bluuebunny/crossref_metadata_2025 huggingface dataset:
Aspirin in the prevention of painful intravenous injection of disoprofol (ICI 35,868) and diazepam (Valium)
Authors: Bahar M. , McAteer E. , Dundee J. W. , Briggs L. P.
Published: February 2007

Pain caused by intravenous injection in the dorsum of the hand of ICI 35,868 and diazepam (Valium) was studied. The effect of pretreatment with intravenous aspirin was compared with two groups—one pretreated with fentanyl and an untreated group. In the case of diazepam neither analgesic drug prevented pain on injection whereas with ICI 35,868 pain was significantly reduced by both drugs.
The anaesthetist and the obstetric department
Authors: LODER R. E.
Published: February 2007

The author retired from active practice as a consultant anaesthetist in the British National Health Service during 1980 at the age of 60. He kept a detailed diary for the last full year as a consultant. One of the editors suggested that the diary, augmented by his considered views culled from the experiences of a professional lifetime, could form the basis of a series of essays on various aspects of the life and practice of a consultant anaesthetist during the second half of the twentieth century. This essay considers the special and increasing responsibility of the anaesthetist in the obstetric department, both for the provision of analgesia in the labour ward and anaesthesia for operative obstetrics, and as a link between others who are vitally concerned in the provision of safe perinatal care for both mother and child.
Epidural morphine in the elderly
Authors: KLINCK J. R. , LINDOP M. J.
Published: February 2007

The effectiveness of epidurally administered morphine in the relief of pain after upper abdominal surgery was assessed in a controlled study involving 20 patients aged 61 to 78 years. Analgesia provided by epidural morphine was comparable to that obtained in matched patients given an intramuscular régime. The total dose required by the epidural route was less than one‐fifth that required intramuscularly, and sedation was correspondingly reduced. Postoperative respiratory mechanics, however, were not significantly improved and delayed respiratory depression was observed in one patient. It is concluded that in elderly patients undergoing upper abdominal surgery the risks related to the use of morphine by the epidural route outweigh the marginal advantages it may offer over conventional analgesic techniques.
Barbotage and spinal anaesthesia
Authors: NIGHTINGALE P. J.
Published: February 2007

Subarachnoid block was performed with 0.5% plain bupivacaine in 67 patients with patients in the lateral position and the table horizontal. Thirty‐six patients had a single injection while in the remaining 31 patients barbotage was used. Injection rates and aspiration rates were constant in both groups at 0.33 ml/second. Mean volumes of bupivacaine used in the two groups were 3.30 and 3.35 ml, respectively. The mean spread of analgesia after 30 minutes was 0.9 dermatomes higher in the group which received a single injection, and this was not statistically significant. The range of spread of analgesia was large in both groups, there was no correlation between spread of analgesia and volume of local anaesthetic used, and there was no correlation between age of patient and spread of analgesia in either group. Control of the level of analgesia during isobaric spinal block is difficult, and is not facilitated by barbotage.
Misconnexion of a cuffed ‘speaking’ tracheostomy tube
Authors: FENECK R. O. , SCOTT WENDY E.
Published: February 2007

Tracheal dilatation in a patient with a cuffed vocal‐aid plastic tracheostomy tube is described. Dilatation followed the inadvertent connexion of continuous flow oxygen, necessary for voice production, to the pilot tube of the tracheal cuff. A modification of the tube is described, and recommendations for future use of such tubes are discussed.
Mannitol, osmolality and steroids during renal transplantation
Authors: CHARTERS P.
Published: February 2007

Mannitol did not have an exaggerated effect on plasma potassium when administered to twelve patients undergoing renal transplantation. Unexpected rises in plasma osmolality, greater than those recorded after mannitol, were observed in two of the patients. In these two patients the osmolality changes were due to sudden hyperglycemia and followed methylprednisolone therapy (given for immunosuppression).

It is suggested that under certain circumstances, such changes in osmolality may lead to a rise in plasma potassium comparable to the effect of mannitol. One of the two patients with the rise in glucose and osmolality did have a rise in plasma potassium.
Epidural analgesia and previous Caesarean section
Authors: UPPINGTON J.
Published: February 2007

A series in which six cases of ruptured uterus occurred following previous lower segment Caesarean section, out of a total of 222 ‘trials of scar’, is presented, and the literature reviewed in an attempt to clarify the term ‘relative contra‐indication’ as applied to this clinical circumstance. The symptoms and signs of ruptured uterus likely to be blocked by an epidural, i.e. maternal tachycardia, scar tenderness and continuous lower abdominal pain, have been shown to be either unreliable (tachycardia and tenderness) or frequently not to occur at all (pain). When pain does occur it is not necessarily masked by an epidural. It is concluded that previous lower segment Caesarean section is not a contraindication to epidural analgesia in a subsequent labour provided certain conditions are fulfilled.
A new anaesthetic breathing system combining Mapleson A, D and E principles
Authors: HUMPHREY D.
Published: February 2007

A new simple anaesthetic breathing system is described which has been designed to incorporate into a single system advantages of Mapleson A, D and E type systems. Coaxial and non‐coaxial versions are available. The system can be used for adults, children or neonates and allows both spontaneous or controlled ventilation with low fresh gas flows at all times.

