bluuebunny/crossref_metadata_2025 huggingface dataset:
The evacuated canister method of personal sampling
Authors: GRAY W. M. , BURNSIDE G. W.
Published: July 2010

Although there is a recognised need for routine monitoring of the exposure of operating theatre staff to waste anaesthetic gases, there is as yet no standard method for carrying out such measurements. We have assessed a commercial version of one proposed sampling system—the evacuated canister—by testing it in the laboratory and also using it to carry out pilot surveys in operating theatres. We encountered many difficulties in using the system; some of these were caused by design faults in the commercial equipment, but others are inherent in the concept of using an evacuated canister for personal sampling.
Drug dilution in anaesthetic practice
Authors: Wright M. , Grant I. S. , MacLeod T. M.
Published: July 2010

The accuracy of dilution by anaesthetists of commonly used drug preparations was assessed by ultra violet spectrophotometric assay of the diluted drugs. Percentage deviation from target concentrations was then calculated. Of a total of 358 drug dilutions carried out by 28 anaesthetists only 58% were within 10% of the target concentration while 6% lay outside 50% of the target concentration.
Isoflurane in paediatric anaesthesia
Authors: WREN W. S. , MCSHANE A. J. , MCCARTHY J. G. , LAMONT B. J. , CASEY W. F. , HANNON V. M.
Published: July 2010

The characteristics of induction with and recovery from isoflurane anaesthesia were studied in 248 children. The mean time to loss of consciousness was 1.5 min (SD 0.5). Tracheal intubation, without interruption of spontaneous ventilation, was accomplished in a mean time of 4.2 min (SD 54 seconds). Movement and excitement, of 20–30 seconds duration, occurred in 23.9% children and 22 patients coughed during induction; 15 (12.6%) during the first 124 inductions; 7 (5.6%) subsequently. The mean haw‐times of reduction of alveolar isoflurane concentrations in 28 children whose lungs were ventilated with isoflurane and in 13 children who breathed isoflurane spontaneously during anaesthesia were: 45 sec after exposure for one hour, 70 sec after exposure of 2–3 hours and 110 second following exposures of 4–8 hours. The mean recovery times of the three groups were 6.5, 9.5 and 11.5 min respectively. In two further groups of nine children the mean hay times of elimination of halothane and isoflurane were 220 secondr and 54 secondr respectively; recovery from isoflurane was markedly faster.

Isoflurane is well accepted by children; induction is more rapid than with halothane, and the marked flexibility in the control of its effects are due to its relative insolubility. It has wide application in paediatric anaesthesia.
A comparison of triazolam and diazepam as premedication agents for minor gynaecological surgery
Authors: PINNOCK C. A. , FELL D. , HUNT P. C. W. , MILLER R. , SMITH G.
Published: July 2010

Triazolam 0.25 mg, diazepam 10 mg and placebo were compared in a randomized double‐blind trial of oral premedication in 90 patients undergoing minor gynaecological surgery. Both triazolam and diazepam produced a significant sedative effect as measured by patient serf assessment linear analogue scales but only diazepam was more anxiolytic than placebo. Psychomotor performance assessed by the letter‐search test at 3 and 6 hours after awakening showed a decrement in performance in patients receiving triazolam at 3 hours compared with the two other groups. Triazolam was shown to have a pronounced amnesic effect and whilst it might be used for premedication, its lack of anxiolysis coupled with a significant impairment of psychomotor performance at 3 hours after awakening, render the drug unsuitable for premedication in the short stay patient.
Anaphylactoid reactions during anaesthesia
Authors: GALLETLY D. C. , TREUREN B. C.
Published: July 2010

Sixty one patients who had suffered intra‐operative anaphylactoid reactions were studied. Intradermal testing identified the causative agent in 84% of cases and, in 75% of these, muscle relaxants were responsible. Predisposing factors in patients sensitive to muscle relaxants were: female sex, previous allergy and atopy. The incidence of previous exposure was considerably higher than that reported in the literature. Pancuronium is suggested to be the least likely currently available agent to provoke a major anaphylactoid reaction.
Temazepam in fast dispensing dosage form as a premedication for children
Authors: Smith Gary B. , Hughes David G. , Kumar Viney
Published: July 2010

