bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of antidepressants on whole gut and orocaecal transit times in health and irritable bowel syndrome
Authors: GORARD D. A. , LIBBY G. W. , FARTHING M. J. G.
Published: July 2010

Background: Antidepressants are used in the treatment of irritable bowel syndrome but it is unclear whether any symptomatic improvement is due solely to correction of an associated affective disorder, or whether these drugs have effects on bowel function which may be of therapeutic benefit. Intestinal transit is known to be abnormal in some irritable bowel syndrome patients.

Methods: We have studied the effects of imipramine, a tricyclic antidepressant with mixed pharmacological properties, and paroxetine, a selective 5‐hydroxy‐tryptamine re‐uptake inhibitor, on intestinal transit times.

Results: Median (range) whole gut transit time was lower in 10 diarrhoea‐predominant irritable bowel syndrome patients, 22.2 (3.6–51.6) h, compared to 28 control subjects 39.6 (7.2–68.4) h, (P < 0.05). Similarly, orocaecal transit time was shorter at 55 (30–90) min in diarrhoea‐predominant irritable bowel syndrome patients compared to 75 (40–150) min in controls, (P < 0.05). Four days’administration of imipramine increasing to a daily dose of 100 mg prolonged both orocaecal and whole gut transit times in 12 control subjects and six diarrhoea‐predominant irritable bowel syndrome patients. In contrast, 30 mg paroxetine daily for 4 days reduced orocaecal transit time in ten controls and eight irritable bowel syndrome patients, but had no effect on whole gut transit time.

Conclusion: Short‐term administration of antidepressants alters intestinal transit, but the selective 5‐hydroxytryptamine re‐uptake inhibitor, paroxetine, has different effects to the tricyclic drug, imipramine. These effects on transit precede any effects on mood. Although there is a high prevalence of affective disorder in irritable bowel syndrome clinic patients, these drugs may have additional therapeutic actions on the gut. These actions might be taken into account when prescribing antidepressants in irritable bowel syndrome.
Improved diagnosis of gastro‐oesophageal reflux in patients with unexplained chronic cough
Authors: BLONDEAU K. , DUPONT L. J. , MERTENS V. , TACK J. , SIFRIM D.
Published: July 2010

Background

Symptoms, oesophageal pHmetry and proton pump inhibitor treatment are used for diagnosing gastro‐oesophageal reflux‐related cough. Weakly acidic reflux is now increasingly associated with reflux symptoms such as regurgitation or chest pain.

Aim

To study the association between weakly acidic reflux and cough in a selected, large group of patients with unexplained chronic cough.

Methods

A total of 100 patients with chronic cough (77 ‘off’ and 23 ‘on’ a proton pump inhibitor) were studied using impedance‐pHmetry for reflux detection and manometry for objective cough monitoring. Symptom Association Probability (SAP) Analysis characterized the reflux–cough association.

Results

Acid reflux could be a potential mechanism for cough in 45 patients (with either heartburn, high acid exposure or +SAP for acid reflux). Weakly acidic reflux could be a potential mechanism for cough in 24 patients (with either increased oesophageal volume exposure, increased number of weakly acidic reflux or +SAP for weakly acidic reflux). Reflux could not be identified as a potential mechanism for cough in 31 patients.

Conclusion

A positive association between cough and weakly acidic reflux was found in a significant subgroup of patients with unexplained chronic cough. Impedance‐pH‐manometry identified patients in whom cough can be related to reflux that would have been disregarded using the standard diagnostic criteria for acid reflux.
Oral budesonide in the treatment of chronic refractory pouchitis
Authors: GIONCHETTI P. , RIZZELLO F. , POGGIOLI G. , PIERANGELI F. , LAURETI S. , MORSELLI C. , TAMBASCO R. , CALABRESE C. , CAMPIERI M.
Published: July 2010

Background  Pouchitis is the major long‐term complication after ileal‐pouch nal anastomosis for ulcerative colitis. Ten to 15% of patients develop a chronic pouchitis, either treatment responsive or treatment refractory.

Aim  To evaluate the efficacy of oral budesonide in inducing remission and improving quality of life in patients with chronic refractory pouchitis.

Methods  Twenty consecutive patients with active pouchitis, not responding after 1 month of antibiotic treatment were treated with budesonide controlled ileal release 9 mg/day for 8 weeks. Symptomatic, endoscopic and histological evaluations were undertaken before and after treatment according to Pouchitis Disease Activity Index. Remission was defined as a combination of Pouchitis Disease Activity Index clinical score of ≤2, endoscopic score of ≤1 and total Pouchitis Disease Activity Index score of ≤4. The quality of life was assessed with the Inflammatory Bowel Disease Questionnaire.

Results  Fifteen of 20 patients (75%) achieved remission. The median total Pouchitis Disease Activity Index scores before and after therapy were, respectively, 14 (range 9–16) and 3 (range 2–10) (P < 0.001). The median Inflammatory Bowel Disease Questionnaire score also significantly improved from 105 (range 77–175) to 180 (range 85–220) (P < 0.001).

Conclusion  Eight‐week treatment with oral budesonide appears effective in inducing remission in patients with active pouchitis refractory to antibiotic treatment in this open‐label study.
Review article: reproduction in the patient with inflammatory bowel disease
Authors: HEETUN Z. S. , BYRNES C. , NEARY P. , O’MORAIN C.
Published: July 2010

Background  Inflammatory bowel disease (IBD) affects mainly the young population. The effect of IBD and its treatment on fertility and pregnancy is therefore an important clinical consideration.