As a Mapleson A system for spontaneous respiration a considerable saving of anaesthetic gases and vapours is achieved since, for adults, the new system requires a lower fresh gas flow even than that for the Magill. For children breathing spontaneously the system requires only one third of the fresh gas flow necessary for the Jackson Rees modification of Ay re's T‐piece. For controlled ventilation the system behaves as a modified Mapleson D/E (Bain type) system with the advantage of predictable CO2 tensions and good humidification. The system is safe, simple in design and operation, and is easily sterilized. Further it offers low resistance to expiration and facilitates scavenging at all times which, with low anaesthetic gas flows, permits complete theatre pollution control.

Its potential application in academic and rural environments and major advantages over the circle absorber system are discussed.
Dose‐response relationships for infusions of Althesin or methohexitone
Authors: SEAR J. W. , PHILLIPS K. C. , ANDREWS C. J. H. , PRYS‐ROBERTS C.
Published: February 2007

A technique is described for the determination of equipotent rates of infusion of intravenous hypnotic agents. Two end points have been defined; the rates needed to suppress the initial response to the surgical incision in 50% (ED50) and 95% (ED95) of patients receiving continuous infusion anaesthesia to supplement 67% nitrous oxide in oxygen. For patients aged 20–60 years, and premedicated with morphine 0.15 mg/kg intramuscularly, the ED50 values for Althesin (as alphaxalone) and methohexitone by infusion were 13.7 and 48.8 μg/kg/minute respectively. The ED95 values were 18.1 and 75.9 μg/kg/minute. For patients of a similar age premedicated with diazepam 10 mg orally, the ED50 values for Althesin and methohexitone were 18.5 and 66.0 μg/kgjminute respectively; while the ED95 values were 24.2 and 80.8μg/kg/minute.
Epidural versus intramuscular fentanyl
Authors: JUSTINS D. M. , KNOTT CHRISTINE , LUTHMAN JUDITH , REYNOLDS FELICITY
Published: February 2007

In a randomised double blind trial, 36 patients in the first stage of labour received either epidural or intramuscular fentanyl at the same time as the epidural test dose of bupivacaine. Analgesia was more rapid in onset and more complete in the epidural fentanyl group. Supplementary doses of bupivacaine were required within the first hour in 62% of the intramuscular fentanyl group compared with only 16% in the epidural group. Plasma fentanyl concentrations showed wide interindividual variation, but after epidural fentanyl the peak occurred earlier. There was no correlation between analgesia and plasma fentanyl concentration, and epidural fentanyl produced superior analgesia but a systemic contribution to this effect cannot be ruled out.
Pneumothorax in the neonatal period
Authors: JONES R. M. , RUTTER N. , COOPER A. C. , PULLAN C. R.
Published: February 2007

The incidence of pneumothorax in the neonatal period is reviewed. Most infants who developed a pneumothorax were undergoing intermittent positive pressure ventilation. The most common underlying pathology associated with pneumothorax was idiopathic respiratory distress syndrome. This was the only condition in which a pneumothorax occurred in spontaneously breathing patients. The development of a pneumothorax was not significantly related to gestational age, birth weight, high ventilator inflation pressure, maximum fractional inspired oxygen concentration or the method of delivery. Evidence is presented to suggest that the development of a pneumothorax is not primarily a complication of ventilation but is due to the more severe pulmonary pathology of infants who require ventilatory assistance. Whatever the mechanism, prompt diagnosis and treatment mean that this common complication does not necessarily increase mortality.
Circulation, respiration and serotonin levels in carcinoid patients during neurolept anaesthesia
Authors: TÖRNEBRANDT K. , NOBIN A. , ERICSSON M. , THOMSON D.
Published: February 2007

Release of hormones peri‐operatively in patients with metastatic carcinoids may lead to severe circulatory and respiratory disturbances. Fourteen patients with liver metastases were studied during 16 operations with a modified neurolept anaesthesia in order to evaluate the central haemodynamic and respiratory functions as well as plasma serotonin levels. The premedication in five patients was supplemented with levopromazine. During the 11 operations performed on patients not pretreated with levopromazine, no major significant fluctuations in circulatory or respiratory functions were recorded although big variations in serotonin plasma levels were measured. In the patients treated with levopromazine, however, significant changes were observed in heart rate, mean pulmonary artery pressure, cardiac index, and left and right ventricular stroke work especially during flushing episodes. However, these changes did not correlate with the changes in plasma serotonin levels. Modified neurolept anaesthesia without levopromazine pretreatment combined with careful monitoring seems to be a safe procedure for carcinoid patients. Using this type of anaesthetic procedure only one major complication occurred in connexion with 16 major operations and then in the postoperative period.
Unilateral cold neck
Authors: WATSON B. G.
Published: February 2007

A case is reported of survival following accidental cannulation of the innominate artery during cardiopulmonary bypass. Coldness of the right side of the neck was noticed during cooling of the patient and is a useful new sign of misplacement of the aortic cannula. Confirmation of miscannulation of first the innominate then the left common carotid artery was obtained by palpation of the neck pulses during total cardiopulmonary bypass using a pulsatile pump.
Quinine overdose Prevention of visual damage by stellate ganglion block
Authors: BOSCOE M. J. , CALVER D. M. , KEYTE C. , AYRES J. G.
Published: February 2007

A case of quinine poisoning is described. Stellate ganglion block was performed immediately on the basis of the clinical history of visual disturbance without waiting for physical signs to develop. There was no residual field defect despite the presence of toxic levels of the drug. It is suggested that stellate ganglion block may prevent development of visual field defects.
Increased cortisol excretion in chronic pain
Authors: DPhil R.A. Moore , Evans P.J.D. , FIMLS R.F. Smith , FFARCS J.W. Lloyd
Published: February 2007

Urine samples were collected from 67 patients attending a Regional Pain Unit for treatment of chronic pain. Patients treated with steroids or with any signs or symptoms of Cushing's syndrome were excluded. The urine Cortisol/ creatinine ratio was subsequently measured.

