bluuebunny/crossref_metadata_2025 huggingface dataset:
Omeprazole for prophylaxis of acid aspiration in elective surgery
Authors: WINGTIN L. NG , GLOMAUD D. , HARDY F. , PHIL S.
Published: February 2007

The aim of the study was to determine whether a single oral dose of omeprazole 40 mg is effective in increasing the pH of gastric residue above 2.5 at the time of anaesthetic induction in adult patients scheduled for elective gynaecological surgery. The patients were allocated to receive either chlorazepate dipotassium 25 mg alone or omeprazole 40 mg and chlorazepate dipotassium 25 mg on the night before surgery. Gastric volume and pH were measured after induction of anaesthesia. Patients who received omeprazole had a higher mean pH than control patients (p < 0.001). The pH was less than 3.5 in 50% of patients in the control group, but in only 4.5% of those who received omeprazole (p < 0.01). Mean (SEM) volume of gastric fluid was 15.2 (2.7) ml in the control group and 9.2 (1.8) ml in the omeprazole group, but the results were not statistically significant. A single dose of 40 mg omeprazole significantly decreased the number of patients at risk of aspiration pneumonitis.
The Fenem CO2 detector device An apparatus to prevent unnoticed oesophageal intubation
Authors: DENMAN W. T. , HAYES M. , HIGGINS D. , WILKINSON D. J.
Published: February 2007

A new oesophageal intubation detector device, the Fenem CO2 detector, was used in 100 patients intubated during anaesthesia for elective surgery. This new device was 100% accurate in the differentiation between tracheal and oesophageal placement of a tube.
Ginger root—a new antiemetic The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery
Authors: Bone M. E. , Wilkinson D. J. , Young J. R. , McNeil J. , Charlton S.
Published: February 2007

The effectiveness of ginger (Zingiber officinale) as an antiemetic agent was compared with placebo and metoclopramide in 60 women who had major gynaecological surgery in a double‐blind, randomised study. There were statistically significantly fewer recorded incidences of nausea in the group that received ginger root compared with placebo (p < 0.05). The number of incidences of nausea in the groups that received either ginger root or metoclopramide were similar. The administration of antiemetic after operation was significantly greater in the placebo group compared to the other two groups (p < 0.05).
Combined air and oxygen entrainment. Effect on the percentage output of fixed performance masks
Authors: LYEW M. A. , HOLLAND A. J. , METCALF I. R.
Published: February 2007

Secondary oxygen was added to air entrained by the primary jet of a fixed performance mask. Twenty such masks, in each of six groups rated at 24%, 28%, 31%, 35%, 40% and 50%, gave higher O2 percentages equivalent to those calculated from an equation that related the O2 concentration to the secondary flow. Actual values of both were closely correlated, with regression slopes and intercepts similar to those derived from this equation. This technique is simple and predictable in altering the composition of an air‐oxygen mixture delivered to the patient.
Relief of injection pain in adults EMLA cream for 5 minutes before venepuncture
Authors: Nott M. R. , Peacock J. L.
Published: February 2007

The effectiveness of skin anaesthesia after 5 minutes’ topical application of a lignocaine‐prilocaine cream was evaluated. One hundred and twenty patients estimated the pain of antecubital venepuncture both on a linear scale and verbally after use of the cream for either 5 or 60 minutes, a placebo cream or no treatment. Reported pain was significantly less after only 5 minutes of the lignocaine‐prilocaine cream (p = 0.002). The cream can be used to relieve the pain of all routine injections.
Changes in haemodynamics and plasma catecholamine concentrations after field block for inguinal herniorrhaphy using lignocaine with adrenaline
Authors: HAYSE‐GREGSON P. B. , ACHOLA K. J. , SMITH G.
Published: February 2007

Haemodynamic changes and plasma catecholamine concentrations were measured in 12 patients aged 24 to 87 years after performance of a field block for elective repair of inguinal or femoral hernia. The local anaesthetic used comprised a mixture of lignocaine 0.5% with adrenaline 1:200000; the dose of lignocaine administered varied from 3.8 mg/kg to 4.9 mg/kg. Plasma adrenaline increased by 326% and plasma noradrenaline by 75% at 10 minutes after completion of the block. Mean heart rate increased from 75 to 94 beats/minute after 20 minutes, whilst there were no obvious changes in systolic and diastolic arterial pressures. Potentially serious arrhythmias developed in two patients, thought to be related to the peak plasma concentrations of adrenaline produced. It is recommended that the dose of adrenaline used as described for this block should be reduced.
Obstetric anaesthesia in dystrophia myotonica
Authors: BLUMGART C. H. , HUGHES D. G. , REDFERN N.
Published: February 2007

Two patients with dystrophia myotonica presented for urgent Caesarean section. Their per‐ and postoperative courses illustrate the anaesthetic problems posed by this disease. Respiratory difficulties are compounded by pregnancy and there is increased susceptibility to uterine haemorrhage. Choice of anaesthetic agent is discussed. Both had general anaesthetics; muscle relaxation was achieved with vecuronium.
Admissions to the intensive care unit after complications of anaesthetic techniques over 10 years 2. The second 5 years
Authors: LEIGH J. M. , TYTLER J. A.
Published: February 2007

