bluuebunny/crossref_metadata_2025 huggingface dataset:
Inheritance of low plasma cholinesterase activity in two families with a history of suxamethonium sensitivity
Authors: WHITTAKER M. , BERRY M. , BRITTEN J. J.
Published: February 2007

An hypothesis advanced in 1970 concerning family inheritance of low enzymic activities of plasma cholinesterase has been substantiated. The recognition of three E1kE1S genotypes is reported in this family after investigation of a new generation. A second family with similar genetic characteristics is described.
The management of Caesarean section in a patient with an intracranial arteriovenous malformation
Authors: LAIDLER J. A. , JACKSON I. J. , REDFERN N.
Published: February 2007

The anaesthetic management of elective Caesarean section in a 25‐year‐old woman with an inoperable intracranial arteriovenous malformation is described. The literature is reviewed.
Failure of repeated blood patch in the treatment of spinal headache
Authors: FRY R. A. , PERERA A.
Published: February 2007

The management of a persistent, incapacitating postdural puncture headache that required four consecutive autologous epidural blood patches is presented. Inadequate blood volumes, early patching and steroid in the epidural space are considered as possible causes of failure. Other associated problems and interventions are briefly discussed.
A new dual function nerve stimulator
Authors: SANSOME A. J. , de COURCY J. G.
Published: February 2007

The Duostim model TV02 is a new peripheral nerve stimulator designed both for nerve identijcation in the performance of regional anaesthesia and for monitoring neuromuscular blockade. The output pulses are unipolar and of adjustable constant current. The provision of single twitch (1 Hz and 1/15 Hz) trainof‐four and tetanic stimuli, together with indication of the current delivered and the small size of the unit, faciiitate its clinical use. Performance was assessed and found to be according to specijication.
Atracurium infusion during paediatric craniofacial surgery
Authors: WAIT C. M. , GOAT V. A.
Published: February 2007

A simple feedback control system was used to administer atracurium to 10 infants aged between 5 and 36 months during craniofacial reconstruction. The purpose of the study was to establish whether the system, previously evaluated only in adults, would be efective in paediatric patients. The individuals studied underwent long procedures with substantial blood loss and the potential, for thermal and electrolyte disturbances. The system maintained the level of neuromuscular block successfully between 88 and 100% in all patients and between 90 and 100% in nine patients. The mean duration of feedback control was 179 (range 111–440) minutes. The mean (SD) dose of atracurium required was 0.40 (0.12) mg/kg/hour. The mean (SD) recovery time to a train‐of‐four ratio of 0.75 was 24.8 (9.9) minutes.
Migration of thoracic epidural catheters
Authors: MOURISSE J. , GIELEN M. J. M. , HASENBOS M. A. W. M. , HEYSTRATEN F. M. J.
Published: February 2007

Migration of thoracic epidural catheters was evaluated in 25 patients by three methods either after placement of the catheter or immediately after surgery. The first method was the determination of the depth of the catheter from the skin, the second the determination of the level of sensory blockade which resulted from a test dose of a local anesthetic agent, while the third consisted of radiological visualisation of the catheter tip in the epidural space with radiopaque dye. The evaluations were repeated on the third or fourth day after operation. We observed an inward movement of the catheter in 56% of the patients instead of the expected outward movement. This inward movemenl was accompanied by a higher level of sensory blockade. No relationship with radiological visualisation was found.
Sodium bicarbonate as a single dose antacid in obstetric anaesthesia
Authors: Mathews H.M.L. , Moore J.
Published: February 2007

Gastric pH and volumes were measured in 84 women who had general anaesthesia for emergency Caesarean section. Forty‐eight received only 20 ml 8.4% sodium bicarbonate immediately before induction of anaesthesia and 36 ranitidine 150 mg 6‐hourly during labour in combination with NaHCO3. Gastric pH was less than 2.5 in four women who received only bicarbonate. All aspirates from the ranitidine plus bicarbonate group had a pH greater than 2.5. Mean volumes of gastric content aspirated were 87 (SD 87.4) and 60 (SD 46.3) ml for the bicarbonate alone and bicarbonate plus rantidine series respectively. These differences were not significant. Twenty millilitres of 8.4% NaHCO3 cannot be recommended as a single dose antacid for emergency Caesarean section. Ranitidine plus bicarbonate is considered a reliable antacid regimen to ensure elevation of gastric pH to safe levels.
Asystole with convulsion following a subanaesthetic dose of propofol plus fentanyl
Authors: DORRINGTON K. L.
Published: February 2007

A case is presented in which asystole and convulsions occurred after an attempted induction of anaesthesia with propofol and fentanyl. The case suggests that a history of syncope may be associated with unusual susceptibility to the bradycardic effects of propofol.
A computer‐controlled anaesthetic gas mixer
Authors: BOADEN R. W. , HUTTON P. , MONK C.
Published: February 2007

The theory and construction of a prototype computer‐controlled gas mixer and flow regulator are described. The device is capable of controlling and mixing flows of oxygen, nitrous oxide and air. The accuracy and repeatability of the device is very high under given conditions, and its performance is quantified. The flow rate and oxygen concentration are selected from a microcomputer and the control program is written in BASIC. Possible improvements to the system are discussed as are uses in both clinical and research work.
A history of anaesthetic rooms
Authors: SONI J. C. , THOMAS D. A.
Published: February 2007

