bluuebunny/crossref_metadata_2025 huggingface dataset:
One lung anaesthesia
Authors: JENKINS J. , CAMERON E. W. J. , MILNE A. C. , HUNTER R. M.
Published: February 2007

Ten patients about to undergo left‐sided thoracotomy for carcinoma of the lung were entered into a crossover trial to compare cardiovascular and respiratory function during high frequency jet ventilation and conventional mechanical ventilation for one lung anaesthesia. All patients were anaesthetised with a standard technique using double lumen tubes and placed in the lateral position with the left chest open.

The results showed no significant differences with regard to ventilation sequence but one lung high frequency jet ventilation gave higher values than one lung conventional ventilation for shunt (p < 0.01) and positive end expiratory pressure (p < 0.05) and lower peak inflation pressure values (p < 0.01). There were no significant differences in cardiac output, pulmonary capillary wedge pressure, arterial carbon dioxide or available oxygen.

Surgical conditions were satisfactory during both methods of ventilation and satisfactory gas exchange occurred. It was, however, more difficult to assess adequacy of ventilation during high frequency jet ventilation and the routine use of this method of ventilation is not recommended during one lung anaesthesia.
Suxamethonium in myasthenia gravis
Authors: WAINWRIGHT A. P. , BRODRICK P. M.
Published: February 2007

The effects of suxamethonium 1.0 and 0.5 mg/kg were studied in myasthenie patients. Resistance was not encountered at the 1.0 mg/kg dose but was seen at the lower dose. A non‐depolarising type of block developed in patients in both groups. However, recovery from the non‐depolarising block was not prolongea beyond the requirements of surgery. The neurophysiological basis for, and clinical implications of these findings are discussed.
Persistent pneumothorax treated with continuous positive airway pressure
Authors: ELPHINSTONE M. G. , GRANT I. S.
Published: February 2007

A patient who presented with persistent pneumothorax after blunt chest trauma is described. The lung re‐expanded partially in response to chest drain suction but some areas remained collapsed. The institution of continuous positive airway pressure on an intermittent basis, was followed by complete re‐expansion of the lung and resolution of the pneumothorax.
Spinal subdural haematoma following spinal anaesthesia
Authors: BARKER G. L.
Published: February 2007

A case is presented of spinal subdural haematoma which developed after spinal anaesthesia.
Isoflurane as an alternative to halothane for Caesarean section
Authors: GHALY R. G. , FLYNN R. J. , MOORE J.
Published: February 2007

Two series of 25 patients who underwent elective Caesarean section with general anaesthesia were given either 0.75% isoflurane or 0.5% halothane as supplements to 50% nitrous oxide in oxygen used for maintenance. The potent inhalational agent was given for the entire operative period and no case of intra‐operative dreaming or awareness was reported. The infusion dose of suxamethonium was significantly less with isoflurane, 50 μg/kg/minute (SD 17), as compared to halothane, 64 μg/kg/minute (SD 24) (p < 0.02). Recovery from anaesthesia was more rapid with isoflurane. The surgeon's assessment of uterine relaxation and bleeding using a visual analogue score indicated that this was significantly less with isoflurane. Infant well‐being as judged by Apgar score and cord blood gas analysis, showed little difference between the two inhalational agents.
Pressure infuser devices
Authors: COX P.
Published: February 2007

Three currently available pressure infusor devices, based on three different principles, were tested to see if the pressure reading on the infusor manometer corresponds to the pressure generated in the infusion system. Each device was tested in two ways. First, the pressure generated in the infusion system was measured when the infusor bag pressure was maintained at 300 mmHg while the infusion bag was emptied in aliquots of 50 ml. Second, the pressures in the infusor bag required to maintain a pressure of 300 mmHg were measured as the infusion bag was emptied stepwise.

The results reveal surprisingly large discrepancies between the pressure registered on the infusor manometer and the actual pressure generated in the fluid, which are not due to manometer inaccuracy. The degree of discrepancy depends on the amount of fluid that remains in the infusion bag and, when the infusor manometer shows a pressure of 300 mmHg, pressure in the fluid can be as much as 170 mmHg above or 200 mmHg below this value. Furthermore, it was impossible to maintain a pressure of 300 mmHg in the infusion system using one of the devices despite the fact that 100 ml fluid remained. The clinical significance of these findings is discussed.
Total intravenous anaesthesia for military surgery. A technique using ketamine, midazolam and vecuronium
Authors: Restall J. , Tully A. M. , Ward P. J. , Kidd A. G.
Published: February 2007

Ketamine and midazolam were used for induction of anaesthesia and by continuous intravenous infusion for maintenance to assess their suitabiliity for use in a total intravenous anaesthetic technique in the management of battle casualties. Muscular relaxation was provided by vecuronium and the patients' lungs ventilated with air. Ketamine was infused at a rate of 2 mg/kg/hour. This was achieved by mixing ketamine 200 mg, midazolam 5 mg and vecuronium 12 mg in 50 ml normal saline. The rate of infusion of the mixture (ml/hour) was then equal to 50% of the body weight in kg. The technique proved to he simple, effective and versatile and should be adaptable for use in the management of battle casualties.
Temazepam and recovery in day surgery
Authors: Obey P. A. , Ogg T. W. , Gilks W. R.
Published: February 2007

