bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypotension following valve replacement surgery in carcinoid heart disease
Authors: HAMID S. K. , HARRIS D. N. F.
Published: February 2007

We report the use of adrenaline in a 62‐year‐old woman with carcinoid heart disease who underwent double valve replacement. She was given an intravenous infusion of octreotide throughout the peri‐operative period. Following the termination of cardiopulmonary bypass she developed profound hypotension which proved to be refractory to various therapies but responded to adrenaline. Adrenaline is said to be contraindicated in carcinoid syndrome, but we would suggest the consideration of its use in such cases where the hypotension may result from myocardial depression rather than from a carcinoid crisis.
Caudal blockade in the management of aortic thrombosis following umbilical artery catheterisation
Authors: HARGREAVES D. M. , SPARGO P. M. , WHEELER R. A.
Published: February 2007

A neonate, with a postconceptual age of 29 weeks, suffered thrombosis of the aorta as a consequence of umbilical artery catheterisation. This resulted in ischaemic lesions of the lower limbs and buttocks. Part of the management consisted of the insertion of an extradural catheter, via the caudal route, which provided good pain relief and may have improved lower limb blood flow.
Thoracic epidural anaesthesia and primary pulmonary hypertension
Authors: ARMSTRONG P.
Published: February 2007

Patients with primary pulmonary hypertension occasionally present for surgery. Anaesthesia requires continuous cardiovascular monitoring and maintenance of stable pulmonary and systemic haemodynamics. The management of a patient with severe pulmonary hypertension, undergoing open lung biopsy under a combination of general anaesthesia and thoracic epidural analgesia is reported and the problems of primary pulmonary hypertension are discussed.
Magnetic resonance for the anaesthetist
Authors: PEDEN C. J. , MENON D. K. , HALL A. S. , SARGENTONI J. , WHITWAM J. G.
Published: February 2007

Anaesthetists are increasingly involved in patient care during magnetic resonance imaging and spectroscopy. This paper describes a system which has been developed for the management of critically ill patients and the conduct of anaesthesia in a magnetic resonance unit with a 1.6 tesla whole body magnet. Difficulties which arise from working in a confined space in a high magnetic field are highlighted. Different approaches to anaesthesia, sedation and the modification of equipment for use in this environment are reviewed. The problems associated with patient monitoring within a magnetic field are discussed and some solutions are suggested. A transport system for critically ill patients is described and a protocol for management is outlined.
Pre‐registration house surgeons
Authors: Power K. J.
Published: February 2007

A group of newly qualified preregistration House Officers completed a questionnaire relating to their knowledge of anaesthetic drugs and to their appreciation of complications which may, in whole or in part, have required some knowledge of anaesthesia. Considerable gaps in knowledge were demonstrable, not only in matters that might arguably be regarded as strictly within the province of anaesthesia, but also in respect of basic pharmacology. The same House Officers were also questioned as to the necessity for various basic pre‐operative investigations prior to six everyday surgical procedures. This demonstrated a marked propensity for House Officers to overinvestigate patients as compared to the requirements of practising anaesthetists. The discrepancy was most marked with respect to pre‐operative chest X rays. However, considerable disparity was also demonstrable amongst a group of experienced anaesthetists as to their requirements for pre‐operative investigations. Permitting students greater exposure to anaesthesia in the undergraduate curriculum could go a long way towards improving this situation.
Ventilatory effects of subarachnoid fentanyl in the elderly
Authors: VARRASSI G. , CELLENO D. , CAPOGNA G. , COSTANTINO P. , EMANUELLI M. , SEBASTIANI M. , PESCE A. F. , NIV D.
Published: February 2007

Twenty‐eight elderly patients scheduled for urological surgery were randomly assigned to receive, in a double‐blind study, subarachnoidhyperbaric bupivacaine 15 mg with 50 μg (group A, n = 7), 25 μg (group B, n = 7), or 12.5 μg (group C, n = 7) of fentanyl or 1 ml of saline (group D, n = 7) in a total volume of 4 ml. The pattern of breathing and the ventilatory response to CO2 were studied before and 90, 150 and 480 min after the subarachnoid injection. In group A, mild pruritus and sedation occurred in five patients, while nausea, vomiting and periodic breathing occurred in two. In group B, mild pruritus and sedation were observed in four patients, while nausea and vomiting occurred in two. No significant differences in minute ventilation, respiratory drive and respiratory timing were observed between the groups. Patients receiving fentanyl 50 ug showed a percentual change from baseline values as function of time (slope V̇E/PE'co2 significantly below baseline at 90 and 150 min (p < 0.05). However, the baseline values in this group reverted after 480 min. No side effects were observed in groups C or D. It is concluded that subarachnoid fentanyl 50 μg can cause an early respiratory depression and its use as a postoperative analgesic should be avoided in the elderly.
Carbon dioxide pneumothorax occurring during laparoscopic cholecystectomy
Authors: GABBOTT D. A. , DUNKLEY A. B. , ROBERTS F. L.
Published: February 2007

A previously fit patient underwent laparoscopic cholecystectomy. During the procedure arterial oxygen saturation fell and clinical examination revealed signs of a right pneumothorax confirmed by chest X ray. Aspiration of the pleural cavity and analysis of the gas removed showed it to be composed entirely of carbon dioxide. Possible mechanisms of entry of carbon dioxide into the pleural space are discussed.
An evaluation of oxygen delivery using nasal prongs
Authors: OOI R. , JOSHI P. , SONI N.
Published: February 2007