The development of anaesthetic induction rooms since 1860 to the present day is outlined.
Anaesthesia and substance abuse
Authors: WOOD P. R. , SONI N.
Published: February 2007

Current practices in the abuse of illicit drugs in the United Kingdom are described with particular reference to their pathological effects and the implications for anaesthesia. Practical guidelines are given for the anaesthetic and peri‐ and postoperative management of addicts.
Temazepam or midazolam for night sedation. A double‐blind study
Authors: Irjala J. , Kanto J. , Salonen M.
Published: February 2007

The effects of oral temazepam (20 mg), oral midazolam (15 mg) and a placebo were compared for night sedation on the evening prior to surgery in a double‐blind study. Patients in the placebo group had significantly worse sleep than those in the temazepam (p = 0.004) or midazolam groups (p = 0.04). There was no significant difference between the two drug groups, nor between the residual effects of the three treatments. Temazepam appears to be somewhat more effective than the ultrashort‐acting midazolam in pre‐operative transient insomnia.
The subdural space: the third place to go astray
Authors: REYNOLDS F. , SPEEDY H. M.
Published: February 2007

Subdural placement of the tip of the Tuohy needle or epidural catheter may account for many unexpected complications of attempted epidural blockade, for example ‘unexplained’ headache, false‐negative aspiration test down needle or catheter, false‐negative test dose, unilateral block, delayed total spinal and neurological sequelae, as well as profound block of delayed onset that is characteristic of subdural blockade. Cases are reported in support of this hypothesis.
An unusual presentation of cardiac tamponade
Authors: BELLAMY M. C. , NATARAJAN V. , LENZ R. J.
Published: February 2007

A case of pericardial effusion with tamponade that presented as an acute abdomen is described.
Cardiovascular response to insertion of Brain's laryngeal mask
Authors: HICKEY S. , CAMERON A. E. , ASBURY A. J.
Published: February 2007

This study was designed to investigate the cardiovascular effects related to insertion of the Brain laryngeal mask airway and to compare these effects with those after insertion of a Guedel oral airway. Arterial pressure and heart rate in 100 patients were measured using an Ohmeda 2300 Finapres arterial pressure monitor. Arterial pressure decreased significantly (p < 0.001) and heart rate increased significantly (p < 0.001) after induction of anaesthesia with 2.5 mg/kg of propofol. A significant increase in arterial pressure (p < 0.02) and in heart rate (p < 0.001) followed insertion of the laryngeal mask and the Guedel airway, with no difference between the two groups at any time. The changes in arterial pressure and heart rate returned to ‘at insertion’ levels within 60 seconds of the stimulus.
Postpartum thrombosis of the great vein of Galen
Authors: KRENZ I. , POWER K. J.
Published: February 2007

Severe fits occurred in a patient 52 hours after placental abruption. Early use of computerised tomography scanning enabled a definitive diagnosis of thrombosis of the great vein of Galen to be made. The case illustrates the point that not all fits in the early postpartum period should be attributed to eclamptic toxaemia.
Blood pressure measurement during transport A comparison of direct and oscillotonometric readings in critically ill patients
Authors: RUNCIE C. J. , REEVE W. G. , REIDY J. , DOUGALL J. R.
Published: February 2007

This study assessed the accuracy of oscillotonometric blood pressure measurement in critically ill patients during transfer. Direct intra‐arterial pressure measurements were taken in 44 transported patients as a ‘gold standard’ and compared with readings from four portable automatic oscillotonometers—the Dinamap 8100, Lifestat 100, Propaq 102 and Takeda UA711. All under‐read systolic pressure (by 13%, 21%, 19% and 13% respectively) and over‐read diastolic pressure (by 15%, 5%, 27% and 15% respectively) in comparison to direct pressure measurement. The limits of agreement for 95% of comparisons were broad. The systematic difference between direct and oscillotonometric measurements and the variability between and within patients show that direct oscillotonometric measurements are not interchangeable in these patients. Portable automatic oscillotonometers should not be substituted for direct monitoring in such circumstances.
Loss of consciousness after emergence from anaesthesia. A case of suspected micturition syncope
Authors: KAO Y. J. , RACZ G. B.
Published: February 2007

A case of postanaesthesia micturition syncope with respiratory arrest is described. If syncope occurs, the temporary myocardial ischaemia and cerebral hypoperfusion may increase anaesthetic risk in the marginally compensated patient. The loss of airway protection during the syncopal period is also a cause of concern. We recommend the use of an indwelling bladder catheter during any prolonged surgical procedure.
Another Selectatec switch malfunction
Authors: CUDMORE J. , KEOGH J.
Published: February 2007

Malfunction of a Selectatec‐3 switch mechanism is reported which caused isolation of the selected vaporizer. This resulted in a delivery of unsupplemented fresh gas to the patient.
The laryngeal mask airway in children
Authors: Mason D. G. , Bingham R. M.
Published: February 2007

The laryngeal mask airway was used in 200 children during a variety of surgical procedures. Some problem with the use of the device was encountered in 47 cases (23%), but in only five cases (2.5%) were the problems serious enough to warrant abandonment of its use. A clear airway was ultimately achieved in 191 children. Downfolding of the epiglottis over the laryngeal inlet was identified in eight out of 24 patients where flexible laryngoscopy was performed, clinically all these had unobstructed airways. The mask was used in 16 children with known airway problems. It is concluded that the size 2 laryngeal mask airway can be successfully used within the weight range 6–30 kg.
An evaluation of a 30‐gauge needle for spinal anaesthesia for Caesarean section
Authors: Lesser P. , Bembridge M. , Lyons G. , Macdonald R.
Published: February 2007