Compared with the first 5 years there was a 19% increase in general anaesthetics, a 171% increase in local and (or) sedation techniques and a 9% increase in obstetric epidurals with no increase in anaesthetic staffing. In this second 5‐year period, 46 patients were admitted to the Intensive Care Unit as a result of a complication of an anaesthetic technique. These patients represented 1 in 2371 anaesthetic techniques carried out in the District compared with the previous 5 years where the incidence was 1 in 1543. Seven patients died (15.2%). The complication was considered to be wholly or partially avoidable in 14 instances (30.4%). Four of these subjects died.
Oral premeditation in children A comparison of trimeprazine with a trimeprazine, droperidol and methadone mixture
Authors: Phillips G. H. , Mian T. , Becker U. , Stone P. A. , Jones H. M.
Published: February 2007

One hundred children who presented for minor general surgical procedures were randomly assigned to receive one of two oral premedications. Those in group A (n = 50) were given 3 mg/kg of trimeprazine and those in group B (n = 50) a mixture of trimeprazine 1.0 mg/kg, droperidol 0.15 mg/kg and methadone 0.08 mg/kg. Patients in group B were more likely to be asleep on arrival in the anaesthetic room (p < 0.02) and were less likely to be distressed at induction of anaesthesia (p < 0.02). Thiopentone requirements were less in group B (p < 0.001). The incidence of side effects was similar in the two groups. It is concluded that the mixture produces more satisfactory sedation than trimeprazine.
Life‐threatening complications during anaesthesia in a patient with a ventriculo‐atrial shunt and pulmonary hypertension
Authors: BUTLER P. J. , WHEELER R. A. , SPARGO P. M.
Published: February 2007

A 6‐year‐old patient with hydrocephalus who underwent revision of a ventriculo‐atrial shunt is described. Anaesthesia was complicated by the occurrence of systemic hypertension and arterial hypoxaemia. The patient was subsequently found to have pulmonary hypertension secondary to recurrent pulmonary thromboembolism. The pathophysiological mechanisms for the patient's deterioration are discussed and the anaesthetic management of children with pulmonary hypertension is outlined. It is concluded that patients with a ventriculo‐atrial shunt who present for surgery should be screened carefully for the presence of pulmonary hypertension.
Nitrobenzene poisoning and spurious pulse oximetry
Authors: KUMAR A. , CHAWLA R. , AHUJA S. , GIRDHAR K. K. , BHATTACHARYA A.
Published: February 2007

The successful management of nitrobenzene poisoning in a 21‐year‐old patient is presented. We report our experience of ventilatory care with additional intravenous methylene blue and ascorbic acid therapy. Pulse oximeters available at present are not useful in patients treated with methylene blue and should be used cautiously in the presence of cyanosis of unknown aetiology.
An evaluation of the Level 1 blood warmer series
Authors: BROWNE D. A. , DE BOECK R. , MORGAN M.
Published: February 2007

The Level 1 blood warmer series comprises three infusion sets and two blood warmers of different power outputs. All systems were found to be extremely efficient, with the larger 500 series capable of warming the equivalent of 80 units of blood an hour almost to body temperature.
Painless loss of vision after transurethral resection of the prostate
Authors: RUSSELL D.
Published: February 2007

A 74‐year‐old män developed complete loss of vision after transurethral prostatectomy under spinal anaesthesia. Eyesight returned to normal over the next 12 hours. A direct inhibitory effect on the retina caused by glycine absorbed with the irrigation fluid is suggested as a possible cause.
The effects of propofol and thiopentone on forearm circulation
Authors: McKEATING K. , HOWE J. P. , McARDLE L.
Published: February 2007

Some effects of propofol and thiopentone induction on the peripheral circulation of healthy patients are examined using mercury strain gauge venous occlusion plethysmography of the forearm. Results indicate that both drugs produce a statistically significant decrease in mean arterial blood pressure and forearm blood flow. Forearm vascular resistance remains unchanged after either drug. These data suggest that bolus dose induction of anaesthesia with propofol does not cause arterial vasodilatation of the limb and that a cause for the reduction in mean arterial pressure must be sought elsewhere.
Neuroleptic malignant syndrome in the intensive therapy unit
Authors: MONTGOMERY J. N. , IRONSIDE J. W.
Published: February 2007

A case of the neuroleptic malignant syndrome occurred in a 40‐year‐old male after administration of chlorpromazine while on an Intensive Therapy Unit. Treatment with dantrolene sodium was successful, and a muscle biopsy was examined in the recovery phase of the illness. The importance of this condition and the difficulties in establishing a diagnosis at an early stage in patients on an Intensive Therapy Unit are discussed, along with implications for treatment .
Postmortem findings after epidural anaesthesia
Authors: WULF H. , STRIEPLING E.
Published: February 2007

Postmortem specimens of 10 patients who had received continuous epidural anaesthesia postoperatively (ranging from 2–21 days) were examined. Slight epidural haemorrhage was observed in six patients and a macroscopically visible haematoma in a thrombocytopenic patient. Nonspecific epidural inflammatory reactions were observed microscopically in all patients. Specimens from seven patients with systemic infection showed signs of epidural infection. No similar pathology was found in a control group without epidural catheters. The aetiology and risk factors of the above findings are discussed, and recommendations given to prevent such sequelae after epidural anaesthesia.
A comparison of the performance of 20 pulse oximeters under conditions of poor perfusion
Authors: CLAYTON D. G. , WEBB R. K. , RALSTON A. C. , DUTHIE D. , RUNCIMAN W. B.
Published: February 2007