Oxygen delivery using nasal prongs was assessed using a lung model for spontaneous ventilation. The analogue lung was attached to a manikin, which provided a model of the ‘face and pharynx’ to which the nasal prongs were applied. Oxygen concentrations were measured in the model trachea at varying fresh gas inflow and peak inspiratory flows. The study demonstrated enormous variability in the both the peak‐inspired (26.3–90.0%) and end‐expired concentrations (25.2–78.6%) of oxygen delivered to the trachea. There was a regular relationship between the ratio of peak inspiratory flows, expressed over fresh gas inflow and the end‐expired oxygen concentrations which could allow estimation of inspired oxygen concentration.
The effect of pre‐induction glycopyrronium on the haemodynamic response of elderly patients to anaesthesia with propofol
Authors: Sneyd J. R. , Mayall R.
Published: February 2007

This study investigated whether pretreatment with glycopyrronium can attenuate the hypotension caused by anaesthesia of the elderly with propofol. Twenty elderly patients (77.1 ± 2.44 years, mean±SEM) of ASA physical status 2 or 3 scheduled for elective urological procedures were given glycopyrronium 0 (n = 10) or 5 μ.kg−1 (n = 10) in a randomised, double‐blind manner, 5 min before induction of anaesthesia with propofol infused at 600 ml.h−1 (average induction dose 1.7±0.06 mg.kg−1, mean±SEM) followed by maintenance with a propofol infusion at 10 mg.kg−1.h−1. Although glycopyrronium significantly increased heart rate (p < 0.01, AOVA), the decrease in blood pressure 2 and 5 min after induction was similar in both groups. The study had a power of 80% to detect a 20 mmHg difference in systolic arterial pressure between treatment groups with p < 0.05.
Mivacurium chloride: a study to evaluate its use during propofol–nitrous oxide anaesthesia
Authors: WRIGLEY S. R. , JONES R. M. , HARROP‐GRIFFITHS A. W. , PLATT M. W.
Published: February 2007

We assessed the neuromuscular and cardiovascular effects of mivacurium chloride, a neuromuscular blocking agent, in 33 patients during propofol‐nitrous oxide anaesthesia. Neuromuscular function was assessed with supramaximal stimuli of the ulnar nerve, using surface electrodes at the wrist, with repeat trains of four. Mivacurium given as a bolus of 0.15 mg.kg−1 (ED95× 2) was found to be haemodynamically stable. Intubating conditions assessed at 2 and 2.5 min were either good or excellent. All patients developed a block of 100% in a mean (SD) time of 105 (34) s. There were mean (SD) intervals of 12 (2.4) min before the reappearance of the first twitch of the train of four (T1) following the bolus dose, and 15.8 (3.1) min for the Tl to reach 25% of its control value (TC). Seventeen patients received an infusion of mivacurium to maintain neuromuscular blockade (T1: TC 10–20%) with a mean (SD) infusion rate of 6.9 (2.2) μ.kg−1 min−1. Recovery from neuromuscular blockade was assessed with spontaneous offset or augmented with edrophonium following either the initial bolus or an infusion. Following a bolus it took a mean (SD) of 26.2 (3.7) min for the fourth twitch of the train of four (T4): T1 ratio to reach 0.7. In patients receiving an infusion with spontaneous offset it took a mean (SD) time of 12.0 (2.2) min to reach the T4: T1 ratio of 0. 7 from a Tl: TC value of 8.8. Edrophonium significantly decreased the recovery time in both groups. It took a mean (SD) time of 5.4 (2.2) min to reach a T4:Tl of 0.7froma T1:TC of 17.1% in the group receiving an infusion and 4.0 (0.7) min for the T4.T1 to reach 0.7 from a T1:TC value of 14.3% in the patients receiving a bolus only. We conclude that mivacurium is a suitable agent for neuromusccular relaxation and may have advantages over existing agents.
Upper respiratory tract infections and general anaesthesia in children
Authors: LEVY L. , PANDIT U. A. , RANDEL G. I. , LEWIS I. H. , TAIT A. R.
Published: February 2007

Conflicting reports regarding the hazards of anaesthesia in children presenting for surgery with an upper respiratory tract infection have appeared in the literature. In the present study 130 children undergoing general anaesthesia with face mask for myringotomy and grommet insertion were graded as having either an acute or recent upper respiratory tract infection or were asymptomatic according to predetermined clinical symptoms and signs. The severity of respiratory and related complications were scored during induction, emergence and recovery. The peripheral oxygen saturation was recorded during induction, emergence, transfer to the recovery ward and in the recovery ward itself. There were no significant differences (p > 0.05) in the complication scores between the three groups of children. However, the incidence of hypoxaemia (oxygen saturation ± 93%) was significantly greater during transfer in the acute infection group (p = 0.001) and the recent infection group (p = 0.02), as well as during recovery in the acute group (p = 0.03) compared with asymptomatic children.
The laryngeal mask airway
Authors: GREENE M. K. , RODEN R. , HINCHLEY G.
Published: February 2007

Two cases of emergency prehospital airway control using the laryngeal mask are described. The patients were trapped following road traffic accidents and limited access prevented tracheal intubation. The laryngeal mask airway may be a useful alternative to tracheal intubation in some cases of prehospital trauma care.
Laryngeal mask and anaesthetic waste gas exposure
Authors: LAMBERT‐JENSEN P. , CHRISTENSEN N. E. , BRYNNUM J.
Published: February 2007

