bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaesthetic induction with isoflurane or halothane
Authors: PHILLIPS A. J. , BRIMACOMBE J. R. , SIMPSON D. L.
Published: February 2007

The authors performed a randomised, prospective trial in which one junior anaesthetist administered gaseous induction of anaesthesia to 50 unpremedicated children with either isoflurane or halothane in nitrous oxide and oxygen. Arterial oxygen saturation and the electrocardiogram were monitored and the incidence of complications noted. Desaturation below 85% occurred in six children, but only with isoflurane. The incidences of complications and desaturation events did not alter throughout the 25 isoflurane inductions. Coughing, movement, laryngospasm and sinus tachycardia occurred more frequently with isoflurane. Isoflurane inductions took longer (7.9 as compared with 5.4 minutes, p < 0.001) and had 4.25 times the number of complications.
Antagonism of neuromuscular blockade
Authors: GOLDHILL D. R. , PYNE A. , JONES C. J.
Published: February 2007

Glycopyrronium 5 or 10 μg/kg was administered either simultaneously with, or 1 minute before, edrophonium 1 mg/kg in order to antagonise competitive neuromuscular blockade in 80 children. Both doses of glycopyrronium given before the edrophonium resulted in an initial significant (p < 0.01) increase in heart rate. Heart rate decreased significantly (p < 0.01) in all groups after the edrophonium was given, and only glycopyrronium 10 μg/kg administered before edrophonium prevented a substantial decrease below baseline. Initial heart rate responses to glycopyrronium or edrophonium are rapid, and measurements at intervals of 30 seconds may be necessary to record these changes.
Induction dose of propofol in children
Authors: PATEL D. K. , KEELING P. A. , NEWMAN G. B. , RADFORD P.
Published: February 2007

In a study of 144 children aged 1–12 years, attempts were made to assess the ED50 and ED90 of the intravenous induction agent, propofol. The doses required for loss of eyelash reflex and tolerance of facemask, in 50% of unpremedicated children, were 1.6 mg/kg and 2.5 mg/kg respectively. In children premedicated with oral trimeprazine the corresponding values of ED50 were 1.1 mg/kg and 2.0 mg/kg. Doses of 2.8 mg/kg in unpremedicated and 2.0 mg/kg for those who received trimeprazine were required for loss of eyelash reflex in 90% of children. This probably corresponds to an effective induction dose. Pain and movement on induction were common; the incidence was 27% and 21.5% respectively.
Anaphylactoid reaction following the use of etomidate
Authors: FAZACKERLEY E. J. , MARTIN A. J. , TOLHURST‐CLEAVER C. L. , WATKINS J.
Published: February 2007

A 13‐year‐old female suffered urticaria and severe bronchospasm sufficient to cause hypoxic cardiac arrest after intravenous induction of anaesthesia. Etomidate was strongly implicated in the reaction. The management and mechanism of the reaction are described and discussed, together with consideration of future anaesthesia in the patient.
The prolonged use of atracurium in a patient with tetanus
Authors: PEAT S. J. , POTTER D. R. , HUNTER J. M.
Published: February 2007

A case of u patient with tetanus is reported in whom an atracurium infusion and artificial ventilation were needed in addition to sedation to control the muscle spasms. The atracurium infusion was used for 71 days, the longest time ever recorded, at a mean rate of 1.3 mg/kg/hour at the end of infusion. The plasma atracurium and laudanosine concentrations were 1.5 μg/ml and 0.985 μg/ml respectively. Subsequently there was an exponential decline in the serum laudanosine concentration which had decreased to 0.014 μg/ml 24 hours later. These results suggest that prolonged use of atracurium by infusion is not associated with excessive cumulation of laudanosine when renal and hepatic function are normal.
Multiple rib fractures and head injury—an indication for intercostal catheterisation and infusion of local anaesthetics
Authors: GRAZIOTTI P. J. , SMITH G. B.
Published: February 2007

A case is presented which demonstrates the advantages of continuous intercostal analgesia in a patient with a head injury and multiple rib fractures.
Hypoxaemia during recovery from anaesthesia—an audit of children after general anaesthesia for routine elective surgery
Authors: Laycock G.J.A. , McNicol L.R.
Published: February 2007

Arterial oxygen saturation was measured by pulse oximetry in 105 children (aged 2 weeks‐14 years) during recovery from general anaesthesia. Oxygen saturation was monitored continuously from the time that anaesthesia ended in the operating theatre until the children were fit to leave the recovery ward. All children breathed room air during transfer to the recovery area; 81 children continued to breathe room air in the recovery ward while the remainder received supplementary oxygen. Fifty‐six children became significantly hypoxaemic (oxygen saturation < 90%) at some stage. Hypoxaemia occurred most frequently after termination of anaesthesia (immediate postoperative period) and then later in the recovery ward when the children began to wake up (post‐waking period). The administration of 100% oxygen at the end of anaesthesia had no effect on the incidence of early hypoxaemia which was greatest in children whose trachea had been intubated. Late hypoxaemia was associated most commonly with crying and breath‐holding and was reduced significantly by supplemental oxygen. The oxygen saturation of children on return to the ward was significantly lower than the pre‐operative value (p < 0.001).
Blood pressure response of neonates to tracheal intubation
Authors: CHARLTON A. J. , GREENHOUGH S. G.
Published: February 2007