The performance of 20 pulse oximeters with finger probes was evaluated by comparison of their readings with directly measured arterial blood oxygen saturations. The samples were taken from patients who had undergone cardiac surgery under hypothermic cardiopulmonary bypass and had poor peripheral perfusion. The mean difference (bias, accuracy), standard deviation (precision) and drop‐out rate for each pulse oximeter was determined. An overall ranking of performance of each pulse oximeter was calculated using five criteria (accuracy, precision, number of readings within 3% of standard, percentage of readings given within 3% of standard, expectedoverread limit in 95% of cases). Two pulse oximeters achieved a combination of accuracy and precision such that 95% of measurements would be expected to be within 4% of the co‐oximeter value; these two also had the lowest dropout rate.
Midazolam‐induced benzodiazepine withdrawal syndrome
Authors: METS B. , HORSELL A. , LINTON D. M.
Published: February 2007

A case history of a patient who developed severe anxiety and agitation on two occasions after discontinuation of a midazolam infusion is presented. The withdrawal symptoms interfered with effective mechanical ventilation and the patient required the reintroduction of a long‐acting benzodiazepine to treat the withdrawal state and to facilitate weaning from mechanical ventilation.
Accidental bronchial intubation with RAE tubes
Authors: BLACK A. E. , MACKERSIE A. M.
Published: February 2007

Preformed tracheal tubes are used frequently in paediatric anaesthesia. A feature which contributes to their popularity is the belief that they can be positioned more reliably than conventional tracheal tubes because of their design. We studied a group of 40 patients in whom the incidence of bronchial intubation was 20%. The tube was too long in 32% of patients, although the tube size was appropriate for the child's age in all patients. The consequences and outcome of this complication are discussed.
A comparison of patient rewarming devices after cardiac surgery
Authors: IMRIE M. M. , WARD M. , HALL G. M.
Published: February 2007

Three regimens for rewarming patients after cardiac surgery involving hypothermic cardiopulmonary bypass were studied in 30 patients. The control group (n = 10) received no active rewarming, the oesophageal group (n = 10) was warmed centrally using an oesophageal heat exchanger and the radiant group (n = 10) was warmed peripherally with an overhead radiant heater. There were no statistically significant differences between the groups apart from the higher mean skin temperatures in the peripheral group.
Coagulation screening before epidural analgesia in pre‐eclampsia
Authors: Barker P. , Callander C.C.
Published: February 2007

A questionnaire survey of current practice at a small cross‐section of obstetric units, covering 22% of all United Kingdom deliveries, revealed a marked lack of standard practice regarding requests for coagulation screens on pre‐eclamptic patients who require epidural procedures. A retrospective audit was therefore carried out on 434 coagulation screens requested for pre‐eclamptic patients in whom epidural analgesia might have been considered. Borderline abnormalities of coagulation were found in only 10 patients (2%). Platelet counts of less than 150 × 109/litre were present in 28% of cases. ‘Significant’ thrombocytopenia (< 100 × 109/litre) and all coagulation abnormalities were only encountered in severe pre‐eclampsia (diastolic blood pressure of greater than 110 mmHg and proteinuria of ++ or greater). Furthermore, coagulation abnormality was always associated with a reduced platelet count (mean, 97 × 109/litre). This study would therefore support anaesthetic practice which restricted any requests for coagulation testing to severe pre‐eclamptic patients only. For these patients first line testing could be limited to a platelet count.
Depth of extradural space and dural puncture
Authors: SUTTON D. N. , LINTER S. P. K.
Published: February 2007

The records of 3011 obstetric extradural blocks were examined to determine the depth of the extradural space and the relative risk of dural puncture. The overall incidence of dural puncture was 0.7%. A disproportionate number of punctures occurred when the space was superficial (1.45%), with a risk factor three times greater than that associated with normal depth spaces (0.48%). Caution is advised when infiltrating with local anaesthetics before extradural procedures, and when initially introducing the extradural needle.
Oxygen delivery Systems–a comparison of two devices
Authors: Fairfield J.E. , Goroszeniuk T. , Tully A.M. , Adams A.P.
Published: February 2007

Two low‐volume, variable performance oxygen delivery Systems were compared in conscious spontaneously breathing volunteers. Oropharyngeal oxygen concentrations were measured during periods of nose and mouth breathing. The Systems were studied at oxygen flow rates of 2 or 4 litres/minute. The performance of both Systems was similar under the test conditions but the nasal catheter is preferable in terms of cost.
Epidural infusion of diamorphine with bupivacaine in labour
Authors: ENEVER G. R. , NOBLE H. A. , KOLDITZ D. , VALENTINE S. , THOMAS T. A.
Published: February 2007

We have compared the analgesic effects of three epidural infusions in a randomised, double‐blind study of 61 mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by either bupivacaine 0.125%, bupivacaine 0.125% with diamorphine 0.0025% or bupivacaine 0.125% with fentanyl 0.0002%. All infusions were run at a rate of 7.5 ml/hour. Analgesia was significantly better in both the groups receiving opioids. Diamorphine was shown to be the more effective supplement to bupivacaine. The 5% incidence of pruritis in the opioid groups was less than that reported by earlier authors.
Computerised axial tomography of the trachea
Authors: BARKER P. , MASON R. A. , THORPE M. H.
Published: February 2007