Values for the urine Cortisol/creatinine ratio were elevated in 31% of the patients, and grossly elevated in some. These patients could not be differentiated from those with normal ratios on the basis of pain or mood scores, cause of pain or drug therapy; they tended to have pain of shorter duration. Possible interpretations of these results are discussed.
Anaesthesia in the morbidly obese
Authors: BUCKLEY F. P. , ROBINSON N. B. , SIMONOWITZ D. A. , DELLINGER E. P.
Published: February 2007

Seventy morbidly obese patients presented for upper abdominal surgery; 17% had pre‐existing cardiovascular disease and 23% pre‐existing respiratory disease. Twenty‐eight patients received general anaesthesia, plus narcotic analgesia postoperatively, and 42 general anaesthesia plus thoracic epidural analgesia intra‐ and postoperatively. Aspects of anaesthetic management are discussed and compared with previous similar reports. Doses of local anaesthetic for induction of epidural analgesia were less than those for the non‐obese but doses of local anaesthetic for maintenance of epidural analgesia were similar to those in non‐obese patients. Patients who had thoracic epidural analgesia required less volatile anaesthesia than the group who had general anaesthesia and narcotic analgesics. Postoperative respiratory complications were more common in patients with pre‐existing cardiovascular and respiratory disease, and occurred less frequently in patients who had thoracic epidural analgesia.
Oculocardiac reflex from the empty orbit
Authors: KERR W. J. , VANCE J. P.
Published: February 2007

Two cases of profound bradycardia (one progressing to asystole) during orbital surgery where the relevant eye had been removed years earlier are reported. Cessation of stimulation was followed by recovery of heart rate. Intravenous atropine prevented further bradycardia.
Midazolam—does it cause resedation?
Authors: Ruiz K. , Asbury A.J. , Thornton J.A.
Published: February 2007

The objective of this double blind study was to compare the sedation following the intravenous injections of midazolam in three dose levels (0.07, 0.10 and 0.15 mg/kg), and to assess the time taken after each dose to return to street fitness.

Recovery was monitored by measurement of reaction time. The mean results for each dose were compared against placebo and each other using the Student's t‐test. All doses gave a significant (p < 0.05) lengthening of reaction time compared to placebo. The two highest doses gave similar results when compared to 0.07 mg/kg. but not when compared to each other. Reaction times always returned to control values within 3 hours of injection. The Deletion of Ps test was also employed. A significant correlation was found between the results of reaction time testing and the Deletion of Ps test.
Day‐case anaesthesia for termination of pregnancy
Authors: OGG T. W. , JENNINGS R. A. , MORRISON C. G.
Published: February 2007

An investigation was undertaken to assess the use of a total intravenous anaesthetic technique offentanyl and methohexilonc for outpatient vaginal termination of pregnancy. When compared with a technique offentanyl, methohexitone, nitrous oxide and trichloroethylene the total intravenous method caused snifter recovery, minimal side‐effects and no cardiovascular depression. However, both anaesthetic techniques produced significant postoperative reduction of memory for new facts when compared with a control group receiving no general anaesthesia. There is a need to continue the search for anaesthetic methods appropriate for day cases.
Postoperative analgesia provided by morphine infusion in children
Authors: BRAY R. J.
Published: February 2007

A technique is described for using morphine by continuous infusion to relieve postoperative pain in children between the ages of 1 year and 15 years. The pain relief produced by the infusion was found to be significantly better than that produced by intramuscular injections of morphine given as required in 20 children after major surgery.
The MIE Carden ventilator
Authors: FLETCHER I. R. , CARDEN E. , HEALY T. E. J. , POOLE T. R.
Published: February 2007

The Carden ventilator is described and assessed when used in adult and paediatric modes against lest lungs with varying compliance and airways resistance. The ventilator proved to have limited ability to compensate for changes in test lung compliance and resistance. Repeated confirmation of tidal volume is mandatory, but the Carden combines simplicity with flexibility of design and may prove useful as a theatre ventilator.
Intramuscular and oral midazolam. Some factors influencing uptake
Authors: Hildebrand P.J. , Elwood R.J. , McClean E. , Dundee J.W.
Published: February 2007

Intramuscular midazolam is better absorbed than when given orally. Addition of hyaluronida.se to the injection significantly increases uptake but causes a high incidence of pain at the injection site. Concurrent administration of oral midazolam and metoclopramide does not increase its uptake.
Diagnosis of the causes of anaphylactoid anaesthetic reactions
Authors: LAXENAIRE M.‐C. , MONERET‐VAUTRIN D. A. , WATKINS J.
Published: February 2007

Adverse, anaphylactoid, reactions to the intravenous drugs and other substances used in anaesthesia and surgery pose a major problem in many countries. The scope of the problem is somewhat difficult to judge since agreement can rarely be reached as to what is, or as to what is not, an adverse reaction. While the death of a fit young patient undergoing minor investigative surgery is an obvious candidate for inclusion, many of the very minor incidents of urticaria, mild hypotension and mild bronchospasm are less easy to classify since they may arise from theatre techniques, from underlying pathology, known or unsuspected, as well as from complex psychosomatic and psychosocial stimuli. Minor manifestations may not hinder the immediate procedure, but their incorrect interpretation may lead to a disaster during a general anaesthetic procedure weeks, or even years, later.
Neurological complications following aortic surgery
Authors: COSTELLO T. G. , FISHER A.
Published: February 2007

