bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of granisetron on radiation‐induced alterations of colonic motility and fluid absorption in rats
Authors: Picard C. , Ksas B. , Griffiths N. M. , Fioramonti J.
Published: March 2003

Background:

Radiation‐induced diarrhoea is attributed to both mucosal injury and alterations of intestinal motility. Previous reports have indicated that 5‐hydroxytryptamine is released following irradiation, which may contribute to these changes.

Aims:

To investigate the effects of granisetron (5‐hydroxytryptamine type‐3 receptor antagonist) on colonic motility, fluid absorption and 5‐hydroxytryptamine colonic content following abdominal irradiation (10 Gy) in rats.

Methods:

In vivo measurements of motility and fluid absorption in the proximal and distal colon, respectively, diarrhoea score and 5‐hydroxytryptamine tissue levels were performed 3 and 7 days after abdominal irradiation. The effects of post‐irradiation granisetron (0.3 mg/kg subcutaneously) were also evaluated.

Results:

Colonic motility and fluid/Na+ absorption were reduced 3 and 7 days after irradiation. All rats developed diarrhoea (3 days) concomitant with increased colonic mucosal 5‐hydroxytryptamine levels. Granisetron prevented diarrhoea, attenuated decreased colonic motility and reduced 5‐hydroxytryptamine levels on day 3, although fluid absorption was only slightly improved. On day 7, colonic motility and fluid/Na+ absorption were restored in granisetron‐dosed animals.

Conclusions:

These results indicate that radiation‐induced diarrhoea involves alterations of both colonic motility and fluid/Na+ absorption. 5‐Hydroxytryptamine could be one of the mediators implicated in these alterations, as post‐irradiation dosage with a 5‐hydroxytryptamine type‐3 receptor antagonist improved colonic motility and prevented diarrhoea on day 3.
Efficacy of a motilin receptor agonist (ABT‐229) for the treatment of gastro‐oesophageal reflux disease
Authors: Chen C. L. , Orr W. C. , Verlinden M. H. , Dettmer A. , Brinkhoff H. , Riff D. , Schwartz S. , Soloway R. D. , Krause R. , Lanza F. , Mack R. J.
Published: March 2003

Background:

ABT‐229 is a potent motilin agonist without significant antibiotic activity. It has been shown to improve gastric emptying in humans and to increase lower oesophageal sphincter pressure in cats.

Aim:

To assess the efficacy of four different doses of ABT‐229 (1.25 mg, 2.5 mg, 5 mg, 10 mg b.d.) compared to placebo in the treatment of gastro‐oesophageal reflux disease, and to determine its safety in patients with gastro‐oesophageal reflux disease.

Methods:

In a double‐blind, multicentre study, 324 patients with heartburn were randomized to receive four different doses of ABT‐229 or placebo for 8 weeks. The efficacy was evaluated by Patient Symptom Questionnaire, daily diary, endoscopy and global evaluation of efficacy.

Results:

There were no statistically significant improvement scores for any of the ABT‐229 treatment groups vs. the placebo group in any of the efficacy parameters. Reflux symptom scores were significantly worse after treatment in the dyspeptic group. ABT‐229 appeared to be well tolerated and safe in total daily doses up to 20 mg.

Conclusion:

ABT‐229 appears to have limited, if any, clinical utility in the treatment of gastro‐oesophageal reflux disease.
Health‐related quality of life among persons with irritable bowel syndrome: a systematic review
Authors: El‐Serag H. B. , Olden K. , Bjorkman D.
Published: March 2003

Aim : To perform a systematic review of the literature with three objectives: (1) to compare the health related quality of life (HRQoL) of patients with irritable bowel syndrome with that of healthy controls; (2) to compare the HRQoL of irritable bowel syndrome patients to those with other diseases; and (3) to examine therapy‐associated changes in HRQoL of irritable bowel syndrome patients.

Methods : Searches of all English and non‐English articles from 1980 to 2001 were performed in Medline and Embase, and two investigators performed independent data abstraction.

Results : Seventeen articles met our selection criteria. 13 studies addressed objective no. 1; 11 showed a significant reduction in HRQoL among irritable bowel syndrome patients. Of these, only one study was considered of high quality. Four studies addressed objective no. 2, none of which was considered to be high quality in addressing this objective. Four trials (three of high quality) addressed objective no. 3. One showed that symptomatic improvement with Leupron compared to placebo was accompanied an improvement only in the comparative health domain of the HRQoL. The second study reported significant positive changes in HRQoL after 12 weeks of cognitive behavioural therapy. The third report of two placebo‐controlled studies indicated significant improvement with alosetron on most domains of Irritable Bowel Syndrome Quality of Life Questionnaire.

Conclusions : (i) There is reasonable evidence for a decrease in HRQoL in patients with moderate to severe irritable bowel syndrome; however, the data are conflicting regarding the impact of irritable bowel syndrome on HRQoL in population‐based studies of nonconsulters. (ii) HRQoL in irritable bowel syndrome patients is impaired to a degree comparable to other chronic disorders such as GERD and depression. (iii) A therapeutic response in irritable bowel syndrome‐related pain has a corresponding improvement in HRQoL. (iv) Limitations of the literature include focusing on moderate‐severe irritable bowel syndrome in referral centres, and lack of appropriate controls
Long‐term risk of malignancy after treatment of inflammatory bowel disease with azathioprine
Authors: Fraser A. G. , Orchard T. R. , Robinson E. M. , Jewell D. P.
Published: March 2003

Background and aim : Data from renal transplant and rheumatoid arthritis patients suggest that there is an increased risk of malignancy after treatment with azathioprine. Whether this is true for patients with inflammatory bowel disease remains uncertain.