Case histories are reported of three patients who had large retrosternal goitres which were responsible for significant abnormalities of the airway. Computerised axial tomography demonstrated the exact anatomy. The site of tracheal compression was shown and accurate measurements of the diameter of the trachea at its narrowest point were made. This information was useful when the management of the patient was planned.
Modified occlusion tests for the Bain breathing system
Authors: HEATH P. J. , MARKS L. F.
Published: February 2007

Undetected defects in the inner tube of the Bain coaxial anaesthetic breathing system may result in a greatly increased apparatus deadspace. Several authorities have advocated tests intended to detect inner tube problems; however, the efficacy of these tests has never been validated. In this study none of the tests were able to detect all the induced defects. A modification of an existing test using the backbar pressure‐relief valve and a new double occlusion test were sufficiently sensitive to detect all defects.
Can esmolol manage surgically‐induced tachycardia?
Authors: Whirley‐Diaz J. , Gold M. I. , Helfman S. M. , DeLisser E. A.
Published: February 2007

A double‐blind, randomised study was conducted to examine the efficacy of a single bolus dose of esmolol in treating surgically‐induced tachycardia. Anaesthetic technique was identical in all patients, and consisted of premedication with midazolam and glycopyrronium, induction with thiopentone followed by suxamethonium, tracheal intubation, and maintenance with isoflurane 0.6% (end‐tidal) and60% nitrous oxide in oxygen. Forty‐eight patients developed a heart rate of greater than 95 beats/minute or 20% more than pre‐induction values at an average time of 34 minutes after tracheal intubation and received placebo (15 patients), esmolol 50 mg (16 patients), or esmolol 100 mg (17 patients). Controlled intervention was instituted if heart rate or blood pressure was not adequate. Both 50 and 100 mg of esmolol resulted in lower heart rates compared to placebo (p < 0.05), with no difference between the two esmolol groups (p > 0.05). Patients who received placebo had more episodes of medical intervention than those given esmolol (p < 0.05). No adverse effects occurred in any patient.
Premedication: An audit
Authors: Kluger M. T. , Owen H.
Published: February 2007

A prospective study of routine premedication management was carried out at a large teaching hospital. Many patients received their premedication at times inappropriate for it to be effective. Several patients receiving regular medication had this suddenly stopped pre‐operatively. Prolonged fasting occurred in both elective and emergency groups of patients. Benzodiazepines and opioids were prescribed most frequently and drying agents were used widely. Antacids, H2‐blockers and agents to promote gastric emptying were used very little despite the potential of aspiration in many groups of patients. This audit of activity has revealed several areas of practice that can either be improved immediately or warrant detailed investigation.
The Brain laryngeal mask
Authors: BAILIE R. , BARNETT M. B. , FRASER J. F.
Published: February 2007

Fifty ASA grade 1 children, who presented for dental outpatient extraction were studied. They were randomly allocated to two groups after induction: group 1 had conventional nasal mask anaesthesia and group 2 anaesthesia with a laryngeal mask. Group 2 had fewer hypoxic episodes and significantly better arterial oxygen saturations (p < 0.01). There was no difference between the groups as regards surgical access, difficulty of extraction or bleeding. The laryngeal mask appears to provide an alternative to conventional nasal mask anaesthesia, with better overall oxygenation and would seem particularly suitable for prolonged or difficult extractions.
Paediatric blood pressure and anaesthesia
Authors: MATHER C. M. P.
Published: February 2007

One percent of children have appreciably and consistently raised arterial blood pressure. A 7‐year‐old girl admitted for routine tonsillectomy, had unrecognised hypertension which put her at increased risk. Should anaesthetic practice take more note of paediatric blood pressures?
A new portable oxygen system using liquid oxygen
Authors: RAMAGE C. M. H. , KEE S. S. , BRISTOW A.
Published: February 2007

Liquid oxygen provides both practical and financial advantages in comparison with compressed oxygen when transferring patients within and between hospitals. We describe a portable liquid oxygen system and evaluate its uses and shortcomings in this area.
Identification of the epidural space in children
Authors: YAMASHITA M. , TSUJI M.
Published: February 2007

We have used an intravenous micro‐drip infusion set to identify the epidural space in 350 infants and children. The infusion set was prepared with saline and connected to the hub of an epidural needle. Free dripping of saline was regarded as a sign that the needle tip had entered the epidural space. The overall success rate of this method was 97.7%.
Immunological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of nitrous oxide and halothane
Authors: PERIĆ M. , VRANEŠ Z. , MARUŠIĆ M.
Published: February 2007

Immunological changes in anaesthetic personnel exposed to occupational concentrations of holothane and nitrous oxide 10—60 times greater than the advised maximum were studied during routine work and after 3—4 weeks holiday. Red cell count, haemoglobin concentration and haematocrit decreased during exposure although not significantly, in comparison with a control group, but all had increased significantly after the holidays. Other changes were altered neutrophils and lymphocyte counts. Basophils disappeared from the blood during the exposure. Monocytes were not affected during the exposure, but increased after its cessation. Percentages of CD2 and CD4 lymphocytes increased significantly, but numbers of cells in T lymphocyte subpopulations (total, helper and cytotoxic/supressor lymphocytes) ‐were not significantly altered. B lymphocytes were most strongly affected: they decreased during working periods and did not recover after holidays. Natural killer (NK) cells, on the other hand, decreased significantly during exposure, but fully recovered during holidays. After stimulation with mitogens, phytohaemaglutin, concanavalin A, and pokeweed, lymphocytes from exposed personnel incorporated significantly more 3H‐thymidine than those from control subjects, but stimulation indices did not differ. The natural killer‐cell activity, serum Ig concentrations and phagocytosis by granulocytes were not altered.
Fatal theophylline poisoning with rhabdomyolysis
Authors: PARR M. J. A. , WILLATTS S. M.
Published: February 2007