Aim  To review the best management of IBD in the reproductive and pregnant population.

Methods  A MEDLINE and an EMBASE search were performed using mainly the search phrases ‘pregnancy AND IBD,’‘sulphasalazine AND male fertility,’‘abdominal surgery AND female fertility,’‘AZA AND placenta’ and ‘infliximab AND pregnancy.’ No language or date restrictions were placed. References of review articles were examined.

Results  Overall male and female fertility are not affected by IBD. Sulphasalzine reduces male fertility. No other drugs used in IBD affect significantly fertility in humans. The risk of pregnancy‐related complications and the disease behaviour during pregnancy depends mainly on disease activity at time of conception. Proactive treatment for maintenance of disease remission during gestation is recommended. Except for methotrexate, drugs used in IBD appear safe in pregnancy. Breast feeding should be encouraged.

Conclusion  The management of IBD in the young and pregnant population remains controversial because the literature comes mostly from retrospective studies. Further studies particularly large prospective trials are needed to guide clinicians in decision making.
Review article: the Lynch syndrome (hereditary nonpolyposis colorectal cancer)*
Authors: VASEN H. F. A.
Published: July 2010

Background  The most common inherited colorectal cancer syndrome is the Lynch syndrome (HNPCC) which is characterized by the development of colorectal, endometrial, and other cancers and the presence of microsatellite instability (MSI) in tumours. The syndrome is due to a mutation in one of the mismatch repair (MMR) genes: MSH2, MLH1, MSH6 and PMS2.

Aims  To evaluate the clinical features of the Lynch syndrome and to assess the tools that are available for the identification of families with this syndrome.

Methods  A systematic literature search using PubMed and reference lists of retrieved articles was performed.

Results  The review provides an update of the clinical phenotype of the Lynch syndrome. Until recently, the Amsterdam criteria were the most important tool for the identification of Lynch syndrome. Nowadays, the Bethesda guidelines are more widely used. These guidelines describe all clinical conditions in which a search for MSI indicated. Both MSI‐analysis as well as immunohistochemical analysis of the MMR‐proteins are appropriate to identify patients with a high probability of carrying a MMR‐gene mutation.

Conclusion  All specialists that are involved in the treatment of cancer patients should know the Bethesda criteria in order to identify all families suspected of the Lynch syndrome.
Meta‐analysis: do irritable bowel syndrome symptoms vary between men and women?
Authors: Adeyemo M. A. , Spiegel B. M. R. , Chang L.
Published: July 2010

Background  Studies suggest that sex and gender‐related differences exist in irritable bowel syndrome (IBS), but data is often conflicting.

Aim  To evaluate gender differences and the effect of menstrual cycle and menopausal status on IBS symptoms.

Methods  We performed a systematic review of MEDLINE to search for studies comparing IBS symptoms between gender, menstrual cycle phases and menopausal states in IBS and/or healthy individuals. We performed meta‐analyses to compare the relative risk (RR) of individual IBS symptoms between men and women.

Results  Twenty‐two studies measured gender differences in IBS symptoms. Women were more likely to report abdominal pain (RR = 1.12, 95% CI: 1.02, 1.22) and constipation‐related symptoms (RR = 1.12, 95% CI: 1.02, 1.23) than men (all P < 0.05). However, men with IBS were more likely to report diarrhoea‐related symptoms than women with IBS (RR = 0.84, 95% CI: 0.75, 0.94, P < 0.05). A systematic review of 13 studies demonstrated that both IBS and healthy women reported increased IBS symptoms during menses vs. other phases. There were insufficient data to determine the effect of menopause and hormone supplementation on IBS symptoms.

Conclusions  In the general and IBS populations, gender differences in IBS symptoms exist, although these differences are modest. Studies suggest that female sex hormones influence the severity of IBS symptoms, but more studies are needed.
Antagonism of neuromuscular block in the elderly
Authors: MIRAKHUR R. K.
Published: July 2010

Glycopyrronium 10 μg/kg has been compared with atropine 20 μ/kg in a mixture with neostigmine 50 μg/kg administered for antagonism of residual nondepolarising neuromuscular block in patients over 65 years of age. The initial peak increase in heart rate was less after glycopyrronium, but there were no differences beyond the first two minutes. The incidence of dysrhythmias was less after glycopyrronium, but the difference was not significant. The control of secretions was superior with glycopyrronium. It is suggested that the dosage of anticholinergic agents given with neostigmine could be reduced in elderly patients in comparison to that in younger patients.
Failure of two benzodiazepines to prevent suxamethonium‐induced muscle pain
Authors: CHESTNUTT W. N. , LOWRY K. G. , DUNDEE J. W. , PANDIT S. K. , MIRAKHUR R. K.
Published: July 2010

In a randomised double‐blind trial carried out on fit, unpremedicated patients undergoing standard minor operations with early postoperative mobility, using a standard form of anaesthesia, pretreatment with diazepam 0.15 mg/kg or midazolam 0.1 mg/kg failed to reduce significantly the incidence of postoperative muscle pains following suxamethonium 1 mg/kg. By contrast, tubocurarine 0.05 mg/kg proved to be effective as a pretreatment. Neither benzodiazepine influenced the incidence or severity of fasciculations seen with suxamethonium or the duration of neuromuscular block. Tubocurarine virtually abolished visible fasciculation and, in the dose used, reduced the intensity and duration of the neuromuscular block. There were no clinically significant changes in serum potassium, creatinine phosphokinase or aldolase after suxamethonium, although 5 out of 47 showed an atypical rise in creatinine phosphokinase.
The present status of blood filtration
Authors: DERRINGTON M. CLARE
Published: July 2010