A case of spinal cord ischaemia developing in a man aged 70 years following thoracic aortic surgery is reported. In contrast, two further cases associated with surgery for resection of coarctation of the aorta are described, in a younger age group. A review of the literature reveals a small but increasing incidence of reports of spinal cord complications following varied types of surgery; the anatomy of the blood supply to the spinal cord is reviewed and recommendations are made for the appropriate conduct of anaesthesia and surgery in patients at risk.
Atypical ventricular tachycardia (torsade de pointes)
Authors: ALEXANDER M. G. , POTGIETER P. D.
Published: February 2007

Torsade de pointes is an atypical or variant ventricular tachycardia. We report a case of atypical ventricular tachycardia (torsade de pointes) in a patient with severe obstructive lung disease which occurred following surgery. The factors that may precipitate this dysrhythmia often occur in the postoperative period. The correct diagnosis is vital as the treatment for this dysrhythmia differs markedly from the treatment for the more common ventricular tachycardia.
Epidural analgesia and forceps delivery: laying a bogey
Authors: Bailey P.W. , Howard F.A.
Published: February 2007

The spontaneous and operative delivery rates on a labour ward are compared in the years before and after the initiation of m epidural analgesia service. An epidural rate of 27% of all deliveries in the first year is the only influence affecting an otherwise almost steady obstetric background. Despite this major impact, the changes in operative delivery rates are small and fail to reach statistical significance, although the decrease in spontaneous deliveries is significant. In later years the epidural rate rose to involve 7.2% of primiparae and 26% of multiparae, yet the pattern of deliveries tended to return toward the pre‐epidural picture.
Postoperative dreaming
Authors: JAGO R. H. , RESTALL J.
Published: February 2007

The incidence of postoperative dreaming following the use of morphine and pentazocine as premedicants in an otherwise standard anaesthetic sequence is compared in healthy volunteers. No statistically significant difference was demonstrated between the two drugs. The causes of psychotomimetic problems in the postoperative period and the difficulty of precise definition of hallucinaltions are discussed.
Coronary artery spasm during non‐cardiac surgical procedure
Authors: BRIARD C. , CORIAT P. , COMMIN P. , CHOLLET A. , MENASCHE P. , ECHTER E.
Published: February 2007

A case of coronary artery spasm during a non‐cardiac surgical procedure is presented. Two paroxysmal episodes of ST segment elevation in lead 11 and aVF without changes in V5 developed during general anaesthesia. These changes were not preceded by increases in heart rate or arterial pressure. The second episode was associated with a ventricular bigeminal rhythm. This case demonstrates the importance of monitoring several leads in patients likely to develop per operative spasm of the coronary arteries. Intravenous nitroglycerin was effective in treating the second episode of coronary artery spasm. However, this episode occurred in spite of nitroglycerin administered intravenously at a rate of 0.25 μg/kg min.
Bypassing a problem airway
Authors: LAYMAN P. R.
Published: February 2007

A case of cancrum oris is described. Airway control was difficult at three different stages of treatment. The use of transtracheal ventilation allowed the problem airway to be bypassed on each occasion, avoiding the dangers of blind nasal intubation, tracheostomy and guided intubation techniques.
Unilateral computerised tomography guided coeliac plexus block: a technique for pain relief
Authors: Filshie Jacqueline , Golding S. , Robbie D.S. , Husband Janet E.
Published: February 2007

Twelve patients have undergone unilateral coeliac plexus block using needle localisation by computed tomography and the technique is described. Computed tomography has the advantage that the needle route to the coeliac axis can be accurately planned, avoiding damage to other organs. In this study nine out of twelve patients had significant pain relief. Most success was achieved in patients with carcinoma of the pancreas.
Ventilatory response to morphine in young and old subjects
Authors: ARUNASALAM K. , DAVENPORT H. T. , PAINTER S. , JONES J. G.
Published: February 2007

The effects of intravenous morphine (10 mg/70 kg body weight) on ventilation in two groups of subjects, young (age 28–37 years) and old (age 65–82 years) were studied prior to elective surgery. There was no significant difference between the two groups in minute ventilation, ventilatory frequency and end‐tidal carbon dioxide before morphine administration. In both groups there was a significant depression of ventilation and elevation of end tidal carbon dioxide tension 20 minutes after intravenous morphine. There was no significant difference between the two groups in the response of these variables to morphine. However, in the older group seven out of thirteen subjects showed frequent periods of apnoea or periodic breathing whereas three of the young subjects had these phenomena at much less frequent intervals. Respiratory depression after morphine is similar in old and young patienls but old patienls have more change in ventilatory control.
Epidural analgesia following thoracic surgery
Authors: CONACHER I. D. , PAES M. L. , JACOBSON L. , PHILLIPS P. D. , HEAVISIDE D. W.
Published: February 2007

