bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaesthesia for day‐care arthroscopy
Authors: GUPTA A. , KULLANDER M. , EKBERG K. , LENNMARKEN C.
Published: February 2007

A study was undertaken to compare desflurane‐ and isoflurane‐based anaesthesia in patients undergoing day‐care arthroscopic surgery. Anaesthesia was induced with propofol 2–3 mg.kg‐1 and a laryngeal mask airway was inserted after loss of the eyelash reflex. Patients were then randomly divided into two groups to receive maintenance anaesthesia with either isoflurane or desflurane delivered in oxygen and nitrous oxide. Alfentanil was used as the analgesic during the operation. Early recovery was assessed by measurement of the times to eye opening, extubation and ability to give a date of birth. Psychomotor recovery was assessed by performance on the finger tapping and perceptive accuracy tests. Mood was evaluated using visual analogue mood scores and the mood adjective checklist. Discharge times were also measured. Early recovery was significantly quicker following desflurane anaesthesia but no differences between the groups were found in psychomotor tests. The mood adjective checklist showed that patients in the isoflurane group had a greater total mood score and were more calm than those in the desflurane group; this was particularly evident 2h after anaesthesia. The discharge times were similar for the two groups. Desflurane is a satisfactory alternative to isoflurane for day care anaesthesia.
Regional anaesthesia for repeat Caesarean section in a patient with phantom limb pain
Authors: Uncles D. R. , Glynn C. J. , Carrie L. E. S.
Published: February 2007

The triggering of phantom limb pain by subarachnoid or epidural anaesthesia has been well described leading to the suggestion that neuraxial regional anaesthesia is relatively contraindicated in lower limb amputees. We report our experience of the provision of anaesthesia for repeat Caesarean section on two occasions in such a patient. Intrathecal fentanyl and morphine supplementation of bupivacaine successfully abolished peri‐operative phantom limb pain, whereas epidural anaesthesia was associated with recurrence of phantom limb pain upon regression of the block
Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine
Authors: Greenhalgh C. A.
Published: February 2007

A 19‐year‐old obstetric patient had a respiratory arrest shortly after receiving intrathecal sufentanil and bupivacaine as part of a combined epidural/spinal technqiue for pain relief in labour.
The efficacy and optimum time of administration of ranitidine in the prevention of the acid aspiration syndrome
Authors: Escolano F. , Sierra P. , Ortiz J. C. , Cabrera J. C. , Castaño J.
Published: February 2007

In order to evaluate the efficacy of a single oral dose of ranitidine 150 mg and the optimum time for its administration, we studied pH and volume measurements in 138 surgical patients, who formed six groups according to the time elapsed from ranitidine administration to gastric fluid aspiration as follows: group A: no ranitidine, group B: 60–90 min, group C: 91–120 min, group D: 121–150min, group E: 151–180min and group F: > 180min. The patients from groups B, C, D, E and F had a significant increase in gastric pH and a significant decrease in gastric fluid volume when compared to the patients from group A. 33.3% (95% CI 16.63–53.22%) of patients in group A were deemed‘at risk’of acid aspiration compared to 0.9% (95% CI 0.02–4.90%) in the other groups. No significant differences were found between the patients receiving ranitidine after 60 min with respect to risk of acid aspiration. It is concluded that a single oral dose of ranitidine 150mg is effective against the acid aspiration syndrome 60min after administration.
The effect of alkalinisation of lignocaine on axillary brachial plexus anaesthesia
Authors: Gormley W. P. , Hill D. A. , Murray J. M. , Fee J. P. H.
Published: February 2007

Alkalinisation of local anaesthetic drugs is a controversial technique for improving regional blockade. Forty‐two patients scheduled for upper limb surgery received axillary brachial plexus anaesthesia using a cannula technique. Patients were randomly allocated to receive either lignocaine 1.5% with 1 in 200 000 adrenaline (pH = 4.2) or lignocaine 1.5% with I in 200000 adrenaline (pH = 7.2). There was no significant difference in the incidence of satisfactory blockade or distribution of anaesthesia between the two groups. The percentage of patients with complete anaesthesia at 10, 20 and 30 min following injection was significantly increased in the alkalinised group with regard to the ulnar and median nerves, and the median cutaneous nerve of the arm (p < 0.05). In the alkalinised group, there was a significant reduction in the time to useful anaesthesia and a reduced requirement for adjuvants (p < 0.05). There was no effect on the duration of anaesthesia.
The palpation of pulses
Authors: Mather C. , O'Kelly S.
Published: February 2007

In 554 anaesthetised patients, the times taken to separately palpate and identify each of the carotid, radial, brachial and femoral pulses were recorded. The patients were divided into three groups based on the form of airway management chosen (tracheal tube, facemask or laryngeal mask airway). Our results demonstrate that in the operating theatre environment the identification of the radial pulse is the most rapid and reliable; by 5s, 98% and by 10s, more than 99% of radial pulses were identified. The carotid pulse was not so easily identified, requiring 10s to enable an identification rate of greater than 95%. The presence of a laryngeal mask airway or a tracheal tube did not hinder the identification of carotid pulse.
Propofol infusion anaesthesia and the immune response in elderly patients undergoing ophthalmic surgery
Authors: PIRTTIKANGAS C‐O. , SALO M. , PELTOLA O.
Published: February 2007

