bluuebunny/crossref_metadata_2025 huggingface dataset:
Controlled ventilation with the Bain co‐axial system
Authors: SAVVA D.
Published: July 2010

The minute ventilation required to maintain either hypocapnia (Fe'co2= 4.0 kPa, group A, n = 36) or normocapnia (Fe'co2= 5.0 kPa, group B, n = 38) in 74 adult patients was determined for the Bain system with controlled ventilation at 10 breath.min−1 and fresh gas flow equal to minute ventilation. Males required a greater minute ventilation and fresh gas flow than females (p < 0.01) in each group (group A, males ∼90 ml.min−1.kg−1, females ∼ 80 ml.min−1.kg−1; group B, males ∼ 75 ml.min−1.kg−1; females ∼ 65 ml.min−1.kg−1). Where capnography is not available, it may be safer to ventilate patients' lungs using the minute volume and fresh gas flow requirements established in group A patients. The administration of 5% carbon dioxide in oxygen for 2 min safely re‐established normocapnia and spontaneous respiration in hypocapnic patients when ventilated with the same minute volume, fresh gas flow and respiratory rate required during surgery. Only one patient required greater than 400 ml.min−1 of carbon dioxide to produce a 5% concentration. Maximum flow from the carbon dioxide flowmeter may be restricted to 400 ml.min−1 rather than the 500 ml.min−1 currently recommended.
A study of laryngeal mask inflation
Authors: O'KELLY S. W. , HEATH K. J. , LAWES E. G.
Published: July 2010

Laryngeal mask airway cuff inflation pressures were measured when inflated with the same volume of gas firstly in free space and then in position in the pharynx. A large difference in these pressures was observed and this was related to pharyngeal mucosal perfusion pressure. This study shows that it may be easy to produce pressures on the pharyngeal mucosa in excess of the critical perfusion pressure and thus potentiate mucosal trauma. Furthermore, laryngeal mask cuff pressures were measured at intervals during anaesthesia and were found to rise by a significant amount if room air was used as the cuff inflating gas. This effect could, however, be reversed if inspired gas was used to inflate the mask cuff. We conclude that care must be taken when inflating the laryngeal mask cuff if postoperative morbidity is to be avoided and also that it may not be necessary to use as high a volume of inflating gas as has been recommended during spontaneous respiration.
Comparison of 2‐chloroprocaine and prilocaine for intravenous regional anaesthesia of the arm: a clinical study
Authors: Pitkänen M. , Kyttä J. , Rosenberg P. H.
Published: July 2010

In a double‐blind, randomised study of patients scheduled for minor hand surgery 0.5% 2‐chloroprocaine (n = 30) and 0.5% prilocaine (n = 30) in a volume of 40 ml were compared for intravenous regional anaesthesia. The onset of sensory and motor block and recovery of sensory block were determined, and the occurrence of side‐effects was noted. Twenty‐four patients in the 2‐chloroprocaine group and 17 in the prilocaine group developed complete sensory block by 15 min after injection (p < 0.05). Complete recovery of sensation was faster after prilocaine (7.1 min) than 2‐chloroprocaine (9.8 min) (p<0.01). Venous irritation and/or urticaria after tourniquet release was observed on 10 occasions in those receiving 2‐chloroprocaine and twice in those receiving prilocaine. An increase in heart rate of > 20% above control values occurred in three patients, all of whom had been given 2‐chloroprocaine. Clinically, local anaesthetic properties of 0.5% 2‐chloroprocaine and prilocaine were similar, but there were more side‐effects with the former drug.
Suxamethonium‐induced muscle pains are not related to cholinesterase activity
Authors: Ansermino J. M. , Burke M. A. , Upton P. M. , McVittie J. , Blogg C. E.
Published: July 2010

We have investigated the possibility of using the pre‐operative measurement of cholinesterase activity to predict the postoperative development of myalgia following the administration of suxamethonium. Seventy‐seven patients presenting for elective extraction of wisdom teeth were entered in the study. All patients received a standard anaesthetic regimen, including suxamethonium to facilitate tracheal intubation, and standardised postoperative analgesia. Myalgia was assessed postoperatively and no correlation between muscle pains and cholinesterase activity was found.
A cost‐utility analysis of intensive therapy
Authors: RIDLEY S. , BIGGAM M. , STONE P.
Published: July 2010

A questionnaire designed to assess changes in quality of life was sent to 56 survivors of critical illness one year after their admission to an intensive therapy unit. Forty‐one patients completed the questionnaire, and for the majority, quality of life remained unchanged (n = 25). However significant decreases in quality of life were found in those patients who previously enjoyed a good quality of life or were admitted with respiratory problems. Survivors also recorded significant decreases in five aspects of their perceived quality of life (ability to think and remember, seeing family, their contribution to society, activities outside work and income). As part of a previous study, the costs incurred by each of these patients had been measured so that changes in quality of life detected in this study could be combined to the individual costs and expressed as cost per quality adjusted life year. The cost of intensive therapy for a patient surviving for one year after acute respiratory or cardiovascular disease was £2600. The total hospital cost per quality adjusted life year was estimated at £7500, which places intensive therapy at the higher end of health programme costs. If the costs of nonsurvivors are included in the cost per quality adjusted life year calculation, the cost of intensive care increases considerably.
Cerebrospinal fluid cutaneous fistula An unusual complication of epidural anaesthesia
Authors: HOWES J. , LENZ R.
Published: July 2010

