bluuebunny/crossref_metadata_2025 huggingface dataset:
Force exerted by epidural catheters
Authors: Hardy P. A. J.
Published: February 2007

In a study of epidural catheters. it was found that catheter material and catheter diameter both influenced the force exerted. Catheters made of nylon exert less force than those made of polyethylene. Diameter is proportional to the logarithm of force exerted.
Clinical automatic control of neuromuscular blockade
Authors: ASBURY A. J. , LINKENS D. A.
Published: February 2007

A simple feedback control technique has been used to automatically deliver pancuronium to anaesthetised surgical patients. The dosage rate is automatically adjusted at 10‐second intervals, according to the measured evoked, rectified, integrated electromyogram. When set to demand 80 percent blockade, in 40 patients. the controller maintained blockade at a steady mean level of 72.9 percent (consuming pancuronium at a mean rate of 0.47 μg/kg/minute). The main clinical practical problems involved protection against electrical noise and the need to spend time setting up the equipment.
Suxamethonium‐induced hyperkalaemia following cold injury
Authors: LAYCOCK J. R. D. , LOUGHMAN E.
Published: February 2007

Within the space of 9 days, a 4‐month‐old baby requiring cardiac surgery was exposed to two periods of hypothermic circulatory arrest for surgery, and prolonged surface cooling postoperatively. At the end of this period, the administration of suxamethonium was associated with a marked rise in serum potassium.
Survey of alarms in an intensive therapy unit*
Authors: O'CARROLL T. M.
Published: February 2007

The origin and frequency of alarm soundings in a general purpose intensive therapy unit were recorded by the nursing staff for 3 weeks. Only eight out of a total of 1455 soundings indicated potentially life threatening problems. There were many false alarms from the monitoring system and the infusion rate pump. The overall frequency of soundings varied little by day or night. There is a need for a graded system of alarms to reflect the priority of the disturbance detected.
Cardiac dysrhythmias during oral surgery. Comparison of hyoscine and droperidol premedication
Authors: Smith D.C. , O'Connell P.
Published: February 2007

The incidence of cardiac dysrhythmias during inpatient dental anaesthesia under halothane was studied following either hyoscine or droperidol as a supplement to papaveretum for premedication. Forty‐three percent of patients given hyoscine exhibited cardiac dysrhythmias compared to 23 percent of the group given droperidol (p = 0.03). The incidence of dysrhythmias bore no relationship to the age. sex or weight of the patient. nor to the end tidal carbon dioxide tension.
Cardiac surgery in Jehovah's witnesses. A review of 36 cases
Authors: Henderson A.M. , Maryniak J.K. , Simpson J.C.
Published: February 2007

Between January 1971 and January 1985, 31 Jehovah's witnesses underwent 24 bypass and 12 non‐bypass cardiothoracic operations at the National Heart Hospital. Fifty‐eight% of the group were under 16 years of age. There was one death in the non‐bypass group unrelated to blood loss. Six deaths occurred in the bypass group. In one of these, blood loss contributed to the cause of death and in two patients. blood loss was directly related to the cause of death. The anaesthetic management of Jehovah's witnesses undergoing cardiac surgery is discussed.
Nitrous oxide in early human pregnancy
Authors: CRAWFORD J. S. , LEWIS M.
Published: February 2007

An analysis of the outcome of 375 cases (383 fetuses) of cervical cerclage and 58 other operations (59 fetuses) conducted under general anaesthesia, which included the administration of nitrous oxide, failed to reveal a single instance of which nitrous oxide could have been clearly indicted as a cause of fetal abnormality The incidence of inevitable abortion and of low birth weight babies in the series of cervical cerclage conducted under general anaesthesia was identical to that in a series conducted under regional analgesia (115 fetuses). This represents the first of a two‐part test of the proposition that nitrous oxide should not be administered to women in the first or second trimester. Our interim conclusion is that the proposition is unacceptable.
Vecuronium and atracurium infusions during hypothermic cardiopulmonary bypass
Authors: DENNY N. M. , KNEESHAW J. D.
Published: February 2007

Two similar groups of patients undergoing coronary artery bypass grafting received either atracurium or vecuronium infusions for neuromuscular blockade. Both groups demonstrated a marked reduction in neuromuscular blocking requirements during hypothermic bypass at 30 C. The ratio of the dose rates at 30 C to that at 37 C was signijicantly less with vecuronium (p<0.01).
The management of labour using continuous lumbar epidural analgesia in a patient with a malignant cerebral tumour
Authors: Goroszeniuk T. , Howard R. S. , Wright J. T.
Published: February 2007

A mother presented at 28 weeks with epileptiform convulsions which were due to a malignant cerebral tumour. Labour and delivery at 34 weeks were managed under epidural analgesia. The infant was healthy, but the mother died several days later following cerebral decompression.
Pompe's disease and anaesthesia
Authors: McFARLANE H.J. , SONI N.
Published: February 2007

A case report of a child with Pompe's disease (glycogen storage disease Cori type II), who underwent two general anaesthetics, is presented. The progressive infiltration of heart and skeletal muscle with glycogen results in a severe form of cardiomyopathy and respiratory muscle weakness. Consequently, there are significant problems in the anaesthetic management of these patients. Although there are theoretical attractions for some anaesthetic drugs, the key factors in a successful outcome are attention to anaesthetic technique and close monitoring.
Patient‐controlled analgesia
Authors: OWEN H. , GLAVIN R. J. , REEKIE R. M. , TREW A. S.
Published: February 2007