In recent years there has been a growing awareness of the possible hazards caused by anaesthetic gases in operating theatres. The laryngeal mask airway provides an alternative both to tracheal intubation and the face mask although the implications for operating theatre contamination have not been quantified. This paper describes the incidence and magnitude of exposure of theatre personnel to waste anaesthetic gases during laryngeal mask airway anaesthesia. The leakage of anaesthetic gases to the anaesthetist's breathing zone was monitored using a Bruel & Kjaer Multi Gas Monitor, Type 1302 during 50 general anaesthetics employing either spontaneous (n = 24) or controlled (n = 26) ventilation. All patients were anaesthetised with propofol, alfentanil and nitrous oxide. There was no statistically significant association between the amount of anaesthetic gas leakage and ventilation method. The laryngeal mask airway meets occupational safety requirements on nitrous oxide concentrations in the operating theatre environment.
The upgraded Finapres 2300e
Authors: JONES R. D. M. , BROWN A. G. , ROULSON C. J. , SMITH I. D. , CHAN S. C.
Published: February 2007

Measurements from the upgraded Finapres 2300e continuous noninvasive blood pressure monitor, the Finapres 2300 and Colin oscillometric noninvasive blood pressure monitor were compared with invasive arterial line blood pressure readings. Fifteen young Chinese patients undergoing elective spinal surgery of more than 2 h duration had contemporaneous blood pressure measurements digitally recorded every minute. Data were analysed using methods described by Bland and Altman to assess agreement of noninvasive devices with an arterial line. Results showed that although the Finapres 2300e was significantly more accurate than the Finapres 2300 and Colin noninvasive blood pressure monitors it could not be recommended as a substitute for continuous arterial line blood pressure monitoring. Both Finapres devices demonstrated reductions in accuracy related to time (drift) and over‐read diastolic and mean pressures by 5–8 mmHg throughout the range of mean arterial line pressures (bias). The Colin was consistently less accurate than the Finapress monitors and performed worst at low mean arterial line pressures.
A comparison of the pharmacodynamics of rocuronium and vecuronium during halothane anaesthesia
Authors: BOOTH M. G. , MARSH B. , BRYDEN F. M. M. , ROBERTSON E. N. , BAIRD W. L. M.
Published: February 2007

Thirty healthy patients were randomised to receive either a single bolus dose of rocuronium 0.6mg.kg−1 or vecuronium 0.1 mg.kg−1 during halothane anaesthesia. Onset time, duration 25, duration 75 and train‐of‐four 70 were measured. The onset of neuromuscular blockade following rocuronium was more rapid than vecuronium (p = 0.0001). All other pharmacodynamic parameters were similar. During the first minute following injection of the neuromuscular blocking agent, the heart rate increased by 36% in the rocuronium group but remained stable in those patients who received vecuronium (p = 0.0008). No adverse effects were noted in either group.
Cannulation of the internal jugular vein
Authors: MESSAHEL F. M. , AL‐MAZROA A. A.
Published: February 2007

A new approach to internal jugular vein catheterisation in the neck (the ‘very high’ approach) was used in 335 patients over a 12‐month period. The success rate was 100% and there were no complications. It proved to be an easy technique to learn and may be particularly useful in difficult and emergency situations.
Six months of shivering in a district general hospital
Authors: CROSSLEY A. W. A.
Published: February 2007

Of 2595 patients admitted to a recovery room in Derbyshire Royal Infirmary over a 6‐month period, 164 (6.3%) shivered postoperatively. Data regarding the anaesthetic techniques to which these patients had been subjected were gathered from the Derby Anaesthetic Audit System. Subsequent analysis demonstrated the importance of a number of factors that led to shivering, including male gender, anaesthetic techniques involving spontaneous ventilation, and anticholinergic premedication. The administration of pethidine, alfentanil or morphine intra‐operatively reduced the incidence of shivering postoperatively.
The laryngeal mask airway in infants
Authors: MIZUSHIMA A. , WARDALL G. J. , SIMPSON D. L.
Published: February 2007

Clinical and fibreoplic assessment of positioning of the size 1 laryngeal mask airway was performed in 50 infants. A clinically patent airway was obtained in 47 patients at the first attempt, but perfect positioning, as assessed by fibreoptic laryngoscopy, was found in only 22 instances. Despite an airway initially patent, delayed airway obstruction occurred in 12 infants. It is concluded that clinical airway patency does not guarantee ideal positioning of LMA in infants, and that care should be taken to ensure continued airway patency because of the tendency of the LMA position to deteriorate in this group of children.
Laryngospasm during transtracheal high frequency jet ventilation
Authors: SCHUMACHER P. , STOTZ G. , SCHNEIDER M. , URWYLER A.
Published: February 2007

A 74‐year‐old woman developed severe cardiovascular depression during percutaneous transtracheal high frequency jet ventilation for laser surgery of the epiglottis. This was found to be caused by acute airway obstruction secondary to severe laryngospasm. We recommend profound neuromuscular blockade during percutaneous transtracheal jet ventilation, in order to prevent this complication.
An evaluation of the gum elastic bougie
Authors: Nolan J. P. , Wilson M. E. , NOLAN J. P. , WILSON M. E.
Published: February 2007