We describe two cases of cerebrospinal fluid‐cutaneous fistula following epidural anaesthesia used for postoperative pain relief. In each case spinal headache occurred only after removal of the catheters and both patients were treated successfully with autologous blood patches.
Flow characteristics of long spinal needles
Authors: PATEL M. , SAMSOON G. , SWAMI A. , MORGAN B. M.
Published: July 2010

A 120 mm, 27‐gauge needle has recently been introduced for subarachnoid anaesthesia when using a single‐space, combined spinal‐extradural technique. The flow characteristics of this needle were compared with those of a 120 mm, 26‐gauge needle using a pressure monitor infusion pump. Surprisingly, the resistance to fluid flow of the 26‐gauge needle was twice that of the 27‐gauge needle. The results of this experiment were confirmed by the findings of a clinical study undertaken in 100 obstetric patients who required regional anaesthesia. The time taken from dural puncture to appearance of cerebrospinal fluid at the hub of the needle was on average three times greater with the 26‐gauge needle.
A comparative study of the incidence of sore throat with the laryngeal mask airway
Authors: Dingley J. , Whitehead M. J. , Wareham K.
Published: July 2010

In a prospective study of 150 patients randomly assigned to three groups, we have compared the incidence and duration of sore throat after a standard anaesthetic regimen using three different methods of airway management: facemask; laryngeal mask, and laryngeal mask with insertion aid. The insertion aid is currently being developed by Portex Ltd and is intended both to facilitate accurate placement of the laryngeal mask and to reduce trauma during insertion. All the patients were women undergoing short operative procedures requiring minimal postoperative analgesia. The incidence of sore throat was significantly less with a facemask (8%) than with the laryngeal mask when used without the insertion aid (28.5%) (p < 0.02). When using the insertion aid the incidence was 18% and this was not statistically different from the facemask. The presence of blood on the laryngeal mask (22%) was less likely when the insertion aid was used (4%) (p < 0.02).
Effects of background stress and anxiety on postoperative recovery
Authors: LIU R. , BARRY J. E. S. , WEINMAN J.
Published: July 2010

The effects of background stress and anxiety on both short‐ and long‐term recovery were measured in 30 healthy patients undergoing general anaesthesia for day‐case dental extractions. Standardised questionnaires presented pre‐operatively, assessed psychological status in terms of trait and state anxiety and stress levels. State anxiety was again measured postoperatively; recovery was assessed with pre‐ and postoperative batteries of cognitive tasks. Correlation coefficients revealed that the level of background stress in the preceding 6 months correlated with physical parameters of recovery such as time taken for patients to open their eyes, perceived pain and increased postoperative morbidity. The study also demonstrated that high levels of state anxiety after surgery correlated with postoperative pain. Trait and state anxiety before surgery did not correlate with any parameters of recovery or postoperative morbidity.
Conjunctival oxygen tension monitoring during liver transplantation
Authors: ALCOCK R. , PEACHEY T. , MALLETT S. , DAVIDSON B. , ROLLES K.
Published: July 2010

Conjunctival oxygen tension has been noted in animal studies to correlate with oxygen delivery. In order to assess this relationship in man, we compared the proportional changes in conjunctival oxygen tension with those in oxygen delivery that occur on the placement and release of the inferior vena caval clamps in 10 patients during orthotopic liver transplantation without veno‐venous bypass. We also examined the changes in mixed venous oxygen saturation at these times. We found a statistically significant correlation between both parameters and oxygen delivery (p < 0.001). However, analysing the data on a Bland and Altman plot of difference versus mean, it is our conclusion that the variation in the data is such that neither conjunctival oxygen tension nor mixed venous oxygen saturation can be used clinically to predict the changes in oxygen delivery that occur during liver transplantation.
Hypomagnesaemia, cardiac arrhythmias and orthotopic liver transplantation
Authors: RANASINGHE D. N. , MALLETT S. V.
Published: July 2010

Two patients who underwent orthotopic liver transplantation and developed peroperative cardiac arrhythmias are presented. In one, the arrhythmias were refractory to treatment with anti‐arrhythmic drug therapy until serum magnesium levels were restored to normal. The other patient had a low pre‐operative serum magnesium level and developed atrial fibrillation on induction of, and during, anaesthesia. Patients undergoing orthotopic liver transplantation may be a group especially predisposed to hypomagnesaemia. The importance of monitoring serum magnesium levels in such patients who develop peroperative cardiac arrhythmias is emphasised.
Lingual haematoma following treatment with streptokinase and heparin; anaesthetic management
Authors: WILLIAMS P. J. , JANI P. , McGlashan J.
Published: July 2010

A 79‐year‐old man with a diagnosis of myocardial infarction treated with streptokinase and heparin developed a large lingual haematoma, precipitating dysphagia and upper airway obstruction. Spontaneous haemorrhage into the tongue is a previously unreported but serious complication of thrombolytic therapy. Tracheal intubation was performed under local anaesthesia.
The effects of dobutamine therapy in critically ill patients measured by transoesophageal echocardiography and intracardiac monitoring
Authors: Steltzer H. , Simon P. , Owen A. N. , Thalmann M. , Hammerle A. F.
Published: July 2010