Method : A retrospective review of clinical notes was performed.

Results : Azathioprine was given to 626 of 2204 patients (855 with Crohn's disease and 1349 with ulcerative colitis). The mean total duration of azathioprine use was 27 months. The mean follow‐up from diagnosis was 13.7 years and the mean follow‐up from the start of azathioprine treatment was 6.9 years. Thirty‐one cancers were observed in 30 patients treated with azathioprine (4.5%) and 77 cancers were observed in 70 patients not treated with azathioprine (4.5%; P=N.S.). Logistic regression analysis (including in the model the age, sex, diagnosis and extent of disease) showed that treatment with azathioprine did not significantly affect the risk of the development of cancer. Eight patients had lymphoma; three had been given azathioprine (P=N.S.). For patients with ulcerative colitis, the number of colorectal cancers (including high‐grade dysplasia) in patients given azathioprine was eight of 355 (2.2%), compared with 28 of 994 (2.8%) for patients not given azathioprine (P=N.S.). The cumulative risk of colorectal cancer or dysplasia/dysplasia‐associated lesion or mass (adjusted to exclude post‐colectomy patients) after 10, 20, 30 and 40 years ofulcerative colitis was 0.4%, 1.3%, 9%and 15.5%, respectively.

Conclusion : No increased risk of cancer diagnosis following azathioprine treatment was observed.
Serum bile acids in patients with liver failure supported with a bioartificial liver
Authors: Pazzi P. , Morsiani E. , Vilei M. T. , Granato A. , Rozga J. , Demetriou A. A. , Muraca M.
Published: March 2003

Background : Serum bile acids are increased in liver failure, but the composition of the bile acid pool in this condition has not been studied in detail. This information is of interest because of dihydroxy bile acid toxicity.

Methods : We measured serum bile acids by gas chromatography–mass spectrometry in 13 patients with fulminant liver failure and five patients with acute‐on‐chronic liver failure. Furthermore, serum bile acids were analysed in the same patients after 6 h of treatment with a bioartificial liver, consisting of a hollow‐fibre cartridge with microcarrier‐attached porcine hepatocytes and a charcoal column.

Results : Pre‐bioartificial liver serum bile acids demonstrated a high dihydroxy/trihydroxy ratio and were higher in patients with acute‐on‐chronic liver failure than in those with fulminant liver failure (452.8 ± 98.6 vs. 182.1 ± 39.7 µmol/L; P < 0.05). Bioartificial liver treatment decreased significantly serum bile acids in patients with fulminant liver failure (−38.8%) and acute‐on‐chronic liver failure (−35.8%), with a decreased dihydroxy/trihydroxy ratio. In vitro, porcine hepatocytes in the bioreactor cleared most conjugated bile acid species from pooled patient plasma.

Conclusions : Acute liver failure is associated with very high serum levels of toxic bile acids that could contribute to the pathogenesis of the syndrome. Bioartificial liver treatment reduces both serum bile acid concentrations and the hydrophobicity of the bile acid pool.
Use of the ‘nutriceutical’, bovine colostrum, for the treatment of distal colitis: results from an initial study
Authors: Khan Z. , Macdonald C. , Wicks A. C. , Holt M. P. , Floyd D. , Ghosh S. , Wright N. A. , Playford R. J.
Published: March 2003

Background: Bovine colostrum is a rich source of nutrients, antibodies and growth factors.

Aim: To examine the efficacy of colostrum enemas in the treatment of distal colitis using a randomized, double‐blind, controlled protocol.

Methods: Fourteen patients (eight female), with a mean age of 45 years (range, 16–75 years) and mild to moderately severe distal colitis (Powell‐Tuck scoring system), received colostrum enema (100 mL of 10% solution) or placebo (albumin solution) b.d. for 4 weeks. Both groups also received mesalazine (1.6 g/day) or, if already taking it, had a dose increment of 1.6 g/day. Disease activity was documented at 0, 2 and 4 weeks.

Results: After 4 weeks, the colostrum group showed a mean reduction in symptom score of − 2.9 (95% confidence interval (CI), − 5.4 to − 0.3), whereas the placebo group showed a mean response of + 0.5 (95% CI, − 2.4 to +3.4). The histological score improved in five of the eight patients in the colostrum group (mean response, − 0.9; 95% CI, − 1.69 to − 0.03), whereas the histological scores only improved in two of the six patients in the placebo group (mean response, 0.2; 95% CI, − 2.4 to +2.6).

Conclusions: Bovine colostrum enema shows potential as a novel therapy for left‐sided colitis with additional benefits over using mesalazine alone. Further studies appear to be warranted.
Effect of the low‐affinity, noncompetitive N‐methyl‐d‐aspartate receptor antagonist dextromethorphan on visceral perception in healthy volunteers
Authors: Kuiken S. D. , Lei A. , Tytgat G. N. J. , Holman R. , Boeckxstaens G. E. E.
Published: March 2003

Background : The use of N‐methyl‐d‐aspartate (NMDA) receptor antagonists may hold promise for the treatment of pain of visceral origin, in particular in conditions characterized by visceral hypersensitivity.

Aim : To study the effect of dextromethorphan, a low affinity, non‐competitive NMDA receptor antagonist, on visceral perception in healthy volunteers.

Methods : Nine healthy volunteers (5 female, median age 22 years) underwent a gastric barostat study after oral administration of placebo, dextromethorphan 10 mg or dextromethorphan 30 mg, on three separate days in a double‐blind, randomised order. Sensations induced by step‐wise isobaric gastric distension (2 mmHg/2 min) were studied during fasting and 30 min after a meal. In addition, proximal gastric tone was measured during fasting and postprandially.