In our earlier studies, propofol infusion anaesthesia increased the percentage of T helper cells in middle‐aged surgical patients undergoing minor or major surgery. In the present study we compared the effects of total intravenous propofol anaesthesia and combined isoflurane anaesthesia on the immune response to ophthalmic surgery in elderly patients. Twenty patients (median age 75 years, ASA 2–3) were randomly allocated to receive total intravenous propofol anaesthesia (median total dose of propofol 710 mg) or combined isoflurane anaesthesia (median end‐expiratory concentration of isoflurane 0.45 vol %). The following were measured pre‐operatively, at the end of operation and on the first postoperative morning: leucocyte and differential counts: percentages of lymphocyte subpopulations (CD3, CD4, CD8, CD20, CD16) and monocytes (CD14); phytohaemagglutinin‐, concanavalin A ‐ and pokeweed mitogen‐induced and unstimulated lymphocyte proliferative responses: polyclonal immunoglobulin synthesis as well as serum cortisol concentrations. The immune response to ophthalmic surgery was basically similar in both anaesthetic groups. The percentage of T helper cells in the blood circulation increased in the propofol group (p < 0.05) but not in the isoflurane group. The difference in the time‐response profile for T helper cell percentages between the groups was also statistically significant (p < 1.01).
The effect of passive smoking on the incidence of airway complications in children undergoing general anaesthesia
Authors: LYONS B. , FRIZELLE H. , KIRBY F. , CASEY W.
Published: February 2007

The aim of this study was to assess whether passive smoking affected the frequency of airway complications in children undergoing general anaesthesia. One hundred and twenty‐five children undergoing general anaesthesia for elective daycase surgery were monitored for adverse respiratory events and desaturation during induction, intra‐operatively and in the recovery room. Oxygen saturation was monitored throughout and a venous sample was taken for estimation of carboxyhaemoglobin levels. Parents were asked to fill in a questionnaire detailing their smoking habits. Sixty‐three of the children were passive smokers with a potential daily exposure varying from 5–130 cigarettes. There was no difference in the frequency of respiratory events between passive smokers and those not exposed to cigarette smoke at induction or intra‐operatively. However, in the recovery room, desaturation was significantly more common in passive smokers (p<0.02). This was related to the cumulative number of cigarettes smoked by individuals to whom the child was exposed (p<0.05). Neither carboxyhaemoglobin levels nor domiciliary address were predictive of desaturation. This study suggests that passive smoking contributes to postoperative arterial oxygen desaturation following general anaesthesia in children.
Patient satisfaction with general anaesthesia
Authors: WHITTY P. M. , SHAW I. H. , GOODWIN D. R.
Published: February 2007

A questionnaire to evaluate patient satisfaction following general anaesthesia was designed with the aid of focus groups. A subsequent audit identified aspects of care which could be improved on the basis of responses to the satisfaction questionnaire. It is possible to design a discriminating satisfaction questionnaire for general anaesthesia.
A comparison of retrospective versus contemporaneous nausea scores with patient‐controlled analgesia
Authors: McINDOE A. K. , WARWICK P. , O'CONNOR M.
Published: February 2007

In the search for an effective method of reducing the incidence of postoperative nausea, a standardised system of patient assessment is required. We examined 76 patients who had undergone elective total abdominal hysterectomy and were receiving patient‐controlled analgesia with morphine. Nausea scores were obtained using an 11‐point rating score. Repeated contemporaneous assessments were compared with a single retrospective score made 5 days after surgery. Retrospective nausea scores were higher than those recorded contemporaneously. Maximum contemporaneous score showed greater agreement with the retrospective score than did the median, mean, or minimum contemporaneous score. Collectively, these results suggest that patients tend to remember their episodes of nausea vividly, even if these episodes were punctuated by relatively nausea‐free periods. The variability between the two sets of results suggests that contemporaneous and retrospective nausea scores should not be used interchangeably.
Pathological changes associated with short‐term nasal intubation
Authors: O'CONNELL J. E. , STEVENSON D. S. , STOKES M. A.
Published: February 2007

In order to define the incidence and anatomical site of nasal damage following nasotracheal intubation, we investigated 100 consecutive patients undergoing dental extractions under general anaesthesia. Patients were questioned pre‐operatively about the physiological function of their noses and examined by anterior rhinoscopy for anatomical abnormalities. Examinations were repeated postoperatively, looking specifically for haemorrhage, mucosal tears and septal and turbinate disruption. Minor bruising was common (54%) and most frequently involved mucosa overlying the inferior turbinate and adjacent septum. In two cases bruising involved the middle turbinate. There was no relationship between the number of attempts at intubation and subsequent damage. Pre‐operative otolaryngological assessment failed to identify those patients who subsequently proved difficult or impossible to intubate nasally and incorrectly predicted difficulty in 11 patients who had pre‐existing deviation of the nasal septum. In conclusion, short‐term nasotracheal intubation was not associated with significant nasal morbidity, and pre‐operative anatomical assessment failed to identify those in whom nasal intubation proved difficult or impossible.
Postoperative cognitive impairment in the elderly
Authors: HERRICK I. A. , GANAPATHY S. , KOMAR W. , KIRKBY J. , MOOTE C. A. , DOBKOWSKI W. , ELIASZIW M.
Published: February 2007