Fourteen patients with severe hypotension and adult respiratory distress syndrome after trauma (n= 7), general surgery (n = 6) or burns (n = 1) were studied. After volume loading with 6 ml.kg‐1 hydroxyethyl starch over 30 min (time I), dobutamine was infused intravenously at 5 μg.kg‐1.min‐1 (time II) and 10 μg.kg‐1 .min‐1 (time III). A 5 MHz transoesophageal echocardiographic probe was used to image a standard transgastric short axis view of the left ventricle. Haemodynamic data were obtained from thermodilution studies using pulmonary flotation catheterisation. Echocardiographic measurements (off‐line from videotape) and qualitative visual assessment of left ventricular function (visual assessment, on‐line) were performed. All measurements were made after fluid replacement, and during infusion of the two dobutamine doses. An improvement in mean systemic arterial blood pressure and mean stroke volume occurred from time I to the end of dobutamine infusion (p < 0.05). All patients, after volume infusion, were normovolaemic according to transoesophageal echocardiography and there was a good correlation between end‐diastolic area and stroke volume (r = 0.73). During dobutamine infusion, echocardiographic measurements showed no significant dose‐related increase in mean (SD) percentage left ventricular short axis area change from baseline after hydroxyethyl starch (time I: 60 (2); time II: 63 (2); time III: 64 (2)). However, a significant increase in short axis area change was seen in nine of the 14 patients (67%). Analysis of the end‐diastolic area/short axis area change relationship revealed a heterogeneous response to dobutamine. Dobutamine infusion resulted in an improvement in haemodynamics in the majority of patients with sepsis‐related adult respiratory distress syndrome, and transoesophageal echocardiography provided important additional information on ventricular performance.
Effects of the cervical collar on cerebrospinal fluid pressure
Authors: Raphael J. H. , Chotai R.
Published: July 2010

We investigated the hypothesis that cervical collars might compress the internal jugular veins and raise intracranial pressure in head‐injured patients. In a randomised, single‐blind, crossover study of nine patients scheduled for elective spinal anaesthesia the cerebrospinal fluid pressure in the lumbar subarachnoid space was measured with and without a ‘Stifneck’cervical collar applied. There was a significant elevation of cerebrospinal fluid pressure in seven of the patients studied when the cervical collar was applied (p < 0.01). This preliminary study raises the possibility that immobilisation of the cervical spine with the 'Stifneck’cervical collar may, by raising the intracranial pressure, contribute to secondary neurological injury in head‐injured patients in whom intracranial compliance is already reduced.
Infra‐orbital nerve block for relief of postoperative pain following cleft lip surgery in infants
Authors: Ahuja S. , Datta A. , Krishna A. , Bhattacharya A.
Published: July 2010

The study was conducted on 20 infants scheduled for cleft lip repair surgery. Ten were randomly allocated to receive bilateral infra‐orbital local anaesthetic nerve blocks at the conclusion of surgery with the other 10 receiving bilateral ‘sham’blocks as controls. Postoperative pain relief was assessed using a pain assessment scoring system and by monitoring arterial blood pressure, heart rate and respiratory rate. The mean pain assessment score was significantly higher (i.e. better) (p < 0.05) in the infants receiving the local anaesthetic block. There were no significant statistical or clinical differences in the physiological measurements between the two groups. The infants receiving the block required less analgesia in the postoperative period. The results suggest that infra‐orbital nerve block is a simple and effective means of achieving postoperative analgesia after cleft lip repair surgery in infants.
Are pulse oximetry and end‐tidal carbon dioxide tension monitoring reliable during laparoscopic surgery?
Authors: NYARWAYA J.‐B. , MAZOIT J.‐X. , SAMII K.
Published: July 2010

Cardiorespiratory changes induced by pneumoperitoneum and head‐up tilt may generate alveolar ventilation to perfusion ratio changes and increased systemic vascular resistances. The reliability of end‐tidal carbon dioxide tension and pulse oximetry in predicting arterial carbon dioxide partial pressure and arterial oxygen saturation may therefore be affected. The 35 ASA 1‐2 patients in this study comprised 12 men and 23 women aged 48 (SD 17) years and weighing 71 (SD 14) kg. Twenty‐nine were to undergo upper abdominal laparoscopy for cholecystectomy and six hyperselective vagotomy. Intra‐abdominal pressure was 1.7 (SD 0.9) kPa and head‐up tilt was 5.6 (SD 4.2)°. After abdominal insuflation, arterial carbon dioxide partial pressure significantly increased (p < 0.05). However, the arterial carbon dioxide partial pressure‐end‐tidal carbon dioxide partial pressure gradient remained constant throughout surgery. This gradient was highly correlated with arterial carbon dioxide partial pressure (p < 0.0001), but was not correlated with elapsed time, intra‐abdominal pressure or head‐up tilt. Arterial oxygen saturation was always greater than 95% in all patients and the arterial oxygen saturation‐pulse oximetric saturation gradient was always less than or equal to +4%. In conclusion, end‐tidal carbon dioxide partial pressure and pulse oximetric saturation allow reliable monitoring of arterial carbon dioxide partial pressure and arterial oxygen saturation in the absence of pre‐existing cardiopulmonary disease and/or acute peroperative disturbance.
A comparison of Plasmalyte 148 and 0.9% saline for intra‐operative fluid replacement
Authors: McFARLANE C. , LEE A.
Published: July 2010

Thirty patients undergoing major hepatobiliary or pancreatic surgery were randomly allocated to receive either 0.9% saline or Plasmalyte 148 (a balanced salt solution), at 15 ml.kg‐1.h‐1. Arterial blood gas analysis was performed before and after surgery. Plasma biochemistry (Na+, K+, Cl‐, lactate) measurements were made before and after surgery and at 24 h after surgery. The patients receiving 0.9% saline had significantly increased chloride concentrations (p < 0.01), decreased standard bicarbonate concentrations (p < 0.01) and increased base deficit (p < 0.01) compared to those receiving Plasmalyte 148. There were no significant changes in plasma sodium or potassium or blood lactate concentrations in either group. The exclusive use of 0.9% saline intra‐operatively can produce a temporary hyperchloraemic acidosis which could be given false pathological significance. In addition it may exacerbate an acidosis resulting from an actual pathological stale. The use of a balanced salt solution such as Plasmalyte 148 may avoid these complications.
Tracheal agenesis
Authors: MANSCHOT H. J. , VAN DEN ANKER J. N. , TIBBOEL D.
Published: July 2010