Forty‐seven children aged between four and 11 years received temazepam 0.5 mg/kg in a novel fast dispensing dosage form. The preparation was well accepted and associated with few side‐effects. Satisfactory sedation and anxiolysis was obtained in over 93% of patients. The relative merits of a variety of routes of administration of premedicant drugs for children are discussed and the advantages of buccally administered formulations for this age group are presented.
Plasma bupivacaine levels associated with extradural anaesthesia for Caesarean section
Authors: THOMPSON E. M. , WILSON C. M. , MOORE J. , McClean E.
Published: July 2010

Plasma bupivacaine levels were measured in 47 women undergoing extradural Caesarean delivery. They were divided into four groups according to the following dose regimens using 0.5% bupivacaine. Group A were given a bolus of 20 ml with increment after 20 minutes. Groups B and C were given 10 ml initially with further increments if required at 10 minutes (group B) and 20 minutes (group C); Group D consisted of patients who had an extradural block extended for emergency Caesarean delivery. In the elective groups the highest and most rapidly achieved values were associated with groyo A and the lowest levels found in group C. The highest levels of all were found in the emergency group. The investigation indicates that slow controlled induction of extradural anaesthesia for Caesarean section greatly reduces the risk of local anaesthetic toxicity.
Cardiovascular and cerebral complications during glossopharyngeal nerve thermocoagulation
Authors: ORI C. , SALAR G. , GIRON G. P.
Published: July 2010

The cardiovascular and cerebral complications observed during percutaneous radiofrequency thermocoagulation of the glossopharyngeal nerve are described. The value of such symptoms in anticipating a lesion of the vagus nerve is discussed.
The influence of age on the onset of anaesthesia with midazolam
Authors: DUNDEE J. W. , HALLIDAY N. J. , LOUGHRAN P. G. , HARPER K. W.
Published: July 2010

There was a considerable individual variation in response to a standard induction dose of 0.3 mg/kg midazolam in unpremedicated patients. This is shown by variations in time to onset of sleep and the fact that about one quarter of subjects did not lose consciousness in 3 minutes. In 166 fit patients a good negative correlation was demonstrated between the age of the patients and time to loss of consciousness. Patients over 50 years differed from younger patients in a greater reliability of effect and significantly shorter induction time. In elderly patients midazolam is a more reliable induction agent than in the young.
Tracheal tube cuff pressures
Authors: RAEDER J. C. , BORCHGREVINK P. C. , SELLEVOLD O. M.
Published: July 2010

Changes in cuff pressure and volume of tracheal tubes were studied in 60 patients undergoing lower abdominal surgery under generol anaesthesia with nitrous oxide and oxygen as the anaesthetic gas mixture. The cuffs were inflated with either anaesthetic gas mixture or air. Three different brands of tubes were used. The pressure in the air filled cuffs increased steadily throughout the procedure and reached level high enough to impede microcirculation in the tracheal mucosa within one hour. We conclude that filling the cuffs with anaesthetic gas mixture is a simple and reliable way to achieve stable cuff pressure during anaesthesia.
Automatic blood pressure monitors A clinical evaluation of five models in adults
Authors: JOHNSON C. J. H. , KERR J. H.
Published: July 2010

Five automatic blood pressure monitors were evaluated by comparing their values with almost simultaneous blood pressure readings from radial artery catheters. A total of 583 comparisons were made on 48 patients. Statistical analysis was performed on the pooled comparisons of systolic and diastolic pressure for each monitor. Agreement between the pressure measurements was variable between both patients and machines. For systolic pressure, two machines (Copal and Sentron) had correlation coefficients of over 0.9 while for the other machines (Dinamap 845XT, Narco and Vitastat 9001S) the values lay between 0.7 and 0.8. The steepest regression lines were also found with the Copal (0.93) and Sentron (0.86) data, but the other machines had considerably flatter slopes (0.55 to 0.67). The intercepts on the y axes ranged from + 14.1 (Copa) to + 50.1 (Dinamap). In clinical use, popularity of the different machines rejected the degree to which the machine reproduced the behaviour of the direct pressure measurement.
Meptazinol as an analgesic adjunct to total intravenous anaesthesia in cystoscopy patients
Authors: Hargreaves J. , Kay B. , Healy T.E.J.
Published: July 2010

