconds (p = 0.048), although a significant difference was not demonstrated between the 10‐second and 20‐second groups. These results concur with experimental evidence that benzodiazepine receptor multiplicity exists, which allows various members of the benzodiazepine group of drugs to exhibit differing therapeutic ratios for their various effects.
Basophil histamine release
Authors: WITHINGTON D. E. , LEUNG K. B. P. , BROMLEY L. , SCADDING G. K. , PEARCE F. L.
Published: February 2007

A patient who suffered a severe hypotensive episode after induction of anaesthesia, was subsequently found to show positive skin‐test responses to suxamethonium. Investigation revealed that suxamethonium induced basophils from the patient to release histamine to an extent comparable to that found after exposure to anti‐IgE. Basophils from control subjects showed no such response. Basophil histamine release may offer a useful approach to the investigation of adverse drug reactions.
Hypercholinesterasaemia and suxamethonium resistance
Authors: WARRAN P. , THEEMAN M. , BOLD A. M. , JONES S.
Published: February 2007

A case is reported of resistance to the muscle relaxing action of suxamethonium due to the rare inherited condition of hypercholinesterasaemia. Family studies suggest dominant inheritance. It is suggested the condition should be considered whenever there is unexpected resistance to the muscle relaxing action of suxamethonium.
A new laryngoscope
Authors: NUNN G.
Published: February 2007

This is a report of a modification to one design of laryngoscope to increase the angle between blade and handle, to facilitate intubation in cases of difficult access, such as in obstetric practice or in patients in whom neck flexion is limited, for example by skull traction. The modification offers the unique advantage of two useful blade angles in one instrument. The first type described would be suitable for use in small units where it is thought that a laryngoscope solely for use in rare cases of difficult access would not be justified. It would also be suitable for inclusion in resuscitation kits for use both within and outside hospital. The second type would be more suitable for the maternity or spinal injuries unit, or the difficult intubation box of a general operating theatre suite.
The influence of premeditation on the occurrence of dysrhythmias during oral surgery
Authors: Smith D. C. , O'Connell P.
Published: February 2007

The incidence of cardiac dysrhythmia during inpatient dental anaesthesia with enflurane was studied following either hyoscine or droperidol as a supplement to papaveretum premedication. None of the subgroup given droperidol exhibited dysrhythmias, compared to 4.4% of those patients given hyoscine. This difference was not significant at the 5% level (0.2 > p > 0.1).
Cardiac arrest in near‐term pregnancy
Authors: LINDSAY S. L. , HANSON G. C.
Published: February 2007

This case study emphasises the multiple factors that may be involved in the precipitation of electromechanical dissociation, which are compounded by additional problems that relate to pregnancy. It reinforces the value of the tracheal route for drug administration when a central vein is not cannulated and stresses the importance of posture and early consideration of Caesarean section in the pre‐term gravid patient who has sustained a cardiac arrest.
A case of prolonged hypotension following intravenous guanethidine block
Authors: SHARPE E. , MILASZKIEWICZ R. , CARLI F.
Published: February 2007

A 25‐year‐old female developed causalgia following a nerve injury in the left hand, and this was treated successfully with a series of intravenous guanethidine blocks. However, after the 13th block, systolic arterial blood pressure decreased to 60 mmHg and remained tow (80 mmHg)for one week. Accumulation of guanethidine at the sympathetic nerve ending, resulting in autonomic denervation, might be the underlying mechanism of the prolonged hypotension. Treatment was conservative; however, the use of tricyclic antidepressants and sympathomimetic amines to restore the blood pressure to a normal level can be considered with appropriate caution.
The Triservice anaesthetic apparatus
Authors: Kocan M.
Published: February 2007