A 30‐gauge spinal needle was evaluated for Caesarean section, using a combined epidural/spinal technique, in 50 mothers. Spinal anaesthesia failed in six mothers and was inadequate in another six. General anaesthesia was required on one occasion. A 25% overall failure rate suggests that a 30‐gauge needle is not a practical proposition for routine clinical practice.
Tussive effect of a fentanyl bolus administered through a central venous catheter
Authors: BÖHRER H. , FLEISCHER F. , WERNING P.
Published: February 2007

One hundred and ten male patients scheduled for coronary artery bypass grafting were allocated randomly into one of three groups. Patients in group A received fentanyl 7 μg/kg via a central venous catheter, those in group B were given fentanyl 7 μg/kg through a peripheral venous cannula, and patients in group C received sterile water via a central venous catheter. In group A, 45.9% of patients coughed after injection of fentanyl; the mean onset time from the end of fentanyl administration to the beginning of coughing was 10.6 seconds. Only one patient in group B and no patient in the control group exhibited a cough response (p < 0.0001). We hypothesise that fentanyl can evoke the pulmonary chemoreflex.
The Keeler Pulsair air impulse tonometer Comparison with the Perkins hand‐held applanation tonometer for peri‐operative measurement of intra‐ocular pressure
Authors: BRICKER S. R. W. , McGALLIARD J. N. , MOSTAFA S. M.
Published: February 2007

The Keeler Pulsair is a noncontact tonometer which can be used by those without specialist ophthalmic training. The instrument was compared, in a series of 30 patients in whom a total of 150 readings were taken, in respect of accuracy, ease and speed of use, and acceptability to patients, with the Perkins hand‐held applanation tonometer. There was good correlation between measurements obtained with the two instruments: r = 0.92, (p < 0.001); the Pulsair was described as easy to use in 87% of subjects, and no patient found the procedure unpleasant. The median times taken for Pulsair measurements were 7 (range 4–14) seconds for a single reading in conscious patients, and 11 (range 4–29) seconds for four readings in anaesthetised patients. These times were significantly quicker than those recorded with the Perkins tonometer which were 83 (range 66–138) seconds and 20 (range 8–45) seconds respectively (p < 0.001). We conclude that the Pulsair is suitable for use by those who are not ophthalmologists for the rapid measurement of intra‐ocular pressure changes during anaesthesia.
Clinical presentation of suspected malignant hyperthermia during anaesthesia in 402 probands
Authors: ELLIS F. R. , HALSALL P. J. , CHRISTIAN A. S.
Published: February 2007

As anaesthetists have become more aware of malignant hyperthermia the mortality rate has fallen, but concommitantly the number of dubious and aborted cases has increased. All probands who developed a suspected malignant hyperthermia reaction during anaesthesia and subsequently underwent muscle biopsy were classified according to the clinical presentation. A probability for malignant hyperthermia can be calculated, using the classification, for each type of clinical presentation; this varied from 0.96 to 0.07. Certain clinical features were found to be of more value as predictors than others; these included a high creatine kinase and myoglobinuria. The accuracy of prediction depends on a clear contemporaneous description of the clinical events.
Total intravenous anaesthesia with propofol and buprenorphine
Authors: Kamal R. S. , Khan F. A. , Khan F. H.
Published: February 2007

A combination of propofol infusion and two bolus doses of buprenorphine, 2.5 or 5.0 μg/kg were evaluated in a total intravenous anaesthesia technique in 36 patients of ASA grade 1 or 2 undergoing cholecystectomy. Additional boluses of propofol were given intravenously if needed. Systolic blood pressure after tracheal intubation increased significantly only in those who received the smaller dose of buprenorphine. Patients in both groups remained haemodynamically stable throughout surgery with minimal side effects. Recovery was fast even with prolonged infusions and without major side effects. No patient reported awareness on postoperative questioning.
The laryngeal mask airway in paediatric anaesthesia
Authors: JOHNSTON D. F. , WRIGLEY S. R. , ROBB P. J. , JONES H. E.
Published: February 2007

Forty‐eight children, aged between 2 and 10 years, admitted as day cases for otological surgery were allocated at random into two groups. The first group was anaesthetised using a standard facemask, and the second with a laryngeal mask airway. The laryngeal airway produced a satisfactory airway in all children, and was inserted on the first attempt in 67% of patients. Hypoxia was significantly less frequent in the laryngeal airway group (p < 0.05), and there were significantly fewer interruptions to surgery than in the facemask group (p< 0.001). Patient safety, operating and anaesthetic conditions were all considered superior in the laryngeal airway group.
Flumazenil in ketamine and midazolam anaesthesia
Authors: RESTALL J. , JOHNSTON I. G. , ROBINSON D. N.
Published: February 2007

A double‐blind, parallel group study using flumazenil and placebo was carried out to determine whether patients who received flumazenil would awake more quickly and whether this drug would reverse the protection conferred by midazolam on the psychic sequelae of ketamine. Fifty female patients were studied. The results showed that there was a significant reduction in awakening time (p = 0.02) and a very significant increase (p = 0.001) in the incidence of dreams in the flumazenil group.
Recurrent bronchospasm during anaesthesia
Authors: MARTIN C. S. , MILLER C. D.
Published: February 2007