The use of thoracic epidurals for postoperative pain relief in 58 patients following thoracic surgery is reviewed. Epidural catheters were inserted at the end of the operative procedure and it was planned that analgesia was to be maintained with a continuous infusion of bupivacaine. In those patients with evidence of successful neurological blockade there was a high incidence of adverse effects. Hypotension occurred in nearly 80% of patients and inadequate analgesia necessitating intramuscular opiates in 30%. The results suggest that the method adopted is unsuitable for some patients who have undergone major pulmonary surgery, although it has proved a useful adjuvant for pain relief in patients who have had other intrathoracic operations.
Evaluation of Spirolog I volume meter
Authors: CHAKRABARTI M. K. , LOH L.
Published: February 2007

A volume meter (Dräger Spirolog I) is evaluated for clinical use. It works on the principle of a constant temperature anemometer and displays tidal volume, minute volume and frequency. It was found that the volume recorded was hardly affected by oxygen concentration, humidity or temperature but was affected by high concentrations of nitrous oxide and during the operation of diathermy.
Sedation for local anaesthesia. Comparison of intravenous midazolam and diazepam
Authors: Dixon J. , Power S.J. , Grundy E.M. , Lumley Jean , Morgan M.
Published: February 2007

Intravenous midazolam and diazepam have been compared as sedatives during surgery performed under local anaesthesia. Satisfactory conditions were produced by both drugs. No difference was detected in the rate of recovery, but a highly significant greater degree of amnesia followed the use of midazolam.
Contamination of hypodermic needles in anaesthetic practice
Authors: CLARKE T. N. S. , HUMAN R. P.
Published: February 2007

The study was undertaken to define and compare the incidence of bacterial contamination on opening three different types of hypodermic needle package. Four user groups were studied (anaesthetists, intensive care nurses, operating department assistants and medical laboratory scientific officers). Bacterial contamination was shown to occur and to be related to the type of needle packaging, the ratio of contamination incidence being similar in all four user groups. The results emphasize the importance of a careful opening technique when using sterile packaged hypodermic needles.
A comparison of midazolam and diazepam for intravenous sedation in dentistry
Authors: Aun C. , Flynn P. J. , Richards J. , Major E.
Published: February 2007

In a randomised cross‐over trial, midazolam, a new water soluble benzodiazepine was compared with the conventional diazepam preparation (Valium) in 34 patients aged 16—45 years who were undergoing outpatient conservation dentistry. Midazolam hydrochloride (0.17 mg/kg) was virtually free of venous complications and showed advantages over diazepam (0.32 mg/kg) in providing a faster onset of action, higher incidence of amnesia and more rapid recovery. Midazolam produced a higher incidence of respiratory side effects: hiccough (17.6% compared with 2.9%), brief apnoea following induction (11.8% compared with 5.8%), and airway obstruction during maintenance (8.8%, compared with 0%). These may be related to the greater potency of midazolam as suggested by the smaller total dose required. Cardiovascular changes and operating conditions were similar.
An assessment of the Humphrey ADE anaesthetic system in the Mapleson A mode during spontaneous ventilation
Authors: Dixon J. , Chakrabarti M. K. , Morgan M.
Published: February 2007

The Humphrey ADE anaesthetic breathing system in the Mapleson A mode has been compared with the Magill system in spontaneously breathing conscious volunteers and anaesthetised patients. In the latter, rebreathing occurred at a significantly lower fresh gas flow with the ADE system than when the Magill system was used (mean 45.6 ml/kg/minute und 56.5 ml/kg/minute respectively). There was no significant difference between the fresh gas flow at which rebreathing orcurred in conscious volunteers.
Intensive care patients in district hospitals. A case for transfer?
Authors: Lavery G. G. , Donnelly P. B. , Dundee J. W.
Published: February 2007

Patients, admitted and primarily treated in a rural hospital, who required varying periods of intensive care management have been reviewed. The criteria for transfer of such patients 10 more specialised units and the hazards associated with ambulance travel are discussed. We describe measures to reduce these hazards and also a scheme for more uniform documentation and follow‐up of such cases by the unaesthetist involved in primary care.
Convulsive reaction following enflurane anaesthesia
Authors: JENKINS J. , MILNE A. C.
Published: February 2007

A case of convulsive muscle activity immediately after recovery from enflurane anaesthesia is reported. The implications for postoperative oxygen therapy and management are discussed.
Postoperative analgesia for Caesarean section using epidural methadone
Authors: Beeby Diana , MacIntosh K.C. , Bailey M. , Welch D.B.
Published: February 2007

A prospective randomised double blind study was carried out to compare the use of epidural methadone, morphine and bupivacaine for pain relief after Caesarean section. The results indicate that methadone is the most effective agent with few side effects. Subsequently this method was used routinely for postoperative analgesia in all patients undergoing Caesarean section. A retrospective study of 178 patients having this method of analgesia was carried out and indicated that epidural methadone is an effective and safe method of postoperative pain relief.
Anaesthetic management during repair of tracheo‐oesophageal fistula
Authors: CHAN C. S.
Published: February 2007

A flexible fibreoptic laryngoscope was used to facilitate the passage of a long polyvinyl chloride tracheal tube into the left main bronchus during repair of a tracheo‐oesophageal fistula situated near the carina in a patient in whom intubation with a double‐lumen endobronchial tube was difficult. Close monitoring of neuromuscular transmission using a peripheral nerve stimulator also contributed to the successful unaesthetic management of this patient.
Anaesthetic carrier gases
Authors: MANN M. S. , WOODSFORD P. V. , JONES R. M.
Published: February 2007