Agenesis of the trachea is a rare anomaly. The main signs are respiratory distress and cyanosis, inability to vocalise and impossible tracheal intubation. In most cases concomitant congenital anomalies of the heart, digestive tract or genitourinary tract are present. Endoscopy and X ray studies will confirm the diagnosis. There is no long‐term surgical solution because no suitable material for a tracheal prosthesis is available at present, therefore the condition is ultimately fatal. We report a case of tracheal agenesis. After the diagnosis was established the baby's lungs were ventilated for several hours via an oesophageal tube and two broncho‐oesophageal fistulae, but she finally died from untreatable respiratory acidosis. Autopsy revealed a Floyd's type III tracheal agenesis and a laryngeal cleft.
Antiemetic efficacy of metoclopramide when included in a patient‐controlled analgesia infusion
Authors: Walder A. D. , Aitkenhead A. R.
Published: July 2010

A double‐blind, randomised, controlled trial was performed to assess the antiemetic efficacy of metoclopramide when included in a morphine patient‐controlled analgesia regimen. Fifty ASA grade 1 or 2 patients scheduled for elective intermediate or major gynaecological surgery were allocated into one of two groups. All patients received a standardised anaesthetic and metoclopramide 5 mg was given intravenously 10 min before the end of the procedure. Group 1 received a patient‐controlled analgesia regimen using morphine 1 mg.ml‐1 solution. Group 2 received a patient‐controlled analgesia regimen using morphine 1 mg.ml‐1 with metoclopramide 0.5 mg.ml‐1 solution. Postoperative antiemetic treatment was with metoclopramide 10 mg intramuscularly or cyclizine 50 mg intramuscularly if this was ineffective. Pain scores, sedation scores, and morphine requirement were not significantly different between the groups. There was no difference in nausea scores between the groups, but more patients suffered moderate or severe nausea in group 1 (10 patients) than group 2 (three patients, p < 0.026). We conclude that metoclopramide, when included in a patient‐controlled analgesia regimen, reduces the incidence of moderate to severe nausea, but not the overall incidence of nausea.
A survey of the intended management of acute postoperative pain by newly qualified doctors in the South West region of England in August 1992
Authors: Gould T. H. , Upton P. M. , Collins P.
Published: July 2010

A questionnaire designed to assess the knowledge of newly qualified house officers about the management of postoperative pain, was sent to 203 preregistration house officers in the South West region of England. The questionnaire sought information on the following: (1) the prescription of postoperative analgesia for four clinical cases, (2) the use of nonsteroidal anti‐inflammatory drugs in patients with six medical conditions, and (3) the management of a patient who had an epidural infusion. The response rate was 26% (54 house officers) and only 13% of those circulated answered all four clinical cases appropriately. The use of nonsteroidal anti‐inflammatory drugs was often inappropriate. The management of the patient with a postoperative epidural infusion was inadequate when compared with a minimum safe response protocol designed by the authors. The poor theoretical and practical knowledge demonstrated in this survey indicates that urgent changes are required in the undergraduate curriculum to take account of the recent revolution in the management of severe postoperative pain.
A comparison of simple identification tests to distinguish cerebrospinal fluid from local anaesthetic solution
Authors: Tessler M. J. , Wiesel S. , Wahba R. M. , Quance D. R.
Published: July 2010

Local anaesthetic solution is sometimes used to enlarge the epidural space in preparation for the insertion of an indwelling epidural catheter and during subsequent checking a small volume of fluid may be aspirated. Twelve anaesthetists were asked to distinguish 0.1 ml plain bupivacaine 0.25% from 0.1 ml simulated cerebrospinal fluid (CSF) solution. The distinction was based on differences in the physicochemical properties of the two test solutions, namely, temperature, presence of glucose, pH, and turbidity when mixed with thiopentone. Temperature difference resulted in correct identification of the two solutions in 75% of cases, the presence of glucose in 92%, pH in 83%, and turbidity in 25% of cases. No single test resulted in correct identification by all the anaesthetists. We suggest that more than one physicochemical test is required to identify correctly the nature of the small volume of liquid which may be aspirated from an epidural catheter.
Extension of epidural blockade for emergency Caesarean section
Authors: Dickson M. A. S. , Jenkins J.
Published: July 2010

A safe and predictable method by which an epidural infusion sufficient for pain control in labour can be rapidly converted to a more intense block adequate for emergency Caesarean section continues to present a challenge. A prospective study was undertaken. The routine use of a bolus dose of 10 ml of 0.5% bupivacaine was assessed as a top‐up for emergency Caesarean section following a 0.1% infusion for labour. This produced an adequate block in 11 out of 18 patients. There were no significant differences in duration of infusion, cumulative local anaesthetic dose or pre‐existing block height in these patients when compared with the remaining seven patients who required an additional top‐up.
Acupuncture versus ondansetron in the prevention of postoperative vomiting
Authors: Somri M. , Vaida S. J. , Sabo E. , Yassain G. , Gankin I. , Gaitini L. A.
Published: July 2010