Blood pressure and pulse rate responses to tracheal intubation were studied by oscillotonometric technique in 45 term neonates and 15 infants of similar postconceptual age. No hypertensive response was found in neonates intubated awake and pressures did not differ from those of babies intubated under halothane or after thiopentone and muscle relaxant. The infants did however show a significant increase in systolic and diastolic pressures which indicates that this response may develop after the first month of life.
Patient‐controlled analgesia—the need for caution
Authors: THOMAS D. W. , OWEN H.
Published: February 2007

Respiratory depression and oversedation occurred during the administration of patient‐controlled analgesia because of a broken syringe barrel. Possible complications in the use of patient‐controlled analgesia are reviewed. These may be because of prescription or provision errors, patient factors or equipment problems.
The first use of physostigmine in the treatment of atropine poisoning
Authors: NICKALLS R. W. D. , NICKALLS E. A.
Published: February 2007

This paper describes a clinical experiment performed by Drs Kleinwachter and Niemetschek in Prague in 1864, which showed for the first time that oral Calabar bean extract (which contains physostigmine) reverses the toxic effects of atropine. Kleinwachter's original paper is translated from the German.
Reversal of pancuronium
Authors: GOLDHILL D. R. , EMBREE P. B. , ALI H. H. , SAVARESE J. J.
Published: February 2007

Moderate to deep (67–99% single twitch depression) pancuronium‐induced neuromuscular blockade was antagonised with neostigmine (30 μg/kg, 60 μg/kg, or 80 μg/kg) in combination with glycopyrronium. Twenty‐seven patients were reversed from 91%‐99% twitch depression. Recovery of the first twitch of a train‐of‐four to 95% of control twitch took at least 20 minutes with neostigmine 30 μg/kg. The higher doses were significantly faster (60 μg/kg p < 0.05, 80 μg/kg p < 0.01) and took 15.8 and 14.8 minutes respectively. Reversal to a train of four ratio of 0.75 was not consistently achieved in under 30 minutes with any dose of neostigmine.

Nineteen patients were antagonised from a 67%‐80% depression of first twitch and in all but two recovery to 95% of control took under 10 minutes. To achieve a train of four ratio of 0.75 took less than 12.5 minutes except in three patients, two of whom, both given neostigmine 30 μg/kg, took longer than 20 minutes. Neostigmine 60 μg/kg produced as rapid a degree of antagonism as SOμg/kg. Heart rates after reversal decreased gradually in all groups, although the decrease was initially greater in the low dose neostigmine (30 μg/kg) group. A fixed 5:1 ratio of neostigmine and glycopyrronium will usually antagonise a moderate (70%‐80%) pancuronium block to a train of four of greater than 75% within 12.5 minutes if at least 60 μg/kg of neostigmine is administered. More than 30 minutes may be required for reversal whatever the dose of neostigmine, for antagonism from greater than 90% twitch depression.
Isoflurane in the treatment of asthma
Authors: REVELL S. , GREENHALGH D. , ABSALOM S. R. , SONI N.
Published: February 2007

A 22‐month‐old child developed severe bronchospasm. Prolonged ventilation of the lungs with isoflurane for 102 hours was used as treatment. The metabolism and fluoride levels obtained are discussed.
Acute localised pulmonary oedema
Authors: KHOO S. T. , CHEN F. G.
Published: February 2007

Re‐expansion pulmonary oedema is a rare complication to follow the treatment of pneumothorax or pleural effusion. A unique ease is described here which occurred in a young man immediately after the surgical repair of a ruptured diaphragm. The possible causative mechanisms are discussed.
Midwive's assessment of the upper sensory level after epidural blockade
Authors: JONES M. J. T. , BOGOD D. G. , REES G. A. D. , ROSEN M.
Published: February 2007

The ability of midwives to assess accurately the level of epidural blockade after a short period of instruction was examined. Seventy‐two midwives estimated the upper level bilaterally in 100 patients, by detection of the loss of sensation to a cold stimulus. The midwife and anaesthetist were in complete agreement over the level of block in 71.5% of cases; the midwife overestimated the height of the block in 9.5% of cases, and underestimated in 19%. The midwife underestimated by three spinal segments in 1.5% of cases, and never by more. The technique was acceptable to patients and midwives alike. This procedure should enable safe management of obstetric analgesia, whoever administers top‐ups; accurate detection of a block that recedes below therapeutic levels should facilitate earlier top‐ups and thus reduce pain for the patient in labour.
Intra‐articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients
Authors: MILLIGAN K. A. , MOWBRAY M. J. , MULROONEY L. , STANDEN P. J.
Published: February 2007

A randomised double‐blind study was conducted to compare the influence on postoperative pain of equal volumes of one of two concentrations of bupivacaine (0.25%, 0.5%), or saline 0.9%, injected into the knee joint after arthroscopy. The results showed that intra‐articular bupivacaine had no significant analgesic effect in either concentration. Plasma bupivacaine concentrations were measured 20 minutes after injection in order to determine the extent of systemic absorption.
Suxamethonium induced myalgia and the effect of pre‐operative administration of oral aspirin
Authors: McLOUGHLIN C. , NESBITT G. A. , HOWE J. P.
Published: February 2007