Two modern patient‐controlled analgesia pumps have been evaluated in the laboratory and in clinical use. Both machines generally performed satisfactorily and patients achieved good pain relief from self‐administered morphine. The relative merits of the two pumps are discussed and although the on demand analgesic computer is preferred, a substantial investment of time on the ward is required to provide continuous patient‐controlled analgesia.
Acute respiratory failure following lithium intoxication
Authors: LAWLER P. G. , COVE‐SMITH J. R.
Published: February 2007

Two patients suffering from severe lithium poisoning (blood level > 4 mmol/litre) were treated by haemodialysis. Both patients developed delayed respiratory failure, with the characteristics of adult respiratory distress syndrome, at a time when lithium levels had fallen below 2 mmol/litre. We recommend early respiratory support in the treatment of severe lithium intoxication.
Intravenous fluids in minor surgery. Their effect on recovery from anaesthesia
Authors: Keane P.W. , Murray P.F.
Published: February 2007

The value of infusing a total of 2 litres of intravenous fluids intra‐ and postoperatively was assessed in 212 fasting patients undergoing minor surgery procedures. The treated patients (108) recovered from the effects of surgery and anaesthesia more quickly than patients without fluids (104). The results of improved quality of the postoperative recovery, a shorter hospital stay and earlier return to work, especially in those patients who had some difficulty in recovering from anaesthesia on previous occasions, encourages the more frequent use of intravenous fluids in minor surgery.
Plasma histamine levels following atracurium
Authors: BARNES P. K. , de RENZY‐MARTIN N. , THOMAS V. J. E. , WATKINS J.
Published: February 2007

Plasma histamine levels were determined in 41 patients, 1.5 and 4 minutes after the intravenous administration of 0.6 mg/kg of atracurium. Clinical features of histamine release were sought at the time of blood sampling. Sixteen patients had elevation of plasma histamine 2.6 (SD 1.2) ng/ml 1.5 minutes after the injection of atracurium. Plasma histamine had returned to control levels at 4 minutes. There was a poor correlation between plasma histamine levels and the clinical manifestations observed. We conclude that atracurium has a low plasma histamine release potential and that cutaneous reactions after atracurium do not always indicate that plasma histamine levels are elevated.
Epidural anaesthesia in von Hippel‐Lindau disease
Authors: MATTHEWS A. J. , HALSHAW J.
Published: February 2007

The management of childbirth, including epidural anaesthesia for Caesarean section is described in a patient with von Hippel‐Lindau disease. The reasons for the choice of epidural anaesthesia are explained and the anaesthetic significance of the disease is discussed.
Continuous infusion epidural analgesia in obstetrics
Authors: Ewen A. , Mcleod D. D. , Macleod D. M. , Campbell Alison , Tunstall M. E.
Published: February 2007

The effects of 0.08% (Group A) and0.25% (Group B) solutions of bupivacaine were compared in a random manner, to assess continuous pump infusion epidural analgesia in labour. Both solutions were infused at a dose rate of 20 mg bupivacaine/hour. The results in all the mothers who had received infusions lasting more than 4 hours were studied. There were 25 11 Group A and 28 in Group B. Any treatment during the infusion epidural for inadequate analgesia, hypotension, etc., was recorded as an intervention. The mean of the intervention‐free intervals n>as significantly greater in Group A than in Group B. and significantly fewer top‐up injections were required in Group.4. The results show that the administration of a 0.08% solution of bupivacaine into the epidural space by continuous pump infusion is more labour saving than the infusion of a 0.25% solution. The concept that a greater volume infusion rate maintains a more extended liquid sleeve of local anaesthetic in the epidural space is supported.
Assisted ventilation and the Servo ventilator in infants
Authors: Bingham R. M. , Hatch D. J. , Helms P. J.
Published: February 2007

A laboratory assessment was made of systems used for Continuous Positive Airway Pressurel lntermittent Mandatory Ventilation (Cpapiimv) with the Servo 900B and 900C ventilators. Pressure‐volume loops recorded during sine wave oscillation using an external Cpapiimv system were similar to those found during normal respiration. Pressure‐volume loops using the systems based on the ventilator's inbuilt trigger mechanism were very djflerent. particularly for the 900B. The results were conjirmed by measurements in two infants. The implications of these jindings with reference to the weaning of infants from mechanical ventilation are discussed.
Monitoring EEG frequency and amplitude during cardiac surgery
Authors: Murray A. , Glaria A. P. , Pearson D. T.
Published: February 2007

Changes in the electroencephalograms of patients undergoing cardiac surgery with cardiopulmonary bypass were studied. An analysis technique with a simple display of amplitude and frequency within the traditional bands was used. During the course qf an operation, there can be dramatic changes in frequency contribution with little or no change in overall EEG amplitude. Evaluation of the results shows that this technique clearly draws attention to periods of EEG change, and examples are given.
A new device for the inflation of the antigravity suit
Authors: Brodrick P. M.
Published: February 2007

The 'Schuro’orthopaedic tourniquet inflator catl be simply converted into a suitable device for inflating an antigravity suit (G‐suit). The antigravity suit may be used on neurosurgical patients undergoing procedures in the sitting position to help prevent hypotension and air embolism. The availability of this device may encourage the more widespread use of an antigravity suit in neuro‐anaesthetic practice.
Obstetric anaesthetic services in Scotland in 1982
Authors: Scott D. B. , Aitken R. E. G.
Published: February 2007