This study evaluated the safety and cognitive impact of patient‐controlled analgesia with fentanyl compared to patient‐controlled analgesia with morphine among elderly postoperative patients. In addition, two screening tests for cognitive impairment, the Mini Mental Status Exam and the Short Portable Mental Status Questionnaire, were compared. Ninety‐six elderly patients were randomly allocated to receive patient‐controlled analgesia with either fentanyl or morphine following hip or knee arthroplasty. Patients were evaluated postoperatively for clinical confusion, cognitive function test results, adequacy of analgesia, drug use and complications. Fentanyl produced less depression in postoperative cognitive function compared to morphine. The incidence of clinical confusion was not statistically different between groups (4.3% for fentanyl versus 14.3% for morphine). Fentanyl patients used more opioid based on a dose ratio of 100:1 suggesting that this dose ratio is inadequate. The incidence of urinary retention was lower in the fentanyl group. A poor agreement between the two tests of cognitive impairment mandates caution when peri‐operative cognitive function is compared using different tests.
Tracheal intubation through the laryngeal mask using a gum elastic bougie in the presence of cricoid pressure and manual in line stabilisation of the neck
Authors: Gabbott D. A. , Sasada M. P.
Published: February 2007

Forty adult patients hud a gum elastic bougie passed blindly through a laryngeal mask on two occasions, after standard insertion, and after the application of cricoid pressure with manual in line stabilisation of the neck. After standard insertion the bougie entered the trachea on 11/40 occasions. With manual in line stabilisation of the neck and cricoid pressure applied, the bougie entered the trachea on 9/40 occasions. These results were not statistically significant. Blind passage of a gum elastic bougie through a laryngeal mask does not provide a reliable route into the trachea in either of the circumstances studied.
What changes drug metabolism in critically ill patients‐III? Effect of pre‐existing disease on the metabolism of midazolam
Authors: PARK G. R. , MILLER E.
Published: February 2007

Liver samples were obtained at hepatectomy from patients with end stage alcoholic liver disease (n = 5), primary biliary cirrhosis (n = 5) and chronic rejection needing retransplantation (n = 5). Normal liver material was also obtained from five organ donors. From these samples microsomes were made containing cytochrome P450 3A. The amount of this enzyme was measured by Western immunoblotting and its function assessed by measuring the rate of production of two metabolites of midazolam, 1‐hydroxy midazolam and 4‐hydroxy midazolam. There was a wide range in all groups for both the expression and function of this enzyme. Liver tissue affected by cirrhotic disease showed greater preservation of enzyme function than that affected by hepatocellulur disease. There was a good correlation between the expression of the enzyme and production of the 1‐hydroxy metabolite, but a poor correlation between production of the 4‐hydroxy metabolite and expression. This poor correlation may reflect the failure to measure the specific enzyme responsible for producing 4‐hydroxy midazolam.
Gas kinetics during nitrous oxide analgesia for labour
Authors: EINARSSON S. , STENQVIST O. , BENGTSSON A. , NORÉN H. , BENGTSON J. P.
Published: February 2007

Hypoxaemia may occur after hyperventilation with nitrous oxide during labour. The purpose of this study was to assess whether diffusion hypoxia is a contributory factor. Twenty‐four parturients were randomly allocated to receive 50 or 70% nitrous oxide in oxygen. The median nitrous oxide inhalation time per contraction was 58 s and 33 s, respectively. The end‐tidal carbon dioxide and the minute ventilation remained unchanged. The end‐tidal oxygen concentration was lowest at 120s, reaching 15.4% in both groups. The oxygen saturation did not differ between the groups with a lowest median value of 96% before the start of nitrous oxide inhalation. Two parturients had episodes ofdesaturation. Both had low end‐tidal oxygen concentrations in association with the desaturation but, as the end‐tidal nitrous oxide concentrations were low, the desaturations could not be attributed to diffusion hypoxia.
Effect of bupivacaine‐induced spinal block on the hypnotic requirement of propofol
Authors: TVERSKOY M. , FLEYSHMAN G. , BACHRAK L. , BEN‐SHLOMO I.
Published: February 2007

The hypnotic dose‐response of propofol was compared with its combination with either bupivacaine‐induced spinal block or intramuscular bupivacaine 12.5mg in 105 men, divided into three groups of 35, undergoing lower abdominal, pelvic or lower limb surgery. Dose‐response curves were determined for each group using bootstrap analysis. Bupivacaine‐induced spinal block at the level of T8‐T9 was found to reduce the ED50, of propofol by 39%. While this enhancement of hypnotic effect by spinal block is mostly attributable to reduced afferent input, differences in its potency between drugs suggest a role for additional factors.
Systemic piroxicam as an adjunct to patient‐controlled analgesia with alfentanil for postoperative pain relief
Authors: VAN LANCKER P. , DEVULDER J. , ROLLY G.
Published: February 2007