Sixty‐four unpremedicated patients undergoing cystoscopy received either intravenous meptazinol 2 mg/kg or saline in equivalent volume in a randomised, double‐blind manner immediately before induction of anaesthesia with Althesin. Inclusion of meptazinol reduced the total dose of anaesthetic required, allowed a more rapid recovery and was associated with less movement in response to surgery. The patients in the control group tended to hyperventilate, and had lower end‐tidal CO2 tension (p < 0.001), and also higher pulse rates during surgery (p < 0.01) than the meptazinol group. However, the patients who received meptazinol had a more frequent incidence of complications during induction and recovery (p < 0.05).
Contamination of internal jugular cannulae
Authors: CLAYTON D. G. , SHANAHAN E. C. , ORDMAN A. J. , SIMPSON J. C.
Published: July 2010

137 internal jugular vein cannulae from 113 patients undergoing open heart surgery were cultured using standard broth culture and a semiquantitative culture technique. 60 of the cannulae were placed using an aseptic technique and 77 using a standard non sterile technique. Significant contamination was found in 18.3% of the cannulae in the aseptic group and 15.6% in the standard group. The contaminating organism was Staphylococcus epidermidis in 87.1% of cases. No advantage in using an aseptic technique of cannula insertion was demonstrated. It was concluded that the major source of contamination was elsewhere.
Cardiovascular effects of spinal subarachnoid anaesthesia
Authors: BARKER I. , ALDERSON J. , LYDON M. , FRANKS C. I.
Published: July 2010

Spinal anaesthesia using 1.2 ml of hyperbaric cinchocaine was found to abolish the autonomic hyper‐reflexic cardiovascular responses to bladder distension and produced little alteration in cardiovascular measurements.
Warming blood before transfusion
Authors: MARKS R. J. , MINTY B. D. , WHITE D. C.
Published: July 2010

The practice of warming blood for transfusion by immersion in a water bath has been studied. Blood, 3 days after collection, with CPD‐adenine anticoagulant, was warmed at 25°C, 37°C and 45°C for up to 2 hours. The procedure was repeated after 2 and 4 weeks' storage at 4°C. Only trivial biochemical and morphological changes resulted from warming. Within these limits, immersion warming of blood appears to be a reasonable alternative to using a blood‐warming coil. Other aspects of immersion warming are discussed.
H2 antagonists and bupivacaine clearance
Authors: O'SULLIVAN G. M. , SMITH M. , MORGAN B. , BRIGHOUSE D. , REYNOLDS F.
Published: July 2010

The effect of the H2 receptor antagonists cimetidine and ranitidine on bupivacaine clearance was assessed in women scheduled to undergo elective Caesarean section under epidural anaesthesia. Thirty‐six women were randomly allocated to receive either no medication, cimetidine 400 mg or ranitidine 150 mg on the night prior to and on the morning of surgery. No significant difference was found between the peak bupivacaine levels: the mean (SD) values were 0.74 (0.17) μg/ml, 0.81 (0.38) μg/ml and 0.70 (0.24) μg/ml in the control, cimetidine and ranitidine groups, respectively. Similarly, the H2 receptor antagonists did not alter the plasma bupivacaine against time curves, half‐life or bupivacaine clearance in the three groups studied.
A single dose epidural technique for Caesarean section
Authors: LAISHLEY R. S. , MORGAN B. M.
Published: July 2010

