bluuebunny/crossref_metadata_2025 huggingface dataset:
Near fatal pulmonary hypertension after surgical repair of congenital diaphragmatic hernia
Authors: FROSTELL C. G. , LÖNNQVIST P. A. , SONESSON S. E. , GUSTAFSSON L. E. , LÖHR G. , NOACK G.
Published: February 2007

The addition of 10–20 parts per million nitric oxide to the inspired gas was successful in controlling near fatal pulmonary hypertension after surgical repair of a congenital diaphragmatic hernia in a neonate. A preceding prostacyclin infusion was unable to prevent the failure of pulmonary perfusion. No side effect of nitric oxide therapy was observed, and ventilatory support could be substantially reduced as a result of the treatment. On the basis of the striking and lifesaving effects of nitric oxide therapy demonstrated in this child, we believe that nitric oxide treatment will prove to be a major contribution to the management of postoperative pulmonary hypertensive crises.
Near infrared spectroscopy in adults
Authors: HARRIS D. N. F. , BAILEY S. M.
Published: February 2007

Does the Invos near infrared spectroscopy monitor detect intracranial oxygenation, or reflect oxygenation of extracerebral tissues? The change in Invos regional cerebral oxygenation was studied during a doubling of middle cerebral artery flow with hypercapnia. There was no significant change in regional cerebral oxygenation, which suggests that the Invos does not reflect intracerebral oxygenation, possibly because of its narrow optode separation. The use of near infrared spectroscopy in adults may require a more powerful machine.
Zingiber officinale (Ginger)–an antiemetic for day case surgery
Authors: Phillips S. , Ruggier R. , Hutchinson S. E.
Published: February 2007

The effect of powdered ginger root was compared with metoclopramide and placebo. In a prospective, randomised, double‐blind trial the incidence of postoperative nausea and vomiting was measured in 120 women presenting for elective laparoscopic gynaecological surgery on a day stay basis. The incidence of nausea and vomiting was similar in patients given metoclopramide and ginger (27% and 21%) and less than in those who received placebo (41%). The requirement for postoperative antiemetics was lower in those patients receiving ginger. The requirements for postoperative analgesia, recovery time and time until discharge were the same in all groups. There was no difference in the incidence of possible side effects such as sedation, abnormal movement, itch and visual disturbance between the three groups. Zingiber officinale is an effective and promising prophylactic antiemetic, which may be especially useful for day case surgery
Intranasal fentanyl titration for postoperative pain management in an unselected population
Authors: STRIEBEL H. W. , POMMERENING J. , RIEGER A.
Published: February 2007

A randomised, double‐blind study was undertaken to investigate the suitability of intranasally administered fentanyl for postoperative pain management under routine conditions in an unselected population. For postoperative pain relief, patients received either 0.027 mg fentanyl intranasally and sodium chloride 0.9% intravenously (intranasal group, n = 53) or sodium chloride 0.9% intranasally and 0.027 mg fentanyl intravenously (intravenous group, n = 59). These doses were repeated every 5 min until the patients were free of pain or refused further analgesia. Pain severity was evaluated before beginning opioid titration and 5, 10, 15, 20, 30, 40, 50, 60, 70 and 80 min thereafter. Adequate pain relief was achieved in 52 of 53 patients in the intranasal and in all patients in the intravenous group. Pain intensities evaluated on a 101‐point numerical rating scale as well as on a verbal rating scale decreased significantly in both study groups within 5 min. At the 15 min measurement point, numerical rating scale pain intensity and at the 10 and 20 min point, verbal rating scale pain intensity was significantly lower in the intravenous group. The incidence of side effects was low in both groups and no patient complained of intranasal pain. Intranasally administered fentanyl would appear to be suitable for the management of postoperative pain.
Classification and severity of postdural puncture headache
Authors: CORBEY M.P. , BERG P. , QUAYNOR H.
Published: February 2007

Two hundred and five patients, aged 16–45 years, undergoing day care surgery were given a spinal anaesthetic using either a 26‐or a 27‐gauge Quincke point spinal needle. The occurrence of headache and accompanying symptoms postoperatively was analysed from 186 returned questionnaires. The incidence of classical postdural puncture headache was 4.5% following the use of a 26‐gauge needle and 8% with a 27‐gauge needle (p > 0.05). A further group of patients suffering headache after dural puncture was identified, the postdural puncture‐related headache. The headache and accompanying symptoms were similar to that seen with a postdural puncture headache except that it was not aggravated by posture. A system of grading the severity of both type of headache is presented and standardised criteria for the classification of postdural puncture headache are proposed.
The anaesthetic management of patients with dystrophic epidermolysis bullosa
Authors: GRIFFIN R. P. , MAYOU B. J.
Published: February 2007