Results : Compared to placebo, dextromethorphan 30 mg significantly increased the distension‐evoked sensation scores for nausea (P=0.004) and satiation (P=0.004) during fasting; and for bloating (P= 0.001), nausea (P=0.000) and satiation (P=0.01) 30 min postprandially. Dextromethorphan did not alter pain scores, proximal gastric tone or gastric compliance.

Conclusions : Dextromethorphan increases the perception of non‐painful sensations during gastric distension, without altering the perception of pain. Therefore, application of dextromethorphan as a visceral analgesic is questionable. Future studies with more specific NMDA receptor antagonist are warranted.
Adult‐to‐adult right hepatic lobe living donor liver transplantation
Authors: Hayashi P. H. , Trotter J. F.
Published: March 2003

Spurred on by the critical shortage of cadaveric livers, adult‐to‐adult right hepatic lobe living donor liver transplantation has grown rapidly as a therapeutic option for selected patients. In the USA alone, the number of living donor liver transplantations has increased six‐fold in the last 4 years. The therapy can be complex, bringing together a variety of disciplines, including transplantation medicine and surgery, hepatology, psychiatry and medical ethics. Moreover, living donor liver transplantation is still defining itself in the adult‐to‐adult application. Uniform standards, guidelines and long‐term outcomes are yet to be determined. Nevertheless, initial success has been remarkable, and a basic understanding of this field is essential to any physician contemplating options for their liver failure patients. This review covers a range of topics, including recipient and donor selection and outcomes, donor risk, controversies and future issues.
Human recombinant lactoferrin is ineffective in the treatment of human Helicobacter pylori infection
Authors: Guttner Y. , Windsor H. M. , Viiala C. H. , Marshall B. J.
Published: March 2003

Background : Lactoferrin, a multifunctional glycoprotein, is known to have anti‐microbial actions. Bovine lactoferrin and recombinant human lactoferrin have been shown to inhibit Helicobacter pylori, and more recently recombinant human lactoferrin was found to significantly increase the eradication rate of H. pylori when added to standard triple therapy.

Aim : To determine the efficacy, safety and tolerability of recombinant human lactoferrin as a therapy in suppressing or eliminating H. pylori infection in subjects with minimal upper gastrointestinal symptoms who have not previously been treated.

Subjects and methods : Nine healthy subjects with minimal upper gastrointestinal symptoms and a positive urea breath test were recruited. None of the volunteers had previously been treated for H. pylori. Subjects received 5 × 1.0 g human recombinant lactoferrin daily for 5 or 14 days. Breath tests were repeated during therapy and shortly after to check for eradication. The safety and tolerability of the drug were assessed by physical examination, by monitoring adverse events, and clinical laboratory evaluation.

Results : No conversion of the urea breath test from positive to negative was observed and there was no consistent change in urea breath test count to indicate a possible suppression of H. pylori.

Conclusion : Lactoferrin, given as a single agent, does not eradicate H. pylori infection.
Rectal tissue, plasma and urine concentrations of mesalazine after single and multiple administrations of 500 mg suppositories to healthy volunteers and ulcerative proctitis patients
Authors: Aumais G. , Lefebvre M. , Tremblay C. , Bitton A. , Martin F. , Giard A. , Madi M. , Spénard J.
Published: March 2003

Objective : Patients with ulcerative proctitis may have rectal mucosal properties different from healthy volunteers. This project compared the pharmacokinetics of rectally administered mesalazine in these two populations.

Methods : In two separate studies, nine patients with ulcerative proctitis and 16 healthy volunteers received a single 500 mg mesalazine suppository and then 500 mg every 8 h for 5 days. Blood samples were collected for 12 h in healthy volunteers and 30 h in patients, and urine for 24 h in healthy volunteers and 30 h in patients. Rectal biopsies were performed 8 h after the last dose.

Results : After a single dose to patients, mean mesalazine half‐life (s.d.) was 5.0 (3.6) h. At steady‐state, means (s.d.) were 89.1 (78.9) ng/mL for Cmin, 361.1 (240.8) ng/mL for Cmax, and 7.1 (7.3) h for half‐life. Mean (range) rectal mesalazine concentrations were 167 (1.4–541.6) ng/mg tissue. After a single dose in healthy volunteers, mean (s.d.) half‐life was 4.0 (4.7) h. At steady‐state, means (s.d.) were 22.4 (61.6) ng/mL for Cmin, 359.4 (166.3) ng/mL for Cmax, and 0.9 (0.5) h for half‐life.

Conclusion : Mesalazine is released in the rectum of patients, with a bioavailability of about 40%. Tissue distribution is also appreciable. Both parameters appear higher than in healthy volunteers.
Wheat‐starch‐based gluten‐free products in the treatment of newly detected coeliac disease: prospective and randomized study
Authors: Peräaho M. , Kaukinen K. , Paasikivi K. , Sievänen H. , Lohiniemi S. , Mäki M. , Collin P.
Published: March 2003

Background : The safety of wheat‐starch‐based gluten‐free products in the treatment of coeliac disease is debatable. Prospective studies are lacking.

Aim : To compare the clinical, histological and serological response to a wheat‐starch‐based or natural gluten‐free diet in patients with newly detected coeliac disease.

Methods : Fifty‐seven consecutive adults with untreated coeliac disease were randomized to a wheat‐starch‐based or natural gluten‐free diet. Clinical response, small bowel mucosal morphology, CD3+, αβ+ and γδ+ intra‐epithelial lymphocytes, mucosal human leucocyte antigen‐DR expression and serum endomysial, transglutaminase and gliadin antibodies were investigated before and 12 months after the introduction of the gluten‐free diet. Quality of life measurements were performed by standardized questionnaires and the bone mineral density was analysed.