A recent survey of Scottish obstetric anaesthesia practice revealed that the majority of deliveries take place in the larger hospitals; these also have the highest epidural rates, both for relief of pain in labour and for Caesarean section. However, as epidural blockade is an essential part of modern obstetric practice, it is a matter of concern to achieve an equal standard in the medium‐sized hospitals, whilst accepting that special arrangements are required in the very small obstetric hospitals.
Alfentanil supplemented anaesthesia for short procedures
Authors: COLLIN R. I. W. , DRUMMOND G. B. , SPENCE A. A.
Published: February 2007

Thirty‐nine unpremedicated patients who presented for cystoscopy were given either alfentanil or saline in a random double‐blind fashion immediately before anaesthesia with etomidate, nitrous oxide and enflurane. Alfentanil significantly reduced myoclonus associated with etomidate. During anaesthesia, patients who received alfentanil had smaller minute volumes, lower respiratory frequencies, and smaller increases in heart rate. The incidence of apnoea was not significantly increased. After operation, patients who received alfentanil were prescribed significantly more analgesia, possibly because of their reduced uptake of volatile anaesthetic agent: It is concluded that supplementation with alfentanil improves the quality of anaesthesia induced with etomidate.
Premedication with cimetidine and metoclopramide
Authors: PANDIT S. K. , KOTHARY S. P. , PANDIT UMA A. , MIRAKHUR R. K.
Published: February 2007

A randomised, double‐blind, placebo‐controlled parallel study was conducted in adult females to evaluate the efficacy and safety of a combination of cimetidine 300 mg orally and metoclopramide 10 or 20 mg intravenously in reducing pre‐operative residual gastric volume and raising gastric pH. The effect of pre‐operative metoclopramide on postoperative nausea and vomiting was also investigated. Oral cimetidine was given approximately 2–2.5 hours before, and intravenous metoclopramide either 15 or 30 minutes prior to induction of anaesthesia. The study showed that placebo‐treated patients undergoing outpatient operations have an increased risk of acid aspiration because of high residual gastric volume and low pH and increased risk of serious pulmonary injury should acid aspiration occur. Metoclopramide 10 or 20 mg intravenously prior to induction of anaesthesia was effective in reducing the residual gastric volume significantly, but not in raising pH. The combination of cimetidine and metoclopramide, as well as cimetidine alone, reduced the risk factors of acid aspiration by raising gastric pH and reducing residual volume. No anti‐emetic effect of metoclopramide was observed. Higher doses of metoclopramide (20 mg) produced significant side effects (pushing. dizziness, extrapyramidal side effects), but were only marginally more effective than 10 mg doses in reducing residual gastric volume.
Ventricular volume and ejection fraction in the diagnosis of the aetiology of low cardiac output in burned patients
Authors: MARTYN J. A. J. , McKUSICK K. , STRAUSS H. W. , BURKE J. F.
Published: February 2007

Cardiovascular instability following burns may result from either cardiac or non‐cardiac causes. We illustrate three cases in whom routine measurements of atrial filling pressures and cardiac output alone did not reject the adequacy of blood volume or the myocardial performance. In each instance, measurements of ventricular volume and ejection fraction by thermodilution technique or 99mTC ventriculography were useful to determine the actual causes of decreased cardiac output.
A portable oxygen generator
Authors: HALL L. W. , KELLAGHER R. E. B. , FLEET K. J.
Published: February 2007

The use of a portable generator which liberates oxygen from hydrogen peroxide solutions has been investigated in veterinary anaesthesia to assess its potential as an alternative to conventional oxygen supplies both in emergency situations and in the event of failure of cylinder systems. The reliability of the supply appears to be good and the operation of the generator simple, making it suitable for a number of potential uses. It should compare favourably with oxygen concentrator devices used for similar purposes.
Bromazepam as oral premedication. A comparison with lorazepam
Authors: Ponnudurai R. , Hurdley J.
Published: February 2007

A double‐blind trial of bromazepam 6 mg versus lorazepam 2 mg as oral premedicant agents was undertaken. A total of 153 patients were studied; 78 received bromazepam and 75 lorazepam. Objective and subjective assessments of sedation, amnesia, nausea and vomiting were performed. No significant difference between the IWO groups was found. It was concluded that bromazepam 6 mg and lorazepam 2 mg were equally satisfactory as premedicant drugs.
Flow through intravenous cannulae
Authors: KESTIN I. G.
Published: February 2007

The flows through intravenous cannulae, generated using the test described in British Standard 4843, are presented for all the cannulae available in the United Kingdom. These flows are compared to those obtained using clinical apparatus with two different pressure gradients. The implications of these results in selecting suitable intravenous cannulae and the other factors influencing flows through cannulae are discussed.
Speed of injection and spread of bupivacaine in the epidural space
Authors: GRIFFITHS R. B. , HORTON W. A. , JONES I. G. , BLAKE D.
Published: February 2007

Speed of injection of bupivacaine was assessed in 73 women who received epidural analgesia in labour. Rapid injection was shown to produce quicker onset of epidural block and more reliable perineal anaesthesia than slow injection, but there was no difference in the final extent of the block.
Oxygen analysers
Authors: ROE P. G. , TYLER C. K. G. , TENNANT R. , BARNES P. K.
Published: February 2007

Five currently available fuel cell oxygen analysers were studied with a view to their use in anaesthesia. The accuracy, response time and safety features of these analysers are discussed. Fuel cell analysers appear to be suitable oxygen monitors for routine anaesthetic use.
Acute beta‐adrenoreceptor blockade and induced hypotension
Authors: SIMPSON D. L. , MACRAE W. R. , WILDSMITH J. A. W. , DALE B. A. B.
Published: February 2007

