bluuebunny/crossref_metadata_2025 huggingface dataset:
One‐week ranitidine bismuth citrate, amoxicillin and metronidazole triple therapy for the treatment of Helicobacter pylori infection in Chinese
Authors: Hung W. K. , Wong W. M. , Wong G. S. W. , Yip A. W. C. , Szeto M. L. , Lai K. C. , Hu W. H. C. , Chan C. K. , Xia H. H. X. , Yuen M. F. , Fung F. M. Y. , Tong T. S. M. , Ho V. Y. K. , Lam S. K. , Wong B. C. Y.
Published: March 2003

Background : We have previously shown that ranitidine bismuth citrate‐based, clarithromycin‐containing triple therapy achieves a higher eradication rate than proton pump inhibitor‐based regimens in areas with a high prevalence of metronidazole resistance.

Aim : To evaluate whether this higher efficacy of ranitidine bismuth citrate over proton pump inhibitor can be extended to non‐clarithromycin‐containing regimens.

Methods : Helicobacter pylori‐positive dyspeptic patients were randomized to receive either ranitidine bismuth citrate, 400 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, or omeprazole, 20 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, each given twice daily for 1 week. H. pylori eradication was confirmed by 13C‐urea breath test 5 weeks later. The side‐effects of the treatments were documented.

Results : Two hundred and twenty‐nine patients were eligible for analysis. By intention‐to‐treat and per protocol analysis, the eradication rates were 77% and 79%, respectively, in the ranitidine bismuth citrate–amoxicillin–metronidazole group and 77% and 82%, respectively, in the omeprazole–amoxicillin–metronidazole group (P = 0.58 and P = 0.65). However, patients in the omeprazole–amoxicillin–metronidazole group reported a significantly higher incidence of minor side‐effects when compared to those in the ranitidine bismuth citrate–amoxicillin–metronidazole group (P = 0.001).

Conclusions : Ranitidine bismuth citrate–amoxicillin–metronidazole was equally as effective as omeprazole–amoxicillin–metronidazole triple therapy, and may be considered as an alternative non‐clarithromycin‐based regimen in the Chinese population.
Helicobacter pylori and uninvestigated dyspepsia
Authors: Fennerty M. B.
Published: March 2003

Although dyspepsia is a very common disorder, the incidence of Helicobacter pylori infection in Western medical clinics is very low (20–35%). In cases where H. pylori is detected, elimination of it may be cost‐effective in the long term, but even eradication is not a guarantee for long‐term relief. Further studies to determine the connection between H. pylori and dyspepsia need to be completed before H. pylori eradication becomes the treatment of choice for that minority of patients. The majority of dyspeptic patients are not as simple to diagnose, and may need several empirical trials of therapy, or more specific diagnostic assessment.
Reflux and Barrett's oesophagitis after gastric surgery — long‐term follow‐up and implications for the roles of gastric acid and bile in oesophagitis
Authors: Taha A. S. , Angerson W. J. , Morran C. G.
Published: March 2003

Background : The role of gastric acid is difficult to separate from that of bile in oesophageal reflux, and the complications of this can take many years to develop. Gastric surgery patients provide a good model for both significant bile reflux and marked gastric acid inhibition.

Aim : To study the oesophageal abnormalities in gastric surgery patients undergoing long‐term follow‐up, compared with patients with intact stomachs.

Methods : Two hundred and forty adult patients were endoscoped regardless of their age, sex or type of surgical procedure. Oesophageal damage was graded on a scale of 0–5, and biopsies were taken to exclude neoplasia, to diagnose Barrett's oesophagus and to identify Helicobacter pylori.

Results : Of the 240 patients studied, 140 had undergone gastric surgery 27 years (19–31 years) [median (interquartile range)] prior to endoscopy, and these patients had milder oesophageal scores and fewer cases of Barrett's oesophagitis. Of the 119 patients with post‐surgical bile reflux gastritis, 31 (26%) had oesophagitis, two (1.7%) had Barrett's oesophagitis and oesophageal scores of 0 (0–1) were found. These results compared with corresponding values of 37 (37%; P = 0.11), 11 (11%; P = 0.007) and 0 (0–2) (P = 0.046), respectively, in 100 patients with intact stomachs. In addition, of the 83 patients with vagotomy, 19 had oesophagitis (23%; P = 0.05), none had Barrett's oesophagitis and lower oesophageal scores (P = 0.02) were found.

Conclusions : The prevalence and severity of reflux and Barrett's oesophagitis are not increased in patients with a long history of gastric surgery, particularly after vagotomy, and despite being at risk of bile reflux.
Gastrointestinal transit and 5‐ASA release from a new mesalazine extended‐release formulation
Authors: Brunner M. , Assandri R. , Kletter K. , Tschurlovits M. , Corrado M. E. , Villa R. , Eichler H. G. , Müller M.
Published: March 2003

Background : Mesalazine (5‐aminosalicylic acid, 5‐ASA)‐containing formulations represent a cornerstone in the treatment of inflammatory bowel diseases. Recently, a new formulation has been developed to provide selective and more homogeneous release of 5‐ASA compared to traditional systems.

Methods : In a first study, gastrointestinal transit was followed by gamma‐scintigraphy after single‐dose application of tablets containing 1200 mg mesalazine to 12 healthy male volunteers. 5‐ASA release was verified by the assessment of plasma pharmacokinetics. In a second, 7‐day, multiple‐dose study, the steady state plasma pharmacokinetics, urinary excretion and safety profile were characterized after twice‐daily tablet administration to 12 healthy volunteers.