Results : In both groups, abdominal symptoms were alleviated equally by a strict diet. There were no differences between the groups in mucosal morphology, the density of intra‐epithelial lymphocytes, serum antibodies, bone mineral density or quality of life tests at the end of the study. Four patients on a natural gluten‐free diet and two on a wheat‐starch‐based gluten‐free diet had dietary lapses; as a result, inadequate mucosal, serological and clinical recovery was observed.

Conclusions : The dietary response to a wheat‐starch‐based gluten‐free diet was as good as that to a natural gluten‐free diet in patients with newly detected coeliac disease.
Pharmacokinetics of budesonide controlled‐release capsules when taken with omeprazole
Authors: Edsbäcker S. , Larsson P. , Bergstrand M.
Published: March 2003

Aim: To investigate whether omeprazole affects the pharmacokinetics and systemic effects of budesonide controlled‐release capsules when the two medications are taken together.

Methods: Thirteen healthy volunteers were enrolled into a randomized, double‐blind, placebo‐controlled, cross‐over study. Participants received omeprazole, 20 mg/day, or placebo every morning for 5 days, with three 3‐mg budesonide controlled‐release capsules being given with omeprazole or placebo on day 5. After a 12‐day washout period, participants were switched from omeprazole to placebo, or vice versa, and the trial was repeated. Blood samples for pharmacokinetic evaluation and urine samples for cortisol assessments were collected before and after the budesonide doses.

Results: No statistically significant differences were seen between omeprazole and placebo treatment with regard to any of the parameters analysed, including the maximum budesonide plasma concentration, time to concentration maximum, area under the concentration–time curve, mean residence time and urinary excretion of cortisol. Very few adverse events were reported during the trial, and the majority were of mild to moderate severity.

Conclusion: Omeprazole treatment does not affect the pharmacokinetics or systemic effects of budesonide controlled‐release capsules when the two medications are taken simultaneously.
Helicobacter pylori strains and histologically‐related lesions affect the outcome of triple eradication therapy: a study from southern Italy
Authors: Russo F. , Berloco P. , Cuomo R. , Caruso M. L. , Di Matteo G. , Giorgio P. , De Francesco V. , Di Leo A. , Ierardi E.
Published: March 2003

Background : Certain evidence suggests that Helicobacter pylori strains expressing genes for cytotoxin production show a higher sensitivity than non‐cytotoxic organisms to eradication treatment. No data are available on the involvement of bacterium‐related lesions in different therapeutic outcomes.

Aims : (i) To investigate whether differences in eradication rates may be related to the different expression of virulent strains (cagA, vacA, iceA) in patients undergoing proton pump inhibitor‐based triple therapy, and (ii) to evaluate whether therapeutic outcome may be affected by bacterium‐induced gastric lesions.

Methods : One hundred and ten H. pylori‐positive subjects were enrolled. H. pylori was genotyped by polymerase chain reaction. Treatment consisted of lansoprazole–amoxicillin–clarithromycin, twice daily for 1 week. Eradication was checked by urea breath test.

Results : The eradication rate was 70%, and the absence of cagA was associated with unsuccessful treatment. No difference between the groups with successful and unsuccessful eradication was found with regard to vacA and iceA. Lympho‐epithelial lesions and fibrosis were associated with unsuccessful treatment.

Conclusions : The present data confirm the importance of cagA (but not vacA and iceA) as a predictor of successful eradication. When fibrosis and lympho‐epithelial lesions are present, therapy appears to be less effective. Therefore, these histological features may be involved in an unsuccessful therapeutic outcome.
Lung fluid and impedance cardiography
Authors: Critchley L. A. H. , Critchley J. A. J. H.
Published: March 2003

Serial thermodilution and impedance cardiac output measurements in two critically ill patients are presented. Impedance cardiography failed to detect changes in cardiac output and provided values lower than those derived from thermodilution. Chest X‐ray examination and changes in thoracic impedance suggested that these two patients had significantly increased extravascular lung water. This failure of impedance cardiography is attributed to aberrant electrical conduction though the lungs as a result of increased lung fluid that alters the impedance waveform. Although reliable when used in normal subjects, impedance cardiography appears not to provide accurate measurements in critically ill patients.
Pre‐oxygenation using face mask or mouthpiece with and without nose clip: patient preferences and efficacy
Authors: Everatt J. , Ng W. S.
Published: March 2003

We assessed the effectiveness of mouthpieces for oxygenation before induction of anaesthesia. In part 1 of the study we asked 52 day case patients whether they would prefer mask, mouthpiece, or mouthpiece with nose clip, and which they would be willing to use. In part 2 we pre‐oxygenated 18 volunteers using each of the three methods in a crossover study. We measured time to 90% end tidal oxygen concentration (FE′O2), or maximum FE′O2 after 3 min if less than 90%. Of the patients surveyed, 20 (39%) preferred mask, 23 (44%) mouthpiece, one mouthpiece with nose clip and nine (17%) expressed no preference. Only 88% would be willing to use the face mask, but all would accept either the face mask or the mouthpiece with nose clip. In part 2 of the study, the mouthpiece alone proved significantly worse than the mask or mouthpiece with nose clip. The latter two did not differ significantly. Offering the alternative of mouthpiece with nose clip would increase patient acceptance of effective pre‐oxygenation.
The effects of volume and speed of injection in peribulbar anaesthesia
Authors: Gillart T. , Bazin J. E. , Montetagaud M. , Bevillard F. , Amara S. , Schoeffler P.
Published: March 2003

