bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant hyperthermia
Authors: HARRISON G. G. , ISAACS H.
Published: February 2007

This paper reports previously unpublished accounts of the deaths in 1915 and 1919 of two members of the same family during general anaesthesia. The deaths were subsequently ascribed to a‘hereditary susceptibility to chloroform. Contemporary evidence is presented which suggests that these deaths were among the very earliest examples of malignant hyperthermia to be described.
Epidural infusion of bupivacaine and diamorphine for postoperative analgesia
Authors: Hobbs G. J. , Roberts F. L.
Published: February 2007

An audit of postoperative epidural analgesia in a District General Hospital is presented. Three hundred and forty‐eight patients received epidural infusions of a bupivacaine and diamorphine mixture, and were managed on general surgical wards using a standard protocol of observations and instructions. Good analgesia was achieved in 339 (97%) patients. Respiratory depression, defined as a respiratory rate of eight breaths.min−1 or less, occurred in 22 (6%) patients, was of gradual onset, and was simply and successfully managed without morbidity. There were no respiratory arrests. Other complications, and the significance of catheter insertion level are discussed.
Pipecuronium versus high dose vecuronium
Authors: HARROP‐GRIFFITHS W. , FAUVEL N. , PLUMLEY M. , FELDMAN S.
Published: February 2007

The onset time and tendency to cumulation of pipecuronium and high‐dose vecuronium were studied during nitrous oxide anaesthesia supplemented with isoflurane. Pipecuronium 0.06 mg·kg−1 had a similar duration of action to vecuronium 0.015 mg·kg−1 (42 vs 49 min). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p < 0.01). The use of pipecuronium was associated with marked cumulation.
Cause of death after critical illness
Authors: RIDLEY S. , PURDIE J.
Published: February 2007

This study reports the causes of death after discharge following treatment of life‐threatening illness on an Intensive Therapy Unit. Details of survivors discharged between June 1985 and December 1988 were sent to the Registrar General for Scotland who subsequently issued copies of death certificates of those patients who had died between discharge and 1 January 1990. The results show that the commonest causes of death after discharge were malignancy and respiratory failure, although there is wide variation in the post‐discharge mortality rates for different diagnostic categories. The admission diagnoses were identical to, or contributed to, the causes of death in 64% of patients who died after discharge. Eighty‐five percent of patients who died from the same condition which prompted admission did so within a year following discharge, but after 2 years no deaths were attributed to the admission diagnosis.
Torsade de pointes and long QT syndrome following major blood transfusion
Authors: KULKARNI P. , BHATTACHARYA S. , PETROS A. J.
Published: February 2007

We report a rare complication following transfusion of a large volume of blood in an adult patient. An electrophysiological disturbance of the cardiac cycle with prolongation of the QT interval developed, which was followed by recurrent episodes of torsade de pointes, a unique form of ventricular tachycardia. The most likely cause of this acquired long QT syndrome was hypomagnesaemia secondary to massive blood transfusion. Treatment with a magnesium infusion restored the QT interval to normal and temporary ventricular pacing prevented further ventricular arrhythmias.
Anaesthesia in a patient with Noonan's syndrome and cardiomyopathy
Authors: CAMPBELL A. M. , BOUSFIELD J. D.
Published: February 2007

A 5‐year‐old girl with Noonan's syndrome and a hypertrophic cardiomyopathy presented for myelography and subsequently, laminectomy. The anaesthetic management of the patient is described and the potential problems of the facial, cardiovascular and skeletal abnormalities associated with the condition are discussed.
A portable mouth pressure meter
Authors: SMITH P. E. M. , ROYALL R. A.
Published: February 2007

The design and function of a device for bedside measurement of maximum static respiratory pressures is reported. The ability to measure maximum inspiratory and expiratory pressures allows a simple means of monitoring respiratory muscle weakness in both acute and chronic conditions.
Two approaches to the axillary brachial plexus
Authors: HILL D. A. , CAMPBELL W. I.
Published: February 2007

A new technique of cannulation of the axillary neurovascular sheath, using loss of resistance to saline, was evaluated and compared to the established technique of eliciting paraesthesiae with a short‐bevelled needle. The cannulation technique produced a more reliable block of axillary, musculocutaneous and radial nerves, significantly fewer incomplete blocks and a lower incidence of accidental vessel puncture.
The use of high‐dose intravenous immunoglobulins in Guillain‐Barré syndrome
Authors: RAHAG A.
Published: February 2007

A patient with severe Guillain‐Barré syndrome responded to treatment with high‐dose intravenous immunoglobulins. It is suggested, on the basis of recent case reports, that immunoglobulins may have an important role in the future treatment of this immune‐mediated disease.
Fibreoptic oximetry in the diagnosis of aortocaval fistula
Authors: KHAN K. J. , TSANG G. M. K. , FIELDING J. W. L. , BION J. F.
Published: February 2007

Fibreoptic oximetry was used to confirm the clinical diagnosis of aortocaval fistula which occurred in a patient with an aortic aneurysm.
Central venous access in children via the external jugular vein
Authors: Taylor E. A. S. , Mowbray M. J.
Published: February 2007

Sixty‐two children undergoing cardiac surgery were surveyed for the presence of external jugular veins. When present, these were used as a route for central venous catheterisation using a ‘J’ wire Seldinger technique. Only 54% of attempted insertions were successful but the results support greater efficacy in older children.
Gastric emptying after minor gynaecological surgery
Authors: MUSHAMBI M. C. , ROWBOTHAM D. J. , BAILEY S. M.
Published: February 2007