A double‐blind trial of temazepam premedication for day cases was undertaken. Effective anxiolysis was recorded in the groups that received temazepam 10 or 20 mg and there was no prolongation of delayed recovery times as measured by memory test cards. All patients were, discharged from the day unit 3 hours after the administration of general anaesthesia.
Hypoxaemia after premedication in cardiac patients. Glycopyrronium compared with hyoscine
Authors: Hetreed M. A. , Aps C.
Published: February 2007

Arterial blood gases were analysed before and approximately one hour after premedication in two groups of 10 patients awaiting cardiac surgery. One group received intramuscular papaveretum and hyoscine, the other papaveretum and glycopyrronium. Similar, small but statistically significant reductions in mean arterial oxygen tension and oxygen saturation, and increases of arterial carbon dioxide tension occurred in both groups. Hypoxaemia in individual patients was unpredictable and in some was clinically relevant.
Adult respiratory distress syndrome—how many cases in the UK?
Authors: WEBSTER N. R. , COHEN A. T. , NUNN J. F.
Published: February 2007

Previously reported figures for the incidence of Adult Respiratory Distress Syndrome, based largely on American results, would suggest that the average British Health District of 200 000 people could expect to see 130 cases per year. This figure is greatly in excess of that expected from our clinical experience. We have undertaken a retrospective survey of patients within a British Health Region (population, 3 599 400). Results indicate an incidence of nine for an average Health District of 200 000 population, or 2.5% of all admissions to intensive therapy units, or 0.045 per 1000 resident population.
Rectus sheath block for diagnostic laparoscopy
Authors: SMITH B. E. , SUCHAK M. , SIGGINS D. , CHALLANDS J.
Published: February 2007

Sixty adult females of ASA grade 1 or 2 scheduled to undergo diagnostic laparoscopy were allocated randomly to one of two groups. In group A, laparoscopy was performed with a standardised general anaesthetic technique alone. In group B, the same general anaesthetic technique was supplemented with bilateral rectus sheath block. Postoperative analgesia was assessed at 1, 6 and 10 hours after operation. Visual analogue pain scores in group B were significantly lower than in group A despite a greater use of intramuscular analgesic injections in group A (p < 0.005 in each case).
Anaphylactic reaction after atropine
Authors: AGUILERA L. , MARTINEZ‐BOURIO R. , CID C. , ARINO J. J. , DE EGUILAZ J. L. SAEZ , ARIZAGA A.
Published: February 2007

A 38‐year‐old woman developed symptoms of anaphylactic shock after intravenous atropine and required adrenaline to maintain per fusion pressure. A strongly positive response was obtained on intradermal testing. The Prausnitz‐Kuestner test was also positive, which indicated the presence of drug specific IgE antibodies. No response was obtained after hyoscine.
Fatal anaphylactic reaction to suxamethonium: new screening test suggests possible prevention
Authors: ASSEM E. S. K. , LING Y. B.
Published: February 2007

A 40‐year‐old woman suffered cardiovascular collapse, cardiac ischaemia and arrest during induction of anaesthesia. Sever cerebral ischaemic damage was sustained during this episode and the patient died 4 days later. This fatal reaction was shown to be anaphylactic in origin; the causative agent was suxamethonium. High levels of IgE antibodies specific to the quaternary ammonium group (two of which are present in suxamethonium) were detected by the radioallergosorbent test. Results of the leucocyte histamine release test were less clear, partly as a result of steroid treatment. The two most relevant points were the absence of a history of previous anaesthesia, and involvement of the heart as the principal target of the reaction. This unfortunate and extreme case indicates the necessity for allergy testing (screening) before anaesthesia, and the need for organisation and funding of this procedure, if these fatal or near‐fatal reactions are to be prevented. It is a timely reminder that action should be taken, since neuromuscular blockers have been confirmed as the most common culprits, and that specific tests for IgE antibodies are now available against haptenic groups generally common to all neuromuscular blockers.
Respiratory failure following envenomation
Authors: KARALLIEDDE L. D. , SANMUGANATHAN P. S.
Published: February 2007

Respiratory failure may occur after envenomation. We report our experiences of a patient who required ventilatory care after krait bite. The krail (Bungarus) venom is known to contain bungarotoxins which act at the neuromuscular junction. No cardiac, renal or coagulation disorders were associated with the muscle paralysis after the snake bite. Ventilatory care was easy to institute and was life saving.
A comparison of isoflurane and halothane in anaesthesia for intra‐ocular surgery
Authors: CRAIG J. F. , COOK J. H.
Published: February 2007

Isoflurane 0.75% was compared with halothane 0.5% as the volatile supplement in a normocapnic technique for intra‐ocular surgery. Both agents gave satisfactory conditions for operation with a comparable reduction in intra‐ocular pressure during the procedure. Systolic arterial pressure, however, was significantly lower in the isoflurane group at the end of surgery and after tracheal extubation than in the halothane group. Isoflurane provides a useful alternative to halothane in anaesthesia for intraocular surgery.
Perineuronal morphine: a comparison with epidural morphine
Authors: DAHL J. B. , DAUGAARD J. J. , KRISTOFFERSEN E. , JOHANNSEN H.V. , DAHL J. A.
Published: February 2007