Bronchospasm complicated several anaesthetics in a diabetic patient with chronic renal failure. The bronchospasm was accompanied frequently by bradycardia. The pathophysiology, treatment and implications for future anaesthetic management are discussed.
Spinal anaesthesia in a child with Job's syndrome, pneumatoceles and empyema
Authors: TAPPER J. B. , GIESECKE A. H.
Published: February 2007

We present a case of acute bowel obstruction in an immunocompromised child, who also had lobar pneumonia and a giant unilateral pneumatocele. She was successfully managed with subarachnoid anaesthesia for exploratory laparotomy to relieve a colonic obstruction. This proved to be a safe alternative to general anaesthesia with tracheal intubation in this patient and should be considered in infants and children in selected cases whenever a contraindication to general anaesthesia exists.
Evaluation of two formulations of dihydrocodeine using patient‐controlled analgesia
Authors: AITKEN H. A. , CLARK E. C. , McARDLE C. S. , DIMITRI W. , KENNY G. N. C.
Published: February 2007

A randomised, double‐blind study of 90 patients after cardiac bypass surgery was undertaken to assess the relative analgesic efficacies of normal‐ and controlled‐release oral dihydrocodeine. Patients received either placebo, normal‐release dihydrocodeine, or controlled‐release dihydrocodeine at regular intervals on the first to third days after operation. This was supplemented in all groups by intravenous morphine administered on demand by a patient‐controlled analgesia system. Morphine requirements in the control group were significantly greater during this 48‐hour period than in either of the active groups (p < 0.01), but there was no statistically significant difference between the two active preparations.
Comparison of intramuscular ketorolac and morphine in pain control after laparotomy
Authors: POWELL H. , SMALLMAN J. M. B. , MORGAN M.
Published: February 2007

Ketorolac, a prostaglandin synthetase‐inhibiting analgesic, was compared with morphine for relief of pain after laparotomy for gynaecological surgery. Eighty patients were studied; they were given either ketorolac 30 mg intramuscularly followed by 10 mg 4‐hourly as required, or morphine 10 mg intramuscularly 4‐hourly as required, administered in a double‐blind, randomised fashion. Pain scores (verbal and visual analogue) were recorded at baseline and assessed at 30 and 60 minutes and then hourly for 6 hours. Pain relief was measured at the same times. Pain and pain‐relief scores were further assessed on the evening of day 1 and at 24 hours. Pain scores were similar in the two groups but pain‐relief scores were better in the morphine group. A considerable number of patients suffered postoperative nausea and vomiting but there was no difference between the groups. One patient in the ketorolac group had unexplained hypotension. It is concluded that ketorolac can provide effective postoperative analgesia.
Pre‐operative anxiety and serum potassium
Authors: McCleane G. J. , Watters C. H.
Published: February 2007

Small decreases in serum potassium in a study of 200 pre‐operative patients were demonstrated in those who had an increase in anxiety, as measured on a linear analogue anxiety scale, in the 24 hours before anaesthesia. The possible aetiology and implications of this change are discussed. The combination of temazepam and a pre‐operative visit by the anaesthetist effectively reduced pre‐anaesthetic anxiety in 60% of patients.
Emery‐Dreifuss muscular dystrophy
Authors: MORRISON P. , JAGO R. H.
Published: February 2007

Emery‐Dreifuss syndrome is a rare form of muscular dystrophy associated with cardiac complications that lead to sudden death. The disorder and its potential anaesthetic implications in the management of a patient who presented for orthopaedic surgery is described.
Emergency adenotonsillectomy for acute postoperative upper airway obstruction
Authors: LIVESEY J. R. , SOLOMONS N. B. , GILLIES E. A. D.
Published: February 2007

Peri‐operative acute upper airway obstruction may be life‐threatening. A case is reported of a child with severe adenotonsillar hypertrophy who developed acute upper airway obstruction after a routine surgical procedure and required emergency adenotonsillectomy. The importance of pre‐operative assessment is stressed.
The role of a critical care unit in an epidemic
Authors: Kumar A , Gupta S. , Ahuja S. , Sethi A. , Bhattacharya A.
Published: February 2007

The role of a critical care unit in life‐threatening situations is well established. The management of 52 children with acute gastroenteritis and 22 children with acute paralytic poliomyelitis as part of recent epidemics is described. The solutions to the problems in the critical care management of these 74 victims (out of a total of 6197 patients admitted during the epidemics) are discussed.
Plasma concentrations of bupivacaine after supraclavicular brachial plexus blockade in patients with chronic renal failure
Authors: RICE A. S. C. , PITHER C. E. , TUCKER G. T.
Published: February 2007

The plasma concentrations of bupivacaine and the latency and duration of anaesthesia after supraclavicular block with 30 ml of 0.5% bupivacaine were measured in 10 patients with chronic renal failure and in 10 patients with normal renal function. No significant difference was found between the two groups in respect of pharmacokinetic parameters, or in block latency or duration.
Hypermetabolism in arthrogryposis multiplex congenita
Authors: HOPKINS P. M. , ELLIS F. R. , HALSALL P. J.
Published: February 2007