Gastric emptying was measured using the paracetamol absorption method in 30 patients immediately after a general anaesthetic for minor gynaecological surgery and in 10 female controls. Anaesthesia was induced with either propofol alone, propofol and alfentanil (4.5 fig.kg −1) or propofol andfentanyl (1.4 ng.kg−1) and maintained with intermittent propofol and 66% nitrous oxide in oxygen. Gastric emptying was delayed significantly in all patient groups when compared with volunteers. However, the delay in gastric emptying was similar in the three patient groups.
The relationship between the concentration of temazepam in cerebrospinal fluid and sedation in man
Authors: OSBORNE G. A. , BADCOCK N. R. , McGRATH P. M. , RUSSELL W. J. , FREWIN D. B.
Published: February 2007

Twenty‐six patients received oral temazepam and subsequently spinal anaesthesia. Blood and lumbar cerebrospinal fluid temazepam levels were measured together with the degree of sedation. The plasma and cerebrospinal fluid concentrations correlated well with the temazepam dose but even better with the weight standardised dose (r = 0.65, p = 0.0003 and r = 0.75, p = p = 0.00001 respectively). Both the plasma and cerebrospinal fluid concentrations of temazepam were correlated with the patient's sedation (r = 0.42 p = 0.037, and r = 0.46 p = 0.021 respectively), but neither was strong. Thus, although the drug concentration at the receptor may be a major factor in producing sedation, others factors, possibly the receptor population or their responsiveness, are also important contributors.
Peroperative arterial hypoxaemia. The interaction between intrapulmonary shunt and cardiac output
Authors: WESTBROOK J. L. , SYKES M. K.
Published: February 2007

A computer model of respiratory physiology was used to investigate the interaction between cardiac output and intrapulmonary shunting during anaesthesia. Significant degrees of arterial desaturation were demonstrated as the cardiac output was reduced. We suggest that volume expansion may correct some episodes of desaturation observed during anaesthesia.
A nasal CPAP system
Authors: THOMAS A. N. , RYAN J. P. , DORAN B. , POLLARD B. J.
Published: February 2007

Nasopharyngeal pressures were compared in eight subjects breathing through either a nasal CPAP system or facemask CPAP system at afresh gas flow of 50, 75 and 100 l.min−1. During nose breathing there was no significant difference in nasopharyngeal pressure between the two systems. During mouth breathing pressures were significantly lower with nasal CPAP. During nose breathing at 75 l.min−1 the mean inspiratory and expiratory pressures in cmH2O (SD) were 3.4 (0.68) and 5.9 (0.55) for nasal CPAP and 3.3 (0.71) and 6.3 (0.73) for facemask CPAP. The respective pressures during mouth breathing were 0.3 (0.73) and 2.9 (1.74) for nasal CPAP and 3.9 (0.73) and 5.8 (0.82) for facemask CPAP.
The effect of nitrous oxide on laryngeal mask cuff pressure
Authors: LUMB A. B. , WRIGLEY M.W.
Published: February 2007

We have studied the effect of nitrous oxide on the cuff pressure of a laryngeal mask both in vitro and in vivo. In laboratory tests, we showed that nitrous oxide and carbon dioxide diffuse across the cuff wall much more rapidly than nitrogen and oxygen. Differing partial pressures of these gases across the cuff wall therefore give rise to changes in volume and pressure within the cuff. We then studied 18 patients undergoing general anaesthesia with nitrous oxide, and found a consistent and linear increase in cuff pressure in all patients. After 30 min, the mean pressure had increased by 30 mmHg, and there was approximately 10% nitrous oxide in the cuff. It is difficult to relate these findings to pressure on pharyngeal structures, but methods of limiting the rise in intracuff pressure are discussed.
Transdermal hyoscine with patient‐controlled analgesia
Authors: SEMPLE P. , MADEJ T. H. , WHEATLEY R. G. , JACKSON I. J. B. , STEVENS J.
Published: February 2007

Transdermal hvoscine (Scopoderm TTS CIBA) was compared with placebo in 67 patients receiving postoperative analgesia via a patient‐controlled analgesia system. All patients underwent an abdominal hysterectomy and had a standard anaesthetic. They were followed up in recovery and daily for 3 days postoperatively. Fewer patients in the hyoscine group suffered emetic sequelae in recovery and on the third postoperative day (p < 0.05). The hyoscine group received half the number of supplementary antiemetic doses compared to placebo. However, despite transdermal hyoscine there was still a high (78%) incidence of nausea and vomiting. The only significant (p < 0.05) increase in side effects attributable to hyoscine was a higher reported incidence of visual disturbance on the second day.
Pulmonary vasoconstriction following intravenous nimodipine
Authors: LOVELL A. T. , SMITH M.
Published: February 2007

A case is reported in which intravenous nimodipine therapy was associated with severe acute pulmonary hypertension in a patient with a subarachnoid haemorrhage. The patient had previously received enteral nimodipine without problems.
Pulmonary collapse during anaesthesia in children with respiratory tract symptoms
Authors: WILLIAMS O. A. , HILLS R. , GODDARD J. M.
Published: February 2007

A frequent dilemma facing the anaesthetist is the child with respiratory tract symptoms. The risks of anaesthesia and surgery in these patients have not been clearly established. We present three cases which illustrate a potentially serious complication which may arise. Our patients each had symptoms of cough, but were systemically healthy. Two of the children had absent clinical signs, whilst the third had a normal chest X ray. However, during surgery and anaesthesia each child developed significant pulmonary collapse, associated with desaturation on oximetry
High frequency jet ventilation for microlaryngeal laser surgery
Authors: DHARA S. S. , BUTLER P. J.
Published: February 2007