Results : Tablet erosion started after 6.9 ± 1.1 h in the ascending or transverse colon. Radioactivity spread homogeneously throughout the colon, indicating the sustained release of active 5‐ASA. Plasma kinetics indicated an earlier initial absorption of 5‐ASA, i.e. during transit of the small intestine and ileum. Mean Cmax values (350.6 ± 322.6 ng/mL) were observed during location in the ileo‐caecal region. The mean relative absorption of 5‐ASA was 19.9 ± 18.2% in the small intestine and ileum and 80.1 ± 18.2% in the colon.

Conclusions : The administration of the new mesalazine formulation was well tolerated, and 5‐ASA was continuously released along the whole colon, a favourable prerequisite for the therapy of distally located inflammatory bowel disease.
Nutrition and adult inflammatory bowel disease
Authors: Goh J. , O'Morain C. A.
Published: March 2003

Major advances in the understanding of the aetio‐pathogenesis and genetics of inflammatory bowel disease have been accompanied by an escalation in the sophistication of immunomodulatory inflammatory bowel disease therapeutics. However, the basic ‘triple’ therapy (5‐aminosalicylates, corticosteroids, azathioprine) and nutrition have maintained their central role in the management of patients with inflammatory bowel disease over recent decades.

This review provides an overview of the supportive and therapeutic perspectives of nutrition in adult inflammatory bowel disease.

The objective of supportive nutrition is to correct malnutrition in terms of calorie intake or specific macro‐ or micronutrients. Of particular clinical relevance is deficiency in calcium, vitamin D, folate, vitamin B12 and zinc.

There is justifiably a growing sense of unease amongst clinicians and patients with regard to the long‐term use of corticosteroids in inflammatory bowel disease. This, rather than arguments about efficacy, should be the catalyst for revisiting the use of enteral nutrition as primary treatment in Crohn's disease.

Treatment failure is usually related to a failure to comply with enteral nutrition. Potential factors that militate against successful completion of enteral nutrition are feed palatability, inability to stay on a solid‐free diet for weeks, social inconvenience and transient feed‐related adverse reactions. Actions that can be taken to improve treatment outcome include the provision of good support from dietitians and clinicians for the duration of treatment and the subsequent ‘weaning’ period. There is evidence to support a gradual return to a normal diet through exclusion–re‐introduction or other dietary regimen following the completion of enteral nutrition to increase remission rates. We also review the evidence for emerging therapies, such as glutamine, growth factors and short‐chain fatty acids.

The future may see the evolution of enteral nutrition into an important therapeutic strategy, and the design of a ‘Crohn's disease‐specific formulation' that is individually tailored, acceptable to patients, cost‐effective, free from adverse side‐effects and combines enteral nutrition with novel pre‐ and pro‐biotics and other factors.
Blood transfusion facilitating difficult weaning from the ventilator
Authors: Schönhofer B. , Böhrer H. , Köhler D.
Published: March 2003

We report a case series of five anaemic patients (haemoglobin: 8.7 ± 0.8 gdl−1) with chronic obstructive lung disease in whom trials of weaning from the ventilator were unsuccessful. After transfer to our regional weaning centre, blood was transfused to increase the haemoglobin value to 12 gdl−1 or higher. Subsequently, all patients were weaned successfully. We conclude from our experience that in anaemic patients with chronic obstructive lung disease there should not be a fixed transfusion threshold. In anaemic patients in whom difficulty in weaning from the ventilator is experienced, blood transfusion should be tailored to the individual patient's needs. Transfusion in those with chronic obstructive airways disease may lead to successful weaning.
Bacterial meningitis following combined spinal–epidural analgesia for labour
Authors: Bouhemad B. , Dounas M. , Mercier F. J. , Benhamou D.
Published: March 2003

We report a case of Streptococcus salivarius meningitis following combined spinal–epidural analgesia for labour. Although rare, bacterial meningitis following combined spinal–epidural anaesthesia is being increasingly described. We review the previously reported cases and discuss the possible aetiological causes and the aseptic precautions likely to reduce the incidence of infectious complications.
Effect of orifice‐area reduction on flow characteristics during injection through spinal needles
Authors: Myers M. R. , Malinauskas R. A.
Published: March 2003

A reduction in hole size for certain side‐port spinal needles has been advocated in recent reports. While the influence of orifice‐area reduction on the aspiration capability of the needle has been studied, the influence on the anaesthetic delivery properties is relatively unknown. As a first step in understanding the effects of hole‐size reduction on anaesthetic distribution within the subarachnoid space, we studied flows emanating from isolated needles using computer simulations. Following validation of the numerical model using experimental particle visualisation, trajectories of anaesthetic particles injected through 25G Whitacre needles of various orifice areas were computed and used to determine the orientation and rate of spread of the anaesthetic jet exiting the needle. Two factors impacting the concentration distribution were observed: the rate of spread of the anaesthetic jet increases markedly with decreasing orifice area and the jet alignment shifts toward perpendicular to the needle axis.
Patient‐controlled analgesia: an assessment by 200 patients
Authors: Chumbley G. M. , Hall G. M. , Salmon Peter
Published: March 2003