The effects of three different anaesthetic carrier gases on middle‐ear pressure in the operative and postoperative periods was assessed. Patients receiving oxygen and oxygen‐enriched air did not have significant changes in middle‐ear pressure. The changes associated with the use of nitrous oxide as the carrier gas were reversed with return of pharyngeal reflexes or after prolonged inhalation of 100% oxygen. In patients undergoing middle‐ear surgery or those with pre‐existing middle‐ear disease, we suggest that oxygen‐enriched air is the anaesthetic carrier gas of choice.
High‐frequency jet ventilation for tracheal surgery
Authors: ROGERS R. C. , GIBBONS J. , COSGROVE J. , COPPEL D. L.
Published: February 2007

The anaesthetic requirements for tracheal resection include a clear airway, adequate ventilation and good surgical access. Many techniques have been described, none of which is entirely satisfactory. This case reports on the use of high‐frequency jet ventilation with 10Fg catheter combined with muscle relaxants and intravenous anaesthesia in a patient with tracheal stenosis.
Ischaemia following selfadministered intra‐arterial injection of methylphenidate and diamorphine
Authors: CORSER G. , MASEY S. , JACOB G. , KERNOFF P. , BROWNE D.
Published: February 2007

A patient presented with a painful, oedematous, cyanosed hand having injected a solution of diamorphine and methylphenidate into his radial artery. Treatment was started with heparin and vasodilators. Benefit from this was limited and a course of intra‐arterial urokinase was instituted. This gave almost total resolution of the injury. The mechanisms producing ischaemia following intra‐arterial injection of drugs of abuse and possible treatment are discussed.
Blocking the circulatory responses to tracheal intubation
Authors: KAY B. , HEALY T. E. J. , BOLDER P. M.
Published: February 2007

The effects of three drug administration programmes on the haemodynamic responses to tracheal intubation have been compared. Thirty patients received thiopentone 4 mg/kg. Ninety seconds later, following the injection of either saline, nalbuphine 0.3 mg/kg or fentanyl 5μg/kg, suxamethonium 1.5 mg/kg was given. The pressor response to tracheal intubation which occurred after saline was reduced after nalbuphine (p < 0.05) but a tachycardia still occurred. In contrast, neither an increase in blood pressure nor heart rate occurred in those patients given fentanyl. It is concluded that nalbuphine 0.3 mg/kg is only partially efective in reducing the cardiovascular responses to laryngoscopy and tracheal intubation.
Evaluation of the IVAC 560 volumetric pump
Authors: HUTCHINSON A. , YEOMAN P. M. , BYRNE A. J.
Published: February 2007

The performance of a new combined infusion pump and central venous pressure monitor, the IV AC 560, has been evaluated in laboratory and clinical studies. The pump performed accurately and reliably, and the pressure readings obtained from the pump correlated well with conventional methods of pressure measurement, although they lost accuracy when using 50% dextrose at higher venous pressures.
Respiratory complications following cardiac surgery
Authors: GOULD F. K. , FREEMAN R. , BROWN M. A.
Published: February 2007

Sputum specimens were received for microbiological examination from 110 patients following open heart surgery. The isolation of Haemophilus influenzae occurred significantly more often in those patients who had pre‐existing chest disease, but was not associated with postoperative chest problems. There was a significant association between pre‐operative heart failure and subsequent severe pulmonary complications.
Excessive dose requirements of local anaesthetic for epidural analgesia
Authors: KUMAR C. M. , DENNISON B. , LAWLER P. G. P.
Published: February 2007

On two separate occasions, a 78‐year‐old obese man suffering from congestive cardiac failure and peripheral vascular disease, required epidural anaesthesia for surgery to his leg. The dosage requirement on the first occasion was large and much greater than on the second occasion. Reasons for the difference in dosage are discussed. We suggest an epidural catheter should be inserted 3 cm into the epidural space.
Assessment and modification of pain on induction with propofol (Diprivan)
Authors: McCulloch M.J. , Lees N.W.
Published: February 2007

Assessment of pain on injection of the emulsified formulation of di‐isopropylphenol (propofol, ‘Diprivan’) was undertaken in 120 unpremedicated patients and comparison made with thiopentone. A high incidence of pain (37.5%) was found using dorsal hand veins, but use of forearm veins showed only a 2.5% incidence of pain. The use of intravenous lignocaine immediately before propofol injection only partially reduced the incidence of pain using dorsal hand veins (17.5%). A degree of cardiorespiratory depression accompanied induction but the incidence of other side effects was low.
Epidural blood patch using a catheter. Diagnosis of an unrecognised dural tap
Authors: Shah J.L. , Veness A.M.
Published: February 2007

Twenty five patients were treated with an epidural blood patch for persistent headache, following a known or suspected dural puncture. Fifteen to 20 ml blood was injected into the epidural space through a catheter inserted one space away from the dural puncture. The catheter technique was useful in confirming the clinical diagnosis of previously unrecognised dural tap in six patients with severe headache. It was possible to perform the blood patch single‐handed.
Opitz‐Frias syndrome
Authors: BOLSIN S. N. , GILLBE C.
Published: February 2007

The unaesthetic management is described of a nine‐month‐old male for surgical palliation of the the functional abnormalities associated with Opitz‐Frias syndrome. Features of this syndrome of interest to anaesthetists include recurrent pulmonary aspiration of intestinal contents, achalasia of the oesophagus, subglottic stenosis, hypertelorism, micrognathia and a high arched palate. No previous reports of anaesthesia for patients uith this condition have been identified.
Anaesthetic management in Moya‐moya disease
Authors: BINGHAM R. M. , WILKINSON D. J.
Published: February 2007