The use of a triple lumen central venous catheter, which can be shielded from laser irradiation by metal tape, as a conduit for high frequency jet ventilation in six children, is described. The problems of anaesthesia for laryngeal laser surgery and the advantages of the technique described in this paper are discussed.
Clinical use of a small soda lime canister in a low‐flow to‐and‐fro system
Authors: LOCKWOOD G. G. , KADIM M. Y. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

It may be possible to overcome the classical disadvantages of a to‐and‐fro system by the use of a small soda lime canister. We report our experience of such a system in a series of 13 adult patients requiring mechanical ventilation of the lungs during surgery. The system was found to be convenient to use and the charge of soda lime had sufficient absorptive capacity to last throughout the great majority of surgical cases. Using afresh gas flow of 11.min−1, the ratio of inspired isoflurane concentration to isoflurane vaporizer setting was found to be approximately one half after 10 min of anaesthesia. This ratio was maintained throughout the procedure, except for a few minutes following each change in vaporizer setting. A to‐and‐fro system using a small soda lime canister is a convenient alternative to the circle system for low‐flow anaesthesia.
Instrumental bronchial tears
Authors: CONACHER I. D.
Published: February 2007

Two case reports of bronchial tears following airway instrumentation are presented, one of which resulted in death. Both patients developed pneumothoraces and other complications after attempts had been made under general anaesthesia to insert bronchial stents. It appeared that bronchial tears were made during instrumentation with the stent introducer and these cases demonstrate that great care should be taken when rigid materials, such as plastic guides and bougies, are used blindly in the airway.
Factors influencing epidural catheter migration
Authors: Bishton I. M. , Martin P. H. , Vernon J. M. , Liu W. H. D.
Published: February 2007

The incidence and amount of migration of epidural catheters was investigated in a prospective randomised study of 153 women who required analgesia in labour. Inward or outward migration occurred in 36% of patients. Inward migration by 1–3 cm occurred in 21 (13.7%) patients and outward migration by 1 cm or more occurred in 34 (22.2%); three (2%) catheters migrated out through the skin. There were significant positive correlations between outward migration and weight, body mass index, and depth of the epidural space. There was no relationship between migration and height, age, intervertebral space used or duration of catheterisation. Problems with epidural block were no more likely in patients in whom migration of I cm or more occurred compared with those in whom migration was limited to a maximum of ± 0.5 cm. However, the pattern of problems was different. All cases of failed epidural block occurred in patients whose epidural catheter migrated outward by 2.5 cm or more. Unilateral blockade was not more likely if migration of 1 cm or more occurred.
Perineuronal morphine in intercostal block
Authors: Sternlo J. E. , Hägerdal M.
Published: February 2007

In a double‐blind, randomised study the potential benefits of combining low‐dose morphine with bupivacaine for intercostal nerve blocks for analgesia after biliary surgery were investigated. There was no significant improvement in pain scores or consumption of supplementary analgesics when morphine was added to bupivacaine. This investigation supports the findings of other workers who showed that perineural morphine was ineffective for postoperative pain relief.
Haemodynamic stability during general anaesthesia for intra‐ocular surgery: the effect of topical oxybuprocaine
Authors: Lytle J. , Thomas N. F.
Published: February 2007

Local anaesthesia is frequently used in combination with light general anaesthesia to reduce the reflex responses to surgical stimulation. This combination has not previously been evaluated for intra‐ocular surgery. During cataract extraction under general anaesthesia, the effect of topical anaesthesia with oxybuprocaine 0.4% on the pressor response was compared with normal saline in a control group. The simple technique of instilling local anaesthetic drops into the conjunctival sac blocked the pain pathway sufficiently to prevent the pressor response to surgical stimulation (p < 0.001). Higher inspired concentrations of enflurane were required in the control group to achieve and maintain haemodynamic stability (p < 0.001).
Intravenous regional anaesthesia with 0.5% prilocaine or 0.5% chloroprocaine
Authors: Pitkänen M. T. , Suzuki N. , Rosenberg P. H.
Published: February 2007

Ten healthy male volunteers received intravenous regional anaesthesia of the upper limb on two separate occasions using 40 ml of 0.5% prilocaine or 40 ml plain 0.5% chloroprocaine by random allocation. Using a double‐blind method, the onset and recovery of sensory block was tested (pinprick) in the four main nerve areas. The onset and recovery of motor block was measured by squeezing a rubber balloon connected to a manometer. The symptoms after deflation of the tourniquet were recorded. Seven volunteers in both groups developed total anaesthesia in 20 min. Complete motor block occurred in 12.3 min with prilocaine and 11.3 min with chloroprocaine. Sensation recovered in all areas in 7.6 min with prilocaine and 10.0 min with chloroprocaine (ns). Motor function recovered in 8.4 and 12.0 min respectively (p < 0.01). Six volunteers in the chloroprocaine group showed signs of venous irritation and/or antecubital urticaria in the test arm for 30–45 min after the deflation. Four volunteers in the chloroprocaine group had increased in heart rate (>20%) and one of them short periods ofjunctional rhythm during the first 2 min after tourniquet deflation. Mild, short‐lived Cns side effects occurred in both groups.
Failed extradural anaesthesia for Caesarean section. Complication of subsequent spinal block
Authors: BECK G. N. , GRIFFITHS A. G.
Published: February 2007