An epidural technique based on a fractionated injection through a Tuohy needle of 20 ml over 10 minutes, was investigated in 40 mothers who underwent elective Caesarean section. Mothers were randomised to receive either 0.5% bupivacaine plain or 0.5% bupivacaine with adrenaline 1:200 000. After a 2‐ml test dose, the remaining 18 ml was injected over 5 minutes. The use of adrenaline did not significantly alter the onset or duration, but improved the efficacy of the epidural block. Mean time to onset of adequate surgical anaesthesia was 20 minutes. Only 10 patients required more than the initial 100 mg of bupivacaine. Epidural anaesthesia was supplemented in eight patients with nitrous oxide and/or intravenous opioids.
A comparison of midazolam and temazepam for premedication of day case patients
Authors: NIGHTINGALE J. J. , NORMAN J.
Published: July 2010

One hundred patients who underwent day case surgery took part in a randomised double‐blind comparison between midazolam 15 mg and temazepam 20 mg orally as premedicants. Postoperative recovery was studied using tests of psychomotor function. Midazolam produced a similar degree of anxiolysis to temazepam and a greater incidence of drowsiness. Recovery was similar after either premedicant and psychomotor function was still depressed 4 hours postoperatively (p < 0.001). Nearly 90% of patients felt that they had benefitted from either premedicant. We conclude that midazolam is a suitable drug for premedication in day case surgery.
AIDS in ICUs: outcome
Authors: Deam R. , Kimberley A. P. S. , Anderson M. , Soni N.
Published: July 2010

The admission of patients with acquired immune deficiency syndrome (AIDS) to intensive care units in the United Kingdom was surveyed in January 1986. Ninety‐three intensive care units completed the questionnaire. Thirty‐two patients had been admitted to 12 units up to that time. Twenty‐five (78%) of these patients had received artificial ventilation of the lungs. The commonest cause of respiratory failure on admission was Pneumocystis carinii pneumonia; this occurred in 27 patients, seven of whom also had pulmonary cytomegalovirus infection. Four patients had Kaposi's sarcoma and three of these patients also had Pneumocystis carinii pneumonia. The overall mortality was 72%; twenty (80%) of the patients who required artificial ventilation, died. Ten patients survived to leave the intensive care unit, but one patient died of respiratory failure prior to discharge home.
Epidural fentanyl and monoamine oxidase inhibitors
Authors: YOUSSEF M. S. , WILKINSON P. A.
Published: July 2010

The successful use of continuous epidural fentanyl infusion to control postoperative pain in a patient treated with monoamine oxidase inhibitors is described. The use of epidural opioids may be a safe technique for the management of such patients.
Use of negative pressure ventilation to facilitate the return of spontaneous ventilation
Authors: SIMONDS A. K. , SAWICKA E. H. , CARROLL N. , BRANTHWAITE M. A.
Published: July 2010

Negative pressure ventilation was used to facilitate the return of spontaneous ventilation in 10 patients with severe, chronic respiratory disability. All patients had required tracheal intubation and intermittent positive pressure ventilation, and conventional weaning techniques had failed. Details of the method are described. It permits extubation before spontaneous ventilation can be sustained indefinitely and thus assists the return of normal speech, sleep pattern and nutrition. The lack of flexible control of ventilatory variables and absence of access to the trachea for sputum clearance limit its widespread application.
Spinal haematoma following epidural analgesia
Authors: GUSTAFSSON H. , RUTBERG H. , BENGTSSON M.
Published: July 2010

A patient who developed an epidural haematoma with multifactorial aetiology (bleeding diathesis, ankylosing spondylitis, chronic alcoholism and acute pancreatitis) after epidural analgesia for pain relief is described. Our conclusion is that adequate laboratory screening of blood coagulation, including platelet count, should be carried out in this category of patient before attempted epidural blockade, the risks of which must be weighed against the benefits. The block should be allowed to wear off intermittently and repeated neurological assessment performed if an epidural catheter is used for repeated injections or for a continuous infusion of local anaesthetic. Neuroradiological examination should be carried out promptly if an epidural haematoma is suspected and surgical decompression performed without delay if the diagnosis is confirmed.
Identification of autonomic dysfunction with a pulse oximeter
Authors: BROOME I. J. , MASON R. A.
Published: July 2010