Thirty patients scheduled for major middle ear surgery and induced hypotension, with a trimetaphan/sodium nitroprusside infusion, were randomly allocated to receive a single oral dose of beta‐adrenoreceptor antagonist 2 hours before surgery. In group 1 ten patients received metoprolol 50 mg, in group 2 ten patients received metoprolol 25 mg and in group 3 ten patients received oxprenolol 20 mg. There were ten controls for each group. The nitroprusside infusion rate was significantly reduced in groups 1 and 3. However, there was an unacceptably high incidence of profound bradycardia after induction of anaesthesia in those patients who had received beta‐adrenoreceptor antagonists pre‐operatively and this technique is not recommended for routine use.
Anaesthesia for combined heart and lung transplantation
Authors: SALE J. P. , PATEL D. , DUNCAN B. , WATERS J.H.
Published: February 2007

In December 1983, Harefield Hospital started a programme for combined heart and lung transplantation. Fifty‐two transplants have been successfully performed, with 36 survivors (April 1986). Patient selection and anaesthetic management of both donor and recipient are discussed. Two case histories are presented which illustrate the principles of anaesthetic management and postoperative care.
A comparison between the effects of fentanyl, droperidol with fentanyl, and halothane anaesthesia on intra‐ocular pressure in adults
Authors: FENECK R. O. , DURKIN M. A.
Published: February 2007

The effects of fentanyl 3.0 μg/kg (group 1), droperidol 0.1 μg/kg with fentanyl 3.0 μg/kg (group 2), and halothane 0.5% inspired concentration (group 3) on intra‐ocular pressure were compared. In each group, a decrease in intra‐ocular pressure was produced which was significantly lower than resting values (p > 0.01) and was independent of changes in arterial blood pressure. The recovery time in group 1 patients was significantly less than that of patients in group 3.
Pregnanolone emulsion
Authors: HøGSKILDE S. , NIELSEN J. W. , CARL P. , SøRENSEN M. B.
Published: February 2007

The anaesthetic activity of pregnanolone (a metabolite of progesterone) in emulsion formulation administered intravenously to male mice was compared with that of Althesin. The loss of righting reflex for 15 seconds was used to estimate the anaesthetic effect. The mean anaesthetic dose (AD50) for the pregnanolone emulsion was 5.25 mg/kg and for Althesin, 2.8 mg/kg. The mean lethal dose (LD50) was 44 mg/kg for pregnanolone and 54 mg/kg for Althesin. The sleeping time after pregnanolone was 2.5–3.5 times longer than after Althesin in dosages above 7.5 mg/kg. No signs of pain or local reaction from injection were observed for either of the drugs. The onset of action was fast for both drugs, with only‐minor signs of excitation, and recovery was rapid and without excitation. The results indicate that the anaesthetic properties of pregnanolone emulsion are very similar to those of Althesin. Further studies will show whether it can fill the major vacuum left in anaesthetic practice after the withdrawal of Althesin.
Phaeochromocytoma as a cause of pulmonary oedema
Authors: BLOM H. J. , KARSDORP V. , BIRNIE R. , DAVIES G.
Published: February 2007

Phaeochromocytoma can mimic many serious disease entities. This report describes a 43‐year‐old man who presented with pulmonary oedema due to a phaeochromocytoma. Predominantly adrenaline‐secreting tumours seem to predispose to this complication. Labetalol, a combined alpha‐ and beta‐receptor blocker, should be considered as the initial treatment in these cases and continued during surgery.
A nasal adhesion following prolonged nasotracheal intubation
Authors: SHERRY K. M. , MURDAY A.
Published: February 2007

A patient who presented with nasal obstruction 4 months after prolonged pernasal tracheal intubation is described. The cause of the obstruction was an adhesion which extended from the septum to the inferior turbinate. The evidence in support of long‐term pernasal tracheal intubation is presented and the aetiology of this complication is discussed.
Pre‐oxygenation and the parturient patient
Authors: RUSSELL G. N. , SMITH C. L. , SNOWDON S. L. , BRYSON T. H. L.
Published: February 2007

The effects of pre‐oxygenation were studied by continuous expired oxygen analysis in twenty pregnant patients and ten nonpregnant controls. The Magill system and a demand valve breathing system were both studied with tidal and vital capacity breathing. Rapid pre‐oxygenation was possible with the demand valve system but the technique was associated with air leaks around the mask. Vital capacity breathing with the Magill system was inefficient in practice because of rebreathing and air leaks, and the recently proposed four vital capacity breath technique provided suboptimal alveolar oxygenation in pregnant subjects. Oxygenation in pregnant subjects was significantly faster than in nonpregnant controls and was achieved after just 2 minutes of tidal breathing from a standard Magill system with a prefilled reservoir. Care was necessary to ensure a gas‐tight seal around the facemask.
Antacid therapy for emergency Caesarean section
Authors: THORBURN J. , MOIR D. D.
Published: February 2007

One hundred patients undergoing emergency Caesarean section were treated with cimetidine 200 mg intramuscularly when the decision was made to deliver the patient by Caesarean section and, preceding general anaesthesia, 30 ml of 0.3 M sodium citrate was administered orally. No routine antacid therapy was employed during labour. No patient had a gastric aspirate pH of less than 2.7, and only one of less than 3. The regimen is simple and effective, and treats only those patients at risk of acid aspiration.
Comparison of etomidate and propofol for anaesthesia in microlaryngeal surgery
Authors: DE GROOD P. M. R. M. , MITSUKURI S. , VAN EGMOND J. , RUTTEN J. M. J. , CRUL J. F.
Published: February 2007