In a double‐blind, placebo‐controlled study, the non‐steroidal anti‐inflammatory drug, piroxicam, in combination with alfentanil given in a patient‐controlled analgesia system, was compared with alfentanil alone given by the same route for analgesic effect, side effects and acute phase reaction over a 4‐day period following anterior cruciate ligament reconstruction of the knee. The patients receiving piroxicam had lower pain scores and consumed less alfentanil. There were no differences with regard to side effects between the two treatment groups, apart from significantly more sedation at 08.00 h on the first postoperative day in the non‐piroxicam group. Piroxicam did not influence either the levels of interleukin‐6 or the acute phase response to surgery.
Upper airway obstruction caused by acquired inhibitor to factor VIII
Authors: Joynt G. M. , Wickham N. W. R. , Young R. J. , Gomersall C. D.
Published: February 2007

Bleeding caused by inhibitors to factor VIII is a rare medical emergency requiring immediate specialist investigation and management. Urgent initiation of therapy with high dose factor VIII concentrates may be life saving. Successful management of acute upper airway obstruction from uncontrolled haemorrhage into the oropharyngeal tissues should be achieved with fibreoptic guided nasotracheal intubation.
The prognostic value of serial measurements of serum albumin concentration in patients admitted to an intensive care unit
Authors: McCLUSKEY A. , THOMAS A. N. , BOWLES B. J. M. , KISHEN R.
Published: February 2007

The prognostic value of serial measurements of serum albumin concentration during the first 72 h after admission to a general adult intensive care unit was retrospectively reviewed in 348 consecutive critically ill patients over a one year period. The accuracy of the admission APACHE II (Acute Physiology And Chronic Health Evaluation) score in correctly predicting patient outcome was compared with the serum albumin concentration measured at different times after intensive care unit admission. Multiple logistical regression analyses were performed to evaluate whether combining APACHE II and serum albumin into a unified risk index improved prognostic accuracy. Serum albumin concentration on admission was lower in non‐survivors than in survivors and decreased more rapidly in non‐survivors (p < 0.001). The admission serum albumin concentration was found to be an insensitive prognostic indicator. However, serum albumin measured after 24 h was as accurate as the admission APACHE II score in correctly classifying patients according to outcome. There was a good correlation between the admission APACHE II score and serum albumin measured after 24 h but not between the admission APACHE II and the admission serum albumin. Combining the APACHE II score and serial albumin concentrations into a unified risk of death equation did not improve the accuracy of outcome prediction.
Difficult intubation: thyromental distance and the atlanto‐occipital gap
Authors: FRERK C. M. , TILL C. B. W. , BRADLEY A. J.
Published: February 2007

Ten patients with a history of difficult intubation and 10 control patients were examined clinically and radiologically. It was shown that thyromental distance can be measured reliably clinically and further support is given to its usefulness as a predictor of difficult intubation. We were unable to demonstrate a conclusive link between thyromental distance and atlanto‐occipital or atlanto‐axial gaps. A review of X rays in other collections may add to the understanding of these factors in difficult intubation.
Effects of carbon dioxide insufflation for laparoscopic cholecystectomy on the respiratory system
Authors: PELOSI P. , FOTI G. , CEREDA M. , VICARDI P. , GATTINONI L.
Published: February 2007

The changes occurring in total respiratory system, lung and chest wall mechanics, lung volume and gas‐exchange during abdominal insufflation with carbon dioxide for laparoscopic cholecystectomy were studied. Using the technique of rapid airway occlusion during constant flow inflation together with an oesophageal balloon, we computed compliance and maximum resistance of the respiratory system, subsequently apportioning it into its lung and chest wall components. Maximum resistance of the respiratory system was further divided into airway resistance and the viscoelastic properties of the lung and the chest wall. In 10 patients (group 1), we measured respiratory system, lung and chest wall mechanics (compliance and resistance), functional residual capacity, end‐tidal carbon dioxide tension and oxygen saturation. In addition, arterial blood gas analysis and end‐tidal carbon dioxide tension were measured in a second group of 10 patients (group 2). Measurements, in both groups, were obtained in the reverse Trendelenburg position, at 15 min after the induction of anaesthesia, 5 min and 45 min after abdominal insufflation and at 15 min after abdominal deflation. Tidal volume, respiratory rate, inspiratory flow and the fraction of inspired oxygen were similar in both groups and maintained constant during the procedure. We found that abdominal carbon dioxide insufflation caused: a reduction in compliance of the respiratory system (both lung and chest wall components) and of functional residual capacity; a marked increase in the maximum resistance of the respiratory system (mainly due to increases in the viscoelastic properties of the lung and chest wall); no change in oxygenation, but an increase in the end‐tidal carbon dioxide tension (which was correlated closely with the arterial carbon dioxide tension). These changes were not affected by the duration of anaesthesia.
The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol
Authors: Wrench I. J. , Ward J. E. H. , Walder A. D. , Hobbs G. J.
Published: February 2007

We have studied the effect of combination antiemetic therapy (ondansetron and droperidol) with morphine delivered by patient‐controlled analgesia following major gynaecological surgery. Sixty patients were randomly allocated to one of three treatment regimens; ondansetron alone (4 mg bolus and 0.13 mg.ml‐1 in the morphine solution), droperidol alone (1.25 mg bolus and 0.05 mg.ml‐1 in the morphine solution), or both drugs in combination. For the first 12 postoperative hours, patients receiving combination therapy experienced significantly less nausea than those receiving single antiemetic therapy (p < 0.001). There was no difference between the regimens from 12 to 18 h. We conclude that a combination of ondansetron and droperidol added to morphine in a patient‐controlled analgesia system reduces postoperative nausea to a greater extent than treatment with either drug alone following major gynaecological surgery.
Effect of injection pressure on the success rate of peribulbar block
Authors: Gillart T. , Bazin J. E. , Deret C. , Aigouy L. , Schoeffler P. , Raynaud C.
Published: February 2007