In a double‐blind, randomised controlled cross‐over study the effects of perineuronal (perifemoral) injections of morphine were compared with epidural injections with the same amount of morphine in patients after knee surgery. Better pain scores were achieved during treatment with epidural morphine. We have not been able to confirm the hypothesis of neuro‐axonal transport of morphine from the periphery to the spinal cord.
The nasocardiac reflex
Authors: BAXANDALL M. L. , THORN J. L.
Published: February 2007

The oculocardiac reflex is well described and recognised in anaesthesia. The nasocardiac reflex is less well‐known. We describe a clinical manifestation of this reflex and describe the relevant anatomy. This reflex may be obtunded during general anaesthesia, during general anaesthesia.
Propofol: clinical strategies for preventing the pain of injection
Authors: Scott R.P.F. , Saunders D.A. , Norman J.
Published: February 2007

Eight modes of administration of propofol were assessed in order to minimise the pain of injection. An intravenous bolus injection in the antecubital fossa was the only approach that caused no pain. When administered intravenously in the dorsum of the hand the pain score and the number of patients who experienced pain was reduced significantly by mixing the agent with lignocaine when compared with a bolus injection. Slowing the speed of injection caused the greatest discomfort. An indirect biochemical mechanism for the pain is proposed.
High frequency jet ventilation in intensive care—a review of 63 patients
Authors: Smith B. E. , Scott P. V. , Fischer H. B. J.
Published: February 2007

High frequency jet ventilation has been used clinically in this unit for over 2 years. During this time we have treated 63 intensive care patients for whom the mean duration of ventilatory support was 3.4 days, which represents more than 5000 patient hours in total, with the Penlon Bromsgrove humidified jet ventilator. The series comprises a wide variety of general intensive care patients; a review of these cases is presented.
Visual disturbances after spinal anaesthesia
Authors: de LANGE J. J. , STILMA J. S. , CREZEE F.
Published: February 2007

A complication in two female patients after spinal anaesthesia for Caesarean section is outlined. Both patients acquired permanent visual disturbances caused by pericentral ring scotomata, a condition not described before.
The Ohmeda Excel anaesthetic machine
Authors: EMMETT C. P. , CLUTTON‐BROCK T. H. , HUTTON P.
Published: February 2007

The Ohmeda Excel 410 anaesthetic machine, is described. A report of its use on 100 patients and impressions of its innovations are given.
Induction characteristics of propofol in children: comparison with thiopentone
Authors: Mirakhur R. K.
Published: February 2007

The induction characteristics of propofol were studied and compared with thiopentone in children aged 3–14 years who received either no premedication or pethidine‐atropine or trimeprazine. Anaesthesia was maintained with nitrous oxide in oxygen, and isoflurane. The induction doses of propofol and thiopentone were 2.9 mg/ kg and 6.5–7.1 mg/kg respectively; premedication had no significant effect on the induction doses of either agent. Spontaneous movement and hypertonus occurred in about 20% of children with both agents. The use of propofol was associated with a high incidence of pain on injection (injections were mostly in veins on the dorsum of the hand), but this was reduced by mixing lignocaine with propofol. Cardiovascular effects were not clinically significant with either agent. Apnoea occurred in 35% of patients given propofol and in 50% of those given thiopentone. Children anaesthetised with propofol awoke significantly earlier after cessation of all anaesthesia. It is concluded that the use of propofol is safe in children and may have advantages where early recovery from anaesthesia is desirable, but offers no advantage over thiopentone for routine induction of anaesthesia.
A comparison of different methods of lubrication of glass syringes used to identify the epidural space
Authors: LEIMAN B. C. , KATZ J. , SALZARULO H. , WARTERS R. D. , BUTLER B. D.
Published: February 2007

Measurement of loss of resistance in glass syringes is a method widely used to locate the epidural space in epidural anaesthesia. Static and dynamic forces were measured under four experimental conditions in new glass syringes: unpolished, dry; polished, dry; unpolished, saline lubricated; and polished, saline lubricated. The unpolished saline lubricated syringes had a mean (SD) static force of 53.18 (15.0) g and dynamic force of 40.88 (15.2) g. These values were significantly greater than for polished dry syringes where the values were 5.27 (2.1) g and 4.38 (0.94) g, respectively. The results show that the least amount of resistance to plunger movement is obtained by dry polishing glass syringes.
Propofol infusion and auditory evoked potentials
Authors: SAVOIA G. , ESPOSITO C. , BELFIORE F. , AMANTEA B. , CUOCOLO R.
Published: February 2007

The effects of propofol on auditory evoked potentials (brainstem and middle latency responses) were recorded in six patients. Two different infusion rates were used, 54 and 108 μg/kg/minute. Effects on brainstem responses were not found. Regression of amplitude and latency of middle latency auditory potentials were dose related (p < 0.01).
The effect of fentanyl on propofol requirements for day case anaesthesia
Authors: Thomas V. L. , Sutton D. N. , Saunders D. A.
Published: February 2007

Fifty women of ASA grade 1 or 2 scheduled to undergo minor gynaecological procedures were allocated randomly to two groups. Group A received fentanyl 100 μg intravenously before induction; group B received no sedative or analgesie drugs. Anaesthesia was induced with propofol intravenously and maintained using 67% nitrous oxide in oxygen with incremental doses of propofol. Induction lime and dose were significantly less and mean arterial pressure decreased significantly lower in Group A. These differences were, however, small and the ranges of values were large. The incidence of side effects and subjective assessment of quality of anaesthesia were similar in both groups. Fentanyl did not confer any practical advantage when used with propofol in the techniques described above.
Comparison of a total intravenous anaesthetic technique using a propofol infusion, with an inhalational technique using enflurane for day case surgery
Authors: Price M. L. , Walmsley A. , Swaine C. , Ponte J.
Published: February 2007