The history of the development of blood transfusion and blood filtration is outlined. Clinical and experimental evidence for the efficacy of microfiltration in both small and large volume transfusions is evaluated. Though microfilters do remove the micro‐aggregates from stored blood, the results of clinical studies suggest that both the debris from septic processes in the body and the formation of micro‐aggregates in the blood stream triggered by processes such as complement activation play a far more important role in the pathogenesis of adult respiratory distress syndrome. If this is so the enhancement of the reticulo‐endothelial system by fibronectin therapy may be indicated. It also follows that the use of microfilters is probably an unnecessary expense and, where exsanguination is a risk, may be positively dangerous. Microfilters have been found useful in the preparation of granulocyte‐free transfusions after centrifugation of the blood, but their routine use for transfusions, small or large, remains to be justified.
Systemic absorption of lignocaine ointment from tracheal tubes
Authors: Sellers W. F. S. , Dye Anne
Published: July 2010

Arterial plasma concentrations of lignocaine were studied in fifreen adult patients following insertion of a tracheal tube whose cuff area was smeared with 5% lignocaine ointment. Twelve patients had 2 ml of ointment (114 mg) and samples were taken every 5 minutes until 30 minutes and in eight of the 12 patients at 40, 50 and 60 minutes after insertion and inpation of the tracheal tube and cuff. Three patients had 1 ml of ointment on the tube and were studied over 60 minutes. Plasma concentrations were determined using gas liquid chromatography. In the 2 ml lignocaine group mean plasma lignocaine levels were 1.9 (SD 0.9) μg/ml at 10 minutes, 2.3 (SD 0.8) μg/ml at 20 minutes, 2.3 (SD 0.8) μg/ml at 30 minutes and 1.7 (SD 1.0) μg/ml at 60 minutes. After 1 ml of lignocaine, levels were 1.2 (SD 0.1) μg/ml at 10 minutes, 1.1 (SD 0.7) μg/ml at 20 minutes, 0.8 (SD 0.3) μg/ml at 30 minutes and 0.75 (SD 0.1) μg/ml at 60 minutes.
Failure of magnesium sulphate to prevent suxamethonium induced muscle pains
Authors: Chestnutt W.N. , Dundee J.W.
Published: July 2010

In fit unpremedicated patients undergoing minor operations and who were ambulant on the afternoon of the operations, pretreatment with magnesium sulphate given intravenously did not reduce the incidence of suxamethonium induced myalgia below that in a similar series who received no prophylactic therapy. The injection of magnesium in conscious patients is followed by unpleasant side effects.
Self‐administered nalbuphine, morphine and pethidine
Authors: BAHAR M. , ROSEN M. , VICKERS M. D.
Published: July 2010

In a double‐blind clinical trial of 48 patients, nalbuphine, morphine, and pethidine were compared by on‐demand intravenous analgesia during the first 24 hours after cholecystectomy. Overall pain relief (visual analogue score) was recorded by the patients as 50 (SEM 4) for nalbuphine, 44 (SEM 4) for morphine and 53 (SEM 5) for pethidine. These scores were not significantly dfferent. The mean demand for each drug over the 24‐hour period was 70 (SEM 12) mg for nalbuphine, 46 (SEM 6) mg for morphine and 614 (SEM 49) mg for pethidine. Pain on movement, either during deep breathing or turning, was found to be less well controlled after nalbuphine (70, SEM 2), and pethidine (67 SEM 7) than after morphine (52, SEM 5; p < 0.01). The incidence of side effects was similar with each drug. Nalbuphine is a useful postoperative analgesic, as effective as pethidine. Nalbuphine 15 mg is apparently equipotent with morphine 10 mg or pethidine 120 mg by this mode of administration.
The ‘Permox’ oxygen concentrator
Authors: CARTER J. A. , BASKETT P. J. F. , SIMPSON P. J.
Published: July 2010

The performance of the ‘Permox’ oxygen concentrator has been investigated in detail with particular reference to its possible use as an alternative to conventional oxygen supplies both in the emergency situation, in the event of failure of pipeline or cylinder systems or when these are unavailable. The stability and concentrations of oxygen produced at various flows provided a viable alternative supply of oxygen, and the portability and reliability of this particular apparatus made it suitable for use in the many situations considered.
A Venturi connector for tracheal tubes
Authors: CONACHER I. D.
Published: July 2010

An attachment for tracheal tubes is described. It functions as a holder for a choice of needles used to conduct a Venturi jet powered from a high‐pressure gas system of the kind used for bronchoscopic ventilation. It is suggested as a potentially useful device for some unusual clinical situations, two of which are illustrated.
A nerve stimulator for peripheral nerve blockade
Authors: SMITH D. C. , MIAH H.
Published: July 2010

An inexpensive, portable nerve stimulator is described which is easily constructed and may be used to enhance the ease and effectiveness of peripheral nerve blockade.
The first reversal of curare
Authors: NICKALLS R. W. D. , NICKALLS ELISABETH A.
Published: July 2010

This paper describes an experiment performed by J. Pal of Vienna in 1900, which showed that physostigmine reverses the neuromuscular blocking properties of curare. Pal's original article is translated from the German.
Parenteral aspirin for pain relief in day‐case dental anaesthesia. A randomised double blind placebo controlled trial
Authors: Foster J. M. G. , Cashman J. N. , Jones R. M.
Published: July 2010