Two patients who developed hypermetabolic reactions during anaesthesia and surgery and who were suffering from arthrogryposis multiplex congenita are reported and it is proposed that the reaction is distinct from malignant hyperthermia and independent of the anaesthetic agents used. The implications for anaesthetists involved in the management of patients with arthrogryposis multiplex congenita are discussed.
Cyclopropane and the Datex Capnomac
Authors: MASON D. G. , LLOYD‐THOMAS A. R.
Published: February 2007

We report the effect of cyclopropane used for induction of anaesthesia in children on the subsequent measurement of maintenance volatile anaesthetic agents with the single wavelength infrared absorption technique. After using cyclopropane to induce anaesthesia we have observed that falsely high readings of the expired maintenance agent occur for up to 60 minutes when using the Datex Capnomac. This is because of the effect of low concentrations of cyclopropane expired from the patient.
Posterior tibial nerve block
Authors: WASSEF M. R.
Published: February 2007

A local analgesic block of the posterior tibial nerve, using a new subcalcaneal approach, is described. The point of insertion of the needle is defined in relation to a bony prominence below the medial malleolus, the sustentaculum tali, to which the posterior tibial nerve bears a constant relationship. Twenty patients given a posterior tibial block using the subcalcaneal approach were compared with 20 patients in whom a traditional retrotibial approach was used. In this technique the major landmark for needle insertion is the posterior tibial artery. In all patients the techniques formed part of an ankle block for foot surgery. Eighty‐five to 90% of patients had peripheral vascular disease and in 60–65% the posterior tibial artery was not palpable. In the group of patients without palpable pulses, the subcalcaneal approach had a success rate of 100%, whereas all those having the retrotibial approach required additional local analgesic supplements (p < 0.001). The subcalcaneal approach is simple and is particularly recommended for patients with peripheral vascular disease.
Are you getting the message?
Authors: WEIR P. M. , WILSON M. E.
Published: February 2007

A questionnaire sent to 109 anaesthetists in the South West Region has revealed that there is a problem with dissemination of information relating to hazards with equipment. Thirty‐four per cent of consultants, and 67% of junior anaesthetists were only slightly or not at all confident that they see the Hazard Notices and Safety Action Bulletins relating to the equipment they use. The study has also demonstrated the large amount of new equipment coming into circulation and has highlighted deficiencies in the reading of equipment manuals. Some suggestions are made as to how the current system may be improved.
Marked decrease in arterial oxygen tension associated with continuous intravenous nifedipine administration
Authors: BÖHRER H. , SCHICK M. , SCHÖNSTEDT R. , BACH A.
Published: February 2007

Intravenous nifedipine was administered to treat arterial hypertension in a 54‐year‐old woman presenting for removal of a meningioma. A marked decrease in arterial oxygen tension occurred during the nifedipine infusion. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine is discussed.
Prolonged action of enoximone in renal failure
Authors: BURNS A. M. , PARK G. R.
Published: February 2007

Enoximone was administered on two separate occasions to a 37‐year‐old woman with renal failure secondary to thrombotic thrombocytopenic purpura. Plasma concentrations of enoximone and its principal metabolite, enoximone sulphoxide, were measured over a 9‐day period. As renal function improved the rate of elimination of enoximone sulphoxide increased. The duration of effect of enoximone may be prolonged in patients with renal failure.
Cardiovascular changes at antagonism of atracurium
Authors: Suresh D. , Carter J. A. , Whitehead J. P. , Goldhill D. R. , Flynn P. J.
Published: February 2007

The cardiovascular changes in the 10 minutes following antagonism of an atracurium‐induced block were studied in 32 patients. A 5: 1 ratio combination of either 15, 35, 55 or 75 μg/kg neostigmine, with a corresponding dose of 3, 7, 11, or 15 μg/kg of glycopyrronium was used for antagonism. The least change in heart rate was with neostigmine 15 μg/kg with an increase of more than 15 beats/minute found in only one patient. Antagonism with 35, 55 and 75 μg/kg neostigmine mixture produced the greatest increase in heart rate at one minute and this was significantly different from the effect of the 15 μg/kg dose. Twenty out of 24 patients given the larger doses had heart rate increases in excess of 15 beats/minute and in nine patients this ranged from 30 to 52 beats/minute, representing increases of 46–80% above baseline values. Arterial pressure increases after antagonism were statistically significant in all four groups, with no between‐group difference; these were clinically unimportant. When antagonising an atracurium‐induced block with clinically useful doses of neostigmine, the standard 5: 1 ratio combination with glycopyrronium will result in an initial tachycardia.
Cost of intensive therapy
Authors: RIDLEY S. , BIGGAM M. , STONE P.
Published: February 2007

A preliminary study was performed to calculate the cost of intensive therapy on an individual patient basis. The fixed (equipment, supporting services and land opportunity), semi‐fixed (staff) and marginal (treatment) costs of 20 critically ill patients were calculated individually. The results show that there is wide variation in intensive therapy costs. The average daily cost for a spontaneously breathing patient was £399 (95% confidence intervals £388–£460) while that for a ventilated patient was £726 (£656–£795). The mean total cost per patient was £1980, but the cost per survivor increased by 16% (£347) because of four deaths on the intensive care unit. High total costs are associated with increased severity of illness and higher marginal (treatment) costs are associated with increased semi‐fixed (staff) costs. The cost of intensive therapy was three to five times that for general ward care.
Intubation through the laryngeal mask
Authors: HEATH M. L. , ALLAGAIN J.
Published: February 2007