A fatal case of theophylline poisoning is described. The patient developed rhabdomyolysis, renal failure and compartment syndrome, as well as the more usual features of severe theophylline poisoning. Dantrolene appeared to be useful in controlling the hypermetabolic state associated with the overdose and may have a role in future treatment.
Tracheal tube resistance and airway and alveolar pressures during mechanical ventilation in the neonate
Authors: TIPPING T. R. , SYKES M. K.
Published: February 2007

The relationship between peak airway pressure, alveolar pressure and respiratory frequency was calculated for the range of compliances and airway resistances which might be encountered during mechanical ventilation of a 3‐kg neonate. The pressure/flow relationships of 2.5, 3.0, 3.5 and 4‐mm tracheal tubes were determined at a series of flows from 0.5 to 4 litres/minute. Peak airway and alveolar pressures were then measured at various frequencies and inspiratory: expiratory ratios with the tubes incorporated in a model lung. Large differences between peak airway and alveolar pressures developed when frequency was increased or inspiratory time decreased; the differences were greatest with the smaller tubes. Shortening expiratory time by increasing the frequency or altering the inspiratory: expiratory ratio resulted in increased end‐expiratory pressure because of incomplete emptying of the lung.
The effects of intravenous clonidine on ventilation
Authors: OOI R. , PATTISON J. , FELDMAN S. A.
Published: February 2007

The effects of clonidine, an alpha 2 adrenergic agonist, on ventilation were studied in a group of adult volunteers. The ventilatory variables measured were minute ventilation, respiratory rate, end‐tidal carbon dioxide tension and the response to carbon dioxide challenge. We found no differences in minute ventilation, respiratory rate and end‐tidal carbon dioxide tension, before and after clonidine administration. However, the ventilatory response to carbon dioxide was significantly attenuated following clonidine, suggesting that clonidine has respiratory depressant effects.
A comparison of dopexamine and dopamine to prevent renal impairment in patients undergoing orthotopic liver transplantation
Authors: GRAY P. A. , BODENHAM A. R. , PARK G. R.
Published: February 2007

The efficacy of low‐dose dopamine as a renal protective agent was compared with that of dopexamine in patients who underwent orthotopic liver transplantation. Twelve patients who received a continuous infusion of dopexamine (1–3 μg/kg/minute) were matched for age, diagnosis, pre‐operative creatinine clearance and blood loss with 12 patients who received a low‐dose infusion of dopamine (2 μg/kg/minute). The catecholamine infusion was started after induction of anaesthesia and continued for 48 hours after surgery. Patients in the dopexamine group had less evidence of renal impairment and failure than those in the dopamine group during 7 days after the operation, although the differences between groups did not achieve statistical significance. Similarly there were no significant differences between the two groups in peri‐operative urine output, urine/plasma osmolality ratio or creatinine clearance. Dopexamine is at least as effective as dopamine for renal protection in patients who undergo liver transplantation.
The laryngeal mask airway
Authors: MILLER A. C. , BICKLER P.
Published: February 2007

The laryngeal mask airway is an important addition to the anaesthetist's armamentarium, but its use is not without the possibility for misfortune. We encountered an unusual and potentially serious complication. A patient's epiglottis became trapped between the pliable grates in the mask portion of the laryngeal mask and partially obstructed his airway. Should this problem occur and remain unnoticed, in addition to the problem of airway obstruction during the anaesthetic, the oedematous epiglottis could be severely injured upon removal of the laryngeal mask. This, in turn, could result in airway obstruction requiring emergency treatment.
Awake intubation: a new technique
Authors: McCRIRRICK A. , PRACILIO J. A.
Published: February 2007

A 46‐year‐old male with a known history of difficult intubation presented for elective surgery. It was considered prudent to perform an awake intubation and a size 3 laryngeal mask was introduced under topical anaesthesia. A gum elastic bougie was then passed, enabling the laryngeal mask to be removed and a tracheal tube to be inserted.
Faulty Superset plastic catheter mounts
Authors: HANNINGTON‐KIFF J. G.
Published: February 2007

Nine Superset (Intersurgical Ltd) single‐use corrugated plastic catheter mounts were found to be faulty in a boxed batch of 75. The manufacturer's meticulous system of batch coding enabled the source of the problem to be traced quickly. Sporadic faults must be expected to occur in mass‐produced disposable equipment and the unusual origin of the defect reported in these catheter mounts is testimony to the way unexpected events can prejudice the most carefully regulated quality control. It is emphasised that the user can help safeguard the community by ensuring that stock is used in strict rotation and that batch numbers are accurately reported when faults arise.
Whole blood electrolyte assay using ChemPro 500
Authors: THOMPSON J. M. , EMMETT C. , SMITH S. C. H. , CRAMB R. , HUTTON P.
Published: February 2007