Two cases of unexpected high spinal anaesthesia following failed extradural anaesthesia for Caesarean section are described. In both cases rapid and unexpected advance of blockade, after the subarachnoid injection of moderate doses of local anaesthetic, required tracheal intubation. In one of the cases 15 ml of 0.9% saline, but no local anaesthetic, had been injected into the extradural space, suggesting that the mechanism involved is the cephalad displacement of the cerebrospinal fluid by extradural fluid, and not leakage of extradural anaesthetic solution into the subarachnoid space.
The influence of arm position and cardiac output on bolus clearance from the arm
Authors: McLINTIC A. J. , MARTIN W. , TWEDDEL A. C.
Published: February 2007

The importance of arm position and cardiac output on the clearance of a bolus injection from the arm was assessed in 63 patients using technetium‐99m. Injections were made in the left arm which was either adducted, abducted or adducted with the forearm flexed over the lower chest. The clearance of isotope was assessed by measuring the amount of radioactivity remaining in the arm at 10 s intervals and calculating it as a fraction of the injected dose. The clearance of Tc‐99m was significantly faster and more complete from the abducted arm than from the adducted arm. There was no correlation between clearance and cardiac output.
Reversible paraplegia following coeliac plexus block
Authors: JABBAL S. S. , HUNTON J.
Published: February 2007

Permanent paraplegia following coeliac plexus block has been reported on several occasions. We report a case of reversible paraplegia following coeliac plexus block.
Profound desaturation following vomiting on induction
Authors: HEAD‐RAPSON A. G. , RALSTON S. J. , SNOWDON S. L.
Published: February 2007

Whilst participating in a clinical trial, a patient vomited during induction of anaesthesia. Subsequent analysis of the continuous record of oxygen saturation showed precipitous desaturation.
Anaphylactoid reaction to propofol
Authors: McHale S. P. , Konieczko K.
Published: February 2007

A case of an anaphylactoid reaction following the induction of anaesthesia is reported. Subsequent intradermal testing suggested propofol to be the causative agent.
Anaesthetic machine checking practices
Authors: MAYOR A. H. , Eaton J. M.
Published: February 2007

Forty anaesthetists, of all grades, were interviewed without prior warning and questioned about the checks they had performed on their anaesthetic equipment before use. The results reveal that a substantial percentage (up to 41%) of anaesthetists perform inadequate checks. Furthermore, of those that do, few follow the Association of Anaesthetists of Great Britain and Ireland's recent guidelines.
Evaluation of the Level 1 Hotline blood warmer
Authors: SMALLMAN J. M. B. , MORGAN M.
Published: February 2007

The Level 1 Hotline warmer is a new type of fluid warmer, developed specifically for use with low flows. It was found to be effective at flows between 1 ml.min−1 and 75 ml.min−1.
The Extensometer—use in spontaneously ventilating awake volunteers
Authors: BRIMACOMBE J. , MacFIE A. , MASTERS A.
Published: February 2007

The extensometer is a new device with potential in the field of respiratory pattern analysis. This paper describes the physical principles upon which the extensometer depends and also assesses its performance as a noninvasive respiratory monitor in respect of its ability to measure tidal volume and to determine obstructive breathing patterns in awake volunteers in the supine position over a limited time period. Further developments of the device are outlined and the current status of torso transducers in anaesthesia and intensive care are discussed.
Estimation of tidal volume from the reservoir bag
Authors: Kulkarni P. R. , Lumb A. B. , Platt M. W. , Nunn J. F.
Published: February 2007

The accuracy of 21 anaesthetists in estimating tidal volumes from reservoir bag movements was assessed using a model lung apparatus. The breathing system configuration (Mapleson A or D), the grade of anaesthetist, and the years of anaesthetic experience had no effect on accuracy. Greater precision of tidal volume estimation was observed with larger tidal volumes and lower fresh gas flows. The mean systematic error of 18 of the 21 anaesthetists was greater than zero, indicating a general tendency to overestimate tidal volume. This study therefore strengthens the view that clinical observations should be supplemented with information from continuous monitoring devices.
Vital capacity breath technique for rapid anaesthetic induction: comparison of sevoflurane and isoflurane
Authors: Yurino M. , Kimura H.
Published: February 2007

This study compares vital capacity rapid inhalational induction of anaesthesia with sevoflurane and isoflurane. Forty‐six volunteers undergoing the procedure had one of the two agents: 25 had sevoflurane and 21 isoflurane. Subjects were unpremedicated and breathed approximately 1.7 MAC equivalents of either vapour. There were no significant differences in the patients' monitored cardiovascular, respiratory, and electrocardiographs variables. The mean time for induction of anaesthesia with sevoflurane (120 s) was significantly shorter than with isoflurane (145 s), reflecting its higher blood‐gas solubility. There were fewer induction complications in the sevoflurane group. Subjects in the sevoflurane group found the induction of anaesthesia more pleasant and were more willing to undergo it again compared to subjects in the isoflurane group. We conclude that sevoflurane is superior to isoflurane in vital capacity rapid inhalational induction of anaesthesia, particularly in instances where premedication should be avoided.
The use of a bite raiser in the intensive care unit
Authors: Wilkinson P. A. , Wilkinson G. R.
Published: February 2007

The use of a simple bite raiser is described to prevent self‐inflicted tongue trauma in patients whose tracheas are intubated or who have tracheostomies during recovery from head injury or tetanus.
Baroreflex control of heart rate during high thoracic epidural anaesthesia
Authors: Goertz A. , Heinrich H. , Seeling W.
Published: February 2007