We have evaluated the effects of the volume and speed of administration of local anaesthetic during peribulbar anaesthesia. One hundred and forty patients scheduled for cataract surgery were randomly allocated to one of four groups of 35. Each patient received an injection of the same mixture of lignocaine, bupivacaine and hyaluronidase. Patients in group A were given 9 ml at a speed of 5 mlmin−1, group B were given the same volume at 12 mlmin−1, group C were given 13.5 ml at 5 mlmin−1 and group D were given 13.5 ml at 12 mlmin−1. A significantly higher incidence of satisfactory akinesia was found in group D, whose pain score at injection was no higher than for the other groups. Large volumes of local anaesthetic significantly affected intra‐ocular pressure. The incidences of early and late ptosis or diplopia were not affected by either the rate of injection or the volume of local anaesthetic.
Anaesthetic depth at inductionAn evaluation using clinical eye signs and EEG polysomnography
Authors: Power C. , Crowe C. , Higgins P. , Moriarty D. C.
Published: March 2003

We describe the stages of non‐REM sleep induced by anaesthesia with sevoflurane 8% in oxygen and relate these stages to clinical eye positions. We explored John Snow's observation (1847) that ‘when voluntary movement ceases, with the eyes fixed in an upward gaze during the gas induction of anaesthesia, the patient is protected against the risk of mental suffering’ (awareness). Unpremedicated ASA 1 patients undergoing elective tonsillectomy were studied using EEG polysomnographic principles and clinical eye movement tracking. The results expressed as median and range were: latency to stage 1 sleep 4.5 min [2.5–7.5], stage 2 sleep 5 min [3.5–8.5], stage 3 sleep 5.5 min [4–12] and stage 4 sleep 6 min [4.5–15.5]. Eye position 5, the point of no further eye movement, was reached after 9 min [5.5–18.5]. This was significantly longer than the time taken to reach the stage 4 sleep EEG, p < 0.01, supporting Snow's observation and encouraging investigation into eye movement tracking technology as a potential monitor of anaesthetic depth.
A comparison of the neuromuscular blocking effects and reversibility of cisatracurium and atracurium
Authors: Carroll M. T. , Mirakhur R. K. , Lowry D. , Glover P. , Kerr C. J.
Published: March 2003

The neuromuscular blocking effects and the reversibility of cisatracurium 0.1 or 0.15 mgkg−1 were compared with those of atracurium 0.5 mgkg−1 during anaesthesia with propofol, nitrous oxide and isoflurane. Neuromuscular block was monitored using train‐of‐four stimulation while recording the mechanomyographic response of the adductor pollicis muscle. The block was either allowed to recover spontaneously or was antagonised with neostigmine 50 μgkg−1 at 10% or 25% recovery of the first twitch of the train‐of‐four. The median times to maximum block were 2.7, 2.2 and 1.5 min following cisatracurium 0.1 and 0.15 mgkg−1 and atracurium 0.5 mgkg−1, respectively. After cisatracurium 0.1 mgkg−1 had been given, the median time to recovery of the train‐of‐four ratio to 0.8 (‘adequate recovery’) was 74 min during spontaneous recovery, 48 min after reversal with neostigmine when the first twitch of the train‐of‐four had returned to 10% of control and 50 min after reversal when the first twitch of the train‐of‐four had returned to 25% of control. These times for cisatracurium 0.15 mgkg−1 and atracurium 0.5 mgkg−1 were 90, 66 and 57 min and 75, 56 and 54 min, respectively. Administration of neostigmine significantly shortened the time to adequate recovery for both drugs but there were no significant differences in the case of either neuromuscular blocking drug between the groups of patients given neostigmine at 10 or 25% recovery of the first twitch of the train‐of‐four.
Nasal fibreoptic tracheal intubation in anaesthetised patients breathing via a modified laryngeal mask airway
Authors: Cook T. M. , Baylis R. J. H. , Marjot R.
Published: March 2003

A modified laryngeal mask airway was used to facilitate nasotracheal intubation with a fibreoptic laryngoscope. A size 4 laryngeal mask airway was modified by creating a defect at the base of the stem and removing the bars to allow passage of the fibreoptic laryngoscope from the nasopharynx to the larynx. The laryngeal mask airway cuff was split and the cut edges were sealed with silicone. This design allowed the cuff to function normally and allowed removal of the split laryngeal mask airway after the tracheal tube had been ‘railroaded’ into place. Thirty‐four patients were studied. The split laryngeal mask airway was easily inserted with satisfactory airway maintenance in 32 patients. Nasal airway endoscopy and laryngoscopy were successfully achieved with the split laryngeal mask airway in place in 31 of 32 patients. Railroading the tracheal tube over the fibreoptic laryngoscope with the split laryngeal mask airway in place was successful in all 31 of these patients. This prototype split laryngeal mask airway allows good airway maintenance while fibreoptic nasotracheal intubation is performed.
The intubating laryngeal maskResults of a multicentre trial with experience of 500 cases
Authors: Baskett P. J. F. , Parr M. J. A. , Nolan J. P.
Published: March 2003