Eighty‐four fit, unpremedicated patients who presented for routine surgery and received a standard anaesthetic technique were allocated randomly to three equal groups. Group 1 received tubocurarine 0.05 mg/kg before induction of anaesthesia. Group 2 received soluble aspirin 600 mg orally one hour before surgery, while Group 3 received no pretreatment. Aspirin prophylaxis produced a significant reduction in the incidence of subsequent suxamethonium‐induced myalgia and the improvement was similar to that achieved with tubocurarine pretreatment. Pre‐operative oral administration of aspirin effectively reduces muscle pains and avoids many of the complications associated with pretreatment with non‐depolarising agents.
Common peroneal nerve palsy
Authors: HATANO Y. , ARAI T. , IIDA H. , SONEDA J.
Published: February 2007

Two cases of common peroneal nerve palsy after coronary artery bypass grafting surgery are described and the possible causative mechanisms are discussed.
Electrical distribution boards in the operating theatre
Authors: NIEMAN M. , SHAW A. , RAILTON R.
Published: February 2007

The safe use of electrical distribution boards in operating theatres is described, with particular reference to British Standard 5724. Recommendations as to a practical working policy are mode.
Pulse oximetry and postoperative hypothermia
Authors: GABRIELCZYK M. R. , BUIST R. J.
Published: February 2007

The accuracy of the Nellcor N‐100 pulse oximeter was evaluated in hypothermic patients (core temperature ≤ 35.0°C) after cardiac surgery. The pulse oximeter overestimated oxygen saturation in comparison to values obtained by direct in vitro oximetry with a mean bias of 0.6% saturation. The 95% predictability limits for individual measurements were ±3.9% oxygen saturation. No demonstrable loss of accuracy was caused by skin pigmentation, the concurrent administration of low doses of dopamine or vasodilators, or the intra‐operative intravascular administration of Patent Blue V dye.
Total intravenous anaesthesia with propofol and alfentanil by computer‐assisted infusion
Authors: SCHÜTTLER J. , KLOOS S. , SCHWILDEN H. , STOECKEL H.
Published: February 2007

The combination of propofol and alfentanil was administered to 20 patients for total intravenous anaesthesia during general surgery. The infusion rates for both drugs were controlled by microprocessors in order to institute constant blood levels adapted to the patients' varying needs. The mean blood level of propofol required for adequate hypnosis during anaesthesia was 2.42 μg/ml (SD 0.43). Awakening occurred 7.9 minutes (SD 3.4) after the end of the infusion, at a propofol blood level of 1.59 μg/ml (SD 0.34). The plasma level of alfentanil was 285 ng/ml (SD 72) during major noxious stimulation and 148 ng/ml (SD 56) during minor stimulation. The computer‐assisted infusions showed a measured/predicted ratio of 1.01 (SD 0.28) for alfentanil and 0.88 (SD 0.22) for propofol. This indicates that the administration device used in this study is reasonably reliable. The technique of total intravenous anaesthesia was characterised by a smooth induction without significant haemodynamic alterations, by good control during anaesthesia and by a very fast recovery without major side effects.
Disposition kinetics of propofol during alfentanil anaesthesia
Authors: GEPTS E. , JONCKHEER K. , MAES V. , SONCK W. , CAMU F.
Published: February 2007

The pharmacokinetics of a constant rate infusion of propofol were studied in 11 patients who received total intravenous anaesthesia for ENT surgery. Alfentanil was administered as an exponentially decreasing infusion using a computer‐assisted infusion device with a constant target plasma alfentanil concentration of 300 ng/ml. Propofol was infused at a constant rate of 6 mg/kg/hours. Plasma alfentanil concentrations were determined by gas chromatography and whole blood propofol concentrations by high‐performance liquid chromatography in arterial blood samples collected at selected times during and up to 8 hours after infusion. Pharmacokinetic modelling of the blood propofol concentration‐time data indicated that a three‐compartment open model with central elimination was most appropriate. Derived pharmacokinetic parameters were in agreement with previous studies on the pharmacokinetics of propofol. The plasma alfentanil concentrations in 10 patients significantly exceeded the expected values at any time during the infusion. The population mean bias amounted to 20.2% (S D 12.6). Only three data sets were significantly underestimated after the infusion was stopped (mean bias 11.9% (SD 25.5)). The elimination half‐life of alfentanil was approximately 75 minutes (SD 21). We conclude that alfentanil does not interfere with the pharmacokinetic profile of propofol but that propofol induces higher plasma alfentanil concentrations than expected.
Induction and maintenance of propofol anaesthesia
Authors: ROBERTS F. L. , DIXON J. , LEWIS G. T. R. , TACKLEY R. M. , PRYS‐ROBERTS C.
Published: February 2007

A simple, manually controlled infusion scheme for continuous administration of propofol was derived by simulation of a computer algorithm designed to achieve a predetermined blood concentration of propofol within 2 minutes and to maintain a constant blood level for the duration of surgery. The manual infusion scheme for a target blood propofol concentration of 3 μg/ml, consisted of a loading dose of 1 mg/kg followed immediately by an infusion of 10 mg/kg/hour for 10 minutes, 8 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour thereafter. An overall mean blood propofol concentration of 3.67 μg/ml was achieved within 2 minutes and maintained stable for the subsequent 80–90 minutes of surgery. The decrease of systolic and diastolic arterial pressures at induction was much less than that previously described after larger induction doses of propofol and there was a negligible haemodynamic response to largyngoscopy and intubation or to the subsequent surgery. The quality of induction and maintenance of anaesthesia was satisfactory in every patient.
Infusions of propofol to supplement nitrous oxide‐oxygen for the maintenance of anaesthesia
Authors: SEAR J. W. , SHAW I. , WOLF A. , KAY N. H.
Published: February 2007