Unexpected difficulty with tracheal intubation contributes to anaesthetic mortality. The laryngeal mask can almost always be placed satisfactorily and its position should facilitate blind intubation. A 6‐mm cuffed tube will pass through both adult sizes of the mask and this study tested the feasibility of intubation through the mask. The effect of the application of cricoid pressure on the technique was also investigated. Intubation via the laryngeal mask was attempted in 100 routine patients: of the first 50 (group 1, no cricoid pressure), 45 (90%) were successfully intubated. Maintenance of cricoid pressure throughout the manoeuvre (group 2) reduced the success rate significantly to 56% (p < 0.05). Despite the possibility that cricoid pressure may have to be interrupted momentarily, the ease with which the technique can be learnt, and the immediate availability of the necessary apparatus suggest that it should be considered for inclusion in failed intubation drill.
Epidural bupivacaine dilution for labour
Authors: NOBLE H. A. , ENEVER G. R. , THOMAS T. A.
Published: February 2007

We have compared the effects of three epidural infusions in a randomised, double‐blind study of 56 primigravid mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by infusion of either bupivacaine 0.125%, 0.062% or 0.031%. All solutions contained fentanyl 0.0002% and were run at 7.5 ml/hour. Women receiving the most dilute solution had significantly less analgesia (p < 0.001) for the first 4 hours of the study, but pain scores were then similar for the three groups. No obvious benefit was gained by using very dilute bupivacaine.
Epidural analgesia in Eaton‐Lambert myasthenic syndrome
Authors: SAKURA S. , SAITO Y. , MAEDA M. , KOSAKA Y.
Published: February 2007

The anaesthetic management of a patient with Eaton‐Lambert myasthenic syndrome undergoing thoracotomy is described. Epidural anaesthesia, in combination with a light level of general anaesthesia, provided good operating conditions and postoperative analgesia. Pulmonary function and ventilatory responses to carbon dioxide and hypoxia were measured before operation. These tests were repeated after the epidural administration of 8 ml 2% lignocaine before surgery and after 2 mg morphine sulphate in 10 ml saline postoperatively. Minor reductions in some of the ventilatory parameters were observed. The epidural technique appears to be a useful and safe method by which to manage patients with Eaton–Lambert syndrome undergoing thoracotomy.
Extradural vein puncture—an avoidable complication
Authors: Mannion D. , Walker R. , Clayton K.
Published: February 2007

Accidental cannulation of an extradural vein is a troublesome and potentially serious complication of extradural catheter insertion. This study was conducted to assess the influence of posture, catheter size and the injection of saline before catheter insertion, on its occurrence. Eight different techniques were studied based on combinations of these three factors. There was no difference in incidence with respect to posture. The use of 18‐gauge catheters, after injection of 10 ml of 0.9% saline, resulted in a significant (p < 0.01) reduction in the incidence of extradural vein cannulation. This technique is recommended in obstetric patients as a means of avoiding accidental intravenous injection of local analgesic.
Unilateral pulmonary oedema of the contralateral lung following transaxillary sympathectomy
Authors: COHEN J. D. , LOEWINGER J. , ZELIKOVSKI A. , GASSNER S.
Published: February 2007

A previously healthy young male developed unilateral pulmonary oedema immediately after re‐expansion of an intentionally collapsed lung after transaxillary sympathectomy. The pulmonary oedema was localised to the contralateral, uncollapsed lung.
Comparison of two techniques for sedation in dental surgery
Authors: Church J.A. , Pollock J.S.S. , Still D.M. , Parbrook G.D.
Published: February 2007

Forty‐eight patients were randomised to receive sedation for outpatient dental surgery with midazolam. Sedation was given using the Verrill technique (24 patients) and the Glasgow Dental Hospital technique (24 patients). The differences in recovery and patient acceptability were assessed. There was no statistical difference in mean recovery times between the two groups. Memory function was examined using the Warrington memory test. Fewer patients in the Verrill group recalled the injection of local anaesthetic but they demonstrated memory defects 4 hours after sedation for words and 3 hours for faces. The Glasgow Dental Hospital group demonstrated memory defects for words up to 2 hours following sedation, but not for faces at any time. Thirty‐eight patients would have dental surgery again with similar sedation. The dental surgeon found conditions for surgery inadequate in two patients. In view of the shorter duration of amnesia we recommend the Glasgow Dental Hospital technique.
Acute tolerance from benzodiazepine night sedation
Authors: SHORT T. G. , GALLETLY D. C.
Published: February 2007

The hypothesis that benzodiazepine night sedation causes acute tolerance to benzodiazepine sedation given the following morning was examined in six volunteers in a double blind, randomised, crossover study. Before each of three study days, subjects received midazolam 15 mg or flunitrazepam 2 mg or placebo as oral night sedation. They were then given intravenous midazolam 5 mg the following morning and the resulting sedative effects examined, using an observers sedation scale and a psychomotor test battery (critical flicker fusion frequency, digit‐symbol substitution, reflex time, tapping test and a visual analogue sedation scale). Although a consistent pattern emerged with the greatest degree of sedation following the placebo night sedation and the least degree of sedation following the midazolam, with flunitrazepam intermediate, no statistically significant differences were present between the three treatment groups. The results indicate that single use of benzodiazepine night sedation is not an important influence on benzodiazepine requirements for intravenous sedation.
Doxapram after general anaesthesia
Authors: SARMA V. , FRY E. N. S.
Published: February 2007