A total intravenous anaesthetic technique with a propofol infusion for maintenance of anaesthesia was compared with an inhalational technique that used oxygen, nitrous oxide and enflurane in 98 unpremedicated patients who presented for day case surgery. Overall quality of anaesthesia during induction and maintenance was comparable in both groups. Quality of maintenance of anaesthesia in the propofol group was improved by an increase of the initial infusion rate from 12 to 15 mg/kg/hour. There was a larger decrease in arterial blood pressure after induction in the propofol group but no difference in blood pressure between the groups during maintenance. Recovery times and scores using the Steward scoring system were not significantly different. Nausea and vomiting were slightly less frequent in the propofol group.
Anaesthesia for extracorporeal shock‐wave lithotripsy. A comparison of propofol and methohexitone infusions during high frequency jet ventilation
Authors: Harries A. , Bagley G. , Lim M.
Published: February 2007

A continuous infusion of propofol 2.(1–2.5 mg/kg for induction followed by 9 mg/kg/hour for the first 30 minutes and 6 mg/kg/hour thereafter, was compared with methohexitone 1.5 mg/kg for induction followed by 4.8 mg/kg/hour thereafter for maintenance of anaesthesia in a randomised study of 40 patients who underwent extracorporeal shock‐wave lithotripsy using high frequency jet ventilation (HFJV). Systolic blood pressure was significantly lower in the propofol group after induction of anaesthesia, tracheal intubation, placement in the semirecumbent position in the hoist, bath immersion and after 5, 10 and 30 minutes of treatment. Diastolic blood pressure was significantly lower in the propofol group after intubation, placement in the hoist, bath immersion and after 5, 10 and 15 minutes of treatment. Heart rate was significantly lower in the propofol group after induction, intubation, placement in the hoist and bath immersion. There was no significant difference in the quality of induction between the two groups. Quality of maintenance of anaesthesia was judged to be poor in six out of 20 patients who received methohexitone compared with one out of 20 who received propofol but this difference did not reach statistical significance. There was no significant difference between the recovery times for the two groups but six out of 20 patients who received methohexitone were fudged to have a poor recovery from anaesthesia compared with none in the propofol group (p < 0.05). Propofol was associated with excellent induction, maintenance and recovery characteristics but it had a propensity to produce greater decreases in blood pressure, which were most marked when the patient was placed in the semirecumbent position in the hoist.
Premedication with temazepam in minor surgery
Authors: RATCLIFF A. , INDALO A. A. , BRADSHAW E. G. , RYE R. M.
Published: February 2007

Fourteen patients received oral premedication of temazepam in soft gelatin capsules before minor surgery. The plasma concentrations of temazepam and its sedative, anxiolytic and amnesic effects were measured for 24 hours. Absorption was rapid and peak concentrations occurred 49 minutes after administration. Clinical effects were evident at 30 minutes and persisted for about 4 hours. The decline in plasma concentration was biexponential with a distribution half‐life of 1.24 hours. The end of the distribution phase coincided approximately with the termination of its clinical effects. A relationship between plasma concentration and effect was observed: concentrations above 300 ng/ml produced measurable changes in tests of mental function. Patients had recovered fully from the effects of temazepam after 24 hours. This dose of temazepam is reliable and efective as premedication before surgery.
Spinal arteriovenous fistula
Authors: SGHIRLANZONI A. , GEMMA M. , PAREYSON D. , CIMINO C. , BOIARDI A.
Published: February 2007

A 62‐year‐old male suddenly developed a severe paraparesis after epidural anaesthesia. He recovered gradually over the next few months. He had an acute relapse one year later and a selective spinal angiography showed a dural T8 arteriovenous fistula with large draining veins. Intravascular embolisation of the fistula produced immediate and sustained clinical improvement. The mechanism commonly held responsible for neurological disturbances in spinal dural arteriovenous fistulas is cord hypoxia secondary to venous hypertension. The 20‐ml of local anaesthetic solution injected into a narrow spinal canal with osteophytosis may have caused further venous engorgement, cord hypoxia and acute neurological deficit.
Postoperative hypotension associated with enalapril
Authors: RUSSELL R. M. , JONES R. M.
Published: February 2007

We describe the case of a patient treated for hypertension with the angiotensin converting enzyme inhibitor enalapril, who developed hypotension after recovery from anaesthesia.
Two early ether inhalers
Authors: MASSON A. H. B.
Published: February 2007

The existence of two of the earliest ether inhalers, a Squire's inhaler and a Tracy's inhaler, in the Museum of the Royal College of Surgeons of Edinburgh is recorded.
The M1 air crash
Authors: COAD N. R. , JONES M. J. , BYRNE A. J. , PEPPERMAN M. L.
Published: February 2007

The M1 air crash provided an enormous challenge to the anaesthetic and intensive care services of the hospitals which admitted the survivors, many of whom had serious injuries. This account describes some of the problems which were encountered in two of the hospitals, details the workload imposed on the anaesthetists and the staff of the Intensive Therapy Units and identifies factors which, if improved, might advance the management of multiple casualties admitted from the scene of a major disaster.
Cardiovascular effects of fibrescope‐guided nasotracheal intubation
Authors: SMITH J. E. , MACKENZTE A. A. , SANGHERA S. S. , Scott‐Knight V. C. E.
Published: February 2007