The aim of this prospective double‐blind study was to evaluate the effect of the pressure on injection of local anaesthetic during peribulbar anaesthesia. Fifty patients scheduled for cataract surgery under peribulbar anaesthesia, with a two injection site technique, were randomly assigned to receive a mixture of 5ml of etidocaine 1%, 4ml of bupivacaine 0.5% and hyaluronidase SOW, injected under a constant pressure of either 140g.cm‐2 (group 1) or 250g.cm‐2 (group 2). After orbital compression, the degree of akinesia of the extra‐ocular and orbicular muscles was graded by clinical assessment. A significantly higher rate of satisfactory akinesia of the extra‐ocular muscles was found in group 2 (72% vs 28% in group 1) (p < 0.01). No significant relationship was found between the time taken to administer the anaesthetic mixture at constant pressure and the quality of the block.
Patients' experiences of patient‐controlled analgesia
Authors: TAYLOR N. M. , HALL G. M. , SALMON P.
Published: February 2007

We examined patients' experiences of patient‐controlled analgesia by the use of semistructured interviews in 26 patients shortly after discontinuation of the device. The opinions expressed by the patients were examined qualitatively to identify recurring themes in their experience of patient‐controlled analgesia. The areas of interest were analgesia, factors influencing whether the patient pressed the button or not, whether they felt in control and side effects. Negative as well as the expected positive evaluations were found. The negative evaluations reflected problems with nausea and vomiting and inadequate analgesia. No clear strategy for pressing, or not pressing, the button emerged and the principle of control by the patient over their pain relief was not considered important.

‘The uncritical acceptance of expert‐driven questionnaires into clinical trial protocols will only diminish the importance of the patient's perspective.’
A comparison of the induction characteristics of sevoflurane and halothane in children
Authors: BLACK A. , SURY M. R. J. , HEMINGTON L. , HOWARD R. , MACKERSIE A. , HATCH D. J.
Published: February 2007

The induction characteristics of sevoflurane and halothane were compared in 81 children aged 6 months to 6 years. The mean time taken to achieve loss of eyelash reflex was significantly shorter with sevoflurane than with halothane (sevoflurane, mean time (SD) 1 min 41 s (35 s), halothane, mean time (SD) 2 min 17 s (43 s), t = 4.11, p = <0.01). The mean time taken to complete induction (to achieve steady spontaneous ventilation and small pupils with central gaze) was also shorter in children induced with sevoflurane (sevoflurane, mean time (SD) 3 min 58 s (1 min 8 s), halothane, mean time (SD) 4 min 50 s, (1 min 27s), t = 2.29, p = 0.027). Effects on heart rate, blood pressure and oxygen saturation during induction were similar for both agents. There were no major complications during induction with either halothane or sevoflurane.
A comparison of the effects of isoflurane and desflurane on the neuromuscular effects of mivacurium
Authors: KUMAR N. , MIRAKHUR R. K. , SYMINGTON M. J. , LOAN P. B. , CONNOLLY F. M.
Published: February 2007

The effects of 1 MAC of desflurane and isoflurane (in 66% nitrous oxide) on the potency and duration of action of mivacurium were studied in 80 patients. The ED95 of mivacurium was 86 μg.kg‐1 (74–100) and 88μg.kg‐1 (76–103) (mean and 95% confidence intervals) during anaesthesia with desflurane and isoflurane respectively. The onset and duration of recovery to 25, 75 and 90% of T1 (first response in the TOF) of 200 μg.kg‐1 of mivacurium were 1.4 (0.3) and 1.5 (0.3) min (mean and SD), 22 (4.9) and 19 (4.0), 29 (6.6) and 26 (5.8), and 32 (7.3) and 29 (6.6) min respectively. There was no significant difference in any of the variables between desflurane and isoflurane. It is concluded that the neuromuscular effects of mivacurium are similar during anaesthesia with 1 MAC of desflurane and isoflurane.
Creatinine and urea clearance during continuous veno‐venous haemofiltration in critically ill patients
Authors: BROCKLEHURST I. C. , THOMAS A. N. , KISHEN R. , GUY J. M.
Published: February 2007

Urea and creatinine clearances achieved using continuous veno‐venous haemofiltration were calculated in 16 critically ill patients, during 50 episodes of filtration. The effects of filter life and the volume of ultrafiltrate on these clearances were also evaluated. Clearances were calculated from urea and creatinine concentrations in blood and ultrafiltrate and the volume of ultrafiltrate produced. The overall mean (SD) urea clearance was 26.6 (6.0) ml.min‐1 and the overall creatinine clearance was 30.1 (6.3) ml.min‐1. The mean (SD) ultrafiltrate production was 29.6 (5.9)ml.min‐1. Creatinine clearance was significantly lower in, filters that failed within 24 h (filters < 24h 27.5 (6.3) ml. min 1, filters > 24 h 32.2 (5.5) ml.min‐1). The clerance of both solutes increased with increasing ulfrafiltrate volume (p < 0.001). We conclude that satisfactory clearance of urea and creatinine can be achieved using continuous two‐venous haemofiltration. Increases in ultrafiltrate production lead to similar increases in urea and creatinine clearance. Prolongation of filter life may improve creatinine clearance.
The practice of anaesthesia—a stressor for the middle‐aged?
Authors: SEELEY H. F.
Published: February 2007