Sixty male patients undergoing limb surgery were anaesthetised using a drawover technique with the Triservice apparatus. They were randomly allocated to receive trichloroethylene and one of three other volatile agents (halothane, enflurane or isoflurane) after thiopentone induction. Signs of inadequate anaesthesia were noted. The incidence of such signs was not significantly different in the three groups. Similarly, no qualitative difference could be demonstrated in the immediate recovery, but the recovery time was significantly shorter with enflurane.
Unintentional dural puncture. A survey of recognition and management
Authors: Okell R.W. , Sprigge J.S.
Published: February 2007

A survey of the recognition and management of 21 unintentional dural punctures that occurred in a series of 3500 obstetric epidurals is presented. In seven cases, dural puncture was not recognised at the time of occurrence and two patients may have subsequently received mixed epidural and subarachnoid analgesia. In two patients with dural puncture in whom air had been used to locate the epidural space, cerebrospinal fluid did not drip from the hub of the needle. A test dose did not reveal incorrect catheter placement in seven patients. The provision of an epidural infusion of Hartmann's solution for 24 hours, together with bed rest, appeared to delay the onset of dural puncture headache rather than prevent it entirely. Blood patching was required only in five of the 21 patients but was entirely successful. The implications of these observations in relationship to obstetric epidural practice are discussed.
Hepatotoxicity and death following two enflurane anaesthetics
Authors: PAULL J. D. , FORTUNE D. W.
Published: February 2007

A 67‐year‐old woman died with massive fatty change in the liver 41 hours after her second enflurane anaesthetic in 28 days. The clinical features of five previously reported similar deaths are summarised. Possible mechanisms of the hepatotoxicity are reviewed briefly.
Retrograde intubation
Authors: COOPER C. M. S. , MURRAY‐WILSON A.
Published: February 2007

An infant with Goldenhar's syndrome is presented in whom two‐stage plastic surgery was undertaken. The first operation, at the age of 5 months, necessitated a retrograde technique for tracheal intubation while in the second, at 10 months of age, conventional intubation was possible. The discussion highlights those refinements that promote a successful outcome when retrograde intubation is indicated, particularly in infants.
Transient hearing loss following spinal anaesthesia
Authors: WANG L. P. , FOG J. , BOVE M.
Published: February 2007

Audiograms were performed pre‐operatively in 14 patients scheduled for transurethral resection of the prostate under spinal anaesthesia and again 2 days postoperatively. Six of the 14 patients showed a minor reduction of hearing in the low frequency range. Follow‐up audiograms showed full recovery after 1–7 months. No significant hearing loss was found in 12 patients who underwent the same procedure with epidural anaesthesia.
Hypolgcaemic encephalopathy following surgery on phaeochromocytoma
Authors: CHANNA A. B. , MOFTI A. B. , TAYLOR G. W. , MEKKI M. O. , SHEIKH M. H.
Published: February 2007

Severe hypoglycaemia as a complication of excision of a phaeochromocytoma has been reported seven times in the world literature. The eighth case, reported here, is unusual for the severity of the hypoglycaemic neurological damage which persisted for 10 weeks before ultimate recovery.
Displacement of a minitracheotomy tube during high frequency jet ventilation
Authors: RAVALIA A. , STOCKWELL M. A.
Published: February 2007

A patient required respiratory support with jet ventilation via a minitracheotomy tube 2 days after right upper lobectomy. After initial improvement, the patient's condition deteriorated because of migration of the minitracheotomy tube out of the larynx. This complication has not been described previously. A number of possible causative factors and remedies are discussed.
Arterial oxygen desaturation during postoperative transportation: the influence of operation site
Authors: Meiklejohn B. H. , Smith G. , Elling A. E. , Hindocha N.
Published: February 2007

Arterial oxygen saturation in 132 patients was measured using a Biox IV oximeter with an ear probe, during transfer from theatre to recovery room following a variety of surgical procedures. Oxygen saturation decreased to 85% or less in 21.9% of patients and to 90% or less in 61.4%. No predictive factors were identified. It is recommended that supplementary oxygen be given to all patients in the immediate postoperative period, including the period of transit to the recovery room.
Nalbuphine for obstetric analgesia
Authors: FRANK M. , McATEER E. J. , CATTERMOLE R. , LOUGHNAN B. , STAFFORD L. B. , HITCHCOCK A. M.
Published: February 2007