The cardiovascular effects of fibrescope‐guided nasotracheal intubation were compared to those of a control group of patients who were intubated using the Macintosh laryngoscope. The 60 patients studied received a standard anaesthetic technique which included a muscle relaxant and were allocated randomly to one of two groups immediately before tracheal intubation. Systolic and diastolic arterial pressures in the fibreoptic group were significantly lower than in the control group during the first minute after intubation. The maximum increase in diastolic pressure was significantly lower in the fibreoptic group. The heart rate in the fibreoptic group was significantly higher than in the control group during all five minutes after intubation. The maximum increase in hearl rate was significantly higher in the fibreoptic group. The cardiovascular responses to fibreoptic nasotracheal intubation under general anaesthesia should not cause undue concern in fit patients, but appropriate measures should be taken to prevent excessive tachycardia in compromised patients.
Transtracheal illumination for optimal tracheal tube placement
Authors: MEHTA S.
Published: February 2007

The tracheas of 420 adult patients were intubated using the tip of a lighted stylet placed inside the lumen of the tracheal tube, just proximal to the tube cuff. The maximum point of transillumination was visible just distal to the cricoid cartilage; with proper cuff positioning. The lighted stylet was also introduced into the oesophagus to see whether transoesophageal illumination could be demonstrated. The intensity of transillumination was measured using a grading system. The distance between the bevel end of the tracheal tube and the carina was determined with a fibreoptic bronchoscope. Tracheal transillumination was graded as excellent in 81% of patients and as good in 19%, when the overhead lights were dimmed and cricoid pressure was applied. Transoesophageal illumination could not be demonstrated in any patient. The mean distance between the tip of the tracheal tube and the carina varied between 3.7 and 4 cm. Transtracheal illumination is a simple, effective and reliable method that can be used during intubation for the recognition of optimal tube placement.
Anaesthesia for patients with mitochondrial myopathy
Authors: BURNS A. M. , SHELLY M. P.
Published: February 2007

The anaesthetic management for an infant with mitochondrial encephalomyopathy due to fumarase deficiency is described. Mitochondrial myopathies may produce skeletal and cardiac muscle abnormalities, central nervous system effects and metabolic problems. The solutions to the anaesthetic problems posed by these patients are discussed.
Propofol infusion for sedation in outpatient oral surgery
Authors: VALTONEN M. , SALONEN M. , FORSSELL H. , SCHEININ M. , VIINÄMAKI O.
Published: February 2007

An infusion of propofol was compared with intravenous boluses of diazepam as sedation for minor oral surgery under local anaesthesia in 12 healthy patients who had elective bilateral surgical extraction of lower third molars; the patients served as their own controls. Plasma catecholamine, vasopressin and cortisol concentrations were determined from repeated blood samples. The total administered dose of propofol was 3.93 (SD 1.34) mg/kg and of diazepam 0.28 (SD 0.07) mg/kg. No cardiovascular depression or airway problems occurred. Other side effects were also rare but some discomfort on injection was frequent with propofol. Recovery times were faster after propofol than after diazepam as assessed by the Maddox wing and visual analogue scales. Propofol also provided better amnesia compared to diazepam at the time of the extraction of the teeth. Eight of the 12 patients subjectively preferred propofol sedation. There was no hormonal stress response in either group.
Effect of intravenous cimetidine on lignocaine disposition during extradural Caesarean section
Authors: FLYNN R. J. , MOORE J. , COLLIER P. S. , HOWARD P. J.
Published: February 2007

We studied whether an intravenous bolus of cimetidine altered the disposition of extradurally administered lignocaine in the parturient. Mothers who requested extradural analgesia for elective Caesarean section were randomly pretreated with either cimetidine 200 mg intravenously (n = 5) or no H2‐receptor antagonist (n = 5). No difference was found between peak plasma lignocaine levels or area under the plasma concentration/time curve between the two groups after administration of 6 mg/kg lignocaine 2% with adrenaline 1:200 000. There was no evidence for an effect of a single intravenous dose of cimetidine on lignocaine disposition in the obstetric patient. In addition, the extradural administration of 6 mg/kg lignocaine produces plasma levels well below toxic levels.
Alteration of maternal posture and its immediate effect on epidural pressure
Authors: JOHNSTON G. M. , RODGERS R. C. , TUNSTALL M. E.
Published: February 2007

A study was undertaken to investigate the changes in pressure inside the epidural space in parturients in the first stage of labour. The purpose was to see whether acute local pressure changes in the epidural space were consistent with the hypothesis that there is physical movement of cerebrospinal fluid with certain changes in maternal posture. Pressure changes were measured via the epidural catheter through which continuous infusion epidural analgesia was administered, using a pressure transducer kept at the level of the lumbar spine. The mothers moved through a series of postures that rejected those expected during the course of labour and delivery. The pressure within the catheter was recorded during these manoeuvres. The pressure changes which were found, taken in conjunction with the associated investigations of others, are consistent with the hypothesis.
Comparison of continuous spinal and continuous epidural anaesthesia for lower limb surgery in elderly patients A retrospective study
Authors: Sutter P.‐A. , Gamulin Z. , Forster A.
Published: February 2007