Two hundred patients completed a questionnaire about their experiences of patient‐controlled analgesia. The questionnaire covered the following topics: pre‐operative information, reasons for pressing and not pressing the button, pain relief, side‐effects, safety, advantages and disadvantages of patient‐controlled analgesia, worries associated with its use and control over pain. A high level of satisfaction with the device, together with a view that it afforded control over pain, emerged from replies to simple, general questions. However, more detailed questions revealed side‐effects and fears that constrained its use and hence patients' ability to control pain. Control is predominantly a feature of the professional's view of patient‐controlled analgesia, rather than the patient's experience of this analgesic technique.
The effect of mivacurium pretreatment on intra‐ocular pressure changes induced by suxamethonium
Authors: Chiu C. L. , Lang C. C. , Wong P. K. , Delilkan A. E. , Wang C. Y.
Published: March 2003

Forty patients without eye disease, undergoing elective nonophthalmic surgery, were studied in a double‐blind, randomised, placebo‐controlled study evaluating the efficacy of mivacurium pretreatment in attenuating the rise in intra‐ocular pressure in response to suxamethonium administration, laryngoscopy and intubation. The patients were randomly allocated to receive either mivacurium 0.02 mg.kg−1 or normal saline as pretreatment 3 min before a rapid sequence induction technique using alfentanil, propofol and suxamethonium. Suxamethonium induced a significant increase in intra‐ocular pressure in the control group but not in the mivacurium pretreatment group (mean (SEM) increase = 3.5 (1.2) mmHg vs. 0.4 (0.8) mmHg, p < 0.05). There was a decrease in intra‐ocular pressure in both groups after laryngoscopy and intubation with no significant difference between the two groups. These results show that mivacurium pretreatment is effective in preventing the increase in intra‐ocular pressure after suxamethonium administration.
Occupancy of a teaching hospital adult intensive care unit by high dependency patients
Authors: Thompson H. , Spiers P.
Published: March 2003

We assessed the hourly occupancy of our intensive care unit by high dependency patients over an 8‐week period using the criteria established by the Working Group on Guidelines on Admission to and Discharge from Intensive Care and High Dependency Units published by the National Health Service Executive. High dependency patients accounted for 1914 bed hours (21.6%) out of a potential available total of 8880 hours. Measurement of Therapeutic Intervention Scoring System points and Acute Physiology and Chronic Health Evaluation II scores confirmed that categorising patients according to the new guidelines produced significantly different populations of patients. Mean (standard deviation) Therapeutic Intervention Scoring System points for intensive care status patients were 38.57 (10.40) compared to 21.66 (5.98) points for high dependency status patients (p < 0.001). Median (range) Acute Physiology and Chronic Health Evaluation II score for intensive care status patients was 16 (1–45) compared to 11 (1–27) for high dependency status patients (p < 0.0001). Calculating bed occupancy with different definitions for the whole of our intensive care unit population during the 8 weeks revealed a range of occupancies between 85.3% and 107.3%. We recommend that intensive care unit bed occupancy should be calculated in a standard manner nationally to allow comparison between units. We suggest that hourly occupancy be adopted as the universal method.
An analysis of training activities in the use of critical care equipment within hospitals in the United Kingdom
Authors: Fouladinejad F. , Roberts J. R.
Published: March 2003

We investigated how training in the use of electromedical devices in adult and neonatal intensive care departments is organised, designed and delivered. Forty‐one departments within two Regional Health Authorities in the United Kingdom returned a detailed questionnaire, from which several nonlinear models were developed using fuzzy logic analysis. The results clearly indicate that training in the use of equipment is a very minor activity, with less than 1% of departmental time spent on providing or receiving such training. Departments that had a higher level of expertise required less assistance from technical personnel. Critical care equipment can be utilised more fully, cost effectively and safely if a formal and regular training programme is implemented.
Postoperative intrathecal patient‐controlled analgesia with bupivacaine, sufentanil or a mixture of both
Authors: Vercauteren M. P. , Geernaert K. , Hoffmann V. L. H. , Dohmen D. , Adriaensen H. A.
Published: March 2003

In a randomised double‐blind study, 45 patients, scheduled for major orthopaedic surgery under continuous spinal anaesthesia, received for relief of postoperative pain patient‐controlled analgesia with either sufentanil 2 μgml−1, bupivacaine 0.0625% or a mixture of both by the intrathecal route. The mean (SD) consumption of sufentanil and bupivacaine during the first 12 h was 65.5 (27.1) μg and 18.2 (4.8) mg, respectively. Combining bupivacaine and sufentanil reduced the consumption of both to ≈40% as compared to the administration of each component separately. Pain relief was very good in all subjects, although this was obtained faster with the combined regimen. Moreover, more patients in this group remained completely painfree during the entire observation period (p < 0.05). The incidence of hypotension was low and not significantly different when the plain bupivacaine group was compared with the two other groups. Nausea and vomiting were significantly more frequently observed in both groups treated with sufentanil. Motor block was not a major problem and was noticed during the first 2 h of treatment only. Tachyphylaxis did not occur. It was concluded that the groups receiving plain bupivacaine and sufentanil alone experienced pain relief of good quality. The use of a mixture, however, accelerated the onset of analgesia, improved the analgesic quality and reduced the doses for both components by 60% but at the expense of a higher incidence of nausea and vomiting.
Regional analgesia in early active labour: combined spinal epidural vs. epidural
Authors: Price C. , Lafreniere L. , Brosnan C. , Findley I.
Published: March 2003