This study compares the anti‐emetic effect of acupuncture with that of ondansetron and a placebo. Ninety children undergoing dental treatment under general anaesthesia were randomly allocated to one of the three equal groups, to receive acupuncture needle insertion, intravenous ondansetron 0.15 mg.kg−1 or a placebo. Parental satisfaction scores and the incidence of emetic episodes were recorded. A significant difference was found in the number of patients who vomited and the total number of the emetic episodes when comparing the two treatment groups with the placebo group (p < 0.0001). A significant difference was also found between the treatment groups and the placebo group with respect to parental satisfaction score (p < 0.03). We conclude that traditional Chinese acupuncture is a valid non‐pharmacological alternative anti‐emetic treatment that can be recommended as a prophylactic technique in children undergoing dental surgery under general anaesthesia.
Motor block in regional anaesthesia
Authors: Haslam N. , Broadhurst M. , Duggan J.
Published: July 2010

A device based on a load cell was constructed to measure the strength of foot dorsiflexion and plantarflexion. Performance of the device was evaluated for both movements. The influence of foot position within the device, its use over a 30‐min period at 30‐s intervals and the effect of the removal and reapplication of the device on measured force of dorsiflexion and plantarflexion was studied in six volunteers. Both dorsiflexion and plantarflexion are suitable movements on which to base a device to quantify the density of motor block during the onset and offset of neuraxial block. Dorsiflexion has a number of advantages: muscle strength is independent of knee position, and therefore a below‐knee device can be constructed; strength of dorsiflexion is less affected by the foot position; we found the device easier to apply using dorsiflexion as the heel tended to self‐locate; innervation of the muscles responsible for dorsiflexion involves fewer spinal segments.
The influence of nitroglycerin and prostaglandin E1 on dynamic cerebral autoregulation in adult patients during propofol and fentanyl anaesthesia*
Authors: Endoh H. , Honda T. , Ohashi S. , Hida S. , Shibue C. , Komura N.
Published: July 2010

We investigated dynamic cerebral autoregulation in 24 normocapnic adult patients during propofol and fentanyl anaesthesia. Hypotension was induced, to a mean arterial pressure (MAP) of 60–65 mmHg, using nitroglycerin or prostaglandin E1. Time‐averaged mean cerebral blood flow velocity in the right middle cerebral artery was measured continuously using transcranial Doppler sonography. Dynamic autoregulatory response was activated by a sudden decrease in MAP following release of bilateral thigh cuffs (thigh cuff test) and evaluated as a dynamic rate of autoregulation (dRoR in %.s−1). The cuff test was repeated to obtain two values of dRoR during baseline and during induced hypotension; the data were then averaged. The mean value of dRoR during baseline and during induced hypotension was 14.2 (2.9) and 14.2 (1.6) %.s−1, respectively, in the nitroglycerin group, and 14.6 (2.6) and 14.4 (2.4) %.s−1, in the prostaglandin E1 group. We were unable to demonstrate significant between‐ or within‐group differences in dRoR. Thus, we conclude that nitroglycerin and prostaglandin E1 do not attenuate dynamic cerebral autoregulation.
Total intravenous anaesthesia in a patient with familial hypokalaemic periodic paralysis*
Authors: Hofer C. , Zalunardo M. P. , Zollinger A.
Published: July 2010

A 35‐year‐old woman with known familial hypokalaemic periodic paralysis received general anaesthesia for reduction of bilateral breast hyperplasia. Uncomplicated general anaesthesia was performed using a propofol target‐controlled infusion, remifentanil infusion and bolus doses of mivacurium with neuromuscular function monitoring. Plasma potassium concentrations were controlled intermittently in the peri‐operative period and supplemented to achieve normokalaemia. Despite continuous substitution, an episode of low plasma potassium concentration occurred during the recovery period; this was without any clinical signs of muscle paralysis or respiratory distress.
Myocardial ischaemia in normal patients undergoing elective Caesarean section: a peripartum assessment
Authors: Moran C. , Ni Bhuinneain M. , Geary M. , Cunningham S. , McKenna P. , Gardiner J.
Published: July 2010

Incidence rates of electrocardiographic changes during Caesarean section vary from 25 to 60%. To date, no investigator has identified myocardial ischaemia resulting from these changes. We investigated patients undergoing elective Caesarean section using peripartum Holter monitoring and serum analysis of cardiac troponin I (cTnI). Twenty‐six patients presenting for elective Caesarean section were studied. Peroperative Holter monitoring continued for 12 h postoperatively, at which time blood samples for cTnI levels were taken. Significant ST changes were recorded in 42% of patients peroperatively and 38.5% of patients postoperatively. Forty‐two per cent of patients experienced peroperative chest pain requiring opioid analgesia. Chest pain was significantly associated with abnormal electrocardiogram (ECG) findings. Ischaemic levels of cTnI were recorded in two patients. This study reports, for the first time, myocardial ischaemia (7.69% of patients) arising in conjunction with the ECG changes seen during elective Caesarean section. We also report episodes of significant postoperative ST‐segment changes.
Cerebral and regional organ perfusion in pigs during xenon anaesthesia
Authors: Schmidt M. , Marx T. , Kotzerke J. , Lüderwald S. , Armbruster S. , Topalidis P. , Schirmer U. , Reinelt H.
Published: July 2010