The ChemPro 500‘near‐the‐patient’analyser, with ChemPro‘Ion Profile’sensor cards, was evalutated for the assay of pH, Ca2+, K+ and Na+ in whole blood samples from patients in the intensive care unit or during surgery for heart or major blood vessel disease, or for liver transplantation. Imprecisions estimated from replicate whole blood measurements were much greater for all four ions than even the least stringent of the generally accepted analytical goals, and much greater than those estimated using quality assurance materials. Comparisons of assayed values with those obtained using standard laboratory instruments showed significant constant and proportional biases. The performance of the ChemPro 500 with the Ion Profile cards gave us no confidence in recommending their use to anaesthetists and intensivists.
Pain on intradermal injection with lignocaine
Authors: Criswell J. , Gauntlett I.S.
Published: February 2007

Twenty ASA 1 volunteers were each injected intradermally with four solutions containing 0.2 ml of 0.5%, 1%, and 2% lignocaine and 0.9% saline to determine whether the pain experienced on injection was related to the concentration of local anaesthetic. A 10 cm linear analogue pain scoring system was used, and the solutions were ranked from most painful to least painful. There were no differences between the different concentrations of lignocaine and 0.9% saline in the severity of pain experienced. We conclude that any concentration of lignocaine may be used intradermally before inserting intravenous catheters without affecting the degree of pain experienced by that injection.
Continuous thoracic epidural fentanyl for post‐thoracotomy pain relief: with or without bupivacaine?
Authors: GEORGE K. A. , WRIGHT P. M. C. , CHISAKUTA A.
Published: February 2007

Twenty‐five ASA 1 or 2 patients undergoing thoracotomy were entered into a prospective, randomised, double‐blind study comparing thoracic epidural fentanyl alone and thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief, pulmonary function and cardiovascular stability were assessed. Pain relief was superior in the bupivacaine series (p < 0.05) during the first day after operation and this was accompanied by better oxygenation (p < 0.05); the difference did not persist into the second day. Forced expiratory variables were reduced in both series to 50–60% of the values before operation throughout the study (p < 0.05) and differences did not occur between the groups. The incidence of side effects attributable to epidural fentanyl was high, but hypotension did not occur. Small doses of bupivacaine administered together with fentanyl into the thoracic epidural space improve analgesia without causing hypotension.
Transient blindness following epidural analgesia
Authors: VICTORY R. A. , HASSETT P. , MORRISON G.
Published: February 2007

A 43‐year‐old woman was given an epidural injection of steroid mixed with local anaesthetic, under general anaesthesia, for treatment of low back pain. In the recovery room she complained of blindness in one eye. Fundoscopy revealed retinal and vitreous haemorrhages in both eyes. Retinal haemorrhages can be caused by an increase in intracranial pressure and are therefore a possible complication of epidural anaesthesia.
Mortality associated with anaesthesia
Authors: GANNON K.
Published: February 2007

The review is based on an analysis of anonymous case record material at the Medical Protection Society's London Office for the 5‐year period 1982–1986, in which death was associated with anaesthetic procedures. A total of 25 cases were analysed. The principal events which resulted in death were failed intubation, drug‐related problems and problems with equipment. The principal contributory factors were inadequate supervision, inadequate pre‐operative assessment and failure of communication. The present review suggests that supervision and training of junior staff, decision‐making by senior staff and patterns of communication both within and between specialities are areas which should be selected for further research.
The impact of the appearance of the anaesthetist on the patient's perception of the pre‐operative visit
Authors: Sanders L. D. , Gildersleve C. D. , Rees L. T. , White M.
Published: February 2007

The clinician's appearance is often considered a symbol which identifies and defines specific characteristics of the individual. Opinion of both lay and medical personnel on appropriate clothing inclines towards formal dress. Our aim was to assess the effect of the anaesthetist's appearance during a ward visit on the patient's evaluation of either the visit or the anesthetist himself. In our sample of 66 patients we found no evidence that the style of dress (formal: suit and tie, informal: jeans and open‐necked shirt) affected that evaluation. However, when 138 patients were asked to rate the desirability of items of clothing for a male hospital doctor they expressed a preference for traditional clothing; a suit was rated as desirable and jeans as one of the four most undesirable items. We conclude that despite the conservatism of expressed opinions, the clothing worn by the anaesthetist is irrelevant to the patient's satisfaction with the visit.
Policies for oral intake during labour
Authors: Michael S. , Reilly C. S. , Caunt J. A.
Published: February 2007

A postal survey was conducted to gain information on the use of policies on oral intake, selection of mothers and type of intake given during established labour by all maternity units in England and Wales. A response rate of 91.6% (351 out of 383) was achieved; 79.5% of units had a written policy for oral intake, 96.4% of units allowed mothers some form of oral intake and 68.3% of these units selected mothers according to risk categories. Of the 268 units allowing oral intake, 67.2% gave drink only and 32.8% drink and food. Of those allowing food, all but 13.6% had a selection policy. Of the 85 units not selecting mothers, 78.8% gave water only; the remaining 21.2% gave water and other drink or food. This survey demonstrates a wide variation in policies for oral intake during labour.
The pharmacodynamics of alcuronium in the elderly
Authors: KENT A. P. , HUNTER J. M.
Published: February 2007