We randomly allocated 93 women in early active labour and requesting epidural analgesia to receive either epidural (n = 48) or combined spinal–epidural analgesia (n = 45). For epidural analgesia 15 ml of bupivacaine 0.1% with 75 μg of fentanyl were injected into the epidural space. For combined spinal–epidural analgesia 1 ml of bupivacaine 0.25% with 25 μg of fentanyl were injected into the subarachnoid space. For both groups subsequent top‐ups of 10 ml of bupivacaine 0.1% with fentanyl 20 μg were given using a lightweight patient‐controlled epidural analgesia (PCEA) pump with a lockout time of 30 min. We assessed analgesia and the degree of motor blockade and found no significant differences in pain or maternal satisfaction scores between the two groups. The time to first top‐up was significantly longer in the epidural group than in the CSE group (p = 0.01). The combined spinal–epidural group had significantly greater motor blockade at 30 min than the epidural group (p = 0.01), but there was no difference after this. The PCEA machine failed completely twice and temporarily many times. We conclude that the combined spinal–epidural technique confers no advantages in early active labour. Also, a lightweight PCEA pump needs to be more reliable before we can recommend its use.
Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit
Authors: Stevens V. G. , Hibbert C. L. , Edbrooke D. L.
Published: March 2003

This study analyses the relationship between the actual patient‐related costs of care calculated for 145 patients admitted sequentially to an adult general intensive care unit and a number of factors obtained from a previously described consensus of opinion study. The factors identified in the study were suggested as potential descriptors for the casemix in an intensive care unit that could be used to predict the costs of care. Significant correlations between the costs of care and severity of illness, workload and length of stay were found but these failed to predict the costs of care with sufficient accuracy to be used in isolation to define isoresource groups in the intensive care unit. No associations between intensive care unit mortality, reason for admission and intensive care unit treatments and costs of care were found. Based on these results, it seems that casemix descriptors and isoresource groups for the intensive care unit that would allow costs to be predicted cannot be defined in terms of single factors.
Major vascular surgery in a patient with sickle cell disease
Authors: Vipond A. J. , Caldicott L. D.
Published: March 2003

We report a patient with homozygous sickle cell disease who underwent femoropopliteal bypass for claudication on walking 10 m. Isotope studies showed a blood flow in his left femoral artery of only 0.808 ml.100 mlmin−1. The potential problems of sickle cell disease combined with peripheral vascular disease were probably reduced in this patient because he had an increased fetal haemoglobin level of 13%. Despite the femoral artery being clamped for 100 min, no sickling crisis occurred.
Predictable normocapnoea in controlled ventilation of infants with Jackson Rees or Bain system
Authors: Park J. W. , Chung S. H. , Choe Y. K. , Kim Y. J. , Shin C. M. , Park J. Y.
Published: March 2003

We have devised a formula for ventilator settings which would provide normal minute ventilation without rebreathing during controlled ventilation using a Jackson Rees or Bain system. As V
T = V
S + V
F − V
L, where V
T = delivered tidal volume, V
S = set tidal volume, V
F = the volume of fresh gas entering during the inspiratory phase and V
L = the lost volume due to the compliance of the system, V
S was derived: V
S = V
L + V
T × [1 − b/(1 + a)] where a = expiratory‐to‐inspiratory ratio and b = the ratio of fresh gas flow to the minute ventilation. It was evaluated in 62 infants. Arterial partial pressure of carbon dioxide (mean (SD)) was 4.6 (0.5) kPa (35 (4) mmHg) with a range of 3.42–5.78 kPa (26–44 mmHg). The 90th percentile was 5.1 kPa (39 mmHg). It is concluded that predictable normocapnoea can be conveniently achieved in infants in controlled ventilation with Jackson Rees or Bain system if our formula is applied.
Transcutaneous CO2/O2 and CO2/air suction in patients undergoing cataract surgery with retrobulbar anaesthesia
Authors: Schlager A. , Lorenz I. H. , Luger T. J.
Published: March 2003

We investigated transcutaneous partial CO2 and O2 pressures and respiratory rate in unpremedicated elderly patients of ASA physical status 1 to 3 who underwent cataract surgery under retrobulbar anaesthesia. In group A no air suction was used. In group B suction was applied under the sterile drapes to avoid rebreathing of CO2. In group A transcutaneous partial CO2 pressure and respiratory rate significantly increased compared with baseline, whereas in group B they remained constant. In both groups transcutaneous partial O2 pressure and oxygen saturation as measured by pulse oximetry significantly rose after insufflating oxygen 3 lmin−1. Heart rate and mean arterial blood pressure remained constant. Our results demonstrate that the application of suction near the patient's head prevents CO2 rebreathing and subsequent hypercapnia associated with an elevated respiratory rate. The use of suction makes it unnecessary to raise oxygen administration. Suction combined with monitoring of partial CO2 pressure using transcutaneous sensors should be used in all ophthalmological operations under retrobulbar anaesthesia.
Hypokalaemic, hyperchloraemic metabolic acidosis requiring ventilation
Authors: Dunn S. R. , Farnsworth T. A. , Karunaratne W. U.
Published: March 2003

A 16‐year‐old patient required intermittent positive pressure ventilation for hypokalaemic muscle weakness resulting from metabolic complications of combined colonic bladder augmentation and incomplete voiding via a prosthetic sphincter. Catheter re‐establishment of urinary flow and electrolyte replacement produced dramatic metabolic and clinical improvement allowing the return of adequate spontaneous respiration.
Theatre monitor alarm settings: a pilot survey in Scotland and Belgium
Authors: Asbury A. J. , Rolly G.
Published: March 2003