The peri‐operative and postoperative effects of propofol given by infusion were compared with halothane as a supplement to nitrous oxide‐oxygen anaesthesia for body surface surgery in patients who breathed spontaneously. Anaesthesia was induced after opioid premedication, with either propofol 2.5 mg/kg or thiopentone 4–5 mg/kg which were followed respectively by an infusion of propofol 12 mg/kg/hour for 10 minutes and at a variable rate thereafter, or by halothane at a mean inspired concentration of 1.2%. Maintenance of anaesthesia required a median rate of infusion of propofol of 149.4 mg/kg/minute. The cardiovascular effects during induction and maintenance of anaesthesia were similar in the two groups. The overall incidence of side effects was low but immediate recovery was significantly faster in patients who received propofol.
Pharmacokinetics of propofol administered by continuous infusion in patients with cirrhosis
Authors: SERVIN F. , DESMONTS J. M. , FARINOTTI R. , HABERER J. P. , WTNCKLER C.
Published: February 2007

Anaesthesia was provided by an infusion of propofol in six healthy patients and six patients with hepatic cirrhosis. There were no significant differences between the groups with regard to the central compartment volume, distribution volume at steady state, total apparent distribution volume, total body clearance or elimination half‐life, although the values were always greater in the cirrhotic patients. Recovery times were significantly longer in the patients with cirrhosis.
Effects of propofol on cardiovascular dynamics and coronary blood flow in geriatric patients
Authors: LARSEN R. , RATHGEBER J. , BAGDAHN A. , LANGE H. , RIEKE H.
Published: February 2007

The cardiovascular and myocardial effects of propofol and etomidate were studied in 20 geriatric patients (age 65–84 years) who underwent major upper abdominal surgery. Ten patients received propofol 1.5 mg I kg for induction of anaesthesia followed by a continuous infusion of 0.1 mg/kg I minute for maintenance; 10 patients received etomidate 18 mg for induction followed by 2.4 mg/minute for maintenance. Vecuronium was used for neuromuscular blockade. Cardiovascular dynamics were recorded in the awake state one minute after induction and 1, 5 and 30 minutes after tracheal intubation; coronary blood flow (argon wash‐in) and myocardial oxygen consumption were determined in the awake state and 5 and 30 minutes after intubation. Both anaesthetics decreased systolic, diastolic and mean arterial pressures, heart rate and cardiac index to the same extent. Myocardial blood flow and oxygen consumption were also reduced in both groups due to a reduction in cardiac work. Tracheal intubation produced a marked increase in arterial pressure in the etomidate group, while haemodynamic changes were absent in the propofol group, Myocardial lactate production was not observed in either group 5 or 30 minutes after tracheal intubation.
Propofol and emesis
Authors: GUNAWARDENE R. D. , WHITE D. C.
Published: February 2007

Ninety patients scheduled to undergo minor gynaecological surgery were divided into three groups. Group 1 received propofol only, for both induction and maintenance of anaesthesia. Group 2 were given propofol for induction and maintenance but inhaled 66% nitrous oxide in addition. Group 3 had propofol for induction only and were given nitrous oxide and enflurane thereafter. The incidence of nausea in group 1 was 0%, in group 2, 3.4% and in group 3, 9.4%. No patient vomited.
Use of propofol for sedation during gastrointestinal endoscopies
Authors: Dubois A. , Balatoni E. , Peeters J. P. , Baudoux M.
Published: February 2007

This study investigated the suitability of propofol as a sole agent for continuous sedation in 100 unpremedicated patients during gastrointestinal endoscopy. The propofol was given very slowly (average 62.7 seconds) in order to prevent apnoea during induction, and the dose adjusted according to age (68% of patients were older than 50 years) and ASA grade (32% were ASA grade 3 or 4). There was no correlation under these circumstances between the observed haemodynamic variations and the age or ASA grade of the patients. The infusion rate during maintenance was also adjusted for age, and for the type of endoscopy. The mean rate was 4.3 mg/kg/hour. Recovery was rapid and of excellent quality; 77 patients were awake within 10 minutes and 99 reported total amnesia.
Comparison between propofol and midazolam as sedative agents for surgery under regional anaesthesia
Authors: Fanard L. , Van Steenberge A. , Demeire X. , van der Puyl F.
Published: February 2007

Propofol (25 patients) or midazolam (25 patients) was used to provide sedation in patients who underwent abdominal or orthopaedic surgery under epidural anaesthesia after intravenous premedication with droperidol 1 mg and fentanyl 20 μg. The quality of sedation whilst the block was performed, was assessed as good in 19 patients after propofol 1.49 mg/kg but six patients exhibited uncontrolled movement. Good sedation was provided in 22 patients after midazolam 3 mg. A mean infusion rate of propofol of 1.74 mg/kg/hour resulted in easily controllable sedation during the procedure. Eleven patients given midazolam required no further sedation but a mean of 5.79 mg was needed in the remaining 14 patients; the dose was unpredictable in individual patients. Recovery was significantly more rapid in the propofol group.
Intravenous infusion of propofol for induction and maintenance of anaesthesia during endoscopic carbon dioxide laser ENT procedures with high frequency jet ventilation
Authors: Mayne A. , Joucken K. , Collard E. , Randour P.
Published: February 2007