This retrospective study compared continuous spinal anaesthesia with continuous epidural anaesthesia for lower limb orthopaedic surgery in the elderly. The anaesthetic records of 457 patients who received continuous spinal anaesthesia and 274 who received continuous epidural anaesthesia over a 5‐year period were analysed. The patients who had continuous spinal anaesthesia were at a higher anaesthetic risk (ASA 3—4, 76% as compared with 37%, p < 0.001), but the incidence of failures was significantly lower (1.7%, as compared with 9%,p<0.001) and fewer patients showed a decrease in mean arterial pressure of more than30%(44%, ascomparedwith 65%,p < 0.001)and(or)receivedvasopressors(65%, as compared with 77%, p < 0.01). Ourdata show continuous spinal anaesthesia to be more reliable and to provide better cardiovascular stability.
Total intravenous anaesthesia for laparoscopy
Authors: Bailie R. , Craig G. , Restall J.
Published: February 2007

Two techniques of total intravenous anaesthesia for laparoscopy were compared in 80 patients. Group 1 received alfentanil, propofol and vecuronium, and Group 2 alfentanil, midazolam, ketamine and vecuronium. Haemodynamic stability after induction and the pressor response to tracheal intubation were signcantly different. There was no significant difference in recovery times between the two groups and little difference in other postoperative sequelae.
Forum Paediatric anaesthesia in a district general hospital
Authors: Bowhay A. R. , Morgan‐Hughes J. O.
Published: February 2007

Over 4000 general anaesthetics were administered during 1987 to children under the age of 13 years in the Norwich Health District. We have reviewed the 2938 anaesthetics performed in the Norfork and Norwich Hospital. Five hundred and fifty‐eight(19%) were undertaken in children aged less than 3 years; 24 of these were neonates. The implications of this workload are discussed, with reference to the more appropriate use of consultants with previous paediatric anaesthetic training, the training of junior staff and the policy for transfer of patients to specialised centres.
Propofol‐induced anaesthesia
Authors: SANDERS L. D. , ISAAC P. A. , YEOMANS W. A. , CLYBURN P. A. , ROSEN M. , ROBINSON J. O.
Published: February 2007

Postoperative psychomotor and cognitive recovery were assessed after anaesthesia induced by either propofol or thiopentone, and maintained with nitrous oxide and halothane in 40 unpremedicated dental patients. Performance was shown to be impaired one hour postoperatively for the whole sample in hand–ye coordination (p < 0.001), reaction time (p < 0.001) and digit span (p < 0.05). There was evidence of impairment at 3 hours postoperatively in reaction time (p < 0.05) and ataxia (p < 0.01). Performance also deteriorated in the dexterity and aiming tasks. Patients reported significantly less clumsiness by 24 hours in blurred vision and shivering (p < 0.05) and by 48 hours less coughing (p < 0.05). However, there was no significant difference between groups. No evidence showed that recovery in the propofol group was faster, so it was concluded that induction with propofol offered no advantage when anaesthesia is maintained with nitrous oxide and halothane for the periods of time reported in this study.
Alfentanil requirement in Crohn's disease
Authors: GESINK‐VAN DER VEER B. J. , BURM A. G. L. , HENNIS P. J. , BOVILL J. G.
Published: February 2007

The dose requirement of alfentanil as a supplement to nitrous oxide anaesthesia was studied in 13 patients with Crohn's disease and seven control patients all of whom underwent laparotomy. Alfentanil was administered as a variable rate infusion with supplemental bolus injections titrated to the patient's needs. The alfentanil requirement was independent of the duration of surgery and was significantly higher in patients with Crohn's disease than in control patients. The results indicate that Crohn's disease alters the dose requirement of alfentanil.
Tracheal dilatation followed by stenosis in Mounier–Kuhn syndrome
Authors: MESSAHEL F.M.
Published: February 2007

A patient with previously undiagnosed Mounier–Kuhn syndrome (tracheobronchomegaly) was admitted with a head injury after a fall. The trachea was intubated with an oral tracheal tube with high‐volume low‐pressure cuff. The intracuff pressure was within the normal safe range recommended by the manufacturer. However, the patient developed tracheal dilatation on the second day after intubation. The trachea was extubated on the 15th day, and it was noticed 48 hours later that the patient was developing a tracheal stenosis at the site of the previous dilatation. The stenosis was so severe that the patient underwent resection‐anastomosis surgery of his stenotic tracheal segment 2 months after extubation. It may be preferable in patients with Mounier–Kuhn syndrome who require mechanical ventilation to intubate the trachea with an uncuffed tube and to pack the throat to decrease the chances of gas leak and inhalation.
Bradycardia in patients receiving atracurium or vecuronium in conditions of low vagal stimulation
Authors: COZANITIS D. A. , LINDGREN L. , ROSENBERG P. H.
Published: February 2007