A double‐blind, randomised study of 60 patients who received intravenous increments of nalbuphine 3 mg or pethidine 15 mg by patient‐controlled analgesia during the first stage of labour, was carried out. Pain intensity, sedation, uterine contractions, maternal cardioventilatory variables and fetal heart rate were recorded as well as any side effects. Apgar scores, time to sustained respiration and resuscitative measures required for the neonate were noted at delivery. Modified neonatal neurobehavioural studies and a retrospective assessment of maternal analgesia, satisfaction and tolerance were also carried out. Group mean values of pain scores of nalbuphine‐medicated primiparous women were statistically significantly lower than those of pethidine‐medicated patients (p < 0.01). Other assessments did not demonstrate a statistical significance between the two groups.
Peak intratracheal pressure during controlled ventilation in infants and children
Authors: SYNNOTT A. , WREN W. S. , DAVENPORT J.
Published: February 2007

The mathematical relationship between peak ventilator breathing system pressure displayed on the digital meter of the Siemens SV900C ventilator, and peak intratracheal pressure measured at the distal end of the tracheal tube, was defined and incorporated into a computer program. The mean difference between peak airway pressure calculated by the computer and directly measured peak intratracheal pressure was 0.02 kPa (SD 0.10) in 18 infants and children. The mean difference between ventilator breathing system pressure and intratracheal pressure in the same group was 0.82 kPa (SD 0.91). Bench tests established that the decrease in peak pressure displayed by the ventilator (from 1.36 to 0.38 kPa) while inspiratory lime was increased from 20 to 80% of the respiratory period, concealed an increase (from 0.2 to 0.38 kPa) in intratracheal pressure which occurs during this process; and that the large increase in pressure displayed by the ventilator (from 0.3 to 6 kPa) while respiratory frequency was increased from 20 to 120 breaths I minute, concealed a small increase in peak intratracheal pressure (0.2–0.3 kPa) which occurs during this process. These changes were accurately predicted by the computer program. The increase in intratracheal pressure associated with prolonged inspiratory times explains the high incidence of baro‐trauma which has recently been associated with this procedure in infants.
Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction
Authors: TACKLEY R. M. , TREGASKIS B.
Published: February 2007

In spite of intensive therapy, an otherwise fit 34‐year‐old man died following the hyperpyrexial reaction to an interaction between tranylcypromine and clomipramine. There was no evidence of drug overdose, but severe disseminated intravascular coagulation developed which proved fatal.
Carcinoid syndrome and intravenous cyproheptadine
Authors: SOLARES G. , BLANCO E. , PULGAR S. , DIAGO C. , RAMOS F.
Published: February 2007

The anaesthetic management of a patient with the carcinoid syndrome is reported. Important cardiovascular complications occurred immediately after tracheal intubation and during manipulation of metastases. Hypertensive crises were controlled with intravenous cyproheptadine, although hypotension and drowsiness were observed due to its use.
Recurarisation after vecuronium in a patient with renal failure
Authors: CODY M. W. , DORMON F. M.
Published: February 2007

Recurarisation after anaesthesia using the muscle relaxant vecuronium is described. The problems of neuromuscular blockade in renal failure are discussed.
Diclofenac sodium for post‐tonsillectomy pain in children
Authors: WATTERS C. H. , PATTERSON C. C. , MATHEWS H. M. L. , CAMPBELL W.
Published: February 2007