Fourteen patients of ASA grades 1 3 were anaesthetised with continuous infusions of propofol and alfentanil for endoscopic carbon dioxide laser ENT microsurgery. Their lungs were ventilated with an oxygen‐air mixture using a high frequency jet ventilator. Propofol was given at an initial rate of 120 μg/kg/minute for 10 minutes after a bolus dose of 2.6 mg/kg, and then at 80 fig μg/kg/minute. Alfentanil was given at a rate of 0.5 μg/kg/minute. Arterial pressure decreased significantly after the bolus dose. It increased significantly for a few minutes after laryngoscopy and returned to baseline values during maintenance of anaesthesia. Heart rate increased significantly during induction and until laryngoscopy was performed but it decreased below its initial value after 5 minutes of maintenance. Platelet count and the degree of aggregation did not change during infusion of propofol.
Effect of propofol on elevated intracranial pressure. Preliminary results
Authors: Herregods L. , Verbeke J. , Roily G. , Colardyn F.
Published: February 2007

The effects of a bolus injection of propofol on mean intracranial pressure were studied in six adult, comatose patients who had severe head injuries. Propofol 2 mg/kg was given intravenously over 90 seconds when the mean intracranial pressure reached or exceeded 25 mmHg. Arterial blood gas values, heart rate and central venous pressure remained stable at all measurements. Arterial blood pressure decreased statistically significantly (p < 0.05) within one minute after propofol administration. The mean (SEM) intracranial pressure decreased statistically significantly (p < 0.05) at 30 seconds and at J and 2 minutes, from 25 (3) to 11 (4) mmHg. The cerebral perfusion pressure decreased statistically significantly from 92 (8) mmHg at all measurements (p < 0.05). The lowest value at 3 minutes was 50 (7) mmHg but in jour patients at that time the perfusion pressure was below 50 mmHg.
Propofol in elderly high risk patients. A comparison of haemodynamic effects with thiopentone during induction of anaesthesia
Authors: Steib A. , Freys G. , Beller J. P. , Curzola U. , Otteni J. C.
Published: February 2007

Twenty elderly patients of ASA grade 3 or 4, received either propofol 1 mg/kg or thiopentone 2 mg/kg for induction of anaesthesia. These doses provided a convenient level of anaesthesia for all patients. There were no significant intra‐ or intergroup haemodynamic changes, with the exception of a decrease in diastolic pressure and rate pressure product after propofol. It is concluded that propofol 1 mg/kg can be used to induce anaesthesia in elderly high risk patients without deleterious cardiovascular effects.
Minitracheotomy—a life‐threatening complication
Authors: DABORN A. K. , HARRIS M. N. E.
Published: February 2007

A 55‐year‐old patient developed profuse haemorrhage immediately after insertion of a minitracheotomy tube. Measured blood loss was 1.1 litres, and the bleeding required to be controlled surgically. The cause was a subglottic granuloma which had developed after prolonged tracheal intubation and which was incised during insertion of the minitracheotomy.
Anaesthesia in an infant with Joubert's syndrome
Authors: MATTHEWS N. C.
Published: February 2007

The presentation and management of a child with Joubert's syndrome is outlined with specific reference to the problems of opioid sensitivity and abnormal control of respiration.
Mortality during intensive care after orthotopic liver transplantation
Authors: PARK G. R. , GOMEZ‐ARNAU J. , LINDOP M. J. , KLINCK J. R. , WILLIAMS R. , CALNE R. Y.
Published: February 2007

The postoperative course of 335 adult patients who underwent orthotopic liver transplantation from 1968–1987 was reviewed retrospectively to identify patients who died in the intensive care unit and the causes of death. Forty‐four percent of all deaths occurred in the intensive care unit. The mortality rate in the intensive care unit peaked in 1984 (48%), but decreased to 11% in 1987. The main causes for death in the intensive care unit were infection (55%) and haemorrhage (19%). The patients who died spent more time in the intensive care unit, had a longer period of tracheal intubation and received a larger intra‐operative blood transfusion than patients who died in other locations.
The in vitro buffering capacity of soluble paracetamol
Authors: MILLS D. C.
Published: February 2007

The capacity to neutralise gastric acid was investigated in three over‐the‐counter paracetamol preparations. Panadol (Winthrop Laboratories) showed a buffering capacity equal to that of existing antacids because of the agents used to make it dissolve. This property, together with its mild analgesic action, widespread availability and palatability, may make it a useful agent, for acid aspiration prophylaxis.
Assessing the position of the tracheal tube The reliability of different methods
Authors: Andersen K. H. , Hald A.
Published: February 2007

Various methods have been developed to confirm proper intubation of the trachea. This blind, randomised study evaluates some of these quantitatively and qualitatively. Forty patients had both their trachea and oesophagus intubated. A procedure that included auscultation of the upper abdomen and lungs was 100% reliable independent of which tube was ventilated. Auscultation of the lungs resulted in a wrong conclusion in 15% (6–30, 95% confidence limits) of the cases when the oesophagus was ventilated: the sounds were misinterpretated as normal breath sounds. Suction on the tubes with a 60‐ml syringe was also a reliable test. Other methods assessed were observation for condensation of water vapor, and abnormal movements of the upper abdomen; these were unreliable.
Prophylactic analgesia for daycase termination of pregnancy A double‐blind study with controlled release dihydrocodeine
Authors: Heath P. J. , Ogg T. W.
Published: February 2007