Baroreflex control of heart rate after cardiac sympathectomy induced by thoracic epidural anaesthesia was evaluated in 30 patients who were randomly assigned to group I (bupivacaine 0.25%), group 2 (bupivacaine 0.5%) or group 3 (control). Plasma volume expanders were given to equalise preload conditions, as assessed using transoesophageal echocardiography. All measurements were made under general anaesthesia. Baroreflex sensitivity was determined from the heart rate response to phenylephrine and nitroglycerine. There was no difference in cardiac slowing in response to phenylephrine between the three groups. Baroreflex sensitivity, measured as cardiac acceleration in response to nitroglycerine, was significantly lower (p < 0.01) in groups 1 and 2 (1.8 and 1.5 ms.mmHg−1 respectively) compared with group 3 (3.5 ms.mmHg−1) with no differences between the two bupivacaine concentrations. The results suggest that baroreflex‐mediated response to decreases in arterial pressure is dependent on the integrity of the sympathetic nervous system.
Vecuronium: an anthropometric comparison
Authors: HOUGHTON I. T. , AUN C. S. T. , OH T. E.
Published: February 2007

This study set out to determine if there was any resistance to vecuronium in Nepalese studied in Nepal compared with Nepalese, Chinese and European patients studied in Hong Kong. The four groups, each of 10 male and 10 female patients, were intubated 60s after administration of 0.1 mg.kg−1 vecuronium. The Nepalese patients in Nepal had significantly less satisfactory intubating conditions (p = 0.002). Similarly, male patients had significantly less satisfactory conditions than female patients (p = 0.004). Some anthropometric measurements were significantly different between the patients in Nepal and those in Hong Kong. There were also sex‐related anthropometric differences. It is suggested that differences in response to vecuronium could be explained by differences in distribution volume and muscle mass
Opioid sensitivity of chronic pain: a patient‐controlled analgesia method
Authors: McQUAY H. J. , JADAD A. R. , Carroll D. , Faura C. , Glynn C. J. , Moore R. A. , LIU Y.
Published: February 2007

Twenty‐two patients with chronic pain of malignant or nonmalignant origin were given intravenous morphine by patient‐controlled analgesia. A prestudy judgment was made from the characteristics of the pain as to whether it was nociceptive or neuropathic. Analgesic efficacy was assessed by a nurse‐observer; adverse events were noted and plasma morphine and metabolitie concentrations measured. Three categories of opioid response were distinguished. Good responders obtained > 70 mm relief on the visual analogue scale, with minimal or manageable adverse events. Moderate responders obtained < 70 but > 30 mm relief with more problematic adverse events, and poor responders had < 30 mm relief with troublesome adverse events. This method for the study of opioid sensitivity allowed a wide dosage range to be studied. The simultaneous analgesic and adverse event measurements showed that the spectrum of observed response was wide, and response category could be judged for the majority by 4 h. In those with poor or moderate response, adverse event severity limited further dose increment. The relationship between pain characteristics and response showed that some pains judged to be neuropathic had a good response to opioid (5/13), and some pains judged to be nociceptive did not (5/14). The study suggests that the pattern of response is not as black and white as the prediction of good response from nociceptive pain and poor from neuropathic pain would suggest, although nociceptive pain was more likely than neuropathic pain to show a good response. For the moderate responders opioid titration may, in the absence of other effective treatments, be useful, but the analgesic endpoint may not be totally satisfactory. The method provides an operational definition of opioid sensitivity.
Does hypothermia protect against the development of hepatitis in paracetamol overdose?
Authors: BLOCK R. , JANKOWSKI J. A. Z. , LACOUX P. , PENNINGTON C. R.
Published: February 2007

A 24‐year‐old female presented in hospital following self‐poisoning with a dose of greater than 30 g of paracetamol (acetaminophen), taken both as co‐proxamol (dextropropoxyphene and paracetamol) and paracetamol. She arrived in hospital more than 18 h after ingestion of the drug. On admission, she was profoundly hypothermic, with a rectal temperature of 19°C. Her paracetamol level was 943 μmol.l−1 which, when related to the time of ingestion, implied a very high risk of hepatocellular damage as well as fulminant liver failure, even if she was treated with the antioxidant n‐acetylcysteine. The patient's condition was stabilised by initial resuscitation with fluids, vasoactive drugs, and active rewarming. N‐acetylcysteine therapy was begun promptly. This patient's liver function tests remained entirely normal in spite of the delay in presentation and she made a rapid and complete recovery. This remarkable clinical course indicates a possible role for therapeutically induced hypothermia in the management of severe paracetamol overdose, particularly in the group of patients who seek medical attention some hours after ingestion of the drug and who therefore remain at high risk, despite treatment with n‐acetylcysteine.
Chronic pain management training for senior registrars in anaesthesia
Authors: Parris M. R. , Warner J. A. , Clark C.
Published: February 2007

In 1985 and 1990 postal questionnaires were sent to anaesthetic senior registrars in training in the United Kingdom to determine the extent of higher specialist training in chronic pain management. There were wide variations in training and experience amongst senior registrars. Overall there was little change between 1985 and 1990. In particular the number of anaesthetic senior registrars who felt equipped to undertake a consultant post with an interest in chronic pain management had not increased.
Ventricular fibrillation after accidental injection of bupivacaine into the pericardium
Authors: EVEN B. J. , DE JONGH R. F. , DE HERT S. G.
Published: February 2007