The use of alarms on operating theatre equipment was explored in a questionnaire to anaesthetists in Belgium and Scotland. They were presented with a scenario of a fit male having an anaesthetic for an abdominal operation. The overall response rate was 72%, giving 100 records for analysis. The responses from Scottish and Belgian anaesthetists were similar except for views on setting an upper limit for systolic arterial pressure; Scottish anaesthetists seemed relatively unwilling to set an upper systolic arterial pressure limit. Beyond this, the respondents considered alarms to be a method of detecting problems before they occur and they readjust alarms for each patient. They would set systolic arterial pressure alarms 30 mmHg above and below the patients normal pressure, the heart rate alarms 30 bpm above and 20 bpm below the actual rate, and the peripheral oxygen saturation lower alarm limit to 90%.
Clinical efficacy and pharmacokinetics of 1% ropivacaine and 0.75% bupivacaine in peribulbar anaesthesia for cataract surgery
Authors: Huha T. , Ala‐Kokko T. I. , Salomäki T. , Alahuhta S.
Published: March 2003

Peribulbar anaesthesia with 1% ropivacaine and 0.75% bupivacaine, both with hyaluronidase, was assessed in a prospective, randomised, double‐blind study of 100 patients undergoing cataract surgery. Pharmacokinetic data were obtained from 22 subjects. Akinesia of the globe developed slightly more rapidly in the ropivacaine group, but this difference was only statistically significant at 2 min after injection of the local anaesthetic. Lid akinesia was significantly more complete in the ropivacaine group. There were no differences between the groups with respect to peri‐operative analgesia or duration of akinesia. The dose‐adjusted maximum concentration of ropivacaine was approximately twice that of bupivacaine with significantly higher values of the area under the concentration–time curves. No drug‐related adverse effects were observed. We conclude that there are no clinically significant differences in the quality of the sensory and motor block between 1% ropivacaine and 0.75% bupivacaine when used for peribulbar anaesthesia.
Effects of low‐dose isoflurane on saccadic eye movement generation
Authors: Khan O. , Taylor S. J. , Jones J. G. , Swart M. , Hanes D. P. , Carpenter R. H. S.
Published: March 2003

The effects of 0.15% quasi‐steady‐state end‐tidal isoflurane on two saccadic eye‐movement tests were examined in five volunteers using a newly devised computer‐based recording system. The tests were saccadic latency and a countermanding task, the latter being an indicator of the highest levels of conscious performance. A moving light‐emitting diode target was displayed on a screen and in the saccadic‐latency task the latency of eye movement to the target was measured. In all five subjects the latency increased with anaesthetic by an amount which varied from 8 to 45 ms. This result was significantly different (p < 0.05) from subjects without anaesthetic. In the countermanding task, the subject had to voluntarily inhibit movement to the target. Again anaesthetic increased the latency of response, which varied from 6 to 33 ms. This result was significantly different (p < 0.05) from subjects without anaesthetic. In these studies it appeared that two tasks, one a simple latency test and the other, the countermanding task, requiring higher cortical processing were equally impaired at subanaesthetic concentrations of isoflurane.
Attitudes to oral feeding following Caesarean section
Authors: Worthington L. M. , Mulcahy A. J. , White S. , Flynn P. J.
Published: March 2003

In order to evaluate postoperative nutrition in women who have undergone Caesarean section, we conducted a national survey. Questionnaires were sent to 100 randomly selected obstetric units in the UK, and were completed and returned by senior midwives. We found that that only 21.5% of units had a departmental policy concerning feeding after Caesarean section. Midwives decided when women could eat and drink in the majority of obstetric units (78.5%), often without the help of guidelines. The period of postoperative starvation was found to vary greatly, from < 1 h in some units to > 24 h in others. We suggest that all obstetric units should produce guidelines in order to rationalise postoperative feeding for women following Caesarean section.
An audit of airway problems in the recovery room
Authors: Abdy S.
Published: March 2003

It has recently been suggested that recovery rooms should have dedicated anaesthetic cover during working hours to deal with serious life‐threatening problems. This audit was undertaken to determine the incidence and severity of airway problems that occurred in the recovery room at a District General Hospital. One thousand consecutive patients who received a general anaesthetic were assessed. If an airway problem was identified, the patient's notes were examined to document the type of surgery and any predisposing factors which may have contributed. The incidence of airway problems in this study was found to be 2.8%, which was in agreement with previous studies and appears too low to warrant a full‐time anaesthetic presence.
Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia
Authors: Abouleish E. I. , Rashid S. , Haque S. , Giezentanner A. , Joynton P. , Chuang A. Z.
Published: March 2003