The case notes and anaesthetic charts of 44 patients with dystrophic epidermolysis bullosa were reviewed retrospectively. A total of 390 general anaesthetics were performed for 469 surgical procedures over a 10‐year period. Procedures included repair of syndactyly, dilatation of oesophageal strictures, extraction of teeth, excision of skin tumours and other procedures related to dystrophic epidermolysis bullosa. Anaemia, thrombocytosis and hypoalbuminaemia was found in many patients pre‐operatively. Damage to skin or mucosa occurred peri‐operatively. Four patients developed bullae around the head and neck, two patients developed oral or pharyngeal bullae and three patients developed conjunctival abrasions including one with a new corneal ulcer. There were no reports of laryngeal bullae and no bullae associated with intramuscular injections or the use of limb tourniquets. Thirty‐one patients (70%) had evidence of oesophageal strictures and six regurgitated peri‐operatively. In all cases there was a history of oesophageal disease. In 10 patients (23%) intubation of the trachea was difficult. It was carried out by various methods including blind nasal andfibreoptic intubation or by using the laryngeal mask airway. One patient requiring a series of general anaesthetics had a tracheostomy formed after fibreoptic intubation. Previous reports have suggested problems with the use of suxamethonium, nondepolarising muscle relaxants and thiopentone. These agents were all used in many of our patients without any adverse effects. There was one intra‐operative death in a 35‐year‐old woman having an oesophageal dilatation which was complicated by oesophageal rupture.
Propofol infusion anaesthesia and immune response in minor surgery
Authors: PIRTTIKANGAS C.‐O. , PERTTILÄ J. , SALO M. , VAINIO O. , LIUKKO‐SIPI S.
Published: February 2007

This study was set up to evaluate the effects of propofol infusion anaesthesia on immunological function in minor surgery. Twenty‐seven patients (median age 51 years, ASA 1‐2) scheduled for minor breast surgery were randomly assigned to two groups. Anaesthesia was induced in group 1 with propofol 2.5 mg.kg‐1 and maintained with propofol 12 mg.kg‐1.h‐1 and 30% O2 in air, whereas in group 2 anaesthesia was induced with thiopentone 4 mg.kg‐1 and maintained with 70% N2O in O2. Fentanyl and vecuronium were used in both groups. The percentages of T cells (p < 0.001), B cells (p < 0.01) and memory T cells increased (p < 0.01) in both groups. T helper cell percentages increased in the propofol but not in the thiopentone group (p < 0.05). The percentages of natural killer cells decreased from pre‐induction values in both groups (p < 0.001). No changes were seen in lymphocyte proliferative responses. Minor breast surgery under propofol or conventional combined anaesthesia had only minor effects on the immune response. The higher percentage of T helper cells after propofol anaesthesia compared to conventional combined anaesthesia is beneficial, but its clinical importance remains to be determined.
The Ohmeda Rascal II
Authors: LOCKWOOD G. G. , LANDON M. J. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

The Ohmeda Rascal II is a multigas analyser and pulse oximeter for dedicated anaesthetic use. It uses the Raman scattering of laser light to identify and quantify oxygen, nitrogen, carbon dioxide, nitrous oxide and three volatile anaesthetic agents. Its response times equal or better the published response times of infrared or photo‐acoustic devices. It is linear within the clinical ranges of all gases and vapours, simple to use, requires no maintenance, holds its calibration well, and is a suitable monitor for clinical and research use.
Midlatency auditory evoked potentials and purposeful movements after thiopentone bolus injection
Authors: SCHWENDER D. , KLASING S. , MADLER C. , PÖPPEL E. , PETER K.
Published: February 2007

The effect of thiopentone on the middle latency auditory evoked potentials was investigated in 12 patients during induction of anaesthesia with thiopentone 5 mg.kg‐1. 100% oxygen was administered throughout the induction, and when the patient moved purposefully a further bolus (2 mg.kg‐1) was given, and anaesthesia continued in the normal way. The middle latency auditory evoked potentials were elicited before and during the induction. Binaural clicks (70 dB above normal hearing threshold) were presented at a rate of 9.3 per s. Averages of 1000 responses were analysed off line, and a fast Fourier transformation of the middle latency auditory evoked potentials were used to calculate the power spectrum of the averages. Awake, the patients had large peak to peak amplitudes and a normal waveform. The power spectra showed a high energy between 30‐40 Hz. After induction the latencies of waves Na, Pa, Nb and PI and the amplitudes of the waves Na/Pa, Pa/Nb, and Nb/PI were decreased or completely attenuated. Both effects lasted for 4 min. When movement occurred (after 4–6 min), the values returned to awake. The second bolus repeated the changes.
Excursions of the cervical spine during tracheal intubation: blind oral intubation compared with direct laryngoscopy
Authors: FITZGERALD R. D. , KRAFFT P. , SKRBENSKY G. , PERNERSTORFER T. , STEINER E. , KAPRAL S. , WEINSTABL C.
Published: February 2007

The most appropriate technique for performing tracheal intubation in patients with cervical spine injury is debatable. Recently, a new device enabling blind oral intubation (Augustine GuideTM) with the patient's head and neck in the neutral position has been introduced. The aim of this study was to compare the extent of upper cervical spine movement during intubation with this device compared to direct laryngoscopy. Twelve patients (Mallampati I and II), without a cervical spine injury, were intubated using the Augustine GuideTM and afterwards by direct laryngoscopy. Both procedures were viewed radiographically. Extension in the upper cervical spine was determined at the point of the maximum excursion. By evaluating the joints occiput‐C3 together as a functional unit, blind oral intubation caused 17° (median) less extension compared to direct laryngoscopy (p < 0.01). The median differences observed for the individual joints were: 7° in occiput‐C1 (p < 0.05), 5° in C1‐2 (p < 0.01) and 6° in C2‐3 (p < 0.01) respectively. Since we assume that intubation‐induced excursions of the injured spine are even higher, blind oral intubation might be a safe alternative for airway management in this special group of trauma victims.
Acute paraplegia following intrathecal phenol block in the presence of occult epidural malignancy
Authors: MORGAN R. J. , STELLER P. H.
Published: February 2007