A case of Moya‐moya disease requiring anaesthesia for both investigation and attempted surgical correction is presented. The influence of the anaesthetic technique on the abnormal cerebral vasculature, with particular reference to induced hypocapnia, is discussed. Guidelines for a safe method of anaesthesia in this group of patients are suggested.
Adverse effects of suxamethonium*
Authors: BUDD A. , SCOTT R. F. P. , BLOGG C. E. , GOAT V. A.
Published: February 2007

One hundred patients were allocated randomly to pretreatment with atracurium 2.5 mg. atracurium 5 mg, fazadinium 3,75 mg or saline 3 minutes before the injection of suxamethonium. The effect upon neuromuscular conduction was studied by recording the mechanical response of the adductor pollicis muscle to indirect stimulation of the ulnar nerve using repeated 2 Hz train of four stimuli. Blood samples were taken at intervals for the measurement of serum potassium. There was no significant difference in the incidence of postoperative muscle pains between the groups in the first 72 hours following anaesthesia. The use of the larger pretreatment dose of atracurium resulted in clinically significant neuromuscular blockade in three of the subjects. Minimal changes in serum potassium occurred in all patients but there was no statistical difference between the groups.
The estimation of midazolam, a water‐soluble benzodiazepine by gas liquid chromatography
Authors: HOWARD P. J. , McCLEAN E. , DUNDEE J. W.
Published: February 2007

A simple, reliable and reproducible method for the estimation of midazolam in plasma samples is described. This involves extraction with benzene and estimation by gas‐liquid chromatography using diazepam as the internal standard. Reproducibility was good and the extraction from plasma was 94% efjcient.
Anaesthesia for suction termination of pregnancy
Authors: West Sheila L. , Moore C. A. , Gillard M. , Browne P. D.
Published: February 2007

The effect of three anaesihetic techniques on blood loss and intra‐uterine pressure changes in response io Syntocinon were siudied in patients undergoing routine first trimester suciion termination of pregnancy. All patients received a standard premedicaiion, a bolus dose of fentanyl, intravenous induction of anaesthesia and maintenance with nitrous oxide and oxygen plus either iniravenous supplementation or 0.5% halothane. Intra‐uterine pressure was related to ihe anaesthetic technique used although blood loss was unrelaied either to anaesthetic technique or to intra‐uterine pressure changes.
The depth of the lumbar epidural space from the skin
Authors: Harrison G.R. , Clowes N.W.B.
Published: February 2007

The depth of the epidural space at different intervertebral interspaces was measured in 1000 parturients. Overall the median distance from the skin to the epidural space was 4.7 cm. but this varied with the lumbar interspace at which it was measured, being greatest at the third (L3‐4) interspace (4.93 cm) and least at the first (L1‐2) interspace (4.23 cm). The clinical significance of these findings is discussed.
Epidural fentanyl in labour
Authors: VELLA LOUISE M. , WILLATTS D. G. , KNOTT CHRISTINE , LINTIN D. J. , JUSTINS D. M. , REYNOLDS FELICITY
Published: February 2007

In a randomised double‐blind trial in the first stage of labour, 20 patients given fentanyl 80 μg in the epidural test dose of bupivacaine, were compared with 20 patients receiving an intravenous infusion designed to produce comparable plasma fentanyl concentrations, at the same time as their epidural test dose. Despite slightly higher plasma fentanyl concentrations in the intravenous, fentanyl group, epidura1, fentanyl produced analgesia which was more complete, more rapid in onset and slightly longer lasting. Supplementary doses of bupivacaine were needed to produce analgesia in 75% of the inlravenous and 30% of the epidural fentanyl group. It is clear that epidural, fentanyl produces satisfactory pain relief when added to the epidural test dose, but that the presence of fentanyl in the systemic circulation makes a negligible contribution to analgesia.
Neuromuscular blockade in dystrophia myotonica with atracurium besylate
Authors: BOHEIMER N. , HARRIS J. W. , WARD S.
Published: February 2007

The anaesthetic management of a young woman with dystrophia myotonica is described. The use of atracurium and monitoring of neuromuscular block allowed suxamethonium and neostigmine to be avoided, and thereby to reduce the risk of myotonic contractions. No adverse sequelae were observed.
Postoperative apnoea and latent myasthenia gravis
Authors: WOJCIECHOWSKI A. P. J. , HANNING C. D. , POHL J. E. F.
Published: February 2007

We report a case of alcuronium induced postoperative apnoea due to latent myasthenia gravis in a patient with no other clinical manfestations of the disease at presentation. Acetylcholine receptor antibody estimation was used to confirm the diagnosis.
Transdermal hyoscine and postoperative nausea and vomiting
Authors: UPPINGTON J. , DUNNET J. , BLOGG C. E.
Published: February 2007

Forty‐two patients, undergoing major gynaecological surgery, were randomly allocated to have a patch applied to the skin behind one ear, containing either hyoscine or placebo. They were followed up at 24‐hour significant (p < 0.01) reduction in nausea and vomiting in the first 24 hours postoperatively, but no difference thereafter. There was an increased incidence of visual disturbance in the hyoscine group at 48 hours. but no other differences in the side effects studied at any other time. However, despite receiving hyoscine there was still a high incidence (68%) of severe nausea and vomiting.
Phenelzine poisoning
Authors: BREHENY F. X. , DOBB G. J. , CLARKE G. M.
Published: February 2007