Surveys conducted in the United Kingdom over the last few years have revealed decreased job satisfaction and increased anxiety and depression in both hospital specialists and general practitioners. Anaesthesia is perceived to be a stressful specialty and there is evidence, albeit patchy, that certain stress‐associated conditions are more common in anaesthetists. The ‘middle years’, seem to be a danger period. The analogy between the work of anaesthetists and airline pilots is often drawn and the principles underlying the assessment and maintenance of pilot competence could be adopted in anaesthesia. While outcome studies are numerous much less attention has been paid to the structure and process of anaesthtic practice. Models for studying these aspects have been developed for investigating stress in general practitioners and doctors in training. Even minor degrees of professional impairment may place patients at risk and an investigation into the effects of the specialty on those who practise it is justified.
The effect of pre‐incisional infiltration with lignocaine on postoperative pain after molar teeth extraction under general anaesthesia
Authors: Tordoff S. G. , Brossy M. , Rowbotham D. J. , James J. N. , James R. , Raphael J. H.
Published: February 2007

In a double‐blind, placebo‐controlled investigation, we studied the effects of pre‐operative inferior alveolar nerve blockade and local anaesthetic intra‐oral infiltration upon postoperative pain following third molar teeth extraction under general anaesthesia. Thirty six patients (12 male), mean (range) age 25.7 (18–40) years received an injection of 2% lignocaine 2 ml with 1:200 000 adrenaline around the inferior alveolar nerve and tissues adjacent to the third molar tooth on one side and of normal saline 2 ml in a similar fashion to the other side. We measured the pain on each side of the mandible on the 1st, 4th and 11th days after surgery using a visual analogue scale. The visual analogue pain score on the lignocaine and saline sides were 25/100 and 26/100 on day 1, 23/100 and 22/100 on day 4 and 0/100 and 1/100 on day 11. This study has a power of 80% to detect differences at the 5% level of significance of 11/100 on days 1 and 4 and 7/100 on day 11. We found no significant difference in the visual analogue scores between the lignocaine side and the saline side at any stage after the procedure.
Postoperative pain in children
Authors: Goddard J. M. , Pickup S. E.
Published: February 2007

An audit project was designed to assess and improve the provision of postoperative analgesia in a children's hospital. Pain assessment for all children and analgesia standards for our institution were introduced prior to data collection. Data were collected on consecutive samples of 316 and 325 children undergoing surgery as inpatients during 10‐week periods. Change was initiated between the two periods in response to our findings; our action plan involved education, changes to documentation, the widespread use of diclofenac in children over 2 years of age and recommendations far the prescription of analgesia. The initial prescription of analgesia increased from 95% to 98% (p = 0.019), administration of analgesia to children experiencing bad or severe pain increased from 57% to 71% (p = 0.032) and the number of children experiencing severe pain reduced from 17% to 11% (p = 0,050). Application of audit, by a clinical nurse specialist, enabled us to achieve and demonstrate improvements in the prescription, administration and effectiveness of postoperative analgesia.
The effect of four different surgical prone positions on cardiovascular parameters in healthy volunteers
Authors: WADSWORTH R. , ANDERTON J. M. , VOHRA A.
Published: February 2007

Twenty healthy volunteers were placed in four different surgical prone positions: on pillows, on an evacuatable mattress, on pelvic props and in the knee—chest position. The normal supine position was used as a control for the measurement of cardiovascular parameters. Mean arterial pressure was measured by automated oscillotonometry. Transthoracic electrical bioimpedance was used to measure cardiac output and heart rate. Cardiac index and total vascular resistance index were derived from these data. No significant changes in heart rate or mean arterial pressure occurred when the volunteers were moved from the supine position to any of the four prone positions or when returned to the supine position again. Cardiac index decreased significantly on going from the supine to the knee—chest position (20%) and onto the props (17%) but not onto the evacuatable mattress (11%) or the pillows (3%).
Changes in tracheal tube position during laparoscopic cholecystectomy
Authors: INADA T. , UESUGI F. , KAWACHI S. , TAKUBO K.
Published: February 2007

The distance from the carina to the tip of the tracheal tube was measured with a fibreoptic bronchoscope in 21 consecutive patients undergoing elective laparoscopic cholecystectomy. After placement of an Eschmann tracheal tube with a printed intubation guide mark at the vocal cords, the distance was 28 (15) [5–54]mm (mean (SD) [range]). The tube was then repositioned so that the distance was 34 (3) [30–40]mm from tip of the tube to the carina. After creation of pneumoperitoneum, the distance was significantly decreased to 26 (5) [17–35] mm (p < 0.005), which was not significantly altered by subsequent moving of the patient to the reverse Trendelenburg and left lateral tilt position. The maximum distance of tube migration was 8 (4) [0–15]mm. Four out of 21 patients would have been at risk of bronchial intubation after pneumoperitoneum if the tube had not been repositioned. Placement of the tube according to the guide mark is not recommended for laparoscopic cholecystectomy.
The effect on the heart of hypoxaemia in patients with severe coronary artery disease
Authors: SMITH H. L. , SAPSFORD D. J. , DELANEY M. E. , JONES J. G.
Published: February 2007