Propofol and etomidate were compared as hypnotics in total intravenous anaesthesia for microlaryngeal surgery combined with jet ventilation. Two groups of 15 patients were studied. In group 1, propofol 2.0 mg/kg was used for induction. For maintenance a continuons infusion of 12 mg/kg/hour was used for the first 10 minutes, followed by 9 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour thereafter. In group 2, the induction dose of elomidate was 0.3 mg/kg followed by continuons infusion of 1.8 mg/kg/hour for 10 minutes, 1.5 mg/kg/hour for the next 10 minutes and 1.0 mg/kg/hour thereafter. Alfentanil was given for analgesia and suxamethonium for muscle relaxation. The propofol group showed better surgical conditions, more stable anaesthesia and better recovery according to the Steward score. Recovery times to opening eyes on command were comparable for both groups.
Delayed respiratory arrest after epidural hydromorphone
Authors: WÜST H. J. , BROMAGE P. R.
Published: February 2007

A case is reported where hydromorphone 1 mg injected into the epidural space produced apnoea 4.5 hours later. No other narcotics had been given in the previous 10 hours.
Intrathecal morphine in aortic aneurysm surgery
Authors: DAVIS I.
Published: February 2007

The purpose of this study was to compare the peri‐operative conditions produced by intrathecal morphine with those that result from conventional analgesia in aortic aneurysm surgery. Low‐dose intrathecal morphine provides a level of analgesia during operation indistinguishable from that of moderate doses of parenteral opiate, but is no more effective in attenuating autonomic responses to the procedure. Analgesia is prolonged into the postoperative period, does not cause clinically evident respiratory depression and can be enhanced by small doses of intravenous opiate. The principal advantage of intrathecal morphine is the avoidance of irregular and inadequate pain relief in the early, and most painful, part of the postoperative period. Low‐dose intrathecal morphine appears safe, effective and feasible in aortic aneurysm surgery and provides an alternative to traditional management with parenteral opiates.
Carbon dioxide laser bronchoscopy
Authors: CONACHER I. D. , PAES M. L. , MORRITT G. N.
Published: February 2007

The records of 20 patients who underwent carbon dioxide laser bronchoscopy were analysed retrospectively. Many of the cases presented with evidence of severe obstruction of the trachea or major bronchi and were regarded as highly at risk from anaesthesia. The majority of problems in the 35 laser sessions related to the use of a rigid bronchoscope for delivering the laser and to the ventilalory difficulties associated with the airway pathology. Invasive arterial monitoring for blood gas analysis and blood pressure measurement proved essential to detect and correct changes of a potentially serious nature. This experience is compared and contrasted with that of others.
Piriform fossa perforation during attempted tracheal intubation
Authors: WENGEN D. F. à
Published: February 2007

Perforation of the piriform fossa is a rare complication of attempted tracheal intubation. The consequences vary from cervical emphysema to respiratory distress, mediastinitis, septic shock, empyema pyopneumothorax and death. The mortality rate due to mediastinitis is over 50%, so early diagnosis and management can improve survival. This case report describes one case and discusses the diagnosis and management of this complication.
Tracheopathia osteochondroplastica
Authors: SMITH D. C. , PILLAI R. , GILLBE C. E.
Published: February 2007

A 60‐year‐old man presented for aortocoronary saphenous vein grafting; tracheal intubation was found to be difficult before surgery. Bronchoscopy at the time suggested tracheal carcinoma, but subsequent biopsy of the trachea demonstrated tracheopathia osteochondroplastica. The condition is described and its implications for anaesthetists are discussed.
Intercostal nerve blockade for children
Authors: Shelly M.P. , Park G.R.
Published: February 2007

A modified technique of intercostal nerve blockade is described which is suitable for use in children. Ten patients received intercostal nerve blockade on a total of 29 occasions in order to provide analgesia following liver transplantation and to facilitate weaning from artificial ventilation of the lungs. The opioid requirement of patients who received intercostal nerve blockade was considerably lower than that of those who did not; 56% of the children who received intercostal nerve blockade required no additional analgesia. One child, the first to receive intercostal nerve blockade, developed a pneumothorax following the procedure. The technique has proved to be safe in skilled hands. It is an acceptable method of postoperative analgesia in children after liver transplantation and may be a useful technique in the management of other paediatric patients.
Bradycardia during intra‐abdominal surgery
Authors: COVENTRY D. M. , McMENEMIN I. , LAWRIE S.
Published: February 2007

The aim of the present study was to examine, in a double‐blind, randomised manner, the effects of glycopyrronium 0.005 mg/kg, atropine 0.01 mg/kg or a placebo (normal saline) on the frequency of bradycardia in 92 patients scheduled for major abdominal or gynaecological surgery. All patients received fentanyl, halothane and vecuronium. The frequency of bradycardia in the group that received saline was 18%. No cases occurred in either anticholinergic group. Mean heart rates intra‐operatively were not significantly different between the atropine and glycopyrronium groups. It is suggested that the routine use of pre‐operative anticholinergic agents should be considered when a similar anaesthetic technique is employed.
Comparison of two regional techniques for postoperative analgesia in children following herniotomy and orchidopexy
Authors: CROSS G. D. , BARRETT R. F.
Published: February 2007