A 46‐year‐old female with severe phenelzine poisoning was managed successfully by alpha blockade and fluid loading, with the aid of invasive haemodynamic monitoring. The pathophysiology was documented, showing elevated plasma and urinary catecholamines, cardiovascular abnormalities and a contracted blood volume. Most of these changes were reversed following treatment.
Cryoanalgesia for pain after herniorrhaphy
Authors: Khiroya R.C. , Davenport H.T. , Jones J.G.
Published: February 2007

The effect of freezing the ilioinguinal nerve on postoperative pain relief was examined in a double blind study in 36 patients undergoing herniorrhaphy. randomly allocated into two groups. Patients in the experimental group had their ilioinguinal nerves frozen during surgery and were compared with the patients in the control group who did nor have cryoanalgesia. Pain relief was assessed overa 48‐hour period in three ways, namely the linear analogue pain scale, peak expiratory flow rates and the amount of analgesic drugs required by patients in the two groups. We conclude that cryoanalgesia of the ilioinguinal nerve alone does not produce significant early post herniorrhaphy pain relief.
One‐lung ventilation
Authors: Obara H. , Tanaka O. , Hoshino Y. , Kaetsu H. , Maekawa N. , Iwai S.
Published: February 2007

We applied positive end expiratory pressure to the nondependent, nonventilated lung, or both non‐dependent and dependent, ventilated lung during one lung anaesthesia, and compared the results to those obtained by other techniques, such as increasing the inspired oxygen concentration in the dependent lung, or insuffating with oxygen using positive end expiratory pressure in the nondependent lung. Our study suggests that arterial oxygenation and intrapulmonary shunt can be lessened during one lung ventilation by continuous oxygen insufflation of the nondependent lung at 0.98 kPa positive end expiratory pressure while the dependent lung is ventilated with 0.49 kPa positive end expiratory pressure.
Cervical epidural anaesthesia in carotid artery surgery
Authors: KAINUMA M. , SHIMADA Y. , MATSUURA M.
Published: February 2007

The successful anaesthetic management using a cervical epidural technique is reported in three patients undergoing carotid artery surgery. Adequate analgesia was obtained in all cases and the adequacy of cerebral blood flow was easily judged by the patient's state of consciousness. Cervical epidural anaesthesia could be a safe and reasonable technique for the management of patients who need carotid artery surgery.
Effects of atracurium on intracranial pressure in man
Authors: Unni V.K.N. , Gray W.J. , Young H.S.A.
Published: February 2007

Intravenous administration of 0.6 mg/kg of atracurium 10 nine patients did not produce any significant change in intracranial, mean arterial or cerebral perfusion pressures. In another three patients, anaesthesia was induced with thiopentone 5 mg/kg after muscle relaxation with atracurium I mg/kg. Intracranial pressure was below pre‐induction levels in two patients whose tracheas were intubated 90 seconds after atracurium. The vocal cords were not fully relaxed at 90 seconds in the third patient. Intubation at 150 seconds in this patient was associated with a rise in intracranial pressure above pre‐induction values.
Plasma cholinesterase changes during the puerperium
Authors: ROBSON N. , ROBERTSON I. , WHITTAKER MARY
Published: February 2007

Changes in plasma cholinesterase activity during the puerperium were studied in 16 women who received epidural analgesia for labour followed by vaginal delivery, and in five women who underwent elective Caesarean section under epidural analgesia. A consistent fall in cholinesterase activity was demonstrated during the first 2 to 3 days post partum. followed by a rise to approximately normal nonpregnant values by the end of the puerperium. An additional patient who manifested prolonged paralysis following an emergency Caesarean section under general anaesthesia, including a suxamethonium infusion, was also studied. Possible mechanisms by which the transient decrease in cholinesterase activity is produced, and its clinical significance, are discussed.
Meptazinol versus pethidine for postoperative pain relief in children
Authors: RIDLEY S. A. , MATTHEWS N. C. , DIXON J.
Published: February 2007

A double‐blind, randomised, clinical trial was undertaken comparing intramuscular meptazinol (1 mg/kg) with intramuscular pethidine (1 mg/kg)for the relief of post‐tonsillectomy pain, in 100 children under 15 years of age. Pethidine provided better analgesia in those patients who were awake after 30 minutes, but thereafter no statistically significant differences between the degree of pain relief could be detected. Meptazinol caused less sedation than pethidine, in that significantly more patients were awake after 40 minutes in the meptazinol group. The incidence of nausea and vomiting was similar in patients of both groups.
The Nellcor N‐101 pulse oximeter
Authors: TYTLER J. A. , SEELEY H. F.
Published: February 2007

The accuracy of the Nellcor N‐101 pulse oximeter has been evaluated in adult patients receiving general anaesthesia or intensive care. Readings obtained noninvasively with this instrument were compared with measurements made on arterial blood using a Radiometer OSM2 oximeter. The pulse oximeter was easy to use and within the range tested (70–100 percent saturation of haemoglobin with oxygen) the readings were within I digit of the values obtained by in vitro measurement.
Ketanserin and the cardiovascular system
Authors: GRIFFITHS H. B. A. , WHITWAM J. G.
Published: February 2007

The effect of 10 mg of ketanserin on the pressor responses to noradrenaline, phenylephrine and angiotensin II in 19 patients during cardiopulmonary bypass was observed. The results were compatible with the previously reported evidence that ketanserin, in addition to its antagonism of serotonin, causes alpha, adrenoceptor blockade.