A multicentre trial of the use of the intubating laryngeal mask was carried out at seven centres in the United Kingdom using the same agreed protocol. Lung ventilation followed by blind tracheal intubation through the intubating laryngeal mask was attempted on 500 ASA grade 1 and 2 patients. It was possible to insert the intubating laryngeal mask in all 500 cases. Ventilation via the intubating laryngeal mask was described as satisfactory in 475 (95%) cases, difficult in 20 (4%) cases and unsatisfactory in 5 (1%) cases. Blind tracheal intubation through the intubating laryngeal mask was possible in 481 (96.2%) cases within three attempts. Intubation was successful at the first attempt in 399 (79.8%) cases, at the second attempt in 62 (12.4%) cases and at the third attempt in 20 (4%) cases. The tracheas of 19 (3.8%) patients were not successfully intubated within the three attempts. Ventilation via the intubating laryngeal mask was described as unsatisfactory during two of these cases but oxygenation remained satisfactory in spite of this. Seventeen of the 19 failures occurred during the individual operator's first 20 attempts. The intubating laryngeal mask provides a successful method for blind tracheal intubation in a large proportion of cases and appears to be superior to the standard laryngeal mask airway for this purpose. The intubating laryngeal mask may be of use when tracheal intubation has failed using conventional methods.
Ambient oxygen concentrations during simulated cardiopulmonary resuscitation
Authors: Robertshaw H. , McAnulty G.
Published: March 2003

Oxygen concentrations were measured at 12 points around a cardiopulmonary resuscitation practice mannequin following simulated ventilation with a self‐inflating bag, a ‘Waters’ bag and a ventilator to determine whether increased oxygen concentrations may contribute to the risk of combustion from arcing defibrillator paddles. Ventilation was simulated using either a mask or via a tracheal tube fitted to the airway. The head of the mannequin rested upon a 10‐cm‐high pillow. Gas sampling took place after 5 min of ventilation with subsequent removal of the ventilatory device and placement on the pillow to the left of the mouth, with the tubing of the device removed to a point 1 m behind the mouth and with the device left connected to the tracheal tube. Gas was sampled after using all devices at oxygen flows of 10 lmin−1 and 15 lmin−1. Slightly increased oxygen concentrations were noted over the anterior chest after placement of all devices on the pillow at the higher flow. Concentrations of greater than 30% were measured in the left axilla after placement of all devices on the pillow at both flows. No increase in oxygen concentration was seen when the devices were either left connected to the tracheal tube or removed to a distance of 1 m. It would appear that leaving a patient connected to a ventilator poses no increase in risk of fire from ignition of combustible material in an oxygen‐enriched atmosphere during defibrillation. Disconnecting any device which continues to discharge oxygen and leaving it on the pillow before defibrillation is dangerous.
An in vitro evaluation of flow from multihole epidural catheters during continuous infusion with four different infusion pumps
Authors: McAtamney D. , O'hare C. , Fee J. P. H.
Published: March 2003

We have observed in vitro the distribution of flow from 10 identical multihole epidural catheters during continuous infusion with four different infusion pumps. The pumps chosen were the B Braun Perfusor Secura FT syringe driver and three volumetric infusion pumps utilising different pumping mechanisms (Dekra 3000 BL, Graseby 500 and CADD‐Prizm). These pumps infused 0.9% saline through each catheter at 5 ml.h−1, 15 ml.h−1, 50 ml.h−1 and 99 ml.h−1 for 3 min. The number of holes through which flow occurred and the catheter hole where flow predominated during each test were recorded. The pressure waveform generated during each infusion was displayed and the peak pressure recorded. In 38 of the 160 tests (24%) the largest proportion of flow was seen at the hole closest to the catheter tip. The CADD pump generated multihole flow during significantly more tests (p < 0.0001) than the other pumps and produced significantly higher driving pressures (p < 0.001) at all infusion rates compared with the Graseby and Perfusor pumps. The CADD was the only pump to produce flow from all three holes of the catheter at 5 ml.h−1.
Evaluation of self‐reported failures in cognitive function after cardiac and noncardiac surgery
Authors: Rödig  , Rak  , Kasprzak  , Hobbhahn
Published: March 2003

Long‐term cognitive deficits after cardiac surgical procedures involving cardiopulmonary bypass have been well documented. The occurrence of prolonged cognitive changes after noncardiac surgery has not, however, been clearly established. Using the Cognitive Failures Questionnaire, which permits self‐assessment of cognitive impairment, we studied 50 patients before and 2 months after coronary bypass surgery and major vascular surgical procedures. Pre‐operative test scores did not differ between groups. Postoperatively, 24 cardiac surgical patients and 22 vascular surgical patients completed the questionnaire. Both groups reported significantly more cognitive failures occurring after surgery than in the pre‐operative period. This suggests that there are factors other than the exposure to cardiopulmonary bypass during cardiac surgery that affect self‐assessed, long‐term postoperative cognitive sequelae.
A simple method to control tracheal cuff pressure in anaesthesia and in air evacuation
Authors: Yoneda I. , Watanabe K. , Hayashida S. , Kanno M. , Sato T.
Published: March 2003

The pressure within latex balloons remains constant despite the balloons being inflated to more than 40 times their initial volume. We used this property to enable improved tracheal cuff pressure control. A latex balloon with an initial volume of 5 ml was connected via a vinyl duct attached with a roller clamp and three‐way stopcock to a standard tracheal tube cuff. The 5 ml latex balloon was then inflated with 250 ml of air. The pressure within the tracheal tube cuff was monitored throughout anaesthesia with the inflated latex balloon acting as a pressure controller. Throat symptoms were recorded on the first four postoperative days. The controller kept the tracheal tube cuff pressures constant, and reduced the incidence of postoperative throat symptoms. Variations in cuff pressures with and without the controller were investigated in an altitude chamber to simulate flight. In the altitude chamber, cuff pressure reached over 200 cmH2O at 10 000 feet without the controller, whereas such variations were practically eliminated when the controller was used.
Spinal cord injury following an attempted thoracic epidural
Authors: Mayall M. F. , Calder I.
Published: March 2003