A 68‐year‐old woman with an invading adenocarcinoma of the lung underwent intrathecal phenol block for chest wall pain. Acute paraplegia resulted immediately following the procedure. Subsequent CT scan showed dural compression from an epidural metastasis five segments above the site of the phenol injection. This was confirmed at surgical decompression of the spinal cord and by histological findings. The cause of the paraplegia, which has not recovered, was probably spinal coning.
A comparison of pre‐ and postoperative tonsillar infiltration with bupivacaine on pain after tonsillectomy A pre‐emptive effect?
Authors: Ørntoft S. , Løngreen A. , Møiniche S. , Dhal J. B.
Published: February 2007

Thirty‐five healthy patients aged 15–36 years scheduled for bilateral tonsillectomy were randomly allocated to receive the following treatments: tonsillar infiltration with 0.25% bupivacaine 5 min before surgical incision (n = 12); identical tonsillar infiltration administered after both tonsils had been surgically removed (n = 12); infiltration with isotonic saline 5 min before the operation (n = 11). There were no significant differences between groups in pain scores (VAS) at rest or during drinking of 100 ml of water as measured at 4 h postoperatively or on the 1st, 2nd, 3rd and 8th postoperative days. Four, five and three patients in the pre‐operative bupivacaine, postoperative bupivacaine, and saline groups, respectively, received one dose of 0.1 mg.kg‐1 morphine intravenously (p = 0.76). Cumulative acetylsalicylic acid requirements during the observation period were not significantly different between groups (p = 0.78). These results suggest that pre‐operative infiltration of 0.25% bupivacaine has no beneficial pre‐emptive analgesic action compared to both an identical treatment administered after tonsillectomy and a placebo.
Intra‐ocular pressure changes in patients with glaucoma
Authors: Barclay K. , Wall T. , Wareham K. , Asai T.
Published: February 2007

We performed a randomised prospective study in 20 patients with glaucoma to examine the effects of tracheal intubation and laryngeal mask insertion on intra‐ocular pressure, mean arterial blood pressure and heart rate. After induction of anaesthesia with propofol, intra‐ocular pressure decreased significantly below baseline values in both the laryngeal mask and tracheal tube groups. After insertion of the laryngeal mask, intra‐ocular pressure remained significantly below baseline values in all patients. In contrast, tracheal intubation was associated with a significant increase in intra‐ocular pressure to above baseline values in three out of eight patients. Insertion of the laryngeal mask had minimal effects on mean arterial blood pressure and heart rate, whereas tracheal intubation significantly increased both factors relative to pre‐intubation values.
Patients’knowledge of anaesthetic practice and the rôle of anaesthetists
Authors: Swinhoe C. F. , Groves E. R.
Published: February 2007

Patients were questioned pre‐operatively to assess the level of their knowledge with regard to anaesthetic qualifications, anaesthesia and the role of anaesthetists. Thirty‐five percent did not realise that anaesthetists were qualified doctors and only 25% could mention any duties that anaesthetists might have outside the operating theatre. However, those questioned were better informed about the anaesthestist's role in monitoring the patient during surgery and recovery.
Haemodynamic and oxygen transport effects of propofol infusion in critically ill adults
Authors: NIMMO G. R. , MACKENZIE S. J. , GRANT I. S.
Published: February 2007

The effects of a sedative infusion of propofol on haemodynamics and oxygen transport were examined in critically ill adult patients. Ten patients receiving mechanical ventilation for treatment of septic shock and respiratory failure were given a decreasing rate propofol infusion designed to achieve and maintain a stable sedation level. Full cardiovascular and oxygen transport variables, arterial blood lactate concentrations and sedation scores were measured before infusion and at 1, 3 and 6 h after starting the infusion. There were significant reductions in mean (SEM) heart rate (97.3(2.9) to 85.7(3.9) beat.min‐1 p < 0.05), mean arterial pressure (87.6(3.7) to 76.2(4.1)mmHg p < 0.05) and systemic vascular resistance index (1461(137) to 1327(141) dyne.s.cm‐5.m‐2 p < 0.05), with no significant change in cardiac filling pressures. There were no significant changes in cardiac output, oxygen delivery, oxygen consumption or arterial blood lactate concentrations. Controlled propofol sedation is well tolerated in appropriately monitored and resuscitated critically ill adult patients, and appears to have no major effects on whole‐body oxygen transport.
Recovery of mivacurium and doxacurium versus vecuronium in the isolated forearm
Authors: CAMPKIN N. T. A. , HOOD J. R. , FELDMAN S. A.
Published: February 2007

To assess rate of biophase recovery, the recovery from neuromuscular block with mivacurium in the isolated forearm was compared with that from vecuronium simultaneously administered into the other isolated forearm of six volunteers. In a second series of similar experiments, recovery from doxacurium was compared with that from vecuronium. Neuromuscular block was monitored using the adductor pollicis mechanomyographic response to ulnar nerve stimulation at 0.2 Hz. Comparable degrees of maximum twitch tension depression were obtained in each series. In the first series, mean (SD) 25–75% recovery index for mivacurium was 8.4 (1.5) min and 10.5 (1.9) min for vecuronium. In the second series, mean (SD) recovery index for doxacurium was 18.3 (4.2) min and 12.2 (5.0) min for vecuronium. The recovery index of doxacurium in the isolated forearm was significantly greater, and the recovery index of mivacurium significantly less, than the recovery index of simultaneously administered vecuronium. Mivacurium block in the isolated forearm recovers rapidly, although not faster than after systemic injection; this is consistent with a drug that is retained in the biophase despite rapid plasma metabolism. Doxacurium block in the isolated forearm is slow to recover, compared with vecuronium; this suggests that high affinity for the biophase may contribute to its long duration of action.
An investigation of the local anaesthetic effects of pethidine in volunteers
Authors: OLDROYD G. J. , THAM E. J. , POWER I.
Published: February 2007