This study compares the quality and duration of analgesia in two groups of patients aged between 1 and 13 years who received either caudal anaesthesia with plain bupivacaine 0.25% or an iliohypogastric and inguinal nerve block combined with skin infiltration using bupivacaine 0.25% with adrenaline 1:200 000. The results indicate no significant difference in the duration or quality of the analgesia provided by the two techniques. There was no difference in the incidence of vomiting or the time of first micturition between the two groups.
Local tissue oxygenation following radial artery cannulation
Authors: MURRAY J. M. , MOWBRAY A.
Published: February 2007

The effect of radial artery cannulation on local tissue oxygenation and acid‐base balance was studied in 20 patients. Using capillary samples drawn from each thumb, a significant difference was observed between capillary Po2 on each side (p < 0.001), with the higher Po2 on the cannulated side. There were no significant differences between sides in terms of [H+] or Pco2. It is considered that the differences in capillary Po2 were due to local tissue vasodilatation. The presence of chlorbutol in the sodium heparin flushing solution is implicated as the causative factor. Further study of 20 patients using preservative‐free heparin demonstrated no significant differences between cannulated and non‐cannulated sides in terms of capillary Po2, Pco2 or [H+]. Sodium heparin with chlorbutol appears to improve local tissue oxygenation and is recommended for use in flushing solutions for invasive arterial monitoring.
Tracheal versus intravenous atropine
Authors: BRAY B. M. , JONES H. M. , GRUNDY E. M.
Published: February 2007

Atropine 600 μg was given either intravenously or intratracheally and the change in heart rate noted in a double‐blind, randomised study of 40 anaesthetised patients. There was no significant difference between the two groups in the maximum increase in heart rate, 20.3 beats/minute in the tracheal compared to 21.4 beats/minute in the intravenous group. However, the maximum increase occurred significantly earlier in the tracheal group, 45.5 seconds after administration compared to 95.5 seconds in the intravenous group (p < 0.01, 95% confidence interval 36.8–63.2 seconds). This study supports the clinical observation that tracheal and intravenous atropine are equally effective and suggests that the trachea should be the route of choice when a rapid response is required.
Large dose epidural sufentanil
Authors: MADEJ T. H. , WATSON N. C. , MARTIN B. C.
Published: February 2007

The postoperative analgesic management of a patient who was intolerant of morphine and pethidine is described. An epidural infusion of fentanyl up to 1 μg/kg/hour was ineffective for analgesia in the first 18 hours. Subsequently. 50‐μg boluses and an infusion of 0.5 μg/kg/hour sufentanil provided satisfactory analgesia with minimal side effects for 28 hours.
Bradycardia during elevation of zygomatic fractures
Authors: SHEARER E. S. , WENSTONE R.
Published: February 2007

Two cases of severe bradycardia are described which occurred during elevations of zygomatic fractures. The two patients and the possible mechanisms involved are discussed.
Feedback control of neuromuscular blockade
Authors: WAIT C. M. , GOAT V. A. , BLOGG C. E.
Published: February 2007

A simple system for closed‐loop control of neuromuscular blockade is described. It comprises a Datex Relaxograph, a small relay and a syringe pump. The equipment is commercially available and requires no complex custom‐built electronics. Atracurium was infused in a semicontinuous manner to 11 patients who underwent general anaesthesia for a variety of surgical procedures. Neuromuscular blockade oscillated within a narrow range around the preset level. The mean rate of infusion of atracurium was 0.5 mg/kg/hour (SD 0.13). The mean recovery time was 25.5 minutes (SD 7.95).
Severe acute asthma and the menstrual cycle
Authors: LENOIR R. J.
Published: February 2007

Three cases of severe acute asthma associated with menstruation are reported. All required admission to an intensive therapy unit and intermittent positive pressure ventilation of the lungs for one week or more. Several bronchodilator drugs and anaesthetic agents were employed in an effort to reduce the severe bronchospasm. In each case, improvement appeared to coincide with the end of menstruation. An awareness of the association of asthma and menstruation by those involved in intensive therapy may help in the management of similar cases.
Lupus anticoagulant
Authors: MALINOW A. M. , RICKFORD W. J. K. , MOKRISKI B.L.K. , SALLER D.N. , McGUINN W. J.
Published: February 2007

Circulating lupus anticoagulant occurs in 5–37% of all patients with systemic lupus erythematosus. Its occurrence is not restricted to collagen vascular disease states. Lupus anticoagulant causes a prolongation of certain laboratory coagulation studies yet it is associated in vivo with a history of systemic intravascular thromboses. Placental vessels are also affected. Less than one in six pregnancies complicated by the presence of this auto‐antibody is successful. Treatment of afflicted parturients with anti‐platelet therapy has increased perinatal survival rates. Derangements in the coagulation profile and concomitant anti‐platelet therapy confound the rational use of regional anaesthesia in the management of labour and delivery in these high‐risk pregnancies.
Anaesthesia and septo‐optic dysplasia
Authors: SHERLOCK D. A. , McNICOL L. R.
Published: February 2007

Septo‐optic dysplasia (De Morsier's syndrome) is a common cause of congenital optic nerve hypoplasia. Associated abnormalities such as hypothalamic/pituitary dysfunction, hypotonia or spasticity, may result in affected children presenting for surgical procedures under general anaesthesia. A 3.5‐year‐old boy with the undiagnosed condition had his Achilles tendons elongated under an uncomplicated general anaesthetic. The postoperative period was complicated by coma and a major convulsive seizure which responded to glucose and steroids. The importance of awareness of this condition in short children with poor visual acuity who require general anaesthesia is stressed, and the presenting features of seven other cases are demonstrated.
Comparison of trichloroethylene and enflurane as adjuncts to nitrous oxide and relaxant anaesthesia
Authors: Rice A. S. C. , Reynolds F.
Published: February 2007