Little is known about the haemodynamic effects of inhaled xenon on regional organ perfusion. The aim of this study was to investigate the effect of 79% xenon ventilation on organ perfusion in pigs. We investigated 10 pigs, which were randomly allocated to receive either xenon 79% or total intravenous anaesthesia (TIVA)/oxygen anaesthesia. Microspheres were used to determine organ perfusion. The following regions of interest were investigated: cerebral cortex, medulla oblongata, brainstem, cerebellum, liver, kidney, small intestine, colon, muscle, skin and heart. The results demonstrated a significant increase in regional perfusion in the brainstem (+63%), cerebral cortex (+38%), medulla oblongata (+35%) and cerebellum (+34%). All other organs showed no significant change in regional perfusion. We conclude that xenon should be used with caution in clinical situations associated with pathological increases in intracranial pressure, e.g. neurosurgical procedures, head injury, cerebral mass lesions or stroke.
Monitoring of irrigation fluid absorption during percutaneous nephrolithotripsy: the use of 1% ethanol as a marker
Authors: Malhotra S. K. , Khaitan A. , Goswami A. K. , Gill K. D. , Dutta A.
Published: July 2010

This study was performed in 32 ASA I patients undergoing percutaneous nephrolithotripsy under general anaesthesia, using absorption of 1% ethanol as a marker to monitor irrigation fluid absorption. Various parameters of fluid absorption were studied and compared, including irrigation fluid volume, irrigation time, total volume of irrigation fluid absorbed and the rate of irrigation. The amount of irrigant used vs. the volume absorbed and the volume absorbed vs. total irrigation time were observed. Fluid absorption occurred in 78% of patients, and 28% absorbed volumes in excess of 1 l. The mean volume of fluid absorbed was 696.7 ml. The maximum fluid absorption was observed when the irrigation fluid volume, total irrigation time and irrigation rate exceeded 10 l, 30 min and 200 ml.min−1, respectively. In conclusion, this study has shown 1% ethanol to be a safe, simple and cost‐effective marker of fluid absorption during percutaneous nephrolithotripsy associated with minimal adverse effects.
Obesity and day‐case surgery
Authors: Davies K. E. , Houghton K. , Montgomery J. E.
Published: July 2010

Day‐case surgery is increasing in popularity and more patients with multiple medical problems are being considered as suitable for this approach. However, the current recommendations exclude morbidly obese patients (body mass index > 35 kg.m−2). We present a review of 258 morbidly obese patients who have received treatment in our day‐surgery unit. Our experience does not show any significant increase in unplanned admission rates or postoperative complications. In conclusion, we feel that morbid obesity alone should not be an exclusion criterion for day‐case surgery.
Somatic paravertebral nerve blockade Incidence of failed block and complications
Authors: Naja Z. , Lönnqvist P‐A.
Published: July 2010

The failure rate and complications following thoracic and lumbar paravertebral blocks performed in 620 adults and 42 children were recorded. The technique failure rate in adults was 6.1%. No failures occurred in children. The complications recorded were: inadvertent vascular puncture (6.8%); hypotension (4.0%); haematoma (2.4%); pain at site of skin puncture (1.3%); signs of epidural or intrathecal spread (1.0%); pleural puncture (0.8%); pneumothorax (0.5%). No complications were noted in the children. The use of a bilateral paravertebral technique was found approximately to double the likelihood of inadvertent vascular puncture (9% vs. 5%) and to cause an eight‐fold increase in pleural puncture and pneumothorax (3% vs. 0.4%), when compared with unilateral blocks. The incidence of other complications was similar between bilateral and unilateral blocks.
Adenotonsillectomy in children: a comparison of morphine and fentanyl for peri‐operative analgesia*
Authors: Mukherjee K. , Esuvaranathan V. , Streets C. , Johnson A. , Carr A. S.
Published: July 2010

This study compared the effectiveness and side‐effects of intra‐operative fentanyl with fentanyl and morphine for elective adenotonsillectomy in a double‐blind study, in 60 children randomly allocated to receive either intravenous fentanyl 1 µg.kg−1 intra‐operatively or intramuscular morphine 100 µg.kg−1 at induction. All children received a standard anaesthetic induction with intravenous fentanyl 1 µg.kg−1 and propofol 4–5 mg.kg−1 and maintenance with oxygen, nitrous oxide and isoflurane. Pain scores, emetic episodes and supplemental morphine requirements were recorded for 24 h postoperatively. The overall incidence of postoperative vomiting was high in both groups: 70% in the fentanyl group and 78% in the morphine group. The incidence of postoperative vomiting was lower in the fentanyl group (p < 0.03) in the first 4 h, but similar by 24 h. Children who received morphine at any time in the first 24 h had more median (range) episodes of vomiting [2 (0–7)] than children receiving fentanyl only [l (0–3); p < 0.03]. Administration of rescue anti‐emetics, pain scores in recovery and pain scores over the next 24 h were similar between the two groups.
Evaluation of clinical effectiveness of the Frova single‐use tracheal tube introducer
Authors: Hodzovic I. , Wilkes A. R. , Stacey M. , Latto I. P.
Published: July 2010

A prospective observational study design was used to evaluate the clinical effectiveness of the Frova single‐use tracheal tube introducer. Data were collected from 203 patients. Consultants and trainee anaesthetists completed 61 (30%) and 142 (70%) forms respectively, when the Frova introducer was used. It was successfully placed in the trachea in 194/203 (96%) of patients with two attempts at placement by the first clinician. The first clinician failed to either pass the Frova introducer or railroad the tube in six (3%) and 10 (5%) of the 203 patients respectively. The success rate by the first clinician was significantly influenced by the laryngeal view obtained (p < 0.0001). There was only one failure to place the Frova introducer in the trachea by either the first or second clinician. Airway trauma was detected in 11/203 (5%) patients. In six of these 11 patients blood was detected on tracheal suction; ‘distal hold up’ was elicited in five of these six. The Frova introducer has a high success rate for tracheal placement but has noteworthy potential to produce airway trauma.
The use of the BERCI DCI® Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation*
Authors: Low D. , Healy D. , Rasburn N.
Published: July 2010