We have investigated the local anaesthetic effects of 0.1% and 0.2% pethidine compared with 0.5% prilocaine using an intravenous regional anaesthetic technique, in a randomised, double‐blind study in volunteers. Both pethidine and prilocaine produced a sensory and motor blockade, although the latter had a more profound effect, with a faster onset and slower recovery. Pethidine in low concentration clearly has a local anaesthetic action on peripheral nerves.
Latex allergy: an unfamiliar cause of intra‐operative cardiovascular collapse
Authors: HODGSON C. A. , ANDERSEN B. D.
Published: February 2007

We describe severe latex allergy in an 8‐year‐old girl undergoing elective orthopaedic surgery and anaesthesia. Sudden, profound cardiorespiratory collapse occurred 40 min after induction. During the 1 h period of resuscitation the child required a total of 14.5 ml adrenaline 1 in 10 000. A subsequent latex radioallergosorbent test was very strongly positive. Two weeks later the child presented again for surgery. Neoprene surgical gloves were used and all latex products eliminated from the anaesthetic equipment. Latex contact was strictly avoided during drug preparation and administration. This time the intra‐operative course was uneventful.
Large cervical osteophyte—another cause of difficult flexible fibreoptic intubation
Authors: RANASINGHE D. N. , CALDER I.
Published: February 2007

A patient suffering from ankylosing spondylitis required surgical excision of a large anterior osteophyte of the cervical spine. Fibreoptic nasal intubation was difficult due to distortion of the airway by the osteophyte. This cause of difficult flexible fibreoptic intubation has not been described previously.
Ondansetron, clinical development for postoperative nausea and vomiting: current studies and future directions
Authors: JOSLYN A. F.
Published: February 2007

The clinical development of ondansetron for the prevention and treatment of postoperative nausea and vomiting has been progressing for 5 years, and continues as new directions of research are being addressed. Large multicentre studies have demonstrated the efficacy of ondansetron in the prevention and treatment of postoperative nausea and vomiting, but no large comparator studies have been reported. Several studies are now being undertaken to compare ondansetron with other currently used antiemetics such as droperidol and metoclopramide; assessing efficacy, safety, pharmacoeconomic, and quality of life parameters. The majority of studies to date have been performed in gynaecological surgery patients receiving general anaesthesia—a population that experiences a high incidence of postoperative nausea and vomiting. Clinical development of ondansetron is therefore progressing to establish its efficacy in a wider surgical population, including paediatrics, the elderly, non‐gynaecological surgery, and as re treatment in patients with failed prophylactic antiemetic therapy.
Dexmedetomidine as intramuscular premedication for day‐case cataract surgery
Authors: VIRKKILÄ M. , ALI‐MELKKILÄ T. , KANTO J. , TURUNEN J. , SCHEININ H.
Published: February 2007

The effects of dexmedetomidine 1.0 μg.kg‐1, midazolam 20 μg.kg‐1 and saline placebo were assessed in a double‐blind, randomised study in 90 patients undergoing day‐case cataract surgery under regional anaesthesia. The trial drug was injected into the deltoid muscle 45 min before the peri‐ocular block. Dexmedetomidine 1.0 μg.kg‐1 decreased intra‐ocular pressure before, during and after surgery. The maximum reduction in mean (SD) intra‐ocular pressure occurred in the dexmedetomine group just before discharge from hospital (17.7 (2.8) mmHg to 11.5 (2.9) mmHg) (p < 0.001 compared with midazolam and placebo). In contrast, midazolam did not differ from saline placebo. Dexmedetomidine and midazolam produced a similar sedative effect of short duration. Dexmedetomidine induced a moderate decrease in blood pressure (p < 0.001 compared with placebo) and a slight but statistically significant decrease in heart rate throughout the study period (p < 0.001 compared with placebo). Dexmedetomidine 1.0 μg.kg‐1 intramuscularly, effectively reduced intra‐ocular pressure and produced short‐acting sedation with marginal cardiovascular effects; it may be a useful premedicant drug for elderly patients undergoing day‐case cataract surgery under regional anaesthesia.
Myocardial infarction in a parturient
Authors: SÖDERLIN M. K. , PURHONEN S. , HARING P. , HIETAKORPI S. , KOSKI E. , NUUTINEN L. S.
Published: February 2007

Myocardial infarction is rare in pregnancy. We report a 38‐year‐old woman with a history of smoking and pre‐eclampsia in her previous pregnancy, who suffered a non‐Q infarction at 18 weeks of gestation. Stenoses in the left coronary artery were verified angiographically. She delivered a healthy child vaginally under epidural anaesthesia.
A rare and fatal complication of oesophagoscopy
Authors: ZUBAIR N. A. , PATIL D. R. , ALGHAMDI A. H.
Published: February 2007