Four groups of 20 patients each received either vecuronium or atracurium together with either glycopyrronium or saline, and underwent anaesthesia free of vagolytic drugs, and surgery devoid of vagal activity. Determinations of plasma histamine concentrations were made to examine the possible correlation between these levels and changes in heart rate and blood pressure as well as a possible relationship with skin reactions after the administration of the relaxants. Patients who received vecuronium without the anticholinergic drug, glycopyrronium, showed a greater tendency towards bradycardia (though not statistically significant) than those given atracurium. More cutaneous reactions were observed with patients who received atracurium than in those with vecuronium, but there was no correlation with plasma histamine concentrations of either relaxant group. There was no correlation either between histamine concentrations and heart rate or blood pressure associated with atracurium. The incidence of bradycardia with either relaxant is low if the anaesthetic technique and the surgery are devoid of vagal activity.
The value of postoperative chest radiology after major abdominal surgery
Authors: COOPER M. H. , PRIMROSE J. N.
Published: February 2007

A prospective study was carried out in which a chest radiograph was performed routinely on the third postoperative day on 35 consecutive patients who had elective abdominal surgery. The aim was to determine whether clinical symptoms and signs could be correlated with the radiographic appearances and whether the routine use of such an X ray could detect serious chest pathology before clinical signs developed. Thirteen patients (37%) had radiological evidence of complications and all had symptoms and (or) signs which suggested postoperative chest pathology. The 22 patients (63%) who had no radiological abnormality, could be subdivided clinically into those who were normal (29%) and those who had symptoms and (or) signs (34%). There was no significant difference between the groups in terms of previous surgery, sex, smoking, nature of surgical incision, age or duration of anaesthesia. There was a poor correlation between the diagnosis of the chest abnormality detected clinically and the diagnosis suggested by the radiographs. These findings suggest that a routine postoperative chest X ray is unnecessary in the absence of clinically detectable chest pathology.
Epidural anaesthesia and spinal arachnoiditis
Authors: SGHIRLANZONI A. , MARAZZI R. , PAREYSON D. , OLIVIERI A. , BRACCHI M.
Published: February 2007

Six patients were referred to our hospital with spinal arachnoiditis after epidural anaesthesia performed one month to 3 years before the onset of symptoms. None had had previous lumbar surgery or trauma, intraspinal haemorrhage, infections or other known causative factors of arachnoiditis. All the patients were free of neurological symptoms before epidural anaesthesia and only two had transient distress in the period immediately following the procedure. The clinical signs and symptoms of spinal arachnoiditis were severe and in every case the diagnosis was confirmed by myelography. Three patients were confined to a wheelchair after 3 years of follow‐up. To our knowledge, the anaesthetic procedures were performed according to standard methods. Arachnoiditis seems to be due to the epidural injection of foreign substances, and may be related to anaesthetic–vasoconstrictor solution or contaminants.
Haemodynamic responses to nicardipine in humans anaesthetised with halothane
Authors: RAY D. C. , DRUMMOND G. B.
Published: February 2007

The haemodynamic effects of an infusion of nicardipine were studied noninvasively before, during and after halothane anaesthesia in man, using a simple technique to achieve constant plasma drug concentrations. Eighty patients were randomly allocated to receive an intravenous infusion of either nicardipine or normal saline. Systolic and diastolic arterial pressures were significantly lower and heart rate significantly higher throughout the infusion than before infusion (p < 0.001, all variables) in those patients who received nicardipine. The hypotension induced by nicardipine was not affected by induction of anaesthesia; halothane significantly reduced the nicardipine‐induced tachycardia (p < 0.001). Nicardipine caused no cardiac rhythm disorders. This technique for the intravenous administration of nicardipine achieves appropriate stable plasma concentrations, is devoid of severe haemodynamic disturbance and appears to be safe to use during halothane anaesthesia in patients with normal left ventricular function.
Peri‐operative management of severe thyrotoxicosis with esmolol
Authors: VIJAYAKUMAR H. R. , THOMAS W. O. , FERRARA J. J.
Published: February 2007

A case of severe thyrotoxicosis with cardiac decompensation is reported. Use of propranolol was followed by cardiovascular collapse. Esmolol, the beta‐1 adrenoceptor blocking agent was successfully used to control the thyrotoxic state. A discussion of possible advantages of esmolol is provided.
Hypertrophic obstructive cardiomyopathy in combination with a prolapsing mitral valve
Authors: BELL M.D. , GOODCHILD C.S.
Published: February 2007

The anaesthetic management of a 27‐year‐old woman who presented for surgical correction of hypertrophic obstructive cardiomyopathy and mitral valve prolapse is described. The rationale for using propofol in a total intravenous anaesthetic technique is discussed.
Possible decrease in mortality associated with anaesthesia A comparison of two time periods in Massachusetts, USA
Authors: Zeitlin G. L.
Published: February 2007

This paper compares mortality associated with anaesthesia in Massachusetts USA, during two periods of time separated by 13 years. The denominators in the calculation of the mortality rates are not precisely comparable but there appears to be approximately a thirteenfold decrease in the death rate after general anaesthesia and a tenfold decrease after spinal anaesthesia.
Alkalinisation of bupivacaine for sciatic nerve blockade
Authors: COVENTRY D. M. , TODD J. G.
Published: February 2007