This prospective, randomised, placebo‐controlled, double‐blind study was performed to evaluate the effects of ondansetron on nausea and vomiting during elective Caesarean section under spinal anaesthesia. Seventy‐four full‐term parturients were studied. After umbilical‐cord clamping, ondansetron 4 mg or 0.9% saline was injected intravenously and the study period continued for 2 h. The severity of nausea was graded from 0 = none to 10 = maximum, while that of vomiting was graded from single = once per min to continuous = multiple per min. The incidence of vomiting was lower following ondansetron (36%) compared with the control group (58%, p < 0.028). Neither the severity of vomiting nor the incidence of nausea was influenced by ondansetron. However, for those who experienced nausea, ondansetron reduced its severity (p = 0.05). We conclude that the intra‐operative administration of 4 mg ondansetron intravenously during Caesarean section under spinal anaesthesia significantly reduces the incidence of vomiting and the severity of nausea.
Cor pulmonale presenting in a patient with congenital kyphoscoliosis following intercontinental air travel
Authors: Noble J. S. , Davidson J. A. H.
Published: March 2003

We present the case of a 59‐year‐old man with congenital kyphoscoliosis who developed cor pulmonale for the first time following intercontinental air travel. Prolonged exposure to the low partial pressure of oxygen in the cabin of the aircraft led to pulmonary hypertension and right heart failure. The case highlights the potential for long‐haul air travel to cause decompensation in patients with thoracic deformity and apparently stable cardiorespiratory function. It also emphasises the need for patients and their medical attendants to carefully consider the potential health implications of the hypoxic atmosphere in pressurised aircraft.
The use of breathing system filters as oxygen‐delivery devices
Authors: Wilkes A. R. , Vaughan R. S.
Published: March 2003

A breathing system filter can remain connected to a laryngeal mask airway during recovery from anaesthesia. The Luer‐lock monitoring port on the filter could be used for the delivery of supplementary oxygen. The efficacy of this technique was assessed in vitro by comparing the performance of two filters with four other devices, including a T‐piece with a 40% oxygen injector. The minimum inspired oxygen fraction and pressure drop were measured over a range of ventilatory conditions and oxygen flows. The minimum inspired oxygen fraction measured with the remaining devices was greater than with the T‐piece at an oxygen flow of 10 l.min−1. The pressure drop was greater with the breathing system filters than with the T‐piece. A potential advantage in using filters is that no additional equipment is required. However, if using the filters as oxygen supplementation devices, there is only one port open to the atmosphere in the system and inadvertent obstruction of this port could cause barotrauma. It must be remembered that the nonstandard use of such equipment contravenes the recently introduced Medical Device Directive regulations.
The cuffed oropharyngeal airway vs. the laryngeal mask airway: a randomised cross‐over study of oropharyngeal leak pressure and fibreoptic view in paralysed patients
Authors: Brimacombe J. , Keller C.
Published: March 2003

We conducted a randomised cross‐over study of 20 patients to test the hypothesis that oropharyngeal leak pressure and the fibreoptic view differ between the cuffed oropharyngeal airway and laryngeal mask airway in paralysed patients. We also tested the design premise that inflation of the cuffed oropharyngeal airway cuff elevates the epiglottis from the posterior pharyngeal wall. Both airways were inserted into each patient in random order. Oropharyngeal leak pressure and fibreoptic view were documented at zero volume and after each additional 10 ml up to the maximum recommended volume for each device. The laryngeal mask had a higher maximum (23 vs. 16 cmH2O, p = 0.03), minimum (9 vs. 2 cmH2O, p < 0.02) and overall (17 vs. 9 cmH2O, p < 0.001) oropharyngeal leak pressure compared with the cuffed oropharyngeal airway. The glottic inlet was visible more frequently with the laryngeal mask (96 vs. 39%, p < 0.0001). There was no elevation of the epiglottis from the posterior pharyngeal wall with the cuffed oropharyngeal airway. We conclude that the laryngeal mask forms a more effective seal and provides a better fibreoptic view of the glottic inlet than the cuffed oropharyngeal airway in paralysed patients. Inflation of the cuffed oropharyngeal airway cuff does not cause elevation of the epiglottis.
Accumulation of carbon dioxide under ophthalmic drapes during eye surgery: a comparison of three different drapes
Authors: Schlager A.
Published: March 2003

Carbon dioxide accumulation under ophthalmic drapes is caused by their impaired permeability to exhaled carbon dioxide in spontaneously breathing patients. Three different ophthalmic drapes were examined under clinical conditions. Sixty unpremedicated patients of each gender, aged over 60 years and with an ASA status of I–III undergoing cataract surgery under retrobulbar anaesthesia were included in the study. Patients with known pulmonary diseases were excluded. The patients were divided into three groups of 20 patients each. In all groups, oxygen was insufflated under the drapes at a constant flow of 2 l.min−1. Carbon dioxide concentration in the inspired air, transcutaneous carbon dioxide pressures, respiratory rate and oxygen saturation by pulse oximetry were measured. Accumulation of carbon dioxide under the drapes, increase of partial pressure of transcutaneous carbon dioxide and hyperventilation were observed in all three groups. An oxygen supply of 2 l.min−1 prevented hypoxaemia but not hypercapnia. Therefore, producers of ophthalmic drapes are encouraged to look for further ways to increase the carbon dioxide permeability of their drapes with the aim of reducing carbon dioxide accumulation and hyperventilation in spontaneously breathing patients undergoing eye surgery.
Dosage of neostigmine for reversal of rocuronium block from two levels of spontaneous recovery
Authors: McCourt K. C. , Mirakhur R. K. , Kerr C. M.
Published: March 2003