Forty patients undergoing day‐case anaesthesia for surgical extraction of third molar teeth received either lysine acetylsalicylate 1.8 g in 10 ml of saline intravenously or a placebo injection of 10 ml of saline intravenously just prior to induction of anaesthesia. Lysine acetylsalicylate was associated with a significantly more satisfactory postoperative recovery overall. However, there was no significant difference in mean pain scores between the two treatment groups at 1, 6, 12 or 24 hours following administration. Both treatment groups self administered additional oral analgesics to the same extent during the first 24 hours following surgery.
Postoperative pain relief with naloxone, Severe respiratory depression and pain after high dose buprenorphine
Authors: Schmidt J.F. , Chræmmer‐Jørgensen B. , Pedersen J.E. , Risbo A.
Published: July 2010

Buprenorphine 30 and 40 μg/kg was given as the sole intravenous analgesic in balanced anaesthesia to 12 patients undergoing cholecystectomy. Significant and severe respiratory depression was found 15 minutes after pre‐operative loading with buprenorphine. In the immediate postoperative period six patients were in pain. They were treated with naloxone 0.08–0.4 mg leading to a long lasting period of pain relief (median 22 hours).
Changes in memory following general or spinal anaesthesia for hip arthroplasty
Authors: HUGHES D. , BOWES J.B. , BROWN M. W.
Published: July 2010

Patients scheduled for hip arthroplasty were anaesthetised using either general or spinal anaesthesia. Each patient's memory was tested for both recall and recognition by using lists of 10 words each of a different category. This testing for memory extended from the pre‐operative visit to one week after operation. Memory was not tested on the day of operation. There was little overall change of memory after either spinal or general anaesthesia although there was an inexplicable but significant decrease in the ability to recognise words after spinal anaesthesia.
Epidural blockade in the treatment of preterm labour
Authors: MELSEN N. C. , NORENG M.F.
Published: July 2010

A case of premature labour induced by necrosis in a fibromyoma followed by laparotomy is described. Unsuccessful treatment with ritodrine was followed by successful treatment with epidural analgesia. The possible role of a sympathetic blockade is discussed.
A comparison of two pulse oximeters
Authors: RIDLEY S. A.
Published: July 2010

The accuracy of the Ohmeda Biox 3700 and the Nellcor N100E was assessed in 25 cyanosed children. The readings obtained front the two puise oximeters were compared with arterial blood measurements using a Radiometer OSM‐2 co‐oximeter. Both pulse oximeters differed significantly from the co‐oximeter measurements and in these patients the error of both machines exceeded the manufacturers' claims. However, the machines appeared to reflect changes in saturation accurately in the same patient.
The appointment of an anaesthetist
Authors: MASSON A. H. B.
Published: July 2010

This is an historical vignette about a stage in the evolution of specialist anaesthesia in the capital city of Scotland. Ignorant management decisions delayed development in Edinburgh by 25 years.
Reducing the risks of laryngoscopy in anaesthetised infants
Authors: Ledbetter J. L. , Rasch D. K. , Pollard T. G. , Helsel P. , Smith R. B.
Published: July 2010

We have evaluated the use of oxygen insufflation during laryngoscopy with an OxyscopeTM laryngoscope blade compared to conventional laryngoscopy for maintenance of transcutaneous Po2 during intubation of anaesthetised, spontaneously breathing infants. Twenty healthy children aged between 1 and 24 months were anaesthetised with halothane in oxygen. Laryngoscopy and intubation were performed in a double‐blind fashion using a Miller No. 1 OxyscopeTM blade either with or without oxygen insufflation. Transcutaneous oxygen tension, arterial pressure and heart rate were measured before and after laryngoscopy, and duration of laryngoscopy was recorded. Transcutaneous oxygen tension decreased by 7.1% (SD 6.1%) when oxygen insufflation was used, compared to 33.0% (SD 15.1%) without oxygen insufflation (p < 0.0001). There were no significant differences in mean duration of laryngoscopy or patient age. We conclude that oxygen insufflation during laryngoscopy and intubation of spontaneously breathing, anaesthetised infants effectively minimises the decrease in transcutaneous oxygen tension from pre‐laryngoscopy levels, and makes instrumentation of the airway safer.
Bladder temperature as an estimate of body temperature during cardiopulmonary bypass
Authors: BONE M. E. , FENECK R. O.
Published: July 2010

Bladder temperature measured by a thermistor‐tipped urinary catheter, was compared to oesophageal, nasopharyngeal, rectal and cutaneous temperatures in 33 patients during cardiopulmonary bypass. The bladder site was warmer than all other monitored sites in the pre‐bypass period and showed least variation in temperature. The rate of change of bladder temperature during cooling and rewarming on bypass was significantly (p < 0.01) lower than for oesophageal and nasopharyngeal temperatures, but was greater than or similar to the rate of change of rectal and cutaneous temperatures. This method of temperature measurement was found to be satisfactory during major surgery and also during the postoperative period in the intensive care unit.
Patient‐controlled analgesia with a mixture of pethidine and doxapram hydrochloride
Authors: CLYBURN P. A. , ROSEN M.
Published: July 2010