Alcuronium (0.2 mg/kg) was given to 12 elderly patients, mean age 77 years (range 70–88 years) and 12 young patients, mean age 24 years (range 18–32 years) undergoing general anaesthesia. A compound muscle action potential was monitored continuously throughout anaesthesia, using an electromyograph and the train‐of‐four twitch technique. The rate of onset and maximum block achieved were similar in both the young and elderly patients, as were the times to 20% recovery of the first twitch compared with control (T1: T0) and fourth twitch compared with the first, (T4: T1). In contrast, the time to 70% recovery of T1: T0 was significantly prolonged in the elderly (138 as compared with 89 minutes: p < 0.01) as was the recovery index (25–75%) for T1: T0 (95 as compared with 46 minutes: p < 0.01) and the time to 70% recovery of T4: T1 (181 as compared with 131 minutes: p < 0.05). The recovery curves for T1: T0 and T4: T1 were also significantly different in the elderly from the young group (p < 0.01 in both instances). These results show that the duration of action of alcuronium is significantly prolonged in the elderly.
Assessment of a hygroscopic heat and moisture exchanger for paediatric use
Authors: WILKINSON K. A. , CRANSTON A. , HATCH D. J. , FLETCHER M. E.
Published: February 2007

A laboratory study of a widely available heat and moisture exchanger marketed for paediatric use was undertaken. The deadspace, measured by volume displacement, was 12 ml, similar to that of a standard catheter mount for paediatric use. Pressure drop across the device was measured at several different flows in five samples of the device in both the dry and wet state. Calculated resistance proved to be markedly lower when compared with that of other anaesthetic equipment such as tracheal tubes, and with similar humidification devices for paediatric use.
Intubation with propofol augmented with intravenous lignocaine
Authors: Mulholland D. , Carlisle R. J. T.
Published: February 2007

Sixty patients of ASA grade 1 and aged 18 to 55 years were admitted to a double‐blind study. Anaesthesia was induced with propofol 2.5 mg/kg after intravenous pretreatment with lignocaine 1.5 mg/kg or a similar volume of isotonic saline. The quality of subsequent tracheal intubation was graded and the pressor response to tracheal intubation assessed. There were no significant differences between treatment groups.
Evaluation of the Graseby PCAS
Authors: JACKSON I. J. B. , SEMPLE P. , STEVENS J. D.
Published: February 2007

The Graseby patient‐controlled analgesia system was evaluated in the laboratory and in clinical use. The problems encountered with eight examples used to treat 510 patients are reported. Laboratory performance revealed the unit to be accurate at infusion volumes of 1 and 2 ml.
Visual evoked potentials and visual acuity after transurethral resection of the prostate
Authors: Mantha S. , Rao S. M. , Singh A. K. , Mohandas S. , Prakas Rao B. Surya , Joshi N.
Published: February 2007

Changes in visual evoked potentials, visual acuity, blood ammonia levels and serum electrolytes (Na+ and K+) after transurethral resection of the prostate using glycine as an irrigating fluid performed under subarachnoid block were studied in 12 patients, in the pre‐operative and immediate postoperative periods. Visual evoked potentials (p100 latency), recorded by shift of a checkerboard pattern, increased significantly from a pre‐operative value of mean (SEM) 101.18 (1.63) msec in the right eye, and 102.5 (1.47) msec in the left eye to 108.91 (1.8) msec (p < 0.01) and 108.08 (2.53) msec (p < 0.01) respectively in the postoperative phase. There were no changes in visual acuity as assessed by a Snellen's chart, blood ammonia levels and serum electrolyte concentrations. The amount of glycine used intra‐operatively for irrigation ranged from 3 to 31 litres.
Pulmonary embolism confirmed by transoesophageal echocardiography
Authors: SERMEUS L. , VAN HEMELRIJCK J. , VANDOMMELE J. , VAN AKEN H.
Published: February 2007

A 60‐year‐old patient suffered a pulmonary embolism following the application of an Esmarch and pneumatic tourniquet before arthroscopy of the knee. The diagnosis was suspected because of sudden hypotension, ECG changes, a decrease in end‐expiratory carbon dioxide concentration and oxygen desaturation as indicated by pulse oximetry. Before performing a sternotomy and cardiopulmonary bypass for removal of pulmonary artery clots, the diagnosis was confirmed by the demonstration of severe right ventricular strain using transoesophageal echocardiography.
Inorganic fluoride in prolonged isoflurane sedation
Authors: Breheny F. X.
Published: February 2007

An 18‐year‐old girl received isoflurane sedation for 48 h to facilitate mechanical ventilation. This resulted in a serum inorganic fluoride level of 37.3 μmol.l−1 when the isoflurane was stopped. As the serum fluoride level may continue to rise after isoflurane and as this level is approaching toxicity, the role of isoflurane sedation in the critically ill should be approached cautiously.
Oesophageal achalasia causing respiratory obstruction
Authors: WESTBROOK J. L.
Published: February 2007

A patient with complete respiratory obstruction due to massive oesophageal dilatation is described. Immediate relief of symptoms and disappearance of the oesophageal swelling occurred after administration of sublingual glyceryl trinitrate. Nitrates cause a reduction in the lower oesophageal sphincter pressure in patients with oesophageal achalasia and in this case it is presumed that spasm of the lower oesophageal sphincter had been a major factor preventing decompression of the dilated oesophagus.
The occurrence of bacteraemia associated with the use of oral and nasopharyngeal airways
Authors: Ali M. T. , Tremewen D. R. , Hay A. J. , Wilkinson D. J.
Published: February 2007