Spontaneous recovery, and recovery following neostigmine 20, 35 or 50 μg.kg−1 administered at 10 or 25% of recovery of the first twitch of the train‐of‐four, was assessed in 80 patients after rocuronium administration under continued isoflurane anaesthesia. In an additional 40 patients, isoflurane administration was discontinued and neostigmine 35 or 50 μg.kg−1 was given at 10 or 25% recovery. The administration of neostigmine reduced the recovery times significantly. A neostigmine dose of 20 μg.kg−1 resulted in slower recovery compared with the higher doses, particularly when reversal was attempted at a first twitch height of 10%. Higher doses of neostigmine given at a first twitch height of 25% resulted in rapid reversal of block [mean (SD) times of 7.0 (4.8) and 6.4 (1.9) min with the 35 and 50 μg.kg−1 doses, respectively, for attaining a train‐of‐four ratio of 0.8]. Discontinuing isoflurane did not alter recovery times. The incidence of emetic symptoms did not differ between groups, including one group that received atropine instead of glycopyrronium in combination with neostigmine. We conclude that rocuronium block can be antagonised safely using a neostigmine dose of 35 μg.kg−1, although recovery may be slightly slower if administered at a first twitch of 10% of control.
A survey of epidural analgesia for labour in the United Kingdom
Authors: Burnstein R. , Buckland R. , Pickett J. A.
Published: March 2003

A postal survey of obstetric units throughout the UK was conducted to obtain information about the provision of epidural analgesia for labour. Ninety per cent of units offered a 24‐h epidural service and the average epidural rate was 24%. The most commonly administered epidural test dose was 3 ml of bupivacaine 0.5% and bupivacaine 0.25% was most often used as the initial epidural top‐up. Continuous infusions of low‐dose bupivacaine and opioid mixtures were the most popular method of maintenance epidural analgesia. Twenty‐four per cent of units offered combined spinal–epidural analgesia in addition to standard epidural analgesia. Midwives played a prominent role in the administration of epidural bolus top‐ups and also in the assessment and maintenance of continuous epidural infusions.
Smokers and haemodynamic responses to desflurane
Authors: Fitz‐Henry J. , Curran J. , Griffiths D.
Published: March 2003

Changes in basic haemodynamic variables following a sudden increase in the concentration of inspired desflurane administered during anaesthesia were compared in 30 female smokers and 30 nonsmokers. Smokers had significantly greater percentage increases in heart rate (p = 0.02), systolic and diastolic blood pressure (p < 0.005 and = 0.01, respectively) and rate–pressure product (p < 0.005). Such increases were reached faster by smokers for both systolic and diastolic blood pressures (p < 0.01) and for rate–pressure product (p = 0.02). The peak values of rate pressure product reached were sufficient to warrant caution when using desflurane for anaesthesia in smokers.
Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants
Authors: Alexander R. , Olufolabi A. J. , Booth J. , El‐Moalem H. E. , Glass P. S.
Published: March 2003

Sixty ASA I and II patients, premedicated with midazolam, were administered propofol 2 mg.kg−1 and remifentanil 3 μg.kg−1 (group R3), remifentanil 4 μg.kg−1 (group R4) and remifentanil 5 μg.kg−1 (group R5). Laryngoscopy and intubation were performed 1 min after the administration of the study drugs and the intubating conditions were assessed. Good to excellent conditions were observed in 12 patients in group R3 compared with 19 patients each in groups R4 and R5 (p = 0.004). Significant reductions in mean arterial pressure (MAP) and heart rate (HR) after administration of the study drug were observed in each group, p < 0.01. There was, however, no difference in mean MAP and HR between the three groups at all time points. We conclude that remifentanil 4–5 μg.kg−1 may reliably provide good to excellent conditions for tracheal intubation when administered after propofol 2 mg.kg−1.
Long‐term outcome of percutaneous thermocoagulation for trigeminal neuralgia
Authors: Yoon K. B. , Wiles J. R. , Miles J. B. , Nurmikko T. J.
Published: March 2003

A retrospective analysis of long‐term efficacy of percutaneous radiofrequency thermocoagulation of the trigeminal ganglion or root for the relief of trigeminal neuralgia was carried out in our unit. From the medical records and questionnaires, outcomes of 108 procedures performed in 81 patients from January 1986 to December 1990 were obtained with a follow‐up period of 6–11 years. The initial success rate was 87% and the probability of remaining pain‐free 1, 2 and 11 years after the procedure was 65, 49 and 26%, respectively. Patients with typical symptoms had a better long‐term efficacy than those with atypical presentations, and patients who had not undergone a previous surgical procedure also had a better outcome. There was no mortality in this series. Common adverse effects included dysaesthesia in 20 patients, corneal numbness in 12 patients and masseter weakness in three patients.
Sevoflurane: a comparison between vital capacity and tidal breathing techniques for the induction of anaesthesia and laryngeal mask airway placement
Authors: Baker  , Smith
Published: March 2003

Sixty unpremedicated adult day‐case patients were randomly assigned to either vital capacity or tidal breathing inhalational induction techniques. End points assessed included loss of eyelash reflex, time to drop a weighted syringe, time to jaw relaxation and time to the end of laryngeal mask airway insertion. Complications occurring during the induction of anaesthesia were recorded. The data show that there is no statistical or clinical difference between the two induction techniques. Patient acceptance of both techniques was similarly high. When the time taken to prime the anaesthetic breathing system is taken into consideration, the vital capacity technique is more expensive for induction of anaesthesia. These results therefore question the need for the vital capacity induction technique with sevoflurane 8%.
Vascular trauma associated with routine spinal anaesthesia
Authors: Knowles P. R. , Randall N. P. C. , Lockhart A. S.
Published: March 2003