Traditional teaching of laryngoscopy is difficult due to the trainer and trainee lacking a shared view. The Karl Storz BERCI DCI® Video Laryngoscope provides a video image for the trainer and a direct view identical to that of a standard laryngoscope for the trainee. Forty‐nine novice subjects were randomly assigned to a control group (n = 24) taught using a standard Macintosh laryngoscope or a study group (n = 25) taught using the Video Laryngoscope. Following training all subjects were assessed using a standard laryngoscope. Under simulated difficult airway conditions the study group performed better in terms of number of attempts (p = 0.02), number of repositioning manoeuvres required (p = 0.046) and teeth trauma (p = 0.034). The study group were more confident of the success of their tube placement (p = 0.035), found it easier than the control group (p = 0.042) and had improved knowledge of airway anatomy (p = 0.011). We conclude that video laryngoscopy confers benefits in the teaching of tracheal intubation.
Indirect determination of ascorbic acid (vitamin C) by spectrophotometric method
Authors: Nejati‐Yazdinejad Massoud
Published: July 2010

A novel spectrophotometric method is described. The procedure involves the use of Cu (II) as vitamin C oxidant. After completion of oxidation reaction, excess of Cu (II) is determined by complexation with alizarin red s (ARS). Thiocyanate ion is used as stabilising agent for Cu (I) which is the product of oxidation reaction. This method is used for determination of vitamin C in fruits and pharmaceutical products. Linearity was found to be perfect in the range 3.5 × 10−6–4.8 × 10−5 m (0.6–8.2 ppm). The detection limit and relative standard deviation of method are 2.0 × 10−6 m (0.35 ppm) and 1.03%, respectively. The proposed method is simple, safe, inexpensive and rapid.
Quantitation by magnetic resonance imaging of heating of commercial baby foods in glass jars
Authors: Gao Amin Maryam H. , Nott Kevin P. , Hall Laurance D.
Published: July 2010

This study demonstrates how magnetic resonance imaging can be used to quantitate the heating of commercially available baby foods as sold in glass jars either ‘on‐line’ during immersion in warmed water in the scanner's magnet, or ‘off‐line’ following microwave heating. The internal temperature distribution can be measured in 2‐ or 3‐dimensions with a precision of ±1.5 °C compared with fibre optical thermo‐probe measurements. Illustrative examples include jars of Heinz ‘Banana & Apple’, Sainsbury's ‘Organic Banana Rice Pudding’ and Cow & Gate ‘Organic Roasted Vegetable Lasagne’. Localised thermal lags induced by pieces of vegetable in the lasagne were observed during on‐line immersion heating. Importantly, the spatially heterogeneous heating by microwaves demonstrates the need for strong warnings about using microwave ovens for heating baby foods.
Application of failure mode and effect analysis (FMEA), cause and effect analysis and Pareto diagram in conjunction with HACCP to a potato chips manufacturing plant
Authors: Arvanitoyannis Ioannis S. , Varzakas Theodoros H.
Published: July 2010

Failure mode and effect analysis (FMEA) model has been applied for the risk assessment of potato chips manufacturing. A tentative approach of FMEA application to the snacks industry was attempted in order to analyse the critical control points (CCPs) in the processing of potato chips. Preliminary hazard analysis was used to analyse and predict the occurring failure modes in a food chain system (potato processing and potato chips processing plant), based on the functions, characteristics and/or interactions of the ingredients or the processes, upon which the system depends. CCPs have been identified and implemented in the cause and effect diagram (also known as Ishikawa, tree diagram and fishbone diagram). Finally, Pareto diagrams were employed towards the optimisation potential of FMEA.
Physicochemical properties of lotus (Nelumbo nucifera Gaertn.) and kudzu (Pueraria hirsute Matsum.) starches
Authors: Geng Zhong , Zongdao Chen , Yimin We
Published: July 2010

Lotus and kudzu starches have been used as functional foods in East Asia for thousands of years. The objective of this work is to investigate the starches’ basic physicochemical properties. The amylose content was the highest (30.61%) in lotus starch. The average particle size (diameters) was 50.27, 24.08 and 38.97 μm for lotus, kudzu and corn starches, respectively. Lotus starch exhibited a B‐type X‐ray diffraction pattern and kudzu starch exhibited a C‐type pattern. Kudzu starch was characterised by a maximum viscosity immediately followed by a sharp decrease in viscosity, while the lotus starch was characterised by a plateau when the maximum viscosity was reached.
Distribution of lipids and trace minerals in different muscle sites of farmed and wild turbot (Psetta maxima)
Authors: Aubourg Santiago P. , Losada Vanesa , Prego Ricardo
Published: July 2010