The incidence and severity of pain and nausea experienced by 40 primigravid day patients who presented for vaginal termination of pregnancy were examined. Controlled‐release dihydrocodeine had no effect upon the incidence or severity of these minor sequelae. The requirements for escape analgesia and antiemetic therapy were less than anticipated and possible explanations are discussed. The low incidence of significant nausea and vomiting recorded in this study confirms that vaginal termination of pregnancy may be safely performed as day cases.
Prediction of neurological damage after cardiopulmonary bypass surgery
Authors: NEVIN M. , COLCHESTER A. C. F. , ADAMS S. , PEPPER J. R.
Published: February 2007

Sixty‐five patients who had coronary artery graft surgery were subjected to detailed neuropsychometric assessment before operation and twice again within 7 days after operation. They were monitored continuously with a cerebral function analysing monitor during the operation. The results of the peroperative cerebral monitoring were compared on completion of the study with the neuropsychometric assessments. Seventy‐six percent of the patients with a significant neuropsychometric deficit after operation also showed significant peroperative changes on the analysing monitor; the majority occurred immediately after the start of perfusion. Twenty‐eight patients failed to demonstrate any evidence of neuropsychometric dejicit and six (21%) of these also showed significant peroperative changes. All patients whose traces demonstrated more than one significant change during the peroperative course had a significant neuropsychometric deficit afterwards.
Outpatient paediatric dental anaesthesia
Authors: SIMMONS M. , MILLER C. D. , CUMMINGS G. C. , TODD J. G.
Published: February 2007

One hundred and fifty unpremedicated children who presented for dental extractions were anaesthetised with nitrous oxide and halothane, enjurane or isofurane. Ventricular arrhythmias occurred only in the halothane group (14%). Respiratory problems and desaturation were significantly more common in the isoflurane group. Induction times differed significantly between the groups halothane < enflurane < isoflurane, while recovery time and induction to recovery time were significantly shorter in the enflurane group. We suggest that enflurane is the most suitable agent for anaesthetising these patients.
Advantages of the paramedian approach for lumbar epidural analgesia with catheter technique
Authors: BLOMBERG R. G. , JAANIVALD A. , WALTHER S.
Published: February 2007

Forty‐nine patients, scheduled for transurethral resection of the prostate or a bladder neoplasm on 50 occasions, were studied. The patients were randomly allocated to one of the two methods of puncture, midline or paramedian. Technical difficulties and the occurrence of complications were recorded. The extent of sensory and motor blockade was also compared. The paramedian approach was associated with a lower frequency of technical problems compared to the midline approach. Statistically significant differences were demonstrated between the two techniques for the following factors: repeated attempts at needle insertion; difficulty in identification of the epidural space; resistance to introduction of the catheter; resistance to injection through the epidural catheter; and the production of paraesthesiae (nine patients in the midline group compared to only one patient in the paramedian group, p < 0.01). The catheter entered a vessel at first in two patients in each group. No significant differences were demonstrated between the groups in the extent of sensory and motor blockade. The study supports the view that the paramedian approach has technical advantages over the midline approach for lumbar epidural analgesia with catheter technique.
Intravenous regional anaesthesia of the arm
Authors: HAASIO J. , HIIPPALA S. , ROSENBERG P. H.
Published: February 2007

The effects of different techniques of exsanguination of the upper arm during intravenous regional anaesthesia on prilocaine plasma concentrations, quality of anaesthesia, toxic symptoms after dejation of the tourniquet and injection pressure of the anaesthetic were studied in 10 healthy male volunteers. The nondominant arm was exsanguinated using either Esmarch's bandage or elevation of the arm for 2 minutes plus arterial occlusion by compression of the brachial artery. The injection pressure after the prilocaine dose (3 mg/kg) was signijcantly higher in the elevation group (maximally 98 mmHg). There were no statistically signijcant differences in the onset of, or recovery from, anaesthesia between the groups. Various mild toxic symptoms, were experienced in the central nervous system after dejation of the tourniquet. However, there was no correlation between the two techniques and the degree of severity of the toxic symptoms. The highest single venous plasma concentration (total) of prilocaine was 2.3 pgcglml measured from the contralateral cubital vein (elevation group, 2 minutes). The differences in prilocaine concentrations between the groups were not statistically significant.
Apnoea after retrobulbar block
Authors: RIGG J. D. , JAMES R. H.
Published: February 2007

Two cases of apnoea after retrobulbar block for cataract surgery are described. The possible causes and mechanisms of this complication, its detection and management are discussed.
Failure of rectal diclofenac to augment opioid analgesia after cholecystectomy
Authors: Colquhoun A. D. , Fell D.
Published: February 2007

The analgesic efjcacy of a single 100‐mg suppository of diclofenac sodium given after elective cholecystectomy was studied in 30 healthy patients in a double‐blind randomised controlled manner. The mean 24‐hour postoperative morphine consumption of the placebo group and the diclofenac group was similar (45 mg). Analysis of the cumulative hourly morphine consumption from the patient‐controlled analgesia system failed to show any statistically significant differences between the groups. Peak expiratory flow rate, forced expiratory volume at I second and forced vital capacity decreased 24 hours after operation to less than 50% of pre‐operative values in both groups. Subjective experiences of pain, nausea and drowsiness assessed by linear analogue scoring were similar in both groups.
The oculo‐emetic reflex
Authors: Van Den BERG A. A. , LAMBOURNE A. , CLYBURN P. A.
Published: February 2007