Twenty‐four patients who underwent elective cholecystectomy received double‐blind increments of either pethidine 30 mg or a mixture of pethidine 30 mg and doxapram 45 mg delivered on a patient‐controlled basis. A loading dose of doxapram 100 mg or saline was administered. There was no difference in respiratory depression as indicated by respiratory frequency and end tidal carbon dioxide concentration. The incidence of respiratory apnoea was similar in the two groups but apnoea was of shorter duration in patients who received doxapram, although the difference was not significant. Patients who received doxapram assessed overall pain as worse on a linear analogue scale (p < 0.05) but demanded similar amounts of pethidine. There was no difference in pain on movement.
Pain‐free injection in infants
Authors: HOPKINS C. S. , BUCKLEY C. J. , BUSH G. H.
Published: July 2010

A randomised, placebo‐controlled, double‐blind study was undertaken in 111 children between the ages of 1 and 5 years to assess the efficacy of EMLA 5% cream in the alleviation of venepuncture pain at intravenous induction of general anaesthesia using 27‐gauge needles. Pain assessment was made by an operating department assistant using both verbal rating scale and visual analogue scale methods. Seventy‐five children, of whom 24 were premedicated, were treated with EMLA cream and 36 with placebo, 14 of whom were premedicated. Significantly lower pain scores were recorded in the children treated with EMLA cream (verbal rating scale: premedicated p < 0.05, unpremedicated p < 0.001; visual analogue scale: premedicated p < 0.0005, unpremedicated p < 0.0002). No variation in analgesia was found for application times between 30 and 300 minutes and there were no serious side effects.
Myocardial infarction in the third trimester of pregnancy
Authors: BEMBRIDGE M. , LYONS G.
Published: July 2010

A 30‐year‐old woman developed severe chest pain while out shopping and was admitted to the delivery suite. She was 38 weeks pregnant with her second child. A diagnosis of myocardial infarction was made and cardiac arrest occurred shortly afterwards. She went into spontaneous labour 30 hours later and was delivered vaginally. This report reviews myocardial infarction in pregnancy and considers the clinical management of this patient.
The accuracy of pulse oximeters
Authors: TAYLOR M. B. , WHITWAM J. G.
Published: July 2010

The accuracy of five commercially available pulse oximeters was compared against arterial blood oxygen saturation, under similar clinical conditions. The oximeters had very similar performance in the clinically useful range of 80–100%, with a tendency slightly to underestimate the true saturation.
Measurement of FEV1 and FVC
Authors: HOSIE H. E. , NIMMO W. S.
Published: July 2010

The performance of a pocket spirometer was compared with that of the Vitalograph to assess the extent of agreement between the instruments and the repeatability of measurements with each instrument. Both instruments showed a similar leval of accuracy when measurements were repeated and in the estimation of forced vital capacity, but there was a mean difference of 201 ml in measurements of forced expiratory volume in one second, for which the Vitalograph gave the larger reading.
Alfentanil infusion in the elderly
Authors: LEMMENS H. J. M. , BOVILL J. G. , BURM A. G. L. , HENNIS P. J.
Published: July 2010

The use of a computer‐assisted infusion of alfentanil, combined with 66% nitrous oxide in oxygen, for induction and maintenance of anaesthesia was evaluated in IS elderly patients. The target alfentanil concentration for induction was varied between 300 and 475 ng/ml, to be achieved in 2 minutes. During maintenance, the alfentanil concentration was increased or decreased according to each patient's responses. Arterial blood samples were taken for measurement of alfentanil concentration. There were high incidences of muscle rigidity, bradycardia and hypotension during induction. Hypotension was dose‐ and concentration‐dependent. Signs of light anaesthesia during maintenance were controlled rapidly by increasing the target plasma concentration. Nine patients required naloxone at the end of surgery. Ventilatory depression recurred in three of these. The use of published alfentanil pharmacokinetic data from elderly patients to predict plasma concentrations during prolonged infusion resulted in significant prediction errors, notably in the higher concentration range.
An analysis of critical incidents in a teaching department for quality assurance A survey of mishaps during anaesthesia
Authors: Kumar V. , Barcellos W.A. , Mehta M.P. , Carter J.G.
Published: July 2010

A prospective survey was conducted from April 1984–January 1985 and April 1985–January 1986 to study the frequency of critical incidents and factors associated with them. Eighty‐six mishaps were reported in the first period, the majority of which were because of human error (80.3%);the must common were the transmission of gases and vapours and errors in drug administration. Factors frequently associated with these mishaps were failure to perform a normal check and lack of familiarity with equipment or technique. An anaesthesia equipment checklist was incorporated in the survey during the second period and 43 mishaps were reported. This decrease in incidence may have resulted from the anaesthesia apparatus checklist, awareness of mishaps since they were discussed regularly at departmental meetings, and new anaesthesia machines (eight older machines were replaced during the first period and 11 at the beginning of the second).
Phaeochromocytoma—a presentation mimicking malignant hyperthermia
Authors: CROWLEY K. J. , CUNNINGHAM A. J. , CONROY B. , O'CONNELL P. R. , COLLINS P. G.
Published: July 2010

A 52‐year‐old apparently healthy, normotensive woman who presented for elective cholecystectomy experienced intra‐operative hypertension and tachycardia, which were controlled by propranolol. Oesophageal temperature increased, there was a metabolic and respiratory acidosis with hypoxaemia, and malignant hyperthermia was diagnosed. Severe cardiogenic pulmonary oedema ensued, and was treated with intravenous glyceryl trinitrate. Ventricular fibrillation caused cardiac arrest, and this was treated successfully. Postoperatively a phaeochromocytoma was discovered, and removed at a subsequent operation. The case illustrates the similarities in presentation of malignant hyperthermia and phaeochromocytoma, and the possibility that misdiagnosis may exacerbate the crisis.
Haemoglobin H disease and cardiac surgery
Authors: ROWBOTTOM S. J. , SUDHAMAN D. A.
Published: July 2010