Chart recordings of the pulse oximeter waveform were taken during the performance of a standard Valsaha manoeuvre, in one subject with and another without autonomic dysfunction. They demonstrate that certain types of pulse oximeter may be used for the rapid pre‐operative identification of patients who have an autonomic neuropathy in which the cardiovascular responses to stress are impaired.
The effect of tracheal intubation and surgical stimulation on median nerve somatosensory evoked potentials during anaesthesia
Authors: SEBEL P. S. , WITHINGTON P. S. , RUTHERFOORD C. F. , MARKHAM K.
Published: July 2010

This study was designed to determine whether alterations in the median nerve somatosensory evoked potentials occur during the stimuli of tracheal intubation and skin incision. Twenty‐two patients scheduled for elective surgery and who required tracheal intubation were studied. Median nerve somatosensory evoked potentials were recorded, analysed and stored approximately every 40 seconds. Anaesthesia was induced with thiopentone and vecuronium used for neuromuscular blockade; the trachea was intubated 2 minutes after induction. Fentanyl 1.5 μ/kg was administered subsequently. Evoked potential monitoring was continued until at least 2 minutes after surgical incision. Induction of anaesthesia was associated with an increase in evoked potential latency of 0.8 msec and reduction in amplitude of 1.7 μV. Small, statistically insignificant changes occurred between induction of anaesthesia and tracheal intubation. Surgical incision was accompanied by a statistically significant mean decrease in evoked potential latency of 0.5 msec and a statistically significant increase in evoked potential amplitude of 0.6 μV. The fact that surgical stimulation produced an activating effect on evoked potentials suggests that they may be used as a measure of the neurophysiological effects of anaesthesia.
A boy with an anterior mediastinal mass
Authors: JOHN R. E. , NARANG V. P. S.
Published: July 2010

A 12‐year‐old boy presented for biopsy of a large mediastinal mass. General anaesthesia precipitated immediate severe airway obstruction. This was overcome by the insertion of two microlaryngeal tubes, one into each main bronchus. The anaesthetic management of patients with an anterior mediastinal mass is discussed and the importance of pre‐operative assessment stressed.
An unexpected functional cause of upper airway obstruction
Authors: MICHELSEN L. G. , VANDERSPEK A. F. L.
Published: July 2010

A case of acute respiratory obstruction in the immediate postoperative period is described in it young woman who emerged front general anaesthesia after a Caesarean section for fetal distress. She had a pregnancy complicated by disabling polyhydramnios and anxiously anticipated the birth of a child with a diaphragmatic hernia, diagnosed antenatally. The cause of the airway obstruction was functional in nature as confirmed by flexible fibreoptic laryngoscopy. The diagnosis, paradoxical vocal cord motion, has to be considered as an infrequent cause of postoperative airway obstruction; its recognition and treatment are discussed. The patient did not have a history which might have indicated its possible occurrence. It is suggested that paradoxical vocal cord movement in a more mild form may be overlooked as cause for postoperative stridor and airway obstruction.
Evaluation of a multigas anaesthetic monitor: the Datex Capnomac
Authors: McPEAK H. , PALAYIWA E. , MADGWICK R. , SYKES M. K.
Published: July 2010

A laboratory investigation was carried out to evaluate the performance of the Datex Capnomac multigas anaesthetic agent analyser, with particular emphasis on accuracy, response and delay times, zero and gain stability and interference from water vapour. The analysis of anaesthetic vapours was less accurate than the analysis of CO2, O2 and N2O, but acceptable for clinical use. The response to square wave changes in gas composition was accurate at frequencies up to 60 per minute for CO2 and 30 per minute for O2, but with N2O and the anaesthetic vapours there was a decrease in accuracy at frequencies above 20 breaths/minute. The instrument appeared to be unaffected by water vapour.
Continuous epidural infusion of 0.075% bupivacaine for pain relief in labour
Authors: HICKS J. A. , JENKINS J. G. , NEWTON M. C. , FINDLEY I. L.
Published: July 2010