Forty women who underwent gynaecological surgery were randomly allocated to receive trichloroethylene. enflurane, or enflurane plus fentanyl as adjuncts to nitrous oxide/relaxant anaesthesia with controlled ventilation. No serious cardiac dysrhythmias were seen in any group. Each patient was observed postoperatively' for 4 hours by a nurse blind to the technique used, and questioned at 24 hours by a similarly blinded anaesthetist. Recovery after trichloroethylene was not significantly prolonged although postoperative analgesia by visual analogue was better, opiate analgesia was required less frequently and there was less nausea and vomiting than in either of the enflurane groups.

We argue for the continued use of trichloroethylene by this technique, because it costs one hundred times less than enflurane and because of the potential morbidity of the postoperative opiate dosage required after enflurane.
The influence of anaesthesia on the acute phase protein response to surgery
Authors: SIMPSON P. J. , RADFORD S. G. , LOCKYER J. A.
Published: February 2007

The influence of anaesthesia on the peri‐operative changes in acute phase protein concentrations was studied in 18 patients undergoing elective cholecystectomy. A standard anaesthetic technique was supplemented either by one of two different doses of fentanyl, or by halothane. Eleven proteins were studied but the acute phase response was significantly altered by the anaesthetic technique for only two, fibrinogen and antichymotrypsin. The concentration of these proteins tended to be lower with 2–3 μg/kg fentanyl than with either halothane or fentanyl 12 μg/kg. There was no evidence of variation in stress suppression between the three techniques. The mechanism of any anaesthetic influence on the acute phase response is uncertain and this study is too small to assess its clinical significance.
The respiratory effects of isoflurane, enflurane and halothane in spontaneously breathing children
Authors: MURAT I. , CHAUSSAIN M. , HAMZA J. , SAINT‐MAURICE Cl.
Published: February 2007

The respiratory effects of halothane, isoflurane and enflurane were assessed during nitrous oxide anaesthesia (N2O 50%) in three groups of unstimulated, spontaneously breathing children who weighed 10–20 kg and were aged 1–6 years. Respiratory variables were measured or calculated from capnographic and pneumotachographic recordings at three multiples of minimal alveolar concentration (MAC). The slope of the carbon dioxide response was measured. Similar increases in end tidal carbon dioxide were found for the three agents at each MAC multiple, and similar decreases in tidal volume and in the slope of the ventilatory response to carbon dioxide. A dose‐related tachypnoea occurred with halothane and a significant decrease in the duration of inspiration and the duration of each breath at the deepest level of anaesthesia. A significant increase in both these times occurred with enflurane, and a decrease in respiratory rate. No change in respiratory rate occurred with isoflurane at increasing alveolar concentrations whereas at each level of anaesthesia inspiratory time was significantly reduced.
One year's experience with the APACHE II severity of disease classification system in a general intensive care unit
Authors: JACOBS S. , CHANG R. W. S. , LEE B.
Published: February 2007

The APACHE II sickness score was applied prospectively for one year in a general intensive care unit in Saudi Arabia. Two hundred and ten patients were studied, 66 of whom died in hospital. The mean APACHE II score of survivors was 11 (SD 7.1) and of non‐survivors, 25.3 (SD 8.8). The mean Risk of Death was 13.3% (SD 13.1) for the survivors and 47.2% (SD 25.8) for non‐survivors. The differences in APACHE score and Risk of Death between survivors and non‐survivors are highly significant (p < 0.0005 for both). No patient survived who had a Risk of Death greater than 60% and none died with a Risk of Death less than 7%. The sensitivity of the APACHE II system in predictions of death can be improved if the scores on the day of admission and on the 3rd day are taken into account.
Unstable cervical fracture
Authors: EASON J. R. , SWAINE C. N. , JONES P. I. E. , GRONOW M. J. , BEAUMONT A.
Published: February 2007

The anaesthetic management of a 26‐year‐old woman who sustained an unstable fracture of C2 when 40 weeks pregnant, is described.
Feedback during patient‐controlled analgesia using a speech synthesiser
Authors: Hodsman N. B. A. , Kenny G. N. C. , Gillies G. W. A. , McArdle C. S.
Published: February 2007

Patients who use on‐demand analgesia prefer voice feedback rather than buzzer tones to indicate operation of the apparatus. Twenty‐four patients had experience of a patient‐controlled analgesia apparatus which incorporated a sophisticated feedback of buzzer tones and a speech synthesiser. Of those who expressed a preference, fifteen preferred the speech synthesiser and only one preferred the buzzer tones. The speech synthesiser is a reliable, inexpensive and simple method of supplying feedback to patients when such apparatus is used.
Propofol infusion for sedation in intensive care
Authors: NEWMAN L. H. , McDONALD J. C. , WALLACE P. G. M. , LEDINGHAM I. McA.
Published: February 2007

Ten patients, with a range of illness severity, received a continuous 8‐hour infusion of undiluted propofol for sedation while undergoing mechanical ventilation in a general intensive care unit. The level of sedation was assessed hourly and measurements were made of haemodynamic, respiratory, haematological and biochemical variables. Sedation remained satisfactory in most patients throughout the study period, with only occasional alterations in infusion rate, and eight patients required further sedative therapy within 45 minutes of discontinuation of the propofol infusion. Arterial pressure tended to decrease from baseline values; mean and diastolic pressures demonstrated a significant decrease (p < 0.05) at 4, 7 and 8 hours during the infusion. Adrenal steroidogenesis was not inhibited significantly.