A 3.5‐year‐old child developed a tight oesophageal stricture following ingestion of caustic soda. At the end of the fourth anaesthetic for oesophageal dilatation, laryngospasm and difficulty in mask ventilation was followed by cyanosis, bradycardia, and cardiac arrest. Chest X ray showed a large pneumopericardium, which was immediately aspirated, but unfortunately resuscitation was unsuccessful. It was presumed that during attempted manual ventilation of the lungs in the presence of a closed glottis, air had been accidentally forced into the pericardium through a small tear in the fragile oesophagus.
Can a drawover vaporizer be a pushover?
Authors: TAYLOR J. C. , RESTALL J.
Published: February 2007

Bench testing was carried out to establish whether the vapour output from an OMV50 vaporizer, as used in the Triservice apparatus, differs according to whether the carrier gas is either drawn or pushed through the vaporizer. Results show that the differences in output concentration between the two modes were clinically insignificant.
Emergency airway management in patients with cervical spine injuries
Authors: Criswell J. C. , Parr M. J. A. , Nolan J. P.
Published: February 2007

A retrospective study of admissions to a Level 1 Trauma Centre, revealed 393 patients with traumatic cervical spine injuries. All 36 patients intubated urgently and 37 and 68 patients intubated between 30min and 24 h of admission, were intubated orally, following a rapid sequence induction with the application of cricoid pressure and manual in‐line stabilisation of the head and neck. There were no neurological sequelae in these 73 patients (95% confidence interval 0–4%). This technique for airway management is described in detail. It is a safe, familiar, and effective method for securing the airway in patients with cervical spine injury.
Validation of a croup score and its use in triaging children with croup
Authors: Jacobs S. , Shortland G. , Warner J. , Dearden A. , Gataure P. Singh , Tarpey J.
Published: February 2007

The Syracuse croup scoring system was validated in 165 children with croup who were admitted to an intensive therapy unit for assessment over a one year period. The unit served as a croup triage point for Cardiff and its environs. A score of > 5 was taken as an indication that a patient was at risk of upper airway obstruction and was used to support a triage decision by the junior hospital doctor to admit a patient to the intensive therapy unit. All patients with an initial score ≤ 5 were considered safe for transfer to a general paediatric ward and none of these required subsequent admission to intensive care. This score was then tested on a further 134 children with croup, in order to identify those patients who required specialised monitoring, observation or treatment in intensive care. A score of > 5 gave a specificity of 100% and a sensitivity of 80%. Croup scoring continued after admission on the general paediatric wards. Two patients who were originally admitted to the intensive therapy unit with a score > 5 improved within 6 h and were transferred to the general ward with a score ≤ 5. These children subsequently required readmission to the intensive therapy unit. Our tracheal intubation rate of 2% was low and may relate to the routine use of regular adrenaline nebulisation. We recommend this scoring system to other paediatric departments for initial triaging decisions and for documenting progress on the wards.
The effect of hyaluronidase on peribulbar block
Authors: Crawford M. , Kerr W. J.
Published: February 2007

The effect of supplementing a standardised local anaesthetic mixture with hyaluronidase was studied in 60 patients undergoing peribulbar block for intra‐ocular surgery. All the patients had the block performed with a 2: 1 mixture of lignocaine 2% and bupivacaine 0.75%, but in half of the cases hyaluronidase 50u.ml‐1 was added to the solution by random allocation. The mean volumes of solution injected were 8.9 and 9.0 ml in the control and hyaluronidase groups respectively. Five minutes after injection the block was deemed unsuccessful in one third of the patients in each group and these patients required supplementary injections. At 15 min all but one patient in each group had satisfactory block and these two patients subsequently required retrobulbar block. There were no statistically significant differences between the two solutions in rate of onset of block, requirement for supplementation, block failure, or surgical conditions. There were no significant complications. We conclude that the addition of hyaluronidase 50u.ml‐1 to the local anaesthetic mixture described confers no advantage at the volumes of local anaesthetic used.
Recovery of mivacurium block with or without anticholinesterases following administration by continuous infusion
Authors: MADDINENI V. R. , MIRAKHUR R. K. , McCOY E. P.
Published: February 2007

Thirty patients received a bolus dose of 0.2mg.kg‐1 of mivacurium followed by an infusion during anaesthesia with thiopentone, fentanyl and halothane. Neuromuscular block was monitored using train‐of‐four stimulation and mechanomyography and the block maintained to keep the first response in the train‐of‐four (T1) at 10% of control. At the end of surgery the patients were randomly allocated to reversal with neostigmine or edrophonium or to spontaneous recovery. The mean dosage of mivacurium for maintaining the T1 at 10% was 5.7 μg.kg‐1.min‐1. There was a significant (r =–0.81, p < 0.001) negative correlation between time to recovery of T1 to 10% after the bolus dose and infusion rate. The times taken for T1 to reach 25, 75 and 90% of control and for the train‐of‐four ratio to reach 0.7 were significantly shorter (p < 0.05 to 0.001) with neostigmine and edrophonium compared to the spontaneously recovering group. The average (SD) times for attaining the train‐of‐four ratio of 0.7 were 7.0 (1.2), 6.8 (1.4) and 13.5 (2.3) min respectively for neostigmine, edrophonium and spontaneously recovering groups. There were no differences between endrophonium and neostigmine in any of the recovery times.
Ethylene glycol antifreeze poisoning Three case reports and a review of treatment
Authors: WALDER A. D. , TYLER C. K. G.
Published: February 2007

We present three patients with ethylene glycol antifreeze poisoning whose management included the use of continuous veno‐venous haemodiafiltration. Results from these cases demonstrate clearance of the ethylene glycol molecule.
Factors important in determining trainee anaesthetists’quality of life
Authors: Masterson G. R. , Ashcroft G. S. , Shah R.
Published: February 2007