The aim of the study was to examine the effect of spontaneous nocturnal hypoxaemia on myocardial ischaemia in patients with severe coronary artery disease. This was a prospective study of continuously measured oxygen saturation and ECG overnight in patients prior to coronary artery bypass graft surgery. Fifteen patients with angiographically proved coronary artery disease were studied between October 1992 and September 1993. All patients had episodes of hypoxaemia with oxygen saturation < 94% and eight of the 15 patients had episodes where oxygen saturation < 85%. An episode was defined as a period of hypoxaemia not less than 2.5min in duration, the longest total duration of hypoxaemia in one patient being 355 min. Twelve of the 15 patients showed a drop in ST segment of 1 mm or more lasting from 5–700 min. The hypoxaemic and ischaemic episodes apparently occurred at random. No causal relationship could be shown between hypoxaemia and ischaemia.
Anaesthesia and the QT interval in humans
Authors: MICHALOUDIS D. , FRAIDAKIS O. , LEFAKI T. , DEDE I. , KANAKOUDES F. , ASKITOPOULOU H. , POLLARD B. J.
Published: February 2007

Prolongation of the QT interval may cause potentially hazardous arrhythmias. The effects on the QT interval (QTc, corrected for heart rate) of isoflurane and halothane followed by vecuronium have been investigated during induction of anaesthesia in 51 patients. All patients were ASA 1 or 2, without cardiovascular problems or electrolyte abnormalities and were not receiving medication. Midazolam 0.08mg.kg‐1 was administered intramuscularly for premedication. Anaesthesia was induced with either isoflurane (n = 26) or halothane (n = 25), and the inspired concentration increased to reach an end‐tidal concentration of 2.5% to 3%. Recordings of ECG, heart rate, systolic and diastolic arterial pressure were obtained at the following times: prior to induction of anaesthesia; 1 min and 3 min after a stable end‐tidal concentration had been reached; 1 min and 3 min following vecuronium administration, at the time of tracheal intubation and 1 min and 3 min later. Halothane significantly shortened QTc (p < 0.05 to p < 0.001), in contrast to isoflurane which prolonged it (p < 0.01). The heart rate decreased (p < 0.01 to p< 0.001) after induction of anaesthesia with halothane and returned to pre‐induction values after tracheal intubation. In contrast, heart rate increased after induction with isoflurane and increased further after laryngoscopy and tracheal intubation (p < 0.001). In the isoflurane group, ST depression was noticed in seven patients and nodal rhythm in two, while in the halothane group seven patients developed nodal rhythm and, in two patients, ventricular ectopics were recorded. There were no sequelae. In both groups, systolic and diastolic arterial pressure decreased after induction of anaesthesia (p < 0.01 to p < 0.001), increasing again after intubation.
Tropisetron and metoclopramide in the prevention of postoperative nausea and vomiting
Authors: ALI‐MELKKILÄ T. , KANTO J. , KATEVUO R.
Published: February 2007

One hundred and twenty patients undergoing elective ophthalmic surgery under general anaesthesia were investigated in a randomised, double‐blind, parallel group study of postoperative nausea and vomiting. Patients received tropisetron 0.1 mg.kg–1, metoclopramide 0.25mg.kg–1 or placebo given at the end of anaesthesia. In comparison with placebo, tropisetron significantly reduced the degree of nausea (p< 0.01), whereas metoclopramide reduced both nausea (p < 0.05) and vomiting (p < 0.05). There were no statistically significant differences between the two active agents in their efficacy to postoperative nausea and vomiting. The patients in the placebo group required rescue antiemesis more often in the postanaesthesia care unit. Our results suggest that tropisetron may not be suitable as a routine, primary therapy for the prevention of postoperative nausea and vomiting.
Measuring rebreathing in spontaneous ventilation A new lung model
Authors: COOK L. B. , WATT S. , PEACHEY G. , CHAKRABARTI M. K.
Published: February 2007

The performance of breathing systems is tested by means of physical lung models. We describe a new lung model, allowing direct measurement of the dead space/tidal volume ratios produced by any breathing system at different fresh gas flows. The model allows a range of different patterns of spontaneous respiration to be studied. Although rebreathing is measured by capnography, the design ensures that the results are unaffected by changes in carbon dioxide inflow, or even calibration drift in the capnograph.
Circle systems with a coaxial inspiratory limb
Authors: COOK L. B. , CHAKRABARTI M. K.
Published: February 2007

A laboratory study of a new circle system is presented. The inspiratory limb encloses a coaxial tube, delivering fresh gas close to the patient, immediately upstream of the inspiratory one‐way valve. The system is more efficient than the non‐coaxial system and allows the expiratory valve to be situated conveniently at the canister end of the expiratory limb. A disadvantage of low flow anaesthesia is the sluggish response of the system to changes in vapour or oxygen concentrations in the fresh gas flow. This is markedly improved by the new system. The advantages of the system are largely independent of respiratory pattern.
Delayed paraplegia following spinal anaesthesia
Authors: Pryle B. J. , Carter J. A. , Cadoux‐Hudson T.
Published: February 2007