This double‐blind study investigates the effect of pH adjustment of bupivacaine 0.5% with adrenaline 1:200 000, on block latency, duration of analgesia and systemic absorption of local anaesthetic after sciatic nerve blockade. Twenty‐four adult patients were randomly allocated into one of two groups: Group A (n = 12) received bupivacaine with adrenaline 1:200 000 (pH 3.9) 2 mg/kg, while Group B (n = 12) received alkalinised bupivacaine with adrenaline 1:200 000 (pH 6.4) 2 mg/kg. Increasing the pH of the local anaesthetic solution significantly reduced block latency from 25 minutes in Group A to 12.5 minutes in Group B (p < 0.001) and prolonged the duration of useful analgesia from 14.1 hours to 18.3 hours (p < 0.001). There was no significant difference in plasma bupivacaine levels between the two groups. The results indicate that alkalinisation of bupivacaine reduces time to onset and prolongs the duration of useful analgesia when used for sciatic nerve blockade, without significantly increasing systemic absorption.
Occupational exposure to nitrous oxide in four hospitals
Authors: Gray W. M.
Published: February 2007

Diffusive samplers were used to measure the exposure of the anaesthetist, anaesthetic assistant and circulating nurse to nitrous oxide in every operating theatre of four Glasgow hospitals. Each theatre was surveyed over 1 or 2 weeks; samples were taken during every operating session. The exposures were in general surprisingly high. The anaesthetist's exposure was greater than 100 ppm on more than half the occasions, while in two of the hospitals the anaesthetic nurse's exposure was greater than 100 ppm on about half the occasions. The study underlines the need for theatre ventilation systems and scavenging equipment to be properly maintained and for scavenging facilities to be used effectively. It is concluded that regular monitoring of staff exposures is required to check the effectiveness of antipollution measures.
Effect of single‐dose omeprazole on intragastric acidity and volume during obstetric anaesthesia
Authors: MOORE J. , FLYNN R. J. , SAMPAIO M. , WILSON C. M. , GILLON K. R. W.
Published: February 2007

Various antacid or antisecretory agents are used to reduce the risk to patients of aspiration of gastric contents during general anaesthesia and a trial of the gastric proton pump inhibitor, omeprazole, is reported here. Twenty women admitted for elective Caesarean section under general anaesthesia received a single 80‐mg oral omeprazole dose at 2000 hours on the evening before surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. Eighty‐five percent of pH measurements at induction and extubation and 80% and 95% of volume measurements at induction and extubation respectively met the defined success criteria (pH ≥ 2.5, volume < 25 ml). Omeprazole treatment was well tolerated by the women and Apgar scores and subsequent progress of the babies were acceptable. These results indicate that gastric acidity and volume were acceptable in the majority of women after omeprazole treatment, but the interval from drug administration to induction of anaesthesia may have been too long in some cases and resulted in unacceptably low pHs.
Equipment deadspace and drug administration
Authors: MACFIE A. G.
Published: February 2007

Equipment deadspace can be a hazard in drug administration. The aim of this study was to measure the size of this problem. The deadspaces of a selection of cannulae, syringes and epidural catheters were measured by displacing the deadspace volume with water and measuring the weight gain. Between 10 and 30% of a 1‐ml intravenous dose will remain in the deadspace depending on the type and gauge of the cannulae. The deadspace of an epidural catheter and filter is approximately 1 ml. All cannulae should be flushed after drug administration. Epidural catheters must be flushed with the same solution as the test dose before insertion.
Pain on injection of propofol Methods of alleviation
Authors: JOHNSON R. A. , HARPER N. J. N. , CHADWICK S. , VOHRA A.
Published: February 2007

A controlled randomised double‐blind design was used to study the effect of lignocaine on the pain produced by intravenous injection of propofol. Patients received a 2‐ml pretreatment solution with temporary venous occlusion, followed by an induction solution. One hundred and three patients were assigned to one of five groups: saline pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 20 mg pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 40 mg pretreatment, followed by induction with propofol plus saline 2 ml; saline pretreatment, followed by induction with propofol plus lignocaine 20 mg; or saline pretreatment, followed by induction with propofol plus lignocaine 40 mg. Pain was reduced significantly in all groups in which lignocaine was used and a dose of 40 mg was more effective than 20 mg. There were no significant differences in the incidence of pain among the groups which received lignocaine as pretreatment and the groups which received lignocaine mixed with propofol. Sixty‐eight percent of patients who experienced pain or discomfort recalled it in the postoperative period.
Epidural anaesthesia and Von Willebrand's disease
Authors: MILASKIEWICZ R. M. , HOLDCROFT A. , LETSKY E.
Published: February 2007

A case is described of a primiparous patient with Von Willebrand's type 1 disease and diabetes who presented at 36 weeks’gestation for Caesarean section. This was performed under epidural anaesthesia in the absence of any coagulation disorder. The effects of pregnancy on coagulation factors in this disorder are discussed.
Intra‐operative pulmonary embolism after intravesical instillation of formalin
Authors: OSHIMA S. , MAEDA A. , MATSUKI A.
Published: February 2007

Intra‐operative pulmonary embolism is a rare and severe complication which is difficult to diagnose. A case is reported in which this condition occurred after intravesical instillation of formalin during radical cystectomy under general anaesthesia. Formalin may be related to formation of intravascular thrombi and result in pulmonary embolism.
Intrathecal diamorphine during laparotomy in a patient with advanced multiple sclerosis
Authors: LEIGH J. , FEARNLEY S.‐J. , LUPPRIAN K. G.
Published: February 2007

A patient with advanced multiple sclerosis was successfully managed for a sigmoid colectomy using spinal anaesthesia. Effective postoperative analgesia was achieved with intrathecal diamorphine administered through an indwelling intrathecal catheter, and wound infiltration with 0.25% bupivacaine.