Samples of cerebrospinal fluid obtained from 130 patients undergoing spinal anaesthesia were examined microscopically. Subarachnoid puncture was performed using either a 25G Whitacre or 25G Quincke spinal needle. Two samples were collected from each patient and the red blood cell count of the second sample collected was taken as a measure of the vascular trauma associated with the procedure. Red blood cells were seen in 50 (38%) of these samples, of which 18 (14%) contained > 100 red blood cells.mm−3. Paraesthesia was felt by 11 (8.5%) patients and the occurrence of paraesthesia was associated with significantly raised red blood cell counts (p < 0.0001). There was also a correlation between the number of needle passes made at lumbar puncture and the red blood cell count in the sample (p < 0.0001). Neither spinal needle type nor antiplatelet drug therapy influenced red blood cell counts (p = 0.66 and 0.37, respectively). These findings suggest that routine spinal anaesthesia is often complicated by minor degrees of vascular trauma, especially when paraesthesiae or technical difficulty occur at subarachnoid puncture.
Postoperative pain control following remifentanil‐based anaesthesia for major abdominal surgery
Authors: Albrecht S. , Fechner J. , Geisslinger G. , Maass A. B. , Upadhyaya B. , Moecke H.‐P. , Haigh C. , Schüttler J.
Published: March 2003

Eighty patients undergoing major abdominal surgery using remifentanil‐based anaesthesia were randomly allocated in a double‐blind manner to receive an intravenous bolus of fentanyl, buprenorphine, morphine or piritramide 20 min before the end of surgery. A reduced dose was administered postoperatively when patients reported moderate pain. Subsequent analgesia was provided by patient‐controlled analgesia (PCA). The mean time from the end of anaesthesia to spontaneous respiration was 9 ± 5 min. At first pain assessment, 63% of patients reported no or mild pain; 80% of patients required the second opioid bolus, those receiving piritramide needed the bolus significantly later than patients receiving buprenorphine or fentanyl. First PCA requirement also occurred significantly later in the piritramide group. This technique provided effective postoperative pain relief and transition to routine PCA and did not compromise recovery.
Evaluation of a needle‐free injection system for local anaesthesia prior to venous cannulation
Authors: Cooper J. A. , Bromley L. M. , Baranowski A. P. , Barker S. G. E.
Published: March 2003

We evaluated a single‐use, disposable, carbon‐dioxide‐powered, needleless injector (J‐Tip, National Medical Products Inc., CA, USA), which is claimed to deliver a virtually painless, subcutaneous injection. Seventy‐two patients undergoing various types of surgery had a large‐bore intravenous cannula inserted prior to induction of general anaesthesia. Three minutes beforehand, a subcutaneous injection of 0.3 ml of 1% plain lidocaine was administered. Subjects were randomly allocated to receive the lidocaine either by the needleless injector or from a conventional syringe and a 25G needle. Pain scores were recorded on injection of the lidocaine and on insertion of the cannula. There was significantly less pain on injection with the needleless injector than with the 25G needle (p < 0.001) but, surprisingly, there was more pain on cannulation (p < 0.001). We conclude that the device certainly delivers a less painful subcutaneous injection than a 25G needle, but perhaps provides less effective skin anaesthesia for venous cannulation at sites where the subcutaneous space is small; its use might be better suited to areas where the subcutaneous space is deeper.
A nonoccluding bag and closed scavenging system for the Jackson Rees modified T‐piece breathing system
Authors: Dhara S. S. , Pua H. L.
Published: March 2003

We used the inner tube and its 22‐mm connector from the patient end of a Bain breathing system to splint the double‐ended bag of the Jackson Rees modification of the Ayre's T‐piece breathing system. A paediatric airway pressure‐limiting valve was connected to the distal end of the tube for closed scavenging. The resistance of the modified bags was similar to that of unmodified bags at gas flows below 11 l.min−1. The valve offered no resistance to gas flows below 5 l.min−1. During its use in 30 paediatric patients, analysis of carbon dioxide from inside the bag and from the expiratory port confirmed no loss of deadspace gas by preferential flow bypassing the bag into the scavenging system.
Fentanyl supplementation of sevoflurane induction of anasthesia
Authors: Plastow S. E. , Hall J. E. , Pugh S. C.
Published: March 2003

Sevoflurane induction of anasthesia has been examined extensively, but little is known about the usefulness of other drugs as adjuncts to hasten and smooth the process. Sixty patients, undergoing surgery of a type suitable for a spontaneous respiration, laryngeal mask airway anasthetic technique, were randomly allocated to receive 1.0 μg.kg−1 intravenous fentanyl or the equivalent volume of normal saline, 30 s prior to triple‐breath induction with sevoflurane. The study was double‐blind. There were no differences between the groups for the times to loss of eyelash reflex, jaw relaxation, insertion of the laryngeal mask airway or regular settled breathing. However, there was a difference in the incidence of adverse airway events (breath‐holding, coughing and laryngospasm) between the two groups (16.5% in the fentanyl group and 40% in the placebo group); this did not reach statistical significance. Both groups were haemodynamically stable throughout induction, although the fentanyl group had a statistically significant decrease in systolic blood pressure at 4 min compared with the placebo group, which was not considered clinically relevant. We conclude that fentanyl has no significant influence over the speed and quality of sevoflurane induction.