This study was designed to evaluate the routine use of a gum elastic bougie for tracheal intubation. The median time to intubation with the gum elastic bougie while simulating an ‘epiglottis only’ view was only 10 s longer than the time taken during conventional intubation with an optimum view. Three of the patients required a gum elastic bougie‐assisted intubation after attempts at conventional visual intubation had failed. There was no significant difference in the incidence of postoperative sore throat and hoarseness between the two groups. We recommend that anaesthetists should use the gum elastic bougie whenever a good view of the glottis is not immediately obtained.
The Mancunian way
Authors: HEALY T. E. J. , UN E. N.
Published: February 2007

The authors have examined early records of the administration of ether anaesthesia in Manchester and the lives of several medical men involved in these events. Charles Strange, a dentist and chemist, in a letter to the Manchester Guardian published on 14 January 1847, described a self‐administration of ether for dental extraction, but George Bowring, a surgeon, subsequently claimed the first anaesthetic administered by a doctor in Manchester. The merits of these claims are discussed in the light of the circumstances surrounding these events.
An audit of induction of anaesthesia in neonates and small infants using pulse oximetry
Authors: Kong A. S. , Brennan L. , Morgan‐Hughes J.
Published: February 2007

The frequency and seventy of hypoxaemia during induction of anaesthesia in neonates and small infants at the Norfolk and Norwich Hospital, a district general hospital, was compared, using pulse oximetry, with that of the nearest specialist hospital, the Queen Elizabeth Hospital for Sick Children in London. There were differences in staffing and the choice of anaesthetic techniques between the hospitals. One third of the patients in both hospitals experienced desaturation of more than 5% (moderate or severe hypoxaemia) at one or more recordings during induction. The highest incidence of hypoxaemia was associated with awake intubation. There was no statistical difference in the incidence or severity of hypoxaemia between the hospitals. In the district general hospital, moderate or severe hypoxaemia of greater than 30 s duration was more likely if an anaesthetist with a regular paediatric operating list was not present at induction (p < 0.01).
The occupational hazard of human immunodeficiency virus and hepatitis B virus infection
Authors: O'Donnell N. G. , Asbury A. J.
Published: February 2007

We have conducted a postal survey of members of the Association of Anaesthetists to ascertain perceived risks and preventive measures adopted with regard to the occupational hazard of Human Immunodeficiency Virus and Hepatitis B Virus infection. Despite recognition of the infection risk and the adoption of appropriate measures when managing known infected patients, the majority of anaesthetists have not implemented simple precautions in their daily routine work. Less than 16% of respondents routinely wear gloves and more than one in three still resheath needles. It would appear that the recommendations of the Association with regard to universal safety precautions have not been implemented by the majority of its members.
Anaesthesia for myocardial revascularisation
Authors: Underwood S. M. , Davies S. W. , Feneck R. O. , Walesby R. K.
Published: February 2007

We studied the effects on mycardial performance and metabolism of fentanyl/propofol and fentanyl/enflurane anaesthesia in 20 patients before coronary artery bypass grafting. Anaesthesia was induced with fenlanyl 20 ug.kg−1 and pancuronium 0.15 mg.kg−1. Patients received, by random allocation, either propofol by infusion, 6 mg.kg−1.h−1 reduced by half after JO min then adjusted as necessary (mean rate 2.8 mg.kg−1.h−1), or enflurane 0.8% inspired concentration for 10 min reduced to 0.6% and adjusted as required (mean 0.7%). Measurements were made before induction, after tracheal intubation, after skin incision and after sternotomy. There were no significant differences between the groups in any haemodynamic variables during the study. Following intubation both groups showed a rise in heart rate (p < 0.01) and cardiac index (p < 0.05). Systemic vascular resistance decreased after intubation (p < 0.05) then returned to baseline during surgery; stroke index was unchanged after intubation but was reduced during surgery (p < 0.01) as systemic vascular resistance increased. Regional and global coronary blood flow were maintained in both groups, as were myocardial oxygen consumption and lactate extraction ratio. However, lactate production did occur in one patient receiving enflurane and Holler monitoring confirmed ischaemia. One patient receiving propofol showed lactate production not accompanied by any Ecg changes. This study suggests that propofol may be a suitable alternative to enflurane as an adjunct to opioids in anaesthesia for coronary artery bypass grafting.
Upper oesophageal sphincter pressure during inhalational anaesthesia
Authors: Vanner R. G. , Pryle B. J. , O'Dwyer J. P. , Reynolds F.
Published: February 2007

Upper oesophageal sphincter pressure was recorded with a Dent sleeve in 30 patients breathing nitrous oxide, oxygen and halothune. Twenty‐three patients, after thiopentone induction, received suxamethonium and had their trachea intubated either before (group A, n = 11), or after (group B,n = 11), a study period of inhalational anaesthesia. Group C (n = 8 j received an inhalational induction. Mean (SD) sphincter pressure after loss of consciousness was 8 (7) mmHg (group A), 6 (5) mmHg (group B) and 24 (13) mmHg (group C) increasing to 79 (7) mmHg in group A immediately after intubation. With an end‐tidal halothane concentration of 1.5%, mean sphincter pressure in group B, 16 (7) mmHg, was significantly lower than in group A, 45 (21) mmHg (p < 0.001 J and group C, 27 (14) mmHg (p < 0.05). Halothane had no dose‐related effect on sphincter pressure. Insertion of a laryngeal mask in group C (n = 7) had no significant effect on sphincter pressure. Induction and maintenance of anaesthesia with halothane, unlike thiopentone or suxamethonium, maintained a degree of upper oesophageal sphincter tone, although three patients in this study had sphincter pressures of less than 10 mmHg and would therefore have been at risk of regurgitation in the presence of gastro‐oesophageal reflux.
Influence on hearing of 22 G Whitacre and 22 G Quincke needles
Authors: Sundberg A. , Wang L. P. , Fog J.
Published: February 2007