Unsuccessful attempts were made to insert a thoracic epidural in an anaesthetised patient. Signs of spinal cord damage were observed the following day. Magnetic resonance imaging demonstrated a haematoma anterior to the spinal cord. Surgical exploration revealed an intradural haematoma and a needle puncture of the cord. The patient suffered a permanent paraparesis.
Anaesthesia for Caesarean section in a patient with recent subarachnoid haemorrhage and severe pre‐eclampsia
Authors: Levy D. M. , Jaspan T.
Published: March 2003

Subarachnoid haemorrhage is a leading ‘indirect’ cause of maternal death in the UK. We describe the case of a 43‐year‐old woman who presented with headache, photophobia and neck stiffness of sudden onset at 32 weeks' gestation. Cerebral computed tomography demonstrated subarachnoid blood in the cisterns around the midbrain, and oral nimodipine was started to prevent vasospasm. Preparations were made for endovascular coil embolisation in the event of identification of a posterior circulation aneurysm. However, angiography under general anaesthesia failed to reveal any vascular abnormality. On emergence from anaesthesia, headache persisted, and over the next 24 h severe pre‐eclampsia developed. Magnesium sulphate was started, and urgent Caesarean section performed under general anaesthesia without incident. The rationale for the neuroradiological, obstetric and anaesthetic management is discussed.
The use of 0.25% isoflurane premixed in 50% nitrous oxide and oxygen for pain relief in labour
Authors: Ross J. A. S. , Tunstall M. E. , Campbell D. M. , Lemon J. S.
Published: March 2003

The addition of 0.25% isoflurane to 50% nitrous oxide in oxygen provides more effective pain relief in labour than 50% nitrous oxide alone. This study was carried out to determine whether self‐administration by demand valve of 0.25% isoflurane in 50% nitrous oxide in oxygen premixed in cylinders at 13.7 MPa (IN2O) was practical and safe during labour. Two hundred and twenty‐one mothers used IN2O in labour after 50% nitrous oxide had become inadequate for pain relief. Data on IN2O use was recorded during labour and details of the course of labour and opioid usage were taken from the clinical notes. The duration of IN2O use was 0.1–12.35 h (median 2.3). Thirty‐two mothers (14.5%) required an epidural and intolerance to IN2O was seen in a maximum of 17 cases (7.7%). One hundred and twenty‐six cases were primiparous and 93 parous with 151 deliveries being spontaneous and 70 interventional, of which 12 were by Caesarean section. Maternal blood loss was 20–1500 ml (median 200 ml). Apgar scores at 1 and 5 min were unaffected by IN2O use although a positive correlation was found between the use of opioids and the number of neonates with a 1‐min score below 8 and the number requiring resuscitation. Six neonates had an Apgar score below 8 at 5 min, but their condition was adequately explained by factors other than the sedative technique used. Self‐administered IN2O was found to be a safe and practical technique for sedation in labour when 50% nitrous oxide alone had become inadequate.
Anaphylaxis caused by neostigmine
Authors: Seed M. J. , Ewan P. W.
Published: March 2003

A patient developed anaphylaxis during anaesthesia, towards the end of surgery, 30 s after intravenous administration of neostigmine. Anaphylaxis to neostigmine was confirmed by demonstrating an elevated mast cell tryptase and a strongly/positive skin prick test, showing the presence of drug‐specific IgE (skin prick tests to neostigmine were negative in normal subjects). This is a rare cause of anaphylaxis during anaesthesia.
Prelude to pancuronium and vecuronium
Authors: McKenzie A. G.
Published: March 2003

The discovery of the neuromuscular blocking activity of malouetine isolated from Malouetia bequaertiana Woodson by Quevauviller and Lainé in 1960 stimulated interest in aminosteroids as potential neuromuscular blockers. Alauddin (a pharmacist) and Martin‐Smith (a medicinal chemist) began research in this area, which was then taken up by pharmaceutical companies. Pure pancuronium was synthesised in 1964 by Savage and his co‐workers, directed by Hewett. Pharmacologists headed by Buckett discovered that pancuronium was far more potent than d‐tubocurarine and had minimal side‐effects. Buckett quickly recognised the value of pancuronium, and his persistence resulted in successful clinical trials, followed by the commercial launch of pancuronium in 1968. Vecuronium was synthesised, tested and the studies published by Buckett, Hewett and Savage in 1973, but this was before anaesthetists called for a ‘clean muscle relaxant’ and, furthermore, it was unstable in aqueous solution. Hence, it was only promoted for clinical trials six years later.
The effect of a heat and moisture exchanger on gas flow in a Mapleson F breathing system during inhalational induction
Authors: Da Fonseca J. M. G. , Wheeler D. W. , Pook J. A. R.
Published: March 2003

Heat and moisture exchangers (HMEs) humidify, warm and filter inspired gas, protecting patients and apparatus during anaesthesia. Their incorporation into paediatric anaesthetic breathing systems is recommended. We experienced delays in inhalational induction whilst using a Mapleson F breathing system with an HME. We have demonstrated that the HME significantly alters gas flow within the breathing system. Approximately half of the fresh gas flow is delivered to the patient, the remainder being wasted into the expiratory limb of the breathing system. We suggest that the HME should be removed from the Mapleson F breathing system until inhalational induction is complete, or that the reservoir bag is completely occluded until an effective seal is obtained with the mask.
Effects of peribulbar bupivacaine as an adjunct to general anaesthesia on peri‐operative outcome following retinal detachment surgery
Authors: Shende D. , Sadhasivam S. , Madan R.
Published: March 2003