Data related to the incidence of postoperative vomiting were collected during prospective studies on 607 ophthafmic surgical patients of all ages who underwent halothane anaesthesia with spontaneous ventilation. Analysis of data in respect of age, sex and surgical site variables, and time of onset of vomiting, identified a female sex‐related vomiting incidence of about 13% and a squint‐related vomiting incidence of about 41%; no relationship between age and vomiting was identified. The analyses showed that squint surgery predisposed particularly to emesis, and was associated with a high incidence of both early and delayed vomiting. It is suggested that the apparent absence of an age‐vomiting relationship in ocular, and especially squint, surgery, and the high incidence of vomiting, particularly the early vomiting associated only with squint surgery, provide clinical evidence for the existence of an oculoemetic rejex. Our observations show that intra‐ and postoperative surgical stimulation of this oculoemetic repex is rejected in the incidences of vomiting after ocular surgery.
The tumour lysis syndrome Intensive care aspects of paediatric oncology
Authors: STOKES D. N.
Published: February 2007

Turnour lysis syndrome occurs when chemotherapy is started in children who present with advanced lymphomas and leukaemias. Rapid cell lysis causes life‐threatening metabolic derangements because of the release of intracellular potassium, phosphate and uric acid. An alkaline diuresis is commonly established before the start of chemotherapy to minimise uric acid and phosphate deposition within the kidney. Two cases are described where intravenous fluid loading resulted in acute pulmonary oedema, and the intensive care management of such cases is discussed. The improved outcome from increasingly aggressive chemotherapeutic regimens means that children with advanced tumours and organ failure may present for supportive therapy during the early stages of treatment. Close liaison between paediatric oncologists and intensive care staff is essential to establish admission criteria for patients at risk of these complications, and to define therapeutic end points in the event of multisystem failure.
A comparison of anaesthetic breathing systems during spontaneous ventilation
Authors: CHAN A. S. H. , BRUCE W. E. , SONI N.
Published: February 2007

Five anaesthetic breathing systems (Magill, Lack, Humphrey ADE, enclosed Magill and Bain) were compared using spontaneous ventilation in a simple lung model. The fresh gas flow at which rebreathing occurred was determined for each system by the application of four modified definitions of rebreathing. Two were based on the measurement of minimum inspired and two on end‐expired carbon dioxide. The four A systems performed similarly with each individual definition. The rebreathing points found for each individual breathing system differed markedly between definitions, with those determined by the minimum inspired CO2, occurring at low, and probably misleading, FGF/V̇E ratio. The Bain system demonstrated rebreathing at considerably higher fresh gas flows whichever definition was used.
Propofol infusion for sedation of patients with head injury in intensive care
Authors: FARLING P. A. , JOHNSTON J.R. , COPPEL D.L.
Published: February 2007

Propofol was given by continuous intravenous infusion to 10 patients with severe head injuries in the intensive care unit. Heart rate, mean arterial blood pressure, intracranial pressure, cerebral perfusion pressure, pupil size and arterial carbon dioxide tension were recorded throughout the study period. A mean infusion rate of 2.88 mg/kg/hour provided satisfactory sedation, and recovery from the propofol was often rapid. Cerebral perfusion pressure was significantly increased at 24 hours.
The laryngeal mask airway
Authors: BRODRICK P. M. , WEBSTER N. R. , NUNN J. F.
Published: February 2007

A prototype size 3 laryngeal mask was used in 100 patients by 18 anaesthetists with no previous experience of its use. A clear and unobstructed airway was obtained in 98% of patients, without requiring support of the jaw, thus leaving the anaesthetists' hands entirely free. The patency of the airway did not deteriorate during the course of the anaesthetic. In 10 patients there was obstruction of the airway at the first attempt to place it without the introducer and this obstruction appeared to be as a result of downfolding of the epiglottis. Subsequent attempts at passage were successful in all 10 patients. The seal between the mask and the larynx was adequate for artifical ventilation of the patients, but the meun leak pressure was 1.7 k Pa.
Obstetric anaesthetic workload in a teaching unit
Authors: Parsloe M. R. , MacDonald R.
Published: February 2007

The distribution of obstetric anaesthetic work through the day was examined. Workload audit and prediction are discussed with their relevance to service and training.
Pulse oximetry in the recovery room
Authors: Smith D. C. , Canning J. J. , Crul J. F.
Published: February 2007

Haemoglobin oxygen saturation (So2) was measured percutaneously with a pulse oximeter, in a group of 150 healthy ambulant volunteers to determine the range of normal values. The measuring site was not arterialised in advance. So2 was below 94% in 13.3% of cases, while in no case was it below 90%. So2 was then measured in 350 patients in the recovery room after a variety of surgical and anaesthetic procedures. Only 1.1% of patients who received additional oxygen following general anaesthesia exhibited an So2 below 90%, compared to 16.7% of similar cases who did not receive additional oxygen. Administration of additional oxygen raised the So2, above 90% in all the latter cases. In only 55.3% of those who did not receive additional oxygen was the So2 above 94%, compared to 86.7% of normal volunteers and 73.9% of patients who received additional oxygen. This study reiterates the need to administer supplemental oxygen to all patients in the recovery room, unless facilities are available to measure So2. A lower alarm limit of 90% is appropriate for the peri‐operative period when using the Criticare Systems 501 oximeter.
The effect of acutely administered phenytoin on vecuronium‐induced neuromuscular blockade
Authors: GRAY H. St. J. , SLATER R.M. , POLLARD B.J.
Published: February 2007