A group of patients who developed postoperative shivering after receiving inhalational anaesthesia were assigned, at random, to receive either doxapram or a placebo under double‐blind conditions. A significantly higher proportion of patients stopped shivering after being given doxapram than after the placebo.
Vocal cord paralysis in the Shy‐Drager syndrome
Authors: DRURY P. M. E. , WILLIAMS E. G. N.
Published: February 2007

A case is presented in which unexpected and persistent postoperative respiratory problems led to the finding of bilateral abductor vocal cord paralysis and confirmed the diagnosis of the Shy‐Drager syndrome. Anaesthetists should be aware that vocal cord paralysis may be a feature of this uncommon condition, and should consider the possibility of glottic obstruction as a cause of ventilatory difficulties.
Minitracheotomy Seldinger—assessment of a new technique
Authors: JACKSON I. J. B. , CHOUDHRY A. K. , RYAN D. W. , MATTHEWS H. R. , CORKE C. F.
Published: February 2007

A multicentre, prospective study of 26 patients was undertaken for the assessment of insertion of minitracheotomy tubes by the Seldinger technique. The technique of insertion is described. There were two misplacements, three blockages of the inserting Tuohy needle with fat, and six cases of difficulty in passing the minitracheotomy tube.
End‐tidal CO2 monitoring in mitral stenosis patients undergoing closed mitral commissurotomy
Authors: Puri G. D. , Venkatraman R. , Singh H.
Published: February 2007

Arterial to end‐tidal carbon dioxide difference (P(a‐E)co2) was recorded in 20 mitral stenosis patients (group A) for closed mitral commissurotomy and 20 healthy individuals (group B) for elective limb surgery. Mitral stenosis patients showed a greater difference than group B patients. Repeated measurements of P(a‐E)co2 in mitral stenosis patients at various stages of closed mitral commissurotomy not only showed a mean increase from before thoracotomy but there was also no correlation between P(a‐E)co2 before thoracotomy with that after thoracotomy, after commissurotomy or after chest closure. This indicated that end‐tidal CO2 monitoring was unsuitable to measure adequacy of ventilation during closed mitral commissurotomy.
Failure of continuous three‐channel Holter monitoring to detect acute peri‐operative myocardial infarction
Authors: MARSCH S. C. U. , CASTELLI I. , SCHAEFER H.‐G. , SKARVAN K.
Published: February 2007

Continuous peri‐operative three‐channel Holter monitoring in a 70‐year‐old patient undergoing elective hip arthroplasty failed to show onset and progression of a lethal postoperative myocardial infarction, which was clearly visible in a 12‐lead electrocardiogram. The modified bipolar leads used for Holter monitoring differed from the corresponding leads of the 12‐lead electrocardiogram. The limitations of Holter monitoring applied to clinical management and research are highlighted.
Anaesthetic problems in a child with ectrodactyly, ectodermal dysplasia and cleft lip/palate
Authors: MIZUSHIMA A. , SATOYOSHI M.
Published: February 2007

The EEC syndrome is a congenital anomaly complex associated with ectrodactyly, ectodermal dysplasia, and cleft lip and palate. We present a patient with the complete form of this syndrome who had undergone eight operations in childhood. The main problems encountered by the anaesthetists were malnutrition, difficulty with control of body temperature related to hypohidrosis and persistent infection of the respiratory tract.
Oxygen saturation and cardiovascular changes during fibreoptic intubation under general anaesthesia
Authors: Smith M. , Calder I. , Crockard A. , Isert P. , Nicol M. E.
Published: February 2007

Sixty patients who required fibreoptic nasotracheal intubation were studied. Arterial oxygen saturation, arterial blood pressure and heart rate were monitored continuously during fibreoptic intubation under deep halothane anaesthesia. There were significant decreases (p < 0.00]) in arterial blood pressure and heart rate despite administration of intravenous colloid and atropine. Almost one third of the patients (18 out of 60) suffered a decrease in arterial oxygen saturation below 90% during the intubation sequence and in five patients the saturation fell below 80%. The episodes of desaturation were not related to the induction‐intubation time or to the grade of laryngeal visibility at direct laryngoscopy.
Reversal of streptokinase induced bleeding with aprotinin for emergency cardiac surgery
Authors: AKHTAR T. M. , GOODCHILD C. S. , BOYLAN M. K. G.
Published: February 2007

Two patients requiring emergency cardiac surgery following the administration of streptokinase are described. In each case aprotinin was given to counteract the haemorrhagic effects of the streptokinase.
Pregnanolone: a new steroid intravenous anaesthetic
Authors: POWELL H. , MORGAN M. , SEAR J. W.
Published: February 2007

The intravenous steroid anaesthetic pregnanolone has been investigated as an induction agent in 60 fit adults premedicated with morphine and atropine. The drug was given in a stepwise fashion starting with 0.5 mg.kg−1; following a successful induction, the next patient received 15% less, while the subsequent patient received 15% more if anaesthesia was not achieved. Taking loss of eyelash reflex as the end point, 31 patients were satisfactorily induced; the AD50 in these patients was 0.44 mg.kg−1 (95% CI 0.41–0.47). A further 23 patients were induced satisfactorily as assessed by cessation of counting. Induction was trouble free with minimal changes in heart rate and arterial blood pressure, a low incidence of apnoea and few involuntary movements; pain on injection was not a feature. Loss of eyelash reflex is not a good end point for assessment of loss of consciousness following pregnanolone.
A clinical evaluation of the ‘Rapitrach’
Authors: BODENHAM A. , COHEN A. , WEBSTER N.
Published: February 2007