A postal survey of all trainee anaesthetists in the North West Region of England was conducted to investigate areas important in determining the trainee's quality of life. The questionnaire enquired about life on‐call, hospital facilities available to doctors and trainees’morale. The results suggest that changes are urgently required to improve trainees’lifestyles and therefore help raise morale within the profession.
Single medial injection peribulbar anaesthesia using prilocaine
Authors: Brahma A. K. , Pemberton C. J. , Ayeko M. , Morgan L. H.
Published: February 2007

A prospective randomised study is reported comparing a single peribulbar injection into the medial compartment of the orbit and the standard two injection peribulbar technique. One hundred and seven patients undergoing elective intra‐ocular surgery were randomly allocated to receive either a single medial injection, or two injections, using prilocaine 3% with felypressin. Akinesia and pain during surgery were assessed following the injection(s). There was no significant difference in pain during surgery and globe akinesia between the two groups. The single medial peribulbar injection is as effective as two injections using prilocaine 3%.
The effect of epidural administration of alfentanil on intra‐operative intravenous alfentanil requirements during nitrous oxide‐oxygen‐alfentanil anaesthesia for lower abdominal surgery
Authors: DER LELY F. HAAK‐VAN , BURM A. G. L. , VAN KLEEF J. W. , VAN DEN NIEUWENHUYZEN M. C. O. , SIEMENS T. J. , MULDER S. M. , BOVILL J. G. , VLETTER A. A.
Published: February 2007

The effects of epidural administration of alfentanil on the intravenous alfentanil dose requirements and the plasma concentrations required to suppress responses to surgical stimulation during nitrous oxide‐oxygen‐alfentanil anaesthesia in 20 patients undergoing lower abdominal surgery were studied. Before induction of anaesthesia, patients in one group (E) received an epidural injection of 1mg alfentanil, followed by an epidural infusion of alfentanil 0.2mg.h‐1 until skin closure, whilst patients in the other group (C, control) received a continuous infusion of sodium chloride via a sham catheter in order to blind the main investigator to the treatment. Anaesthesia was induced and maintained with nitrous oxide (66%) in oxygen and a‘target’‐controlled intravenous infusion of alfentanil. During surgery, the‘target’alfentanil concentration was increased or decreased according to patients’responses. The number of responses to surgical stimulation was smaller in patients from group E (median 1, range 0‐3) than in patients from group C (median 4, range 1–15; p < 0.005), even though the alfentanil intravenous infusion rates were smaller in group E [mean (SD): 1.6(0.5)μg.kg‐1min‐1] than in group C [2.9(1.2)μg.kg‐1min‐1, p < 0.02]. Both the lowest concentrations associated with no response [133(40)ng.ml‐1]and the highest concentrations associated with a response [155(65)ng.ml‐1] in group E were lower than those in group C [238(100) ng.ml‐1, p < 0.01 and 334(163) ng.ml‐1, p < 0.05, respectively]. We concluded that epidural administration of alfentanil reduces intravenous alfentanil requirements during nitrous oxide‐oxygen‐alfentanil anaesthesia for lower abdominal surgery. The results indicate a spinal mechanism of action of epidural alfentanil.
Right ventricular function and oxygen transport patterns in patients with acute respiratory distress syndrome
Authors: STELTZER H. , KRAFFT P. , FRIDRICH P. , HIESMAYR M. , HAMMERLE A. F.
Published: February 2007

We investigated the impact of right ventricular performance on oxygen kinetics in 15 consecutive patients with acute respiratory distress syndrome. Six hundred and twenty‐two complete assessments of haemodynamics, right ventricular function and oxygenation were used for evaluation. Patients were grouped as survivors (n = 8) and nonsurvivors (n = 7) and studied during four phases of lung failure. Oxygen delivery and consumption were significantly higher in survivors compared to nonsurvivors despite comparable arterial oxygen saturation. Right ventricular end‐diastolic volumes were similar for both groups, while end‐systolic volumes were significantly higher in nonsurvivors due to depressed ejection fraction (40.5 (SD 1.2) versus 34.4 (SD 2.8)%) during all phases of lung failure. No clinically relevant differences in right ventricular function or oxygenation were observed between periods of moderate or severe pulmonary hypertension. Nonsurvivors have depressed cardiac function caused by reduced contractility and not by inadequate right ventricular end‐diastolic volume (preload) or increased pulmonary artery pressure (afterload). Maintenance of oxygen delivery in ARDS is predominantly a function of cardiac performance and not of pulmonary gas exchange.
The effect of propofol sedation in pregnancy on neonatal condition
Authors: BACON R. C. , RAZIS P. A.
Published: February 2007

A woman who suffered an intracerebral haemorrhage secondary to Moyamoya disease in her 33rd week of pregnancy was sedated for ventilation with propofol for 48 h until she underwent emergency Caesarean section. There appeared to be no adverse metabolic effects on the neonate from the use of propofol in the mother although sedation was prolonged.
Anaesthesia and mucopolysaccharidoses
Authors: WALKER R. W. M. , DAROWSKI M. , MORRIS P. , WRAITH J. E.
Published: February 2007