Phenytoin was administered intravenously in a dose of 10 mg/kg to a group of patients in whom steady state neuromuscular blockade had been established with an infusion of vecuronium. A control group of patients were given 0.9% saline instead of phenytoin. Administration of phenytoin produced significant augmentation of neuromuscular blockade (p < 0.001). The possible mechanism of this effect is discussed.
The effects of speed of injection on induction with propofol A comparison with etomidate
Authors: GILLIES G. W. A. , LEES N. W.
Published: February 2007

One hundred and eighty female patients received either propofol 2.5 mg/kg or etomidate 0.3 mg/kg injected over 20, 40 or 80 seconds for induction of anaesthesia after premedication with temazepam 20 mg. The mean induction times for both etomidate and propofol were significantly reduced with increasing speed of injection. The mean induction times for etomidate were significantly less than propofol at the slower rates of injection. At each speed of injection, the decrease in systolic, mean and diustolic arterial blood pressures with etomidate were less than with propofol. The decrease in systolic blood pressure was not significantly affected by injection speed for either drug. Apnoea occurred significantly more frequently with propofol than with etomidate at each speed of injection and the incidence of apnoea greater than 60 seconds with propofol was significantly higher when injected over 20 seconds than 80 seconds. The incidence of pain on injection was unaffected by injection speed, for either drug. The incidence of myoclonus and (or) hypertonus was significantly higher following etomidate.
Cardiovascular instability following bolus dose of etomidate
Authors: McGRADY E. M. , WRIGHT I. H.
Published: February 2007

A patient with alveolar proteinosis develqed unexpected cardiovascular instability after broncho‐alveolar lavage. He had received two bolus doses of etomidate within an 18‐hour period. Serum cortisol concentrations were low and hydrocortisone replacement therapy was necessary to restore arterial pressure. Implications for management of critically ill patients who receive bolus doses of etomidate are discussed.
The oesophageal detector device
Authors: WILLIAMS K. N. , NUNN J. F.
Published: February 2007

Misplacement of a tracheal tube in the oesophagus remains a significant cause of mortality and morbidity in anaesthesia, despite decades of effort aimed at prevention, or perhaps more importantly, detection, of such an event. We have evaluated a cheap, simple and quick device which relies mainly on the reflation or otherwise of an Ellick's evacuator applied to the supposed ‘tracheal’ tube. Identical tracheal tubes were passed into the trachea and oesophagus of 100 patients; the left and right position in the mouth was chosen at random. The test was conducted by a second anaesthetist, not present at intubation, and unaware of which tube was in the trachea. There were no false positive results and the correct deduction of which was the tracheal tube was reached in 100 tests using this device. Its use is recommended for widespread evaluation as a valuable adjunct to existing methods of detecting misplacement.
The Malawi anaesthetic machine
Authors: FENTON P. M.
Published: February 2007

One year's experience with a new type of oxygen concentrator and anaesthetic machine, designed for anaesthesia in developing countries, is presented. The apparatus, its performance and problems are described and the author's suggested modijications to improve the original design are outlined. The apparatus, with these changes, represents a signifcant advance in oxygen availability for hospitals in developing countries as well as improving the anaesthetic capabilities.
Serious morbidity attributable to anaesthesia Considerations for prevention
Authors: Pedersen T. , Johansen S. H.
Published: February 2007

The types and frequency of complications attributable solely to anaesthesia, and which caused serious morbidity and substantial negative outcome, were examined in a prospective study of 7306 anaesthetics, The analysis demonstrated that severe complications and mortality attributable to anaesthesia occurred in 0.59% (1:170) and 0.04% (1:2500) of patients respectively. The data suggest that‘high‐risk'patients are more likely to be affected by errors and a substantial negative outcome than more healthy patients. We judged one‐third of the anaesthesia‐related morbidity to be preventable. Anaesthetists are faced with an increasing number of patients who are at high risk, and who undergo increasingly extensive surgical interventions. Concomitant with the increasing complexity of care and increasing demands on the anaesthetists may be an expected increase in the incidence of errors. Recognition of the importance of human factors in morbidity and mortality attributable to anaesthesia is a necessary jrst step.
A double‐blind comparison of epidural ketamine and diamorphine for postoperative analgesia
Authors: PEAT S. J. , BRAS P. , HANNA M. H.
Published: February 2007

Twenty patients who had abdominal hysterectomy under general anaesthesia were randomly assigned to receive either epidural ketamine (30 mg), or epidural diamorphine (5 mg) peri‐operatively and on first request for analgesia. Failure to obtain satisfactory analgesia with one of the agents was treated by epidural administration of the other. Pain was assessed by an independent observer, and by the patient using a visual analogue scale. The mean (SD) pain score on recovery from general anaesthesia, on a scale of 0–4, was 2.9 (1.2) for the ketamine group and 1.0 (1.0) for the diamorphine group (p < 0.01). The mean (SD) time to first request for analgesia was 272 (206) and 72 (41) minutes in the diamorphine and ketamine groups respectively (p < 0.01). All patients in the diamorphine group obtained adequate analgesia, but all patients in the ketamine group were changed to epidural diamorphine. Epidural ketamine does not appear to be a suficiently effective alternative to epidural diamorphine for routine use in postoperative pain.