Seventy‐three women who requested epidural analgesia during labour were randomly allocated in a prospective study to receive either a continuous epidural infusion of 0.075% bupivacaine at a rate of 12–18 ml/hour (38 mothers) or intermittent top‐ups of 0.5% bupivacaine (35 mothers). Both groups received an initial dose of 6–8 ml bupivacaine 0.5%. Patients were asked to score their pain using a 10‐cm linear scale prior to insertion of the epidural, 30 minutes after its insertion and hourly thereafter. The quality of analgesia in the continuous infusion group was significantly better than in the intermittent top‐up group (p < 0.025). There was no significant difference in the total dose of bupivacaine given to the two groups.
Plasma morphine concentrations after intramuscular injection into the deltoid or gluteal muscles
Authors: KIRKPATRICK T. , HENDERSON P. D. , NIMMO W. S.
Published: July 2010

The absorption of morphine 10 mg after intramuscular injection into the gluteal and deltoid muscles was investigated. Ten patients received the injection into the deltoid and 10 were given the injection into the upper outer quadrant of the buttock. Blood was taken at frequent intervals up to 2 hours after the injection for plasma morphine analysis by high performance liquid chromatography. Morphine concentrations were generally higher in the gluteal group although the mean peak concentrations (62.8 ng/ml in the gluteal group and 52.3 ng/ml in the deltoid group) were similar. Peak morphine concentrations varied from 22.5–99.3 ngjml in the gluteal group and 26.5–84.5 ng/ml in the deltoid group. The area under the concentration‐time curve was significantly greater in the gluteal group than in the deltoid group but this difference disappeared when allowance was made for differences in body weight of the two groups. We conclude that the absorption of morphine from the deltoid and gluteal sites is similar
Adriamycin cardiomyopathy
Authors: McQUILLAN P. J. , MORGAN B. A. , RAMWELL J.
Published: July 2010

The death under general anaesthesia of a child with Adriamycin cardiomyopathy is reported. The acute, subacute and chronic cardiotoxic effects of Adriamycin are discussed and the risk factors for chronic Adriamycin cardiomyopathy presented, with particular reference to cumulative dosage of Adriamycin. The insidious onset of impairment of cardiac function is stressed and suggestions for anaesthetic management outlined.
Ischaemic pain in Buerger's disease
Authors: SADDLER J. M. , CROSSE M. M.
Published: July 2010

A female patient with Buerger's disease developed severe ischaemic pain in her left index finger which was refractory to several therapeutic measures. A silastic catheter inserted in the region of the, median nerve at the elbow was topped up intermittently with local anaesthetic for 6 weeks and effected excellent analgesia. The catheter was removed when the pain had abated, and the finger tip later amputated.
Tracheal tube cuff pressure
Authors: WILLIS B. A. , LATTO I.P. , DYSON A.
Published: July 2010

Seventy‐one adult patients (31 male, 40 female) who presented for surgery underwent orotracheal intubation with Portex Blue Line standard cuff disposable tubes (9‐mm for males, 8‐mm for females). The tracheal tube cuff was inflated by a trained assistant using a syringe and the initial cuff pressure measured; the minimum cuff pressure required to prevent respiratory gas leakage was also measured and the cuff pressure maintained above this pressure throughout the operation by means of the Cardiff Cuff Controller. Initial cuff pressure values averaged 11.9 k Pa for males and 13.5 k Pa for females compared with minimum cuff pressure values of 5.2 and 1.2 k Pa, respectively. The differences between initial and minimum pressures were statistically highly significant (p ≪ 0.001). It is concluded that the present method of inflation may lead to gross overinflation of tracheal tube cuffs and that cuff pressure monitoring may be performed simply by means of an electropneumatic controller. The difference in minimum cuff pressure between males and females suggests that the difference in tracheal size between the sexes is greater than the 9‐mm to 8‐mm difference in tracheal tube size.
Blood flow in the upper limb during brachial plexus anaesthesia
Authors: Cross G. D. , Porter J. M.
Published: July 2010