A number of percutaneous tracheostomy devices are now available commercially. We report a preliminary clinical study of the use of the ‘Rapitrach’ kit (Fresenius, Runcorn, Cheshire, UK). Twenty critically ill adult patients underwent tracheostomy using the kit. Nineteen of the procedures were carried out at the bedside in the intensive therapy unit. Correct tube placement was achieved in all cases.
Epidural pethidine and bupivacaine in labour
Authors: Edwards N. D. , Hartley M. , Clyburn P. , Harmer M.
Published: February 2007

A double‐blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty‐nine patients received either I ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.
Hyperkalaemic periodic paralysis and anaesthesia
Authors: ASHWOOD E. M. , RUSSELL W. J. , BURROW D. D.
Published: February 2007

Hyperkalaemic periodic paralysis is the rarer of the two forms of potassium‐associated familial paralysis. We report a family with hyperkalaemic periodic paralysis with paramyotonia and the anaesthetic management of four affected members. In three of these, paralytic episodes had been precipitated by previous anaesthesia, but this was avoided in the anaesthetics described. We conclude from our experiences that with depletion of potassium before surgery, prevention of carbohydrate depletion, avoidance of potassium‐releasing anaesthetic drugs and maintenance of normothermia, patients with hyperkalaemic periodic paralysis can be anaesthetised without complications. We have no evidence that they exhibit abnormal sensitivity to nondepolarising neuromuscular relaxants.
An analogue approach to audit in anaesthesia
Authors: SCOTT P. V. , HADEN R. M. , PINNOCK C. A. , BRIDGE H. S. , LAWRANCE A. J.
Published: February 2007

The predicted outcome of anaesthesia and surgery was compared with the immediate outcome in 508 patients by means of two 100 mm linear analogue scales. The results were used to obtain a statistically based rule by which the anaesthetist may consistently select three groups of patients for audit: group l, patients in whom immediate outcome of anaesthesia and surgery is worse than predicted; group 2, patients whose outcome is better than predicted; and group 3, the remaining patients. The rule, which is simply adapted to departmental audit, does not necessarily need a computer but is suited to the computer as it is numerically based.
A comparison of laryngeal mask airway with tracheal tube for intra‐ocular ophthalmic surgery
Authors: AKHTAR T. M. , McMURRAY P. , KERR W. J. , KENNY G. N. C.
Published: February 2007

The use of the laryngeal mask was compared with tracheal intubation in 30 patients who underwent intra‐ocular ophthalmic surgery and who received intravenous anaesthesia with propofol. Changes in intra‐ocular pressure, heart rate and mean arterial pressure after the insertion of the laryngeal mask airway or the tracheal tube were not significantly different. However, at the end of the procedure, a significantly higher percentage of patients with a tracheal tube coughed, reacted to head movement and suffered breath‐holding. In addition, significantly more patients in this group complained of a sore throat (p<0.05). During intravenous propofol anaesthesia, the laryngeal mask airway does not offer any advantage over tracheal intubation in the control of intra‐ocular pressure for intra‐ocular ophthalmic surgery. However, there were fewer complications immediately following surgery in the laryngeal mask group.
An overdose of ecstasy
Authors: SINGARAJAH C. , LAVIES N. G.
Published: February 2007

An overdose of the semisynthetic, hallucinogenic amphetamine 3,4‐methylenedioxymethamphetamine resulted in convulsions, hyperthermia, hyperkalaemia and rhabdomoy lysis. The patient's management, which included the use of dantrolene, is discussed.
Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula?
Authors: Langham B. T. , Harrison D. A.
Published: February 2007

A recent study performed in this department showed that a subcutaneous injection of local anaesthetic was significantly less painful than the insertion of a 22‐gauge venous cannula. However, our colleagues remained sceptical that local anaesthetic infiltration would eliminate the pain of cannulation. Consequently a further study was undertaken to compare the pain of cannulation with and without the use of local anaesthetic. The results show that pain of cannulation is significantly (p < 0.003) reduced after subcutaneous infiltration with 1% lignocaine when compared to cannulation without local infiltration. Persistent discomfort at the site of cannulation was eliminated by the use of local anaesthetic.
The occupational hazard of human immunodeficiency virus and hepatitis B virus infection
Authors: O'Donnell N. G. , Asbury A. J.
Published: February 2007

The effect of grade, age, sex and region of employment on the attitude of anaesthetists to the possible risk of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) infection and the measures adopted to minimise the risk were assessed. As a group, anaesthetists in training were more concerned than consultants about the risk of HIV or HBV infection and, as a consequence, were more likely to adopt protective measures. A similar variation was seen with age, younger anaesthetists being more concerned about the risk of infection and adopting preventive measures in greater numbers than their older colleagues. The sex of the anaesthetist had minimal effect on their attitude. Despite the marked variation in the incidence of both HIV and HBV, the attitude of anaesthetists to the risk of infection and the numbers adopting simple preventive measures did not vary significantly on a regional basis throughout the country. However, there was a significant inter‐regional variation in the availability and uptake of HBV immunisation (p < 0.01) and knowledge of the existence of local policy guidelines for the management of known HIV or HBV positive patients (p < 0.01).