The management of two patients with haemoglobin H disease, who underwent open‐heart surgery, is described and the problems that relate to anaesthesia in the presence of this condition are discussed.
Transcutaneous electrical nerve stimulation after thoracotomy
Authors: STUBBING J. F. , JELLICOE J. A.
Published: July 2010

Forty patients scheduled to undergo thoracotomy were randomly allocated to receive either transcutaneous electrical nerve stimulation with intramuscular papaveretum (20 patients) or intramuscular papaveretum alone (20 patients) for postoperative pain relief. Total intramuscular analgesic requirements in the first 24 hours, time to satisfactory transfer to oral analgesia, antiemetic requirements and length of stay in hospital postoperatively were noted. Peak expiratory flow rate was compared pre‐and postoperatively in the two groups. Use of nerve stimulation did not significantly alter the requirements for analgesia although there was a reduction in postoperative nausea and vomiting in the nerve stimulation group. There was no difference between the two groups with respect to changes in peak expiratory flow rate.
Recurarisation following a suxamethonium–alcuronium sequence in patients with atypical cholinesterase
Authors: BARAKA A. , SIBAI A.‐N. , HAMED M. , DELLEH R.
Published: July 2010

Alcuronium 10 mg was administered to maintain muscle relaxation in two patients before recovery from suxamethonium neuromuscular blockade to facilitate tracheal intubation. This sequence resulted in a markedly prolonged block which could not be antagonised adequately by neostigmine 0.05 mg/kg; initial antagonism was followed rapidly by prolonged recurarisation. Estimation of plasma cholinesterase activity revealed that the two patients were homozygous for the atypical and silent genes, respectively.
A cost‐benefit analysis of intensive therapy
Authors: RIDLEY S. , BIGGAM M. , STONE P.
Published: July 2010

The daily costs of 90 critically ill patients treated on an intensive therapy unit were calculated on an individual patient basis. Twenty‐one patients (23%) died on the intensive therapy unit and another 13 (15%) died within one year of discharge. The results demonstrate that there is wide variation in costs among the patients and the diagnoses. The mean daily cost of nonsurvivors was almost £300 greater than that of survivors (£816 (95% confidence interval =£649–982) versus £550 (£498–601)). Renal failure, sepsis and pneumonia proved to be some of the most expensive conditions to treat, and postoperative respiratory failure the cheapest. The cost of the first day of management was significantly related to the APACHE II score and individual costs on the first day may be predicted from admission APACHE II score. Patients who die in the intensive therapy unit continue to incur the same high level of expenditure throughout admission. The study could not provide conclusive answers concerning the trend in daily costs for survivors.
The effect of fentanyl administered epidurally by patient‐controlled analgesia, continuous infusion, or a combined technique of oxyhaemoglobin saturation after abdominal surgery
Authors: OWEN H. , KLUGER M. T. , ILSLEY A. H. , BALDWIN A. M. , FRONSKO R. R. L. , PLUMMER J. L.
Published: July 2010

The aims of this study were to determine the effect of three different modes of epidural administration of fentanyl on oxyhaemoglobin saturation and pain control. Forty‐three patients undergoing elective abdominal surgery were randomly allocated to the following groups: (1) continuous infusion of fentanyl at a rate of 50 μg.h−1 with additional epidural boluses (25 μg.Ug) as required; (2) patient‐controlled analgesia using a 25 fig epidural bolus of fentanyl with a 15 min lockout period; (3) a combination of patient‐controlled analgesia and continuous infusion. Oxyhaemoglobin saturation was measured by continuous computerised pulse oximetry for 48 h after operation together with pain and sedation scores. In the first 24 h after surgery patients in the continuous infusion group spent a significantly greater proportion of time below oxygen saturations of 94% and 85% than those in the other two groups. On day 2 all oxygen saturation measurements were worse than during day 1, but differences between groups were not significant. Those patients receding patient‐controlled analgesia required significantly less fentanyl than patients in either of the other groups (p < 0.05). However, the mean pain and sedation scores did not differ significantly between the three treatment groups. There was no association between total fentanyl dose and oxygen saturation values. Overall, self‐administered fentanyl appeared to cause less oxyhaemoglobin desaturation than nurse‐administered analgesia without any loss of analgesic effect.
Histamine release by morphine and diamorphine in man
Authors: WITHINGTON D. E. , PATRICK J. A. , REYNOLDS F.
Published: July 2010

Intravenous morphine and diamorphine are routinely used for postoperative analgesia but the relative histamine releasing abilities of these drugs have not been compared in man. Thirty‐eight patients were randomly allocated to receive morphine (0.16 mg.kg−1) or diamorphine (0.08 mg.kg−10) after abdominal surgery. Blood samples for histamine were taken before, and at timed intervals after, opioid administration and analysed by an isotopic radioenzymatic technique. Haemodynamic parameters and pain scores were recorded before and after analgesic administration, and a series of eight basophil histamine release studies was also performed. Significant histamine release (plasma concentration > 2 ng.ml−1or rise of > 700% baseline) occurred in 23.5% of the morphine group and 21.1% of the diamorphine group. Histamine was released earlier in those receiving diamorphine, but no significant change in haemodynamic parameters occurred, and no histamine release was demonstrated in the basophil histamine release studies. These findings suggest that morphine and diamorphine release histamine from mast cells rather than basophils.
Lignocaine spray applicators are a potential source of cross‐infection in the anaesthetic room
Authors: Williams O. A. , Wilcox M. H. , Nicol C. D. , Spencer R. C. , Reilly C. S.
Published: July 2010