Changes in finger blood flow, arm blood flow and cardiac output were measured using electrical impedance plethysmography in 20 patients after brachial plexus anaesthesia. The anaesthetic solution used in all patients was 1% lignocaine with adrenaline 1:200 000. Significant increases in cardiac output and blood flow to the unanaesthetised arm were observed immediately after anaesthesia had become effective. A highly significant increase in the blood flow to fingers of the blocked hand was observed throughout the period of anaesthesia but there was no overall increase in the blood flow to the arm. It is suggested that the adrenaline contained in the local anaesthetic solution increased the cardiac output and caused arterial vasoconstriction at the site of injection.
Enhanced brachial plexus blockade. Effect of pain and muscular exercises on the efficiency of brachial plexus blockade
Authors: Okasha A. S. , El‐Attar A. M. , Soliman H. L.
Published: July 2010

Three groups each of 20 patients scheduled to undergo operations on hand or forearm, received supraclavicular brachial plexus blocks with 25 ml lignocaine 1.5%. Patients in the control group did not suffer from pain and were not asked to do muscular exercise. Patients with acute trauma of the upper limb formed the pain group and showed significantly decreased latency for onset of analgesia, partial and complete muscle paralysis. Patients in the muscle exercise group were free of pain and were asked to do muscular exercise for 5 minutes after injection of the lignocaine. Onset of analgesia, partial and complete muscle paralysis was significantly more rapid than in both control and pain groups. Changes in the duration of block were not significant. It is concluded that pain and muscular exercise enhance the onset of brachial plexus blockade.
Training nursing staff in airway management for resuscitation
Authors: MARTIN P. D. , CYNA A. M. , HUNTER W. A. H. , HENRY J. , RAMAYYA G. P.
Published: July 2010

The place of the larvngeal mask in emergency airway management by nonanaesthetists has yet to be established. We have compared the tidal volume achieved by nurses during hand ventilation using standard resuscitation equipment with a facemask, with or without a Guedel airway, and following placement of a laryngeal mask in the same patients. The tidal volumes measured while using the laryngeal mask were significantly greater (p < 0.01) than those measured during facemask ventilation.
Effects of halothane and isoflurane on beta‐endorphin release in children
Authors: GARCIA‐SANCHEZ M. J. , POLO A. , RERAN F.
Published: July 2010

We compared the effects of halothane and isoflurane with 50% nitrous oxide (seven children each) on plasma beta‐endorphin concentrations in a group of 14 children aged 1 to 6 years. The findings were compared for four periods of anaesthesia: basal, induction, maintenance and recovery. Beta‐endorphin release was most increased with isoflurane, especially during the maintenance period. Measurements of haemodynamic parameters (heart rate and blood pressure) showed diastolic blood pressure significantly lower after isoflurane anaesthesia. The findings suggest that the use of isoflurane for paediatric inhaled isoflurane anaesthesia leads to a more marked surgical stress adaptation effect than the use of halothane.
Use of EMLA cream for skin anaesthesia prior to epidural insertion in labour
Authors: Ralston S. J. , Head‐Rapson A. G.
Published: July 2010

The efficacy of the use of EMLA cream to provide skin anaesthesia prior to the insertion of 16 G Tuohy needles was assessed. Sixty women in labour were randomly allocated to receive either EMLA cream over the proposed epidural site for a minimum period of 5 min (mean 9.1 min), a skin bleb and subcutaneous injection oflignocaine 2% (1 ml), or a skin bleb with additional lignocaine 2% (2 ml) infiltrated into the supra and interspinous ligaments using a 23 G needle. Once the epidural catheter was sited, using a standard technique, 10 cm visual analogue pain scales were completed independently by the patient, by a blinded midwife and by the anaesthetist siting the epidural. Patients' perception of pain was not significantly different in any of the three groups, although the mean pain score was least in the group receiving full infiltration. The anaesthetists consistently underestimated the patients' perception of pain.
Neuromuscular effects of rocuronium bromide (Org 9426) during fentanyl and halothane anaesthesia
Authors: COOPER R. A. , MIRAKHUR R. K. , MADDINENI V. R.
Published: July 2010