Lipid and trace mineral composition were studied in different sites of the edible flesh of farmed and wild turbot (Psetta maxima). Lipid matter (total content, sterols, tocopherols) showed to accumulate in the edge zone (EZ), except for phospholipid (PL), which provided a distribution that was found to be independent from the kind of turbot and the zone considered. Fatty acid composition of total lipids showed a non‐homogeneous distribution, as the EZ exhibited a different fatty acid group composition (higher monounsaturated and lower polyunsaturated and ω3/ω6 ratio values) than the other zones considered; fewer differences were observed by considering the PL fatty acid composition. Most minerals (Ca, Cu, Fe, Mn and Se) studied showed to be homogeneously distributed along the muscle sites of the wild fish, while more differences were obtained when considering the farmed one. For both kinds of turbots, the most important difference was obtained in the case of Zn, as a largely higher content in the EZ than in the other zones was detected. A close relationship between Zn and total lipid contents (r2 = 0.90 and 0.76 for farmed and wild turbots, respectively) was observed.
Characteristics of fermentation and bioavailability of isoflavones in Korean soybean paste (doenjang) with application of Bacillus sp. KH‐15
Authors: Choi Yang Mun , Kim Yoon Sook , Ra Kyung Soo , Suh Hyung Joo
Published: July 2010

We attempted to increase the fibrinolytic activity and aglycone contents of isoflavone in doenjang prepared with Bacillus sp. KH‐15. An initial rapid increase of viable cells was observed in the first 30 days followed by a gradual decrease to 1.78 × 108 CFU g−1 wet weight. The amino type nitrogen sharply was increased after 15 days, and showed the highest level (788.7 mg%) after 90 days. The total nitrogen was increased from 2.21% to 2.52% of final content after 90 days. Soluble carbohydrate was increased to 32.9 mg g−1 for 60 days, and after 60 days, the content was slowly decreased to 29.5 mg g−1. A rapid increase in fibrinolytic and caseinolytic activities were observed in the first 30 and 45 days of fermentation followed by a gradual decrease to 2.54 and 144.5 U g−1, respectively. β‐Glucosidase activity also showed a similar change pattern of the caseinolytic and fibrinoytic activities. Daidzein and genistein were increased to the maximum level of 764.5 and 561.4 mg kg−1 at day 30, respectively. At day 90, the contents of daidzein and genistein were 661.5 and 524.9 mg kg−1, respectively. The rats were fed a diet supplemented with either doenjang powder prepared with Bacillus sp. KH‐15 (D‐1 group) or commercial doenjang powder (D‐2 group) for 40 days. The level of serum total isoflavones in the D‐1 group was significantly higher than that in the D‐2 group.
Cohort variation, climate effects and population dynamics in a short‐lived lizard
Authors: Le Galliard Jean François , Marquis Olivier , Massot Manuel
Published: July 2010

1. Demographic theory and empirical studies indicate that cohort variation in demographic traits has substantial effects on population dynamics of long‐lived vertebrates but cohort effects have been poorly investigated in short‐lived species.

2. Cohort effects were quantified in the common lizard (Zootoca vivipara Jacquin 1787), a short‐lived ectothermic vertebrate, for body size, reproductive traits and age‐specific survival with mark–recapture data collected from 1989 to 2005 in two wetlands. We assessed cohort variation and covariation in demographic traits, tested the immediate and delayed effects of climate conditions (temperature and rainfall), and predicted consequences for population growth.

3. Most demographic traits exhibited cohort variation, but this variation was stronger for juvenile growth and survival, sub‐adult survival and breeding phenology than for other traits.

4. Cohort variation was partly explained by a web of immediate and delayed effects of climate conditions. Rainfall and temperature influenced distinct life‐history traits and the periods of gestation and early juvenile life were critical stages for climate effects.

5. Cohort covariation between demographic traits was usually weak, apart from a negative correlation between juvenile and sub‐adult body growth suggesting compensatory responses. An age‐structured population model shows that cohort variation influences population growth mainly through direct numerical effects of survival variation early in life.

6. An understanding of cohort effects is necessary to predict critical life stages and climatic determinants of population dynamics, and therefore demographic responses to future climate warming.
Feeding Behaviour in Galanin Knockout Mice Supports a Role of Galanin in Fat Intake and Preference
Authors: Adams A. C. , Clapham J. C. , Wynick D. , Speakman J. R.
Published: July 2010

It has been widely suggested that saturated fat consumption has fuelled the current obesity epidemic. Macronutrient choices appear to be important not only as potential factors influencing obesity, but also independently as risk factors for diabetes, cardiovascular disease and cancer. The neuropeptide galanin has previously been implicated in the regulation of fat intake, although its precise role has been contested. The present study investigated mice with targeted knockout of the galanin gene (GKO). We demonstrate that, when only a high fat diet (HFD) was available, wild‐type (WT) animals consumed significantly more energy than the GKO mice (89.85 ± 4.57 kJ/day versus 76.84 ± 3.55 kJ/day, P < 0.001, n = 17 versus 15). Consistent with this, WT animals gained more body weight when fed the HFD than GKO animals (3.48 ± 0.44 g versus 2.02 ± 0.62 g, P < 0.001, n = 17 versus 15). In a macronutrient choice scenario, WT mice ate almost three‐fold more fat than GKO animals (0.63 ± 0.02 g versus 0.23 ± 0.01 g, P < 0.001, n = 18 versus 24).Chronic administration of galanin by mini‐osmotic pumps into the lateral ventricle of GKO animals partially reversed the fat avoidance phenotype. Fat intake was significantly lower in the phosphate‐buffered saline‐treated GKO group compared to galanin‐treated GKO animals (0.32 ± 0.01 g versus 0.38 ± 0.01 g, P < 0.005, n = 17 versus 17). These data are compatible with the hypothesis that galanin specifically regulates fat intake, and implies that an antagonist to one or more of the galanin receptor subtype(s) may be of use in the treatment of some forms of obesity.