Audiograms were performed pre‐operatively and 2 days postoperatively in 48 patients given spinal anaesthesia for transurethral resection oj the prostate. Hearing levels were examined at 1000 Hz and below. Either 22 G standard design (Quincke) needles (n—25) or 22 G pencil‐point design (Whitacre) needles (n = 23) were used. Hearing loss of 10 dB or more at two or more frequencies were observed in six of 25 patients in the Quincke group and in two of 23 patients in the Whitacre group. The mean hearing level was more reduced in the Quincke group. The shape of the tip of the spinal needle seems to be of some importance to the effects on hearing level that mav occur after spinal anaesthesia.
An evaluation of a combined spinal/epidural needle set utilising a 26‐gauge, pencil point spinal needle for Caesarean section
Authors: Westbrook J. L. , Donald F. , Carrie L. E. S.
Published: February 2007

We have conducted a prospective study into the ease of use and incidence of postdural puncture headache with the ‘Portex’ combined spinal/epidural set. The pack contains a 16‐gauge Tuohy needle of standard 8 cm shaft length with a matching 26‐gauge pencil point spinal needle. The study included 150 consecutive combined spinal/epidural anaesthetics for lower segment Caesarean section. Eighty‐eight percent of the cases fulfilled the criteria as technically perfect, i.e. cerebrospinal fluid obtained at the first attempt after identifying the epidural space. There were two cases of significant postdural puncture headache requiring blood patch due to puncture by the 26‐gauge spinal needle giving an incidence of 1.3%. This compares favourably with previously reported rates in obstetric patients.
Implicit memory tested in children during inhalation anaesthesia
Authors: BONKE B. , VAN DAM M. E. , VAN KLEFF J. W. , SLIJPER F. M. E.
Published: February 2007

Memory for stimuli presented during inhalation anaesthesia was tested in 80 children undergoing eye surgery. Two groups were exposed, in a random double‐blind study, to repeated neutral phrases including either the colour orange or green. A postoperative colouring task was used as a test of implicit memory to detect any preference for the colour named under anaesthesia. No colour preference attributable to implicit memory could be demonstrated. One patient had a distinct preference for the named colour. No patient remembered any intra‐operative events.
Isoflurane and propofol for long‐term sedation in the intensive care unit
Authors: MILLANE T. A. , BENNETT E. D. , GROUNDS R. M.
Published: February 2007

Propofol and isoflurane have been reported recently to offer better sedation than alternative agents in patients who require long‐term ventilation in the Intensive Care Unit. This is the first report of a direct comparison between propofol and isoflurane. Twenty‐four patients predicted to require artificial ventilation for at least 48 h were entered into a randomised crossover study to monitor sedation quality and time to recovery from sedation. There were no significant differences between the two agents in either end‐point, with over 95% optimal sedation achieved by the use of each drug. Few adverse events were noted. Technological advances in the administration of volatile agents as long‐term sedatives in the Intensive Care Unit may facilitate their more widespread use.
The Riyadh Intensive Care Program applied to a mortality analysis of a teaching hospital intensive care unit
Authors: JACOBS S. , ARNOLD A. , CLYBURN P. A. , WILLIS B. A.
Published: February 2007

A computerised system of prediction of death using the Riyadh Intensive Care Program was applied retrospectively over a 17‐month period to data collected prospectively on 1155 patients admitted to our intensive care unit. Variables which enable organ failure scores to be generated were recorded daily to make these predictions. Consultant medical opinion predicted that outcome was hopeless in 55% (115/209) of the patients who died. The predictive power of the computer demonstrated a sensitivity of 14.8% and a specificity of 99.8%. It is possible that the occurrence of three false predictions of death in the latter part of the series may have been related to a change in our antibiotic policy. We would be unhappy to recommend the general use of a computerised program for prediction of death without careful explanation of its significance and dangers.
Advanced trauma life support
Authors: BENNETT J. R. , BODENHAM A. R. , BERRIDGE J. C.
Published: February 2007

The experience of Advanced Trauma Life Support training received by three anaesthetists is discussed with particular reference to the teaching of airway management, the grade of staff who should attend the present courses and the relevance to the British hospital system. We conclude that these courses are useful but limited by their inflexibility and failure to recognise the difference in skill mix in the British setting.
Patient‐controlled epidural analgesia following post‐traumatic pelvic reconstruction
Authors: NOLAN J. P. , DOW A. A. C. , PARR M. J. A. , DAUPHINEE K. , KALISH M.
Published: February 2007

A randomised, single‐blinded study was conducted to compare patient‐controlled epidural analgesia with continuous infusion epidural analgesia for the treatment of pain following post‐traumatic pelvic reconstruction. The patient‐controlled group (n = 11) received a background infusion of 4 ml.h−1 of bupivacaine 0.125% with fentanyl 1 μg.ml−1, and 3–6 ml bolus doses, self administered, as required (with a 15 min lockout interval). The continuous infusion group (n = 12) received a continuous infusion of the same solution through an identical apparatus, but with the demand button deactivated. This was started at 10 ml.h−1 and adjusted by the anaesthetist, as required, up to a maximum of 25 ml.h−1. Pain scores, side effects, and the volumes of drug infused were recorded over the first 3 postoperative days. One patient from each group was withdrawn because of catheter‐related problems. Pain scores were similar and the incidence of nausea and pruritus was low in both groups. There was no recorded instance of respiratory depression or hypotension and there was no significant difference between the groups in the volumes of drug solution received. Patient satisfaction was equally very good in both groups. Patient‐controlled epidural analgesia is an effective means of providing pain relief after post‐traumatic pelvic reconstruction, but did not significantly reduce analgesic requirements in comparison with continuous infusion epidural analgesia.
The caudal boundary of the thoracic paravertebral space
Authors: LÖNNQVIST P. A. , HILDINGSSON U.
Published: February 2007

The caudal limit of the thoracic paravertebral space was examined in 13 human cadavers. The origin of the psoas major muscle was found to completely seal off the paravertebral space below the level of the 12th thoracic vertebra. The possibility of caudal spread of a thoracic paravertebral block below this level through the paravertebral space would appear unlikely.
Postoperative oxygenation in the elderly following general or local anaesthesia for ophthalmic surgery
Authors: McCarthy G. J. , Mirakhur R. K. , Elliott P.
Published: February 2007

Peripheral oxygen saturation was recorded on the pre‐operative night (between 2400 and 0600 h), the immediate postoperative period (first 60 min) and the first postoperative night (2400 to 0600 h) in 18 elderly patients aged 70 years or over presenting for elective ophthalmic surgery. Nine patients had surgery performed under general anaesthesia employing muscle relaxants and controlled ventilation and nine under local anaesthesia using a peribulbar block. The median (interquartile range) percentage of time during which the patients had an oxygen saturation of less than 90% was 0 (0–0.2) and 0.04 (0–0.4) on the pre‐operative night, 0.7 (0–1.4) and 0.3 (0–1.2) in the immediate postoperative period, and 0.05 (0–0.16) and 0 (0–0.3) on the postoperative night in the general and local anaesthesia patients respectively. There were no significant differences between general and local anaesthesia in respect of these data and the overall incidence of significant desaturation was low. The present study could not demonstrate any adverse effect of general anaesthesia on oxygen saturation in patients undergoing minimally invasive surgery.
Comparison of recovery index of rocuronium or vecuronium with simultaneously administered pancuronium in the isolated forearm
Authors: FAWCETT W. J. , FAUVEL N. J. , FELDMAN S. A.
Published: February 2007

A series of isolated forearm experiments is described in which rocuronium or vecuronium were injected into one arm, and pancuronium injected simultaneously into the contralateral arm. The time for 25%–75% twitch recovery (recovery index) was recorded in both arms. The recovery indices of rocuronium and vecuronium were similar, but that of pancuronium significantly longer. Because the recovery indices compared in any one experiment occurred in the presence of identical background plasma concentration, the differences observed in recovery index between pancuronium and either rocuronium or vecuronium are due to different rates of dissociation from the effect compartment at the neuromuscular junction.
Dose‐response for analgesic effect of amitriptyline in chronic pain
Authors: McQUAY H. J. , CARROLL D. , GLYNN C.J.
Published: February 2007

A randomised, double‐blind, multiple dose, crossover study with three 3‐week treatment periods was set up to compare the analgesic efficacy and adverse effects of amitriptyline in oral doses of 25, 50 or 75 mg. Patients used diaries to assess their pain, and clinic assessments were made at the end of each treatment period. It was found that in 29 patients with chronic (more than 2 months) pain, amitriptyline 75 mg provided significantly greater efficacy than amitriptyline 25 or 50 mg. There was no significant difference in mood scores between the different doses of amitriptyline, but sleep was judged significantly better with 75 mg compared with 25 mg. The incidence of adverse effects was significantly higher with the 75 mg dose, and the principal adverse effects were dry mouth and drowsiness. In the context of chronic pain, the analgesic effect of amitriptyline was shown to have a dose‐response unrelated to mood elevation, but there was a dose‐response for the incidence of adverse effects.
The ‘SiteRite’ ultrasound machine—an aid to internal jugular vein cannulation
Authors: ARMSTONG P. J. , CULLEN M. , SCOTT D. H. T.
Published: February 2007

The ‘SiteRite’ is a portable ultrasound imaging system designed to aid vein location during internal jugular vein cannulation. It was compared to the use of anatomical landmarks for internal jugular vein cannulation. It was easy to use and gave good quality images, increased the speed of cannulation, decreased the number of attempts to locate the internal jugular vein and reduced the failure rate, although it had no effect on the incidence of carotid artery puncture.
Epidural tramadol for postoperative pain relief
Authors: Delilkan A. E. , Vijayan R.
Published: February 2007

The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. Blood pressure, pulse rate, respiratory rate, arterial blood gas analyses, pain scores, the interval between doses and the occurrence of any side effects were recorded. Pain scores (assessed using a visual analogue scale) were significantly less (p < 0.05) at 3, 12, and 24 h in patients receiving tramadol 100 mg than in those receiving tramadol 50 mg or bupivacaine. The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).
Thyrotropin concentration predicts outcome in critical illness
Authors: ROTHWELL P. M. , UDWADIA Z. F. , LAWLER P. G.
Published: February 2007

Concentrations of thyrotropin, total thyroxine, total tri‐iodothyronine and cortisol were measured on admission to an intensive care unit in 200 consecutive patients who did not receive dopamine. Thyrotropin concentration was subnormal (< 0.4 mU.l−1) in 25 patients (12%) and increased (> 5.0 mU.r') in 27 (13%). Mortality in these groups differed 22‐fold (88% and 4% respectively) despite comparable Apache II outcome predictions (51% and 32%). Thyrotropin concentration correlated positively with total thyroxine concentration (r = 0.46, p < 0.001) and negatively with cortisol concentration (r =–0.56, p < 0.001). In 15 of the patients with increased thyrotropin concentration on admission, repeat measurements were made on recovery and were normal in 13. The high frequency of abnormal thyrotropin concentrations casts doubt on the assumption of euthyroidism in critical illness. Admission thyrotropin concentration is of prognostic value in critically ill patients.
Pethidine has a local anaesthetic action on peripheral nerves in vivo
Authors: ARMSTRONG P. J. , MORTON C. P. J. , NIMMO A. F.
Published: February 2007

In a double‐blind, randomised study, we have examined the effects of the addition of pethidine 100 mg to 40 ml prilocaine 0.25% for intravenous regional anaesthesia in healthy volunteers. During intravenous regional anaesthesia the hand and forearm are isolated from the rest of the circulation and pethidine interaction with central opiate receptors does not occur. Pethidine increased the speed of onset and extent of sensory and motor block, reduced tourniquet and forearm pain, and subjectively improved the quality of the block. Pethidine has local anaesthetic action on peripheral nerves in vivo.
Reduction of acute haemorrhage with aprotinin
Authors: VALENTINE S. , WILLIAMSON P. , SUTTON D.
Published: February 2007

We describe the use of aprotinin in two patients to control life threatening haemorrhage due to coagulopathy when other therapeutic measures had failed. We review the use of aprotinin and give a rationale for its use in acute coagulopathy.
The parallel Lack anaesthetic breathing system
Authors: OOI R. , LACK J. A. , SONI N. , WHITTLE J. , PATTISON J.
Published: February 2007

The parallel Lack system is a new modification of the Mapleson A system comprising separate inspiratory and expiratory tubes. To determine that the function of the system was that anticipated of a Mapleson A, the fresh gas flow requirements to prevent rebreathing during spontaneous ventilation were assessed in three situations: (I) a lung model (2) conscious volunteers and (3) anaesthetised patients. Two sets of criteria to define rebreathing were used; (A) those based on changes in ventilation or end‐expired carbon dioxide tension and (B) minimum inspired carbon dioxide tension. Using A, rebreathing occurred at afresh gas flow to minute ventilation ratio (Vfjve) of 0.75 for the lung model, and 0.73 for conscious volunteers. These results were comparable to those obtained for a Magill attachment. They were also close to the point at which mechanical dead space began to increase in the lung model. Criteria B gave much lower values for the onset of rebreathing. Rebreathing was present by criteria A in five of the six anaesthetised patients at afresh gas flow of 60 ml.kg ‘.min’ (Vfjvf of 0.78). The results confirm that the parallel Lack behaves as a Mapleson A system. The resistance to breathing posed by the parallel Lack was also comparable to the Magill system.
An evaluation of the effect of vasodilatation on oxygen saturations measured by pulse oximetry and venous blood gas analysis
Authors: BROOME I. J. , MILLS G. H. , SPIERS P. , REILLY C. S.
Published: February 2007

Measurements of arterial oxygen saturation were estimated using a pulse oximeter under conditions of reactive hyperaemia in the arms of 10 volunteers. Oxygen saturation measured by pulse oximetry was significantly lower, and venous oxygen saturation measured by co‐oximetry was significantly higher, in the hyperaemic arm than in the other arm. Pulse oximeters analyse the pulsatile component of blood flow and exclude nonpulsatile causes of absorption in estimating arterial oxygen saturation. The pulsatile component is assumed to be purely of arterial origin. However, other vessels may pulsate when vasodilatation occurs and pulse oximeter saturation readings taken under these conditions may not give a true reflection of arterial saturation.
A prospective randomised study of local versus general anaesthesia for cataract surgery
Authors: Campbell D. N. C. , Lim M. , Muir M. Kerr , O'Sullivan G. , Falcon M. , Fison P. , Woods R.
Published: February 2007

One hundred and sixty‐nine patients (aged 65–98 years) were randomised to receive either local or general anaesthesia for cataract surgery. Cognitive function was assessed using a battery of psychometric tests performed pre‐operatively, and at 24 h, 2 weeks and 3 months postoperatively. Oxygen saturation, blood pressure and heart rate were monitored and the results recorded throughout the anaesthetic and immediate recovery period. In the general anaesthetic group, 19% of patients experienced at least one episode of oxygen desaturation during the procedure compared with none in the local anaesthetic group. Pulse rate and blood pressure were stable in the local anaesthetic group compared with the general anaesthetic group where marked fluctuations were noted; 61% of patients in the general anaesthetic group experienced falls in systolic blood pressure greater than 30% of the pre‐induction value. No evidence of long‐term postoperative cognitive dysfunction was detected and there was no significant difference between the performances of the two groups.
The effects of midazolam on the EEG during sedation of critically ill patients
Authors: VESELIS R. A. , REINSEL R. , MARINO P. , SOMMER S. , CARLON G. C.
Published: February 2007

Patients who require mechanical ventilation are often sedated with midazolam. As clinical signs of sedation are often confusing or nonexistent, and there are few adverse side effects when large doses are infused over a period of days, substantial drug accumulation can result in these critically ill patients, despite the short half‐life of midazolam. An objective monitor of sedation would help maintain sedation at a constant level despite changing pharmacokinetic values in patients. We undertook this study to describe the electroencephalographic changes which occur with intravenous midazolam in critically ill patients, and to determine if a relationship exists between these changes and the depth of sedation as measured using a clinical scoring method. A series of 31 critically ill patients who required intravenous midazolam during mechanical ventilation were studied. Four different levels of sedation were defined ranging from execution of verbal commands to no response to suctioning through the tracheal tube or sternal rub. Electroencephalographic recordings were obtained in patients on a daily basis and a concurrent sedation level was determined. High frequency electroencephalogram activity decreased as sedation level increased. This was reflected in decreases in the spectral edge (17.61 to 10.56 Hz (p = 0.0024)), the median frequency (4.27 to 2.56 Hz (p = 0.0278)), and the logarithm of the absolute power in the beta, (p = 0.0012), and beta2 (p < 0.0001) bands. An incidental finding of asymmetry in power between right and left frontal electrodes was observed, with right‐sided power being 9–18% greater (p < 0.001). This form of monitoring of midazolam sedation in critically ill patients, which may allow better discrimination of different sedation levels than clinical examination alone, may be useful in guiding administration of midazolam to produce a constant sedative effect. Changes in electroencephalogram power, a useful sign of cerebral ischaemia, may be affected by the use of midazolam, which appears to cause asymmetry in power.
Dexmedetomidine as intramuscular premedication in outpatient cataract surgery
Authors: VIRKKILÄ M. , ALI‐MELKKILÄ T. , KANTO J. , TURUNEN J. , SCHEININ H.
Published: February 2007

Alpha2 agonists have been shown to decrease intra‐ocular pressure in ophthalmic surgery. We studied the effects of dexmedetomidine, a new a2 agonist, on intra‐ocular pressure, haemodynamic parameters, sedation, anxiolysis and dryness of mouth in 35 (Asa physical status 1–3) patients undergoing day‐case cataract surgery under peri‐ocular anaesthesia. Five different doses of dexmedetomidine (0.25, 0.5, 0.75, 1.0 and 1.5 μg.kg−1) were used in this double‐blind, randomised and placebo‐controlled study. The trial drug was administered into the deltoid muscle 60 min before surgery. The 1.0 μg.kg−1 dose of dexmedetomidine produced a 32% reduction of intra‐ocular pressure (p = 0.002). This dose induced moderate sedation, but was not associated with significant haemodynamic changes. A significant decrease in heart rate and systolic blood pressure was seen only with the highest dose of dexmedetomidine. Our results suggest that dexmedetomidine 1.0 μg.kg−1 produces sedation and a reduction of intra‐ocular pressure with minimal haemodynamic side effects when given intramuscularly as premedication before cataract surgery under regional anaesthesia.
Intra‐operative monitoring of cerebral haemodynamics in a patient with Takayasu's arteritis
Authors: KAWAGUCHI M. , OHSUMI H. , NAKAJIMA T. , KURO M.
Published: February 2007

Transcranial Doppler and continuous measurements of jugular venous oxygen saturation were used to monitor intra‐operative cerebral haemodynamics in a patient with Takayasu's arteritis who underwent carotid revascularisation. These techniques were found to be of clinical value for detection of cerebral hypoperfusion and assessment of the effects of therapeutic intervention.
The levering laryngoscope
Authors: McCOY E. P. , MIRAKHUR R. K.
Published: February 2007

This is a report of a modification of the standard Macintosh laryngoscope blade to facilitate tracheal tube placement in cases of difficult visualisation of the larynx. The modification offers the unique advantage of a hinged blade tip, controlled by a lever on the handle of the larygoscope which allows elevation of the epiglottis while decreasing the overall laryngoscopic elevation or levering movement required. It is an adaptation which can be applied to most laryngoscope blades, does not require any special training in its use and will prove useful for both routine intubations as well as those which may be difficult and associated with an anterior larynx.
Anxiety levels following anaesthesia for day‐case surgery
Authors: WINWOOD M.A. , JAGO R.H.
Published: February 2007

The effect of different induction agents on postoperative state anxiety levels was investigated. Propofol produces statistically significant lower levels when compared with thiopentone. This finding suggests that propofol should remain the drug of choice for short duration anaesthesia.
The distance between the grille of the laryngeal mask airway and the vocal cords
Authors: ASAI T. , LATTO I. P. , VAUGHAN R. S.
Published: February 2007

The distance between the grille of the laryngeal mask airway and the vocal cords was measured with afibreoptic bronchoscope in 30 male and 30 female patients. The mean distance was 3.6 cm (SD 0.5 cm; range 2.5–4.7 cm) in males and 3.1 cm (SD 0.5 cm; range 2.0–4.2 cm) in females. These results suggest that the cuff of an uncut 6.0 mm tracheal tube would often lie between the vocal cords when the tube is fully inserted through a laryngeal mask airway. To avoid this complication, the tracheal tube must protrude more than 9.5 cm beyond the grille of the laryngeal mask airway. When either neck extension or flexion is required, the laryngeal mask airway should be removed as the margin of safety is small.