A postoperative cardiac surgical patient developed ventricular fibrillation immediately after accidental pericardial injection of bupivacaine at room temperature. The possible causes, which include systemic toxicity, local vasoconstriction with myocardial ischaemia, local toxic effect of bupivacaine or local hypothermia, are discussed.
Transoesophageal echocardiography during removal of a caval filter in a patient at high risk of massive pulmonary thromboembolism
Authors: Metzler H. , Lammer J. , Berger J. , Rigler B. , Gombotz H.
Published: February 2007

A new type of vena caval filler was to be removed from a woman who had a high risk of massive pulmonary thromboembolism because of extensive thrombus in the iliac vein incorporating the filter. The removal was performed under general anaesthesia in the cardiac operating theatre using transoesophageal echocardiography to monitor the right heart and the pulmonary artery during the critical phase of removal. The manoeuvre succeeded with only insignificant embolisation occurring, and that was identified by transoesophageal echocardiography.
An evaluation of the behaviour of children undergoing dental extraction under general anaesthesia
Authors: Burns M. T. , Blinkhorn A. S. , Asbury A. J.
Published: February 2007

The cooperation of a random sample of 190 children with an average age of 5 years (range 1–17 years), presenting with a dental emergency requiring tooth extraction under general anaesthesia, was evaluated using the Frankl Behaviour Scale. The results showed that 60% of the children cooperated in the operating theatre. Furthermore, removal of only one or two teeth per patient accounted for 40% of the cases. This survey has identified a group of child dental patients who might benefit from conscious sedation and local anaesthetic techniques.
The effect of paracetamol or diclofenac administered before operation on postoperative pain and behaviour after adenoidectomy in small children
Authors: Baer G. A. , Rorarius M. G. F. , Kolehmainen S. , Selin S.
Published: February 2007

We compared the effects of rectally administered diclofenac (12.5 mg) with paracetamol (125 mg) on pre‐ and postoperative behaviour and the need for supplementary analgesia in 44 children scheduled for adenoidectomy (with or without myringotomy). The study drugs were given in combination with diazepam (0.5 mg.kg1) about 20 min before the children were taken to the operating theatre. On arrival there, the children who had received diclofenac were significantly quieter (<0.05), easier to handle (p < 0.01) and cried less (p < 0.05) than those in the paracetamol group. During recovery, children in the diclofenac group needed fewer supplementary doses of intravenous pethidine than those receiving paracetamol (p < 0.001). There were no obvious differences between the groups in intra‐operative bleeding (as estimated by the surgeon), or in measured blood loss. No postoperative complications became evident. The pre‐operative rectal administration of diclofenac for pain relief after adenotomy is safe and effective.
Administration of vancomycin during cardiopulmonary bypass
Authors: Baraka A. , Taha S. , Bijjani A. , Arab W. , Mashefedjian G.
Published: February 2007

Vancomycin was given during cardiopulmonary bypass to 12 anaesthetised patients undergoing open heart surgery. Injection of vancomycin 1 g within 60 s via the venous inlet of the oxygenator resulted in a moderate and transient decrease of mean arterial pressure. This minimal reaction may be attributed to dilution of vancomycin by the extracorporeal circuit volume, to the bypassing of the lungs which are a major site of storage of vasoactive substances, or to the maintenance of adequate perfusion flow during cardiopulmonary bypass. The results suggest that the haemodynamic adverse reactions to vancomycin, given as antibiotic prophylaxis, may be decreased by its administration after initiation of cardiopulmonary bypass.
Pharmocokinetic model‐controlled infusion of midazolam
Authors: SHORT T. G. , TAM Y. H. , TAN P. , OH T. E.
Published: February 2007

The accuracy of a computer‐controlled infusion of midazolam, based on previously published pharmacokinetic parameters, was tested prospectively in 12 adult female patients undergoing general anaesthesia. Anaesthesia consisted of an initial bolus followed by an exponetially decreasing infusion of midazolam given according to body weight, fentanyl, nitrous oxide and vecuronium. Venous blood samples were taken at 15 min‐intervals throughout the procedures and for 1–2 h postoperatively. The bias of the model was – 5.1% (95% C1 –11.3 to 1.2%) and precision 24.8% (95%CI 20.9 to 28.6%). Least squares regression analysis decreased the bias to—2.8% but did not alter precision. Retrospective fitting of an alternative set of published parameters for midazolam resulted in significant deterioration of the model. The precision was similar to that found in past studies of intravenous anaesthetic agents. Further improvement in the accuracy of midazolam infusion awaits improved understanding of the causes of pharmocokinetic variability.
Extending a pipecuronium neuromuscular block
Authors: ROBERTS S.P. , RAMSAY T.M. , HEALY T.E.J. , WILSON A. , POLLARD B.J.
Published: February 2007

Ten patients received increasing doses of pipecuronium at induction of anaesthesia. A dose response relationship was then constructed from which ED90 and ED95 values were measured as 43.4 μ.kg−1 and 50.5 μ.kg−1 respectively. A further 30 patients received pipecuronium in a dose sufficient to produce greater than 90% neuromuscular block. When the first contraction of the train‐of‐four had returned to 10% of control, a small increment of atracurium (1.1 mg), vercuronium (0.25 mg) or pipecuronium (0.21 mg) was administered, and this was repeated subsequently using the same criterion of recovery on each occasion. The duration and intensity of the block with pipecuronium increments remained constant. The duration of the block following atracurium or vecuronium was progressively less with subsequent increments until steady state was reached. The final mean durations at steady state were pipecuronium 7.37 min, atracurium 6.99 min, and vecuronium 5.15 min.
Closed loop control of arterial hypertension following intracranial surgery using sodium nitroprusside
Authors: MACKENZIE A. F. , COLVIN J. R. , KENNY G. N. C. , BISSET W. I. K.
Published: February 2007