Diclofenac sodium was assessed as an analgesic for postoperative pain following paediatric tonsillectomy in a randomised double blind trial. In a comparison made with both a pethidine and a control group diclofenac was shown to be an effective analgesic. No significant difference in analgesic efficacy was demonstrated between the two drugs, although patients who received diclofenac tended to be less drowsy postoperatively than those who received pethidine. There were no significant differences between the two drugs in respect of time to awaken from anaesthesia or incidence of postoperative vomiting.
Propofol induction and maintenance with nitrous oxide in paediatric outpatient dental anaesthesia
Authors: PUTTICK N. , ROSEN M.
Published: February 2007

Intravenous induction of anaesthesia with propofol (3.5 mg/kg) and maintenance boluses (I mg/kg), with 30% oxygen and 70% nitrous oxide, were compared with intravenous thiopentone induction (5 mg/kg) followed by 30% oxygen and 70% nitrous oxide, supplemented with 2 to 3% halothane in children aged 2–11 years who underwent dental extractions. Both techniques were found to he acceptable in clinical practice. Recovery from anaesthesia was assessed by the time taken to reach clinically‐defined milestones. Times to open eyes, give name, stand unaided, and time to discharge were all 3 to 7 minutes shorter in those who had the propofol technique compared with those who had thiopentone‐halothane (p < 0.05). These indices of recovery were more sensitive than the Steward score.
Plasma bupivacaine concentrations during caudal analgesia and ilioinguinal‐iliohypogastric nerve block in children
Authors: STOW P. J. , SCOTT A. , PHILLIPS A. , WHITE J. B.
Published: February 2007

Plasma bupivacaine concentrations were measured in 27 children aged 3 ‐7 years who received one of two analgesic regimens for herniotomy or orchidopexy. Analgesia was provided either by caudal epidural bupivacaine 0.2% 2 mg/kg (n = 14) or by ilioinguinal‐iliohypogastric nerve block with bupivacaine 0.5% 1.25 mg/kg (n = 13). Mean (SD) peak venous bupivacaine concentrations were 0.57 (0.17) μg/ml and 0.79 (0.38) μg/ml respectively. Time to peak plasma concentrations were 29.6 (7.9) and 22.3 (10.9) minutes respectively. These concentrations are well below the potentially toxic level of 4.0 μg/ml, but suggest that uptake of bupivacaine is more rapid after ilioinguinal iliohypogastric nerve block than during caudal analgesia.
A survey of anaesthetic charts
Authors: Bembridge M. , Bembridge J. L.
Published: February 2007

This survey reviews the structure and content of all anaesthetic record charts in use in the 40 hospitals of the Yorkshire Regional Health Authority in the light of previous recommendations. Twenty‐two different anaesthetic charts were used by 290 anaesthetists in this region. Some of the charts did not meet the ideal standard for size (A4) and the majority had no colour coding. Fourteen of the 22 charts omitted important headings concerned with patient identification and eight charts did not provide a record of the whole perioperative period. Some comprehensive forms are in use, chiefly in smaller hospitals, but there have been few changes in design in the last 10 years despite increasing medicolegal awareness.
Premeditation with oral slow release morphine in dental anaesthesia. A comparison with temazepam
Authors: Richmond M. N. , Daum R. E. O.
Published: February 2007

Oral slow release morphine 30 mg and temazepam 30 mg given as premedication 2 hours before operation were compared in 62 patients who underwent extraction of four third molar teeth in a randomised double‐blind trial. There was no significant difference in pre‐operative sedation; the majority were mildly or moderately sedated. Patients in the morphine group woke up significantly faster and had significantly reduced requirements for analgesics after operation.
Fibreoptic intubation in Klippel‐Feil syndrome
Authors: DAUM R. E. O. , JONES D. J.
Published: February 2007

A patient with Klippel‐Feil syndrome who underwent abdominal surgery is presented and the anomaly reviewed. The anatomical abnormality and potentially unstable neck provide a potentially difficult tracheal intubation which was undertaken using an awake fibreoptic technique. The role of the fibrescope and the advantage of pre‐operative assessment of the difficult airway are discussed.