The airway problems encountered during anaesthesia in all children with mucopolysaccharidoses presenting for a surgical procedure from 1988 to September 1991 are reviewed. Thirty‐four patients underwent 89 anaesthetics for 110 procedures. The results reveal a high incidence of airway problems. The overall incidence of difficult intubation was 25% and failed intubation 8%. In those children with Hurler's syndrome, the difficult intubation incidence was 54% and failed intubation incidence 23%. Other potential anaesthetic problems such as cardiac anomalies and obstructive sleep apnoea are also reviewed.
Comparison of the addition of three different doses of sufentanil to 0.125% bupivacaine given epidurally during labour
Authors: VERTOMMEN J. D. , LEMMENS E. , VAN AKEN H.
Published: February 2007

In a double‐blind, randomised, prospective study 150 women in labour received intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1: 800000) with 5, 7.5 or 10 μg of sufentanil added. The onset, duration, and quality of analgesia were compared. Motor block, type of delivery and neonatal Apgar scores were noted. The onset, duration, and quality of analgesia were generally similar in the three groups, except following the second injection when the quality of analgesia was significantly superior in the sufentanil 7.5 and 10 μg groups. Motor blockade and type of delivery did not differ between the groups and there were no differences in neonatal Apgar scores. No patient required more than three injections. We conclude that 7.5 μg sufentanil is the optimal dose to add to intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1: 800000) for pain relief in labour.
Prolonged epidural anaesthesia in a patient with Dupuytren's diathesis
Authors: DE LA CALLE J. L. , LA VILLA M. , VALLE J. , PLIEGO M.
Published: February 2007

A patient with Dupuytren 's diathesis experienced a prolonged sensory and motor block following epidural anaesthesia. It was postulated that this occurred secondary to fibrous changes within the epidural space.
The oesophageal and precordial stethoscope transducer as a monitoring and teaching aid
Authors: BARTHRAM C. N. , TAYLOR L.
Published: February 2007

We describe a low cost, easy to construct monitoring and teaching aid for the oesophageal and precordial stethoscopes. It is constructed from two readily available 'state of the art’integrated circuits. The aid allows more than one observer simultaneously to hear heart and breath sounds, without being acoustically isolated from the other monitoring. In addition it is possible to record from the device to audiotape.
Patient knowledge of anaesthesia and peri‐operative care
Authors: Hume M. A. , Kennedy B. , Asbury A. J.
Published: February 2007

One hundred and sixty six patients were questioned by means of a multiple choice questionnaire, to determine their knowledge of peri‐operative care, anaesthesia and the role of anaesthetists. In general, knowledge was good, but there were some important misconceptions; in particular, 28.3% of respondents thought that fasting referred to food only, and not to fluid intake. In addition, 47.6% of respondents considered pain to be a necessary part of the healing process and 38.6% believed that it was something that just had to be endured. When forthcoming anaesthesia is discussed, anaesthetists need to ascertain that patients really do understand the language used.
Difficulties in spinal needle use
Authors: Tarkkila P. , Huhtala J. , Salminen U.
Published: February 2007

The effect of different size (25‐, 27‐ and 29‐gauge) Quincke‐type spinal needles on the incidence of insertion difficulties and failure rates was investigated in a randomised, prospective study with 300 patients. The needle size was randomised but the insertion procedure was standardised. The time to achieve dural puncture was significantly longer with the 29‐gauge spinal needle compared with the larger bore needles and was due to the greater flexibility of the thin needle. However, the difference was less than 1 min and cannot be considered clinically significant. There were no significant differences between groups in the number of insertion attempts or failures and the same sensory level of analgesia was reached with all the needle sizes studied. Postoperatively, no postdural puncture headaches occurred in the 29‐gauge spinal needle group, whilst in the 25‐ and 27‐gauge needle groups, the postdural puncture headache rates were 7.4% and 2.1% respectively. The incidence of backache was similar in all study groups. We conclude that dural puncture with a 29‐gauge spinal needle is clinically as easy as with larger bore needles and its use is indicated in patients who have a high risk of postdural puncture headache.
Intra‐operative patient‐controlled sedation and patient attitude to control
Authors: OSBORNE G. A. , RUDKIN G. E. , JARVIS D. A. , YOUNG I. G. , BARLOW J. , LEPPARD P. I.
Published: February 2007

Intra‐operative patient controlled sedation with propofol (bolus dose 18 mg over 5.4 s; lockout period 1 min) has been compared 10 continuous propofol infusion (3.6 nig.kg−1.h−1) in a randoniised crossover study of 38 ASA 1 or 2 day surgery patients mdergoing two‐stage bilateral extraction of third molar teeth under local anaesthesia (76 procedures). Mean (SD) propofol used (mg.kg−1) was less with patient‐controlled sedation (2.39 (1.28)) than with the infusion (2.58 (0.84)) but the difference was not statistically signifcant. There were only minor differences between the methods in postoperative recovery of cognitive tirnction and no differences for patient cooperation and surgeon's satisfaction with sedation. Patient‐controlled sedation was preferred by 19 patients, continuous infusion by 10, with nine indifferent. Preferences, expressed as mild, moderate or strong, were significantly stronger for patient‐controlled sedation (p < 0.05). Sedation was no deeper than eyelid closure with response ro command in all 76 procedures. This level was reached in all 38 infusion cases but in only 26 cases with patient‐controlled sedation, where 12 patients remained less sedated (p < 0.01). Patient‐controlled sedation with propofol provided safe sedation and was strongly preferred over the infusion by a large proportion of patients.
Delayed ACTH response to human corticotropin releasing hormone during cardiopulmonary bypass under diazepam‐high dose fentanyl anaesthesia
Authors: AMADO J. A. , DIAGO M. C.
Published: February 2007