We report an extremely rare complication of regional anaesthesia, a spinal subdural haematoma, which resulted in permanent neurological damage occurring 8 days after dural puncture at T12–L1. Although spinal subdural haematoma following spinal anaesthesia and lumbar puncture has been described before, this is the first report of this complication occurring after dural puncture using a 25G atraumatic pencil point (Whitacre) needle. Contributory factors might have been the perioperative intermittent low dose aspirin therapy and the fact that spinal anaesthesia was performed at the T12‐L1 level.
Sociology as Public Discourse and Professional Practice: A Critique of Michael Burawoy
Authors: Holmwood John
Published: February 2007

In this article I discuss Burawoy's (2005) argument for public sociology in the context of the sociologist as both citizen and as social scientist; that is, as simultaneously a member of any ‘society’ being researched and as researcher claiming validity for the knowledge produced by research. I shall suggest that the relation between citizenship and social science necessarily places a limit on sociological claims to knowledge in terms both of what can be claimed and of the legitimacy of any claims, but that this need not be damaging to sociology as an expert practice producing distinctive and significant forms of knowledge about the social world. Burawoy's claims on behalf of public sociology take their force from the idea of the sociologist as citizen, but they go beyond this limit in a way that would not only undermine the legitimacy of sociology as professional practice, but also, I shall argue, that of public sociology itself. Ultimately, Burawoy argues for a partisan profession that actively promotes human values that he believes to be embodied in the sociological standpoint. In contrast, I shall argue that political neutrality is central to the corporate organization of sociology, not because social inquiry can, or should be, value-neutral, but because corporate political neutrality creates the space for dialogue and is the condition for any sociology to have a voice.
Against Narrative: A Preface to Lyrical Sociology
Authors: Abbott Andrew
Published: February 2007

This article develops a concept of lyrical sociology, a sociology I oppose to narrative sociology, by which I mean standard quantitative inquiry with its “narratives” of variables as well as those parts of qualitative sociology that take a narrative and explanatory approach to social life. Lyrical sociology is characterized by an engaged, nonironic stance toward its object of analysis, by specific location of both its subject and its object in social space, and by a momentaneous conception of social time. Lyrical sociology typically uses strong figuration and personification, and aims to communicate its author's emotional stance toward his or her object of study, rather than to “explain” that object. The analysis considers many examples and draws on literary criticism, the philosophy of time, and the theory of emotion. It also addresses contemporary debates in ethnography.
TEACHING FUNCTIONAL ENGLISH
Authors: COOK VIVIAN J.
Published: February 2007

Writers of textbooks published since the beginning of 1978 are invited to submit 1000 word articles discussing the principles underlying their work and accompanied by two pages from the book in question. The articles should be problem‐based, not advertisements, and the extracts should be in a form suitable for reproduction without redrawing. Writers will be responsible for obtaining all necessary permissions.

The role of practical communicative approaches in language teaching and the need for active participation by students in the language learning process are two of the major current concerns of applied linguistics. In much present‐day ELT practice these concerns are reflected in the organization of syllabuses in terms of language functions and notions, rather than grammatical structures, in the emphasis placed in recent course design on the learner's use of ‘real‐life’ language through simulation and interaction techniques, and on the relation of course content to the needs of the traveller or the professional user of English. Such approaches are exemplified in a recently completed series, the first book of which has the specific aims of enabling the students to use English for travelling and for talking about themselves and their interests in the classroom.
ACQUIRING A SECOND LANGUAGE
Authors: KRASHEN STEPHEN D.
Published: February 2007

Perhaps the most important discovery researchers in second‐language acquisition have made in recent years is something that most people knew already: acquiring a second language is not simply a matter of ‘knowing the rules’. Real second‐language competence is subconscious knowledge, similar to knowledge of a first language. Competent second‐language users, like competent users of the native language, do not think grammatical rules when they are producing or understanding the second language, and in many cases never consciously ‘learned’ the rules they use so well. (Grammar rules do help in certain limited situations: good ‘grammar’ users can apply conscious rules when they have time to think about and use them, as in writing, but even here our research indicates that grammar use makes a very modest contribution to grammatical accuracy. For most people, using ‘grammar’ in real conversation only leads to trouble. Constantly referring to rules gives one a very hesitant style of speaking that is not pleasant to listen to, and some of us have the bad habit of constructing our sentences via grammar rules while the other person is talking, which means that we are not listening!)
DOES REPETITION BELONG IN THE LANGUAGE CLASS?
Authors: ALLEN VIRGINIA FRENCH
Published: February 2007

Writing for teachers in 1904, Otto Jespersen defined ‘our most important object’ as follows: ‘that the foreign turns of expression shall make such an impression upon our pupils that they themselves can use them ….’ (How to Teach a Foreign Language, p. 90).
LEARNING/ACQUISITION STRATEGIES FOR BUSINESS ENGLISH
Authors: WHITE GRAHAM
Published: February 2007

Writers of textbooks published since the beginning of 1978 are invited to submit 1000 word articles discussing the principles underlying their work and accompanied by two pages from the book in question. The articles should be problem‐based, not advertisements, and the extracts should be in a form for reproduction without redrawing. Writers will be responsible for obtaining all necessary permissions.