The neuromuscular effects of intravenous rocuronium bromide, 0.6 mg.kg−1 or 0.9 mg.kg−1, were studied in four groups of 10 patients during anaesthesia with or without halothane (0.5–0.75% inspired concentration). Neuromuscular block was monitored using mechanomyography and train‐of‐four stimulation. The mean times to onset of complete neuromuscular block were 58 and 59 s using the 0.6 mg.kg−1 dose in patients anaesthetised with fentanyl and halothane respectively. The times of 34 min and 33 min for 25% recovery of T1 (first response in the train of four), 54 min and 52 min for 90% recovery of T1, 55 min and 60 min for a train of four ratio of 0.7, and 13 and 13 min respectively for the recovery index (25–75% recovery of T1) were not significantly different in these groups. Complete block with the 0.9 mg.kg−1 dose occurred in 47 s and 44 s respectively in the fentanyl and halothane groups. T1 recovered to 25% in 51 min and 58 min, and to 90% in 77 min and 86 min respectively in the two groups. The recovery indices and the times to spontaneous recovery of the train of four ratio to 0.7 were 17 min and 19 min, and 83 min and 93 min respectively. All the parameters were significantly different between the 0.6 mg.kg−1 and 0.9 mg.kg−1 doses. Halothane in the concentrations used did not influence the neuromuscular effects. It is concluded that rocuronium is a rapidly acting non‐depolarising muscle relaxant with a duration of action similar to that of vecuronium and may be a useful alternative to suxamethonium for rapid tracheal intubation.
Can pre‐emptive lumbar epidural blockade reduce postoperative pain following lower abdominal surgery?
Authors: PRYLE B. J. , VANNER R. G. , ENRIQUEZ N. , REYNOLDS F.
Published: July 2010

In a double‐blind study, 36 patients who received a standard general anaesthetic for abdominal hysterectomy or myomectomy, received either 15 ml of bupivacaine 0.5% with adrenaline by lumbar epidural injection 15 min before surgery (group A) or the same dose at the end of surgery but before waking (group B). Pain was assessed for 24 h by cumulative morphine dose (self‐administered by patient‐controlled analgesia), visual analogue scale and verbal rating score. Patients were included for analysis if they were pain free on waking and for at least 2 h after. There was no significant difference (p > 0.05) between the two groups in morphine dose, visual analogue scale or verbal rating score at 6 and 24 h after waking. As expected, there was a significant difference in the mean time of first use of patient‐controlled analgesia (4.26 h in group A vs 5.06 h in group B, p < 0.05). Consequently, we compared the morphine dose, visual analogue scale and verbal rating score at 23 h in group A with those at 24 h in group B. Again there were no significant differences between the two groups. We were unable to demonstrate that epidural blockade had a significantly better effect on postoperative pain when administered before, rather than after, surgery.
Sumatriptan relieves and prevents peri‐operative migraine attacks
Authors: HANNINGTON‐KIFF J. G.
Published: July 2010

The novel use of sumatriptan as an adjunct to the management of general anaesthesia in patients with a historv of migraine is described. In two unpremedicated patients awaiting day surgery an acute pre‐operative attack of migraine was successfully terminated by the injection of sumatriptan, allowing surgery to proceed uneventfully under general anaesthesia without postoperative complications. Two other patients with a history of severe habitual vomiting after general anaesthesia, who also had a history of migraine, were each given a prophylactic injection of sumatriptan after induction of anaesthesia and for the first time emerged from general anaesthesia free of these distressing complications.
Association of Anaesthetist's checklist for anaesthetic machines
Authors: JACKSON I. J. B. , WILSON R. J. T.
Published: July 2010

Eight experienced anaesthetists performed a ‘cockpit drill’, following instructions in the Association of Anaesthetist's checklist, on an anaesthetic machine that had a significant leak (3 l.min−1 at a pressure of 16 kPa). Only one anaesthetist detected the leak and this was by audible means rather than by any of the protocol's set manoeuvres. We demonstrated that a leak of 3