The inhibitory effect of high dose fentanyl (0.1 mg.kg−1) and diazepam (0.5 mg.kg−1) anaesthesia on the pituitary‐adrenal response to coronary artery surgery during cardiopulmonary bypass was assessed by comparison of the adrenocorticotropic hormone and cortisol responses to intravenous boluses of either 0.1 mg (n = 14) or 0.2 mg (n = 14) human corticotropin releasing hormone administered 5 min after starting cardiopulmonary bypass, with the responses obtained in a control group (n = 14). Blood samples were taken before inducing anaesthesia, just before cardiopulmonary bypass and at 5, 20, 35, 50, 65 and 80 min thereafter. The administration of human corticotropin releasing hormone at both doses resulted in significantly greater plasma concentrations of adrenocorticotropic hormone at 50, 65 and 80 min compared to the control group; at the other sampling times there were no differences between the three groups. Plasma cortisol concentrations did not vary between the three groups at any sampling time. During cardiopulmonary bypass the early adrenocorticotropic responses to human corticotropin releasing hormone are blunted but later there is a good response, suggesting that the inhibitory effect of high dose fentanyl and diazepam anaesthesia takes place in the hypothalamus.
The relationship between clinical effect and concentrations of temazepam in plasma and cerebrospinal fluid
Authors: MOFFAT A. C. , OSBORNE G. A. , BADCOCK N. R. , MARANUCCI P. , NYMAN T. , RUSSELL W. J.
Published: February 2007

The clinical pharmacodynamics of temazepam were investigated in patients who received spinal anaesthesia. Total plasma and cerebrospinal fluid temazepam concentrations were measured and correlated with the clinical effects. Sedation was measured by three separate methods. None, including an aggregated score of all three measures, was correlated closely with either the plasma or the cerebrospinal fluid levels (p = 0.86 and 0.12 respectively). Anxiety was measured before and after premedication. The two scores were correlated but the change in anxiety after premedication did not correlate with either the plasma or the cerebrospinal fluid concentrations (p = 0.11 and 0.45 respectively). Short‐term memory was measured before and after premedication. The decline in short‐term memory ability was moderately well correlated with both the plasma and the cerebrospinal fluid levels (p = 0.0005 and 0.013 respectively). With temazepam, the variation in sedative and anxiolytic effects between subjects is explained not by differences in pharmacokinetics but rather by differences in the pharmacodynamic response. Because sedative and anxiolytic effects are poorly correlated, but the amnesic effect is well correlated with temazepam concentrations, different sites of action for these effects are suggested.
Stress response to tracheal intubation: direct laryngoscopy compared with blind oral intubation
Authors: PERNERSTORFER T. , KRAFFT P. , FITZGERALD R. D. , KRENN C. G. , CHIARI A. , WAGNER O. , WEINSTABL C.
Published: February 2007

Haemodynamic and hormonal responses to tracheal intubation can be profound and associated with serious cardiovascular and cerebral side effects. The Augustine Guide, a device enabling blind oral intubation, has been introduced recently. The aim of our study was to compare the haemodynamic and hormonal stress response of this method with direct laryngoscopy. Thirty five patients (ASA 1 and 2) were randomly assigned to undergo either direct laryngoscopy (n = 17), or blind oral intubation (n = 18). Haemodynamic responses and concentrations of adrenaline, noradrenaline and prolactin were determined prior to induction, before intubation and 5 min after intubation. The median duration of intubation was 22 s for direct laryngoscopy vs 46 s for blind oral intubation (p < 0.05). Between the groups, no significant differences were observed for heart rate, systolic or mean arterial blood pressure. Serum levels of adrenaline decreased slightly after induction and remained unaltered after intubation in both groups. Noradrenaline (1.01 vs 0.66 nmol.l‐1) and prolactin (5.2 vs 2.9 nmol.l‐1) levels were significantly higher after direct laryngoscopy compared to blind oral intubation. Although blind oral intubation took significantly longer to perform than direct laryngoscopy, hormonal stress response was less pronounced. Blind oral intubation should therefore not be withheld from patients with impaired cardiovascular reserve.
Anaesthesia in an infant with Rubinstein‐Taybi syndrome
Authors: CRITCHLEY L. A. H. , GIN T. , STUART J. C.
Published: February 2007

The anaesthetic management of a 5‐month‐old Chinese infant with Rubinstein‐Taybi syndrome requiring bilateral inguinal hernia repairs is described. This is a rare congenital syndrome characterised by mental retardation, broad thumbs and first toes, craniofacial abnormalities, recurrent respiratory infections and, in one third of cases, congenital heart disease. General anaesthesia combined with caudal block was successfully used. The main complications encountered were minor difficulties with intubation and easily precipitated episodes of oxygen desaturation.
A comparison of the priming properties of two central venous catheters and one pulmonary artery catheter
Authors: SANDERSON P. M.
Published: February 2007

The time taken to prime the individual lumina of two multilumen central venous catheters (Viggo‐Spectramed 14G 20 cm Hydrocath and Vialon 14G 20cm Deltacath) and one pulmonary artery catheter (Viggo‐Spectramed 110cm 7.5F Pentacath) at flows between 5 ml.h‐1 and 99ml.h‐1 is reported. The catheters supplied by different manufacturers but of identical length and gauge have significantly different priming times (p < 0.001). A protocol which may be used to prime the individual lumina of the three catheters studied is described. By means of an in vitro test the accuracy of this protocol is validated.