Sixty premedicated, ASA physical status I or II patients weighing > 25 kg scheduled for elective retinal detachment repair were randomly assigned to receive either peribulbar block with 10 ml of 0.25% bupivacaine (block group) or intravenous morphine 150 µg.kg−1 (morphine group), prior to the induction of general anaesthesia (n = 30 in each group). Patients were evaluated for intra‐operative oculocardiac reflex , peri‐operative pain relief, recovery from anaesthesia and postoperative nausea and vomiting. Apart from significantly reducing the incidence of oculocardiac reflex (30% vs. 70%, p = 0.0019), peribulbar bupivacaine also attenuated the severity of the reflex. Postoperative pain relief was superior in the block group. More block group patients had the maximum recovery score in the immediate postoperative period (80% vs. 27%, p < 0.0001) and they achieved complete recovery significantly faster than the morphine group (17.3 (14.7) min vs. 66.7 (29.7) min, p < 0.0001). The incidence (40% vs. 77%, p = 0.004) and severity of postoperative nausea and vomiting were significantly less in the block group. In summary, peribulbar bupivacaine, when administered together with general anaesthesia, attenuated oculocardiac reflex, provided comparable intra‐operative and superior postoperative analgesia, resulted in significantly earlier and better recovery from anaesthesia, and significantly reduced the incidence and severity of postoperative nausea and vomiting.
Drawbacks of pushovers
Authors: Bell G. T. , Ralph J. K.
Published: March 2003

Some military anaesthetists have started to use the Oxford Miniature Vaporiser in a pushover configuration with the Triservice anaesthetic apparatus. This vaporiser performs identically in the pushover and drawover configurations with the Cape TC 50 ventilator. We tested the Oxford Miniature Vaporiser with three other ventilators and found variable performance. When used in the pushover configuration with the Laerdal bag at normal minute volumes, the Oxford Miniature Vaporiser delivers a higher than set output.
Ultrasonography of the femoral vessels in the groin: implications for vascular access
Authors: Hughes P. , Scott C. , Bodenham A.
Published: March 2003

The femoral artery and vein are commonly used for access to the circulation. Accidental puncture of one vessel whilst attempting to cannulate the other is a common complication. Identification of relevant surface anatomical landmarks and ultrasonography of both groins was performed on 50 consecutive adult patients admitted to the intensive care unit. In most patients there was overlap of the artery over the vein far closer to the inguinal ligament than conventional anatomical texts would indicate. The frequency and degree of overlap increased as the vessels descended distally towards the knee. Surface anatomical landmarks were not useful in predicting the underlying anatomy. The side‐by‐side relationship of artery and vein is commonest close to the inguinal ligament. Therefore, to avoid damage to the neighbouring vessel, percutaneous access should be undertaken just below the inguinal ligament.
Organisational failures in urgent and emergency surgeryA potential peri‐operative risk factor
Authors: Pearse R. M. , Dana E. C. , Lanigan C. J. , Pook J. A. R.
Published: March 2003

Medical error is an important cause of morbidity and mortality. Organisational failure in the pre‐operative period has been associated with catastrophic outcome. Little information is available regarding peri‐operative organisational problems. The incidence and nature of organisational failure before urgent and emergency surgery in a district general hospital was studied prospectively in 159 cases over a 30‐day period. Organisational failure affected more than half of the cases overall, but varied in both its incidence and its complexity between surgical disciplines. Various causative factors were identified, e.g. 8% of cases were subject to delay due to clinical emergencies. The median [range] time required to rectify the problems was 115 [5−750] min. A consultant anaesthetist and surgeon were present in 30 and 20% of cases, respectively. Difficulty with the preparation of patients for emergency surgery is an important but underevaluated cause of medical error that may put patients at risk.
Effect of halothane on the cerebral circulation in young children: a hysteresis phenomenon
Authors: Paut O. , Bissonnette B.
Published: March 2003

To determine the effect of halothane on the cerebral blood flow velocity (CBFV) with increasing then decreasing concentrations, 11 children scheduled for minor surgery were studied. Anaesthesia consisted of halothane, vecuronium, nitrous oxide in oxygen and a caudal block. End‐tidal carbon dioxide, temperature, heart rate and systolic arterial pressure were maintained constant. CBFV increased significantly between 0.5 and 1.0 MAC (p <0.001), and 0.5 and 1.5 MAC of halothane (p <0.001), but was not different after increasing concentration from 1.0 to 1.5 MAC. During the decreasing phase, CBFV decreased significantly from 1.5 to 1.0 MAC of halothane (p <0.001), whereas there was no difference in CBFV when decreasing halothane MAC from 1.0 to 0.5 MAC. In children, the decrease in CBFV during decreasing halothane concentration is not superimposable to the increase in CBFV seen when increasing halothane concentration, suggesting the presence of cerebrovascular hysteresis to halothane.
Xenon expenditure and nitrogen accumulation in closed‐circuit anaesthesia
Authors: Reinelt H. , Marx T. , Schirmer U. , Schmidt M.
Published: March 2003

The high price of xenon has prevented its use in routine, clinic anaesthetic practice. Xenon therefore has to be delivered by closed‐circuit anaesthesia. The accumulation of nitrogen is a significant problem within the closed circuit and necessitates flushing, which in turn increases gas expenditure and costs. In previous investigations, nitrogen concentrations between 12% and 16% have been reported in closed‐circuit anaesthesia. In order to avoid such nitrogen accumulation, we denitrogenised seven pigs using a non‐rebreathing system and connected the animals to a system primed with a xenon/oxygen mixture. In comparison, seven pigs were anaesthetised with xenon using a standard low‐flow anaesthetic procedure. Anaesthesia time was 2 h. Nitrogen concentrations in the closed system ranged from 0.08 to 7.04% and were not significantly different from those observed during low‐flow anaesthesia. Closed‐circuit anaesthesia reduced the xenon expenditure 10‐fold compared with low‐flow anaesthesia.