In order to determine whether placement of oral or nasopharyngeal airways during anaesthesia induces a significant bacteraemia, 36 ASA grade 1 or 2 patients undergoing body surface surgery, in whom it was anticipated that spontaneous respiration would be maintained, were randomly allocated to one of two groups. One group was given oral airways and the other, nasopharyngeal. A series of blood samples, which were taken before and after airway insertion, were cultured aerobically and anaerobically. Nasal and oral swabs were taken at the same time. Single isolates of Corynebacterium species and Acinetobacter species, together with two isolates of Staphylococcus epidermidis were grown from one culture bottle from 4 of the 36 patients studied. None of the oral or nasal swabs, or any of the subsequent or previous blood samples produced positive cultures for these organisms in these four patients. We believe that these results represent skin commensal contamination rather than bacteraemia in these four patients, and that bacteriological considerations should not influence decisions about the type of airway used during anaesthesia. However, prophylactic antibiotic therapy should still be provided for all high risk cases.
Muscle pains and biochemical changes following suxamethonium administration after six pretreatment regimens
Authors: McLOUGHLIN C. , ELLIOTT P. , McCARTHY G. , MIRAKHUR R. K.
Published: February 2007

The incidence of muscle pains and changes in serum concentrations of potassium, calcium and creatine kinase following suxamethonium were investigated after no pretreatment or pretreatment with intravenous tubocurarine 0.05 mg.kg−1, intravenous chlorpromazine 0.1 mg.kg−1, alphatocopherol (vitamin E) 600 mg in three divided doses orally, aspirin 600 mg orally or intravenous calcium chloride 5 mg.kg−1 in groups of 20 patients each. The incidence of myalgia was reduced significantly by tubocurarine, chlorpromazine and alphatocopherol. However, the increase in creatine kinase was attenuated only in the groups of patients who received tubocurarine and chlorpromazine. The changes in serum potassium and calcium concentrations were within acceptable limits. The intubating conditions were not as good in the patients who received tubocurarine as in the other groups. Effectiveness of chlorpromazine in preventing both the myalgia and the biochemical changes suggests the involvement of phospholipases in the pathogenesis of suxamethonium‐induced muscle damage.
Suxamethonium block in the myasthenic patient
Authors: BARAKA A.
Published: February 2007

The neuromuscular block of suxamethonium 1.5 mg.kg−1 was investigated in three myasthenic patients (Class HA), undergoing thymectomy. Two of the patients were receiving pre‐operative pyridostigmine therapy. In the three patients, plasma cholinesterase activity was determined on the morning of surgery and was correlated with the neuromuscular response to suxamethonium as monitored by electromyography. The results suggest that the response to suxamethonium in the myasthenic patients can show wide variations according to the level of their plasma cholinesterase activity. The degree and duration of suxamethonium block is inversely related to the plasma cholinesterase activity.
Pituitary apoplexy following cholecystectomy
Authors: YAHAGI N. , NISHIKAWA A. , MATSUI S. , KOMODA Y. , SAI Y. , AMAKATA Y.
Published: February 2007

A case of pituitary apoplexy, which presented with hyperaesthesia in the distribution of the ophthalmic division of the left trigeminal nerve and a left sixth nerve palsy following cholecystectomy, is reported. Computed tomography and magnetic‐resonance imaging revealed a large intrasellar mass which extended laterally into the left cavernous sinus and showed evidence of old and recent haemorrhage within the tumour. This case demonstrates that patients who present with unusual neurological symptoms involving the cranial nerves after general anaesthesia, should undergo neurological and radiological investigations.
Magnetic resonance for the anaesthetist
Authors: MENON D. K. , PEDEN C. J. , HALL A. S. , SARGENTONI J. , WHITWAM J. G.
Published: February 2007

Anaesthetists are being increasingly involved in magnetic resonance (MR) procedures, both in patient care and as a research tool. This paper outlines the physical basis of nuclear magnetic resonance and describes its application in magnetic resonance imaging and spectroscopy. Principles of magnet design and safety relevant to anaesthetic practice in a magnetic resonance environment are discussed and guidelines for anaesthetic practice suggested. Some recent clinical magnetic resonance studies of anaesthetic interest are reviewed.
Oxyhaemoglobin saturation following elective abdominal surgery in patients receiving continuous intravenous infusion or intramuscular morphine analgesia
Authors: Kluger M. T. , Owen H. , Watson D. , Ilsley A. H. , Baldwin A. M. , Fronsko R. R. L. , Plummer J. L. , Brose W. G.
Published: February 2007

Oxygen saturation was continuously measured using computerised pulse oximetry for 8 h overnight pre‐operatively and for the first 24 h postoperatively in 40 patients receiving intermittent intramuscular morphine or continuous infusion of morphine following elective upper abdominal surgery. The proportion of time with an oxygen saturation less than 94% was used as an index of de'saturation. Patients receiving continuous infusion analgesia received a larger morphine dose and achieved better analgesia than the intramuscular group. Postoperatively, the duration of desaturation increased 10‐fold over pre‐operative values, ‘intramuscular’ patients spending 39.0% (SD, 37.0%) and ‘continuous infusion’ patients 40.0% (SD, 37.5%) of the time below 94% saturation. Although newer therapies (e.g. epidural analgesia and patient‐controlled analgesia) are currently receiving greater attention, the sequelae of these more traditional analgesic techniques warrant further study.