Ten percent lignocaine spray is in widespread clinical use as a means of suppressing responses to tracheal intubation, ft is sprayed from a multidose container into the glottis and on to the vocal cords through an applicator nozzle, which may be used on successive patients. We have investigated the likelihood of the contamination of these nozzles, with patients' mouth flora. Spray applicators from four of the 20 cases investigated showed contamination with potential bacterial pathogens. We therefore recommend that lignocaine spray should not be applied to successive patients using the same applicator nozzle.
Combined infusions of morphine and ketamine for postoperative pain in elderly patients
Authors: EDWARDS N. D. , FLETCHER A. , COLE J. R. , PEACOCK J. E.
Published: July 2010

The value of using a combined infusion of morphine with a variable dose of ketamine for postoperative analgesia following upper abdominal surgery was assessed in a double‐blind randomised study of 40 elderly patients. Four groups of 10 patients received an infusion of morphine at J mg.h−1, either alone, or combined with ketamine at a rate of 5, 10 or 20 mg.h−1. The addition of ketamine to a continuous infusion of morphine did not significantly improve either analgesia or postoperative lung function. Increasing the dose of ketamine resulted in an increased incidence of postoperative dreaming (p < 0.01).
Subcutaneous emphysema in labour
Authors: JAYRAN‐NEJAD Y.
Published: July 2010

Spontaneous subcutaneous and mediastinal emphysema is a rare but potentially dangerous complication of labour. The condition was observed in an 18‐year‐old primigravida in the first stage of labour, who subsequently required Caesarean section which was performed under epidural anaesthesia.
A case of acute poisoning due to organophosphate insecticide
Authors: KECIK Y. , YORUKOGLU D. , SAYGIN B. , SEKERCI S.
Published: July 2010

A case of acute severe organophosphate poisoning by deliberate self administration is reported. The patient required intensive therapy for 30 days. Unusual features of the case were the avoidance of atropine, because of the high risk of ventricular fibrillation, and the ineffectiveness of pralidoxime.
Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium
Authors: MADDINENI V.R. , MIRAKHUR R.K. , McCOY E.P. , FEE J.P.H. , Clarke R.S.J.
Published: July 2010

Mivacurium chloride has been assessed in respect of intubating conditions and neuromuscular effects. The influence of suxamethonium on the onset and duration of subsequently administered mivacurium was also studied. A dose of 0.15 mg.kg−1 of mivacurium was found to provide unacceptable intubating conditions at 2 min in 9/9 patients and further studies were conducted using 0.2 mg.kg−1. Intubating conditions with this dose were acceptable in 65% and 80% of patients at 2 min and 2.5 min respectively. In comparison, intubating conditions were acceptable in 100% of patients at 1 min following 1 mg.kg−1 of suxamethonium. The onset of block occurred in 96 s and 97 s after 0.15 mg.kg−1 and 0.2 mg.kg−1 respectively, and the durations of block in terms of recovery of the first twitch (T1) to 25% and 90% of control, and to recovery of train‐of‐four ratio to 0.7, were 16.1 and 17.9; 24.1 and 25.8; and 24.2 and 27.0 min respectively with the two doses. The time for the onset of complete block with suxamethonium 1.0 mg.kg−1 was 50 s and the times to 25% and 90% recovery were 9.8 min and 13.3 min. The differences between suxamethonium and both doses of mivacurium were significant (p < 0.05) but there were no significant differences between the two doses of mivacurium in any of the neuromuscular measurements. Prior administration of suxamethonium had no influence on the effects of mivacurium. Cutaneous flushing was observed in 30 out of 75 patients but this was associated with transient hypotension in only two patients. Our results show mivacurium to have a duration of action approximately half that of comparable doses of the intermediate acting relaxants atracurium and vecuronium.
Dexamethasone reduces pain and swelling following extraction of third molar teeth
Authors: BAXENDALE B. R. , VATER M. , LAVERY K.M.
Published: July 2010

Extraction of multiple third molar teeth can cause significant postoperative pain, swelling and trismus, which may result in delayed hospital discharge. We have examined the effect of a single prophylactic dose of oral dexamethasone 8 mg on these complications, in a randomised double‐blind study of 50 adult patients. The number of extractions performed and the operative approach were standardised. Dexamethasone resulted in a significant reduction in pain 4 h postoperatively, and eliminated the need for opioid analgesia in the postoperative period. The incidence of severe swelling was also reduced significantly, but there was no effect an trismus. Postoperative nausea and vomiting were significantly lower in the dexamethasone group. We conclude that the use of prophylactic oral dexamethasone is useful in reducing postoperative analgesia requirements in this group of patients, and may facilitate surgery performed on a day case basis.
Anaesthesia for cardiomyoplasty
Authors: GREENHALGH D. L. , BARMAN D. , HOOPER T. L.
Published: July 2010

Cardiomyoplasty is a new surgical procedure for the treatment of severe heart failure, but early mortality has been high in the preliminary experience of many centres. This report describes the anaesthetic techniques used for the first two successful cases to be performed in the UK.
Blood ordering practices in obstetric units in the United Kingdom
Authors: Clark V.A. , Wardall G.J. , McGrady E.M.
Published: July 2010