Propofol infusion proved to he a useful and readily controllable sedative agent, and discontinuation of the drug was followed by rapid recovery in most cases. The critically ill may be particularly sensitive to the cardiovascular depressant properties of the drug.
The effects of vecuronium on intra‐ocular pressure
Authors: MIRAKHUR R. K. , SHEPHERD W. F. I. , LAVERY G. G. , ELLIOTT P.
Published: February 2007

The effects of vecuronium on intra‐ocular pressure were investigated in doses of O.1 mg/kg during steady state anaesthesia (n = 5), 0.1 mg/kg as part of a normal sequence induction preceded by thiopentone (n = 10), and 0.15 mg/kg as part of a rapid sequence induction with vecuronium administered prior to thiopentone (n = 10). Administration of vecuronium during steady state anaesthesia was associated with a significant decrease. Vecuronium produced a small reduction in pressure during a normal sequence induction, following a significant reduction after thiopentone. Tracheal intubation during normal sequence and rapid sequence inductions produced increases in pressure above the pre‐intubation value (significantly so in the case of normal sequence induction); however, the intra‐ocular pressure always remained helow the pre‐induction value, which suggests that vecuronium 0.15 mg/kg is a suitable relaxant as part of a rapid sequence induction technique where the use of suxamethonium is contraindicated.
Ketamine infusion
Authors: PARK G. R. , MANARA A. R. , MENDEL L. , BATEMAN P. E.
Published: February 2007

A patient with acute lymphatic leukaemia developed a bilateral fulminating Pseudomonas aeruginosa pneumonia and required controlled ventilation of the lungs. Marked agitation, hypotension and bronchospasm unresponsive to conventional bronchodilators presented a therapeutic challenge. A continuous intravenous infusion of midazolam failed to provide adequate sedation. A continuous intravenous infusion of ketamine resulted in better sedation, an increase in arterial pressure and a dimunition of bronchospasm. The clinical improvement was maintained for the 5 days during which ketamine was infused. Plasma concentrations of ketamine and its metabolites are reported.
Upper limb sympathetic blockade following intercostal nerve blocks
Authors: PURCELL‐JONES G. , SPEEDY H. M. , JUSTINS D. M.
Published: February 2007

A case of transient sympathetic block of the arm following percutaneous intercostal nerve injections is described and the possible aetiology discussed.
Brünings' bronchoscopic mask
Authors: CONDON H. A.
Published: February 2007

A tubular gauze mask suitable for inhalational anaesthesia for bronchoscopy, designed by Wilhelm Brünings, is described.
Heart rate and arterial pressure changes during fibreoptic tracheal intubation under general anaesthesia
Authors: SMITH J. E.
Published: February 2007

The cardiovascular responses to fibreoptic orotracheal intubation under general anaesthesia were compared with those in a control group in whom tracheal intubation was effected with a Macintosh laryngoscope. The patients received a standard anaesthetic and were allocated randomly to either group immediately before intubation. Fibreoptic intubation took significantly longer to perform. There were significant increases in heart rate and arterial pressure in both groups compared with pre‐induction values. The tachycardia in the fibreoptic group was significantly greater than that in the control group during the second minute after intubation, and the increase in systolic pressure was sustained for a longer period in the fibreoptic group. The maximum increases in systolic and diastolic pressures above pre‐intubation values were significantly greater in the fibreoptic group. The cardiovascular responses associated with fibreoptic intubation under general anaesthesia appear to be more severe than those which follow intubation effected with a Macintosh laryngoscope.
Low volume intercostal injection. A comparative study in patients and cadavers
Authors: MOWBRAY A. , WONG K. K. S.
Published: February 2007

This study compared the spread of 3 ml of a solution of bupivacaine‐methylene blue in the intercostal space of patients and cadavers. There were 51 successful injections in each group which demonstrated in 86% of patient injections and 84% of cadaver injections that spread was confined to one intercostal space. Spread was more extensive in cadavers, probably as a result of autolysis. It would therefore still appear necessary, when low volumes of local anaesthetic are used, to block each intercostal nerve individually.
Tracheal stenosis or agenesis in association with tracheo‐oesophageal fistula and oesophageal atresia
Authors: BRAY R. J. , LAMB W. H.
Published: February 2007

Two babies are described with oesophageal atresia, a tracheo‐oesophageal fistula and severe subglottic tracheal stenosis. A third baby, who did not survive, had a tracheal agenesis associated with bronchi arising from the oesophagus. A review of the types of tracheal stenosis and agenesis associated with various forms of tracheo‐oesophageal fistula is included.
Multiple anaesthetics for a malignant hyperthermia susceptible patient
Authors: EMMANUEL E. R.
Published: February 2007

A patient is described who has received nine anaesthetics, the last three since he was confirmed as susceptible to malignant hyperthermia. The ninth anaesthetic illustrates the prophylactic therapy and management in detail. Certain aspects of the problem are discussed.
Subarachnoid spread of epidural local anaesthetic following dural puncture
Authors: LEACH A. , SMITH G. B.
Published: February 2007

A case is described of an extensive block and hypotension which occurred after inadvertent dural puncture and subsequent epidural injection of bupivacaine. The subarachnoid spread of solution from the extradural space was confirmed radiologically.