Forty patients were chosen at random to receive halothane or isoflurane anaesthesia during craniotomy and a comparison of the postoperative hypertensive response was made using a microcomputer‐based closed‐loop arterial pressure control system with sodium nitroprusside to control and assess arterial pressure during the first 6 postoperative hours. A desired target systolic pressure was chosen for each patient and the frequency of hypertension, sodium nitroprusside requirements and quality of arterial pressure control were compared between the two groups. Thirty‐five patients required sodium nitroprusside. The halothane group required a median dose of 15.2 mg (range 0–72) compared to 3.4 mg (range 0–87) in the isoflurane group. This difference is not statistically significant. Quality of arterial pressure control was satisfactory in both groups. In conclusion, arterial hypertension occurs frequently following intracranial surgery and is uninfluenced by the choice of halothane or isoflurane intra‐operatively. This closed‐loop arterial pressure control system functioned safely and effectively in this context.
The effect of oral ondansetron in the prevention of postoperative nausea and vomiting after major gynaecological surgery performed under general anaesthesia
Authors: DUPEYRON J. P. , CONSEILLER C. , LEVARLET M. , HEMMINGSEN C. , SCHOEFFLER P. , PEDERSEN F. M. , GRIBOMONT B. , KAPLAN L. A.
Published: February 2007

The efficacy and safety of ondansetron in preventing postoperative nausea and vomiting following major gynaecological surgery was evaluated in this multicentre, double‐blind study. A total of 243 patients were randomised to receive three doses of oral ondansetron 8 mg or matching placebo at 8‐hourly intervals, with the first dose being given an hour before surgery. A standard general anaesthetic technique was employed throughout. Nausea, vomiting and safety assessments were performed continuously during the 24 h postrecovery period. Of the 237 patients evaluated for efficacy, significantly fewer ondansetron 8 mg treated patients (65/117: 56%) experienced postoperative nausea and/or vomiting compared with placebo‐treated patients (94/120; 78%) during the study period (p < 0.001). In addition, ondansetron 8 mg reduced the severity of nausea (p < 0.001) and the total number of vomiting episodes experienced (p < 0.001). Overall, ondansetron 8 mg was well tolerated and effective in preventing postoperative nausea and vomiting in this surgical setting.
The effect of the anaesthetist's attire on patient attitudes
Authors: HENNESSY N. , HARRISON D. A. , AITKENHEAD A. R.
Published: February 2007

Two groups of adult patients (55 each) were visited pre‐operatively by an anaesthetist who was dressed either formally or casually. Their response to this visit, their opinions regarding anaesthetists and their knowledge of anaesthetic work were elicited afterwards by means of a questionnaire. Patients' satisfaction with the anaesthetist and his/her visit was not influenced by dress. The anaesthetist was awarded a high level of prestige and the length of his/her training was recognised to be comparable to that of other professionals: 81.8% of patients thought that anaesthetists held a medical degree but only 35.4% thought that they worked in the intensive care unit. Patients expressed a preference for doctors to wear name tags, white coats and short hair but disapproved of clogs, jeans, trainers and earrings.
Laboratory assessment of the Baxter disposable patient‐controlled analgesia system
Authors: DAVIDSON J. A. H. , DRYDEN C. M. , SMITH D. D.
Published: February 2007

The performance of the Baxter patient‐controlled analgesia infusor system was assessed in the laboratory. The flow of the 5 ml.h−1 infusor was measured gravimetrically with the flow restrictor maintained at 31°C and the reservoir at either 20°C or 25°C. At 25°C the mean flow was 4.98 (Sem 0.06) ml.h−1 and at 20°C the mean flow was 4.32 (0.05) ml.h−1. The patient‐control module performed reliably, delivering a mean of 0.42 (0.001) ml following depression of the button, slighly less than the manufacturer's quoted value of 0.5 ml.
Anaesthesia for procedures on the larynx and pharynx
Authors: Mendel P. , Bristow A.
Published: February 2007

Twenty patients undergoing elective procedures on the larynx and pharynx were anaesthetised using a propofol infusion and a bolus of vecuronium. High frequency jet ventilation was employed via a 7 French gauge catheter, with a second catheter being used to measure expired carbon dioxide levels. The Bullard laryngoscope was compared with the Macintosh instrument both for visualising the larynx and subsequently inserting a catheter. One catheter was left in place until the patient was fully awake, and in one case this enabled gas exchange to be maintained in the presence of laryngospasm. Using the Bullard laryngoscope, intubation was possible in all 20 patients, in a mean time of 22 (6.8) s. Using the Macintosh laryngoscope only 16 patients could be intubated and this took significantly longer at 34 (18.3) s (p < 0.05). The Bullard laryngoscope and high frequency jet ventilation offer a reliable method of intubating and anaesthetising patients with upper airways pathology and further benefits may accrue in the recovery period.
The effect of cardiopulmonary bypass on cholinesterase activity
Authors: SHEARER E. S. , RUSSELL G. N.
Published: February 2007

Cholinesterase activity was determined in 18 patients who had undergone either hypothermic (n = 9) or normothermic (n = 9) cardiopulmonary bypass. The anaesthetic technique was standardised to avoid agents known to affect cholinesterase. Activity was determined in blood samples taken before the induction of anaesthesia, during cardiopulmonary bypass and far at least 7 days postoperatively. In six patients cholinesterase activity was also measured at 6 weeks postoperatively. All the patients were of normal cholinesterase genotype. In both groups cholinesterase activity fell by approximately 60% coinciding with the start of cardiopulmonary bypass, from a mean of 5976 to 2636 IU.l−1 in the hypothermic group, and from 5901 to 2615 IU.l−1 in the normothermic group (p < 0.001 in both instances) (normal range 4300–10 500 IU.l−1). Cholinesterase activity remained at this reduced level for at least 7 days postoperatively. By 6 weeks, activity had returned to within 7% of pre‐induction values. There were no differences in cholinesterase activity between the hypothermic and normothermic groups at any of the sampling times.
The measurement of right ventricular ejection fraction by thermodilution
Authors: COCKROFT S. , WITHINGTON P. S.
Published: February 2007

Thermodilution measurements of cardiac output and right ventricular ejection fraction were obtained using a rapid response pulmonary artery catheter. Values were compared when injectate was administered via either a cannula within the right internal jugular vein or the dedicated right atrial port of the pulmonary artery catheter. Mean (SD) bias for cardiac output and right ventricular ejection fraction measurements were 0.08 (0.32) l.min−1 and 2.6 (6.6)% respectively. We therefore conclude that both injectate techniques will provide similar values for cardiac output but dissimilar values for right ventricular ejection fraction measurement.
The effect of low dose aspirin on bleeding times
Authors: Williams H. D. , Howard R. , O'Donnell N. , Findley I.
Published: February 2007

This double‐blind, controlled study assessed the effect of low‐dose aspirin on bleeding times. Thirty patients, in the last trimester of their first pregnancy, who were also taking part in a trial to evaluate the effect of low‐dose aspirin on the development and progress of pregnancy‐induced hypertension, had their bleeding times measured using the Sirnplate 11 Bleeding Device. Our study showed there was no significant difference between the bleeding times of the two groups and all measurements fell within the normal range.
Continuous subarachnoid infusion of local anaesthetic
Authors: Morton C. P. J. , Armstrong P. J. , McClure J. H.
Published: February 2007

We observed the sensory, motor and cardiovascular changes occurring during subarachnoid infusion of bupivacaine 0.125% at 15 ml.h−1 in six patients. After I h, motor block and lower sensory levels were consistent and predictable but upper sensorv levels were variable. There was a moderate decrease in systolic blood pressure. Regular assessments of motor block are more likely to detect accidental subarachnoid infusion than assessments of upper sensory level or measurements of blood pressure.
Suxamethonium myalgia: an ethnic comparison with and without pancuronium pretreatment
Authors: HOUGHTON I. T. , AUN C. S. T. , GIN T. , LAU J. T. F. , OH T. E.
Published: February 2007

The incidence of myalgia after suxamethonium was determined in 200 fit military male dental patients of European, Chinese and Nepalese descent. Half received pancuronium 1 mg and the other half received saline pretreatment on a randomised double‐blind basis. The percentage incidence of postsuxamethonium myalgia after saline or pancuronium was found to be: Europeans 26%, 13%: Chinese 13%, 7%; Nepalese 20%, 14%. Although pancuronium reduced the incidence of myalgia by about 50% overall, these values were not significantly different from each other. The recovery of spontaneous ventilation following suxamethonium was quicker in the Europeans than in the Asians (p < 0.05). Pancuronium pretreatment also delayed the recovery of spontaneous ventilation and recovery from neuromuscular block (p < 0.05) but this was independent of ethnicity. The Europeans recovered from anaesthesia more quickly than the Asians. It was concluded that ethnicity affected recovery from suxamethonium and from anaesthesia but was not of clinical relevance to the incidence of myalgia in male Asians and Europeans.
Dermal patch anaesthesia: comparison of 10% lignocaine gel with absorption promoter and EMLA cream
Authors: SAKAMOTO M. , KANO T. , SACTANAGA M. , SHIMODA O. , MORIOKA T. , MISHIMA M. , NAKANO M.
Published: February 2007

The analgesic effects of transdermally applied 10% lignocaine aquagel containing 3% glycyrrhetinic acid monohemiphthalate disodium (as an absorption enhancer) and EMLA cream were compared on the forearms of 34 adult volunteers in a double‐blind fashion. The mean pinprick pain scores (graded by noting the number of painful pinpricks out of five) at 30, 60 and 90 min after application and 30 min after removal of the anaesthetics were 3.3 (0.3) (mean SE), 1.2 (0.3), 0.3 (0.1) and 0.3 (0.1) respectively, in the lignocaine gel group. Corresponding scores were 3.5 (0.3), 1.5 (0.3), 0.7 (0.2) and 0.1 (0.1) respectively, in the EMLA group. Insertion of a 26‐gauge needle into the treated skin to a depth of 1 mm at 90 min after application was not painful in 91% of the volunteers in the lignocaine gel group and 88% of those in the EMLA group. There was no significant difference in any of the corresponding pain scores between the two groups.
Zingiber officinale does not affect gastric emptying rate
Authors: PHILLIPS S. , HUTCHINSON S. , RUGGIER R.
Published: February 2007

The effect of the powdered rhizome of Zingiber officinale (ginger root) on the gastric emptying rate was investigated. In a double‐blind crossover trial, 16 healthy volunteers were randomly allocated to receive either 1 g of ginger or placebo. Gastric emptying was measured using the oral paracetamol absorption model. Ingestion of ginger did not effect gastric emptying. The antiemetic effect of ginger is not associated with an effect on gastric emptying. No adverse effects were noted.