A postal questionnaire on blood ordering practices and blood availability was sent to 89 randomly selected maternity units within the United Kingdom. The replies demonstrated a wide variation in crossmatching practices. Of those units that replied, 56% crossmatch for elective and 64% for emergency Caesarean section, 54% for manual removal of placenta, and 29% for fetal distress in labour. The remainder ‘group and screen’ for these indications. Lack of 24 h cover by a resident haematology technician, and location of blood banks distant to the obstetric unit were associated with significant delays in blood availability. More extensive use of the ‘group and screen’ technique may reduce unnecessary crossmatching without jeopardising patient safety, and is advocated for maternity units.
Patient evaluation of four different combinations of intravenous anaesthetics for short outpatient procedures
Authors: Jakobsson J. , Oddby E. , Rane K.
Published: July 2010

We studied 200 female patients (ASA group 1) scheduled for termination of pregnancy under general anaesthesia. The patients were randomly allocated to receive one of four anaesthetic combinations; (1) propofol in combination with ketamine 20 mg, (2) propofol in combination with fentanyl 0.1 mg, (3) thiopentone in combination with fentanyl 0.1 mg, (4) methohexitone in combination with fentanyl 0.1 mg. All patients were breathing oxygen in nitrous oxide 1:2. Patients' self assessments of per‐ and postoperative course and time to discharge were compared. No patient's response suggested light anaesthesia, but dreams were frequently experienced during anaesthesia especially among the propofol‐ketamine combination (29 out of 50). Time to discharge was shortest for the groups of patients given propofol; the mean time was 93 and 96 minfor the ketamine and fentanyl groups respectively. During the recovery period significantly more patients experienced pain in the ketamine‐propofol group. Complaints of nausea were seen in only 15 patients, and seven patients noted psychomimetic side effects during recovery, without any differences between the groups. All four combinations tested offered good conditions for short outpatient procedures. However, the propofol‐fentanyl combination was found to offer the best quality of anaesthesia as assessed by the patients themselves.
An evaluation of a new self‐adhesive patch preparation of amethocaine for topical anaesthesia prior to venous cannulation in children
Authors: DOYLE E. , FREEMAN J. , IM N. T. , MORTON N. S.
Published: July 2010

A new preparation of amethocaine in the form of a self‐adhesive patch, designed to provide topical cutaneous anaesthesia prior to venous cannulation, was evaluated in an open study of 189 children. The new preparation of amethocaine was in place for a mean time of 48 min (SD 3.9). Eighty percent of patients had a satisfactory degree of analgesia for venous cannulation. Nine percent of patients experienced moderate pain and 11% experienced severe pain during venous cannulation. In 26% of patients there was slight (24%) or moderate (2%) erythema at the site of application, and in 5% slight oedema was noted at the site of application. Eight percent of patients had slight itching and 1% had moderate itching at the site of application. There was a clinical impression that venous dilatation made cannulation easier than with EM LA cream. These results suggest that this convenient preparation of amethocaine is highly effective at providing adequate topical cutaneous anaesthesia with a short onset time and a low incidence of minor side effects with no evidence of systemic toxicity.
Intercostal neuralgia associated with internal mammary artery grafting
Authors: CONACHER I. D. , DOIG J. C. , RIVAS L. , PRIDIE A. K.
Published: July 2010

Two patients who underwent coronary artery bypass grafting in which the internal mammary arteries were used, developed chronic, atypical chest pain. After further investigation a diagnosis of intercostal neuralgia was made. It is thought that this condition is due to damage to the intercostal nerves when the internal mammary arteries are dissected. Intercostal neuralgia should be included in the differential diagnosis of chest pain after coronary artery surgery, as its recognition may save the patient unnecessary investigation and suffering.
Quality of life after multiple trauma requiring intensive care
Authors: THIAGARAJAN J. , TAYLOR P. , HOGBIN E. , RIDLEY S.
Published: July 2010

A prospective observational study using structured interviews was used to assess changes in quality of life experienced by surviving trauma victims after management on a general intensive therapy unit in a district general hospital. Each patient's age, distribution of injuries, severity of illness on admission and duration of management were recorded. Deaths in the study group were excluded by examining the Hospital's‘Patient Administrative System’. Three attempts were then made to contact all known survivors and to assess their quality of life using three previously recognised and validated methods. Eighty‐three survivors of multiple trauma were discharged but 19 were not studied. Of the remaining 64, 42 patients completed the questionnaire. After multiple trauma, patients reported significant decreases in their quality of life in relation to their overall health, happiness, ability to think and to pursue leisure activities, their income and their employment. Their mean Perceived Quality of Life Score decreased by 13% (95% confidence intervals 7.5–19.5%). Sixty‐two percent of survivors experienced severe social disability and a modest or severe impairment at work. The Nottingham Health Profile identified major changes in‘psychological’aspects of quality of life, namely energy and emotional reactions.
Basic simulations for anaesthetists A pilot study of the ACCESS system
Authors: BYRNE A. J. , HILTON P. J. , LUNN J. N.
Published: July 2010

This paper describes the design and initial testing of the ACCESS (Anaesthetic Computer Controlled Emergency Situation Simulator) system, which has been designed to simulate anaesthetic emergencies with the aim of providing training for junior doctors. The simulations require little or no capital expenditure with minimal use of time by staff or trainees. They are based on standard anaesthetic equipment, with a microcomputer providing an image of commonly used instruments. Problems are presented as scenarios administered by the teacher, and test the skills of the pupil. During 64 scenarios, five trainees caused two‘deaths’and solved the problems in a median time of2.5min, while an experienced group of anaesthetists caused one‘death’and took 1.8 min. The simulation was rated by the pupils as easy to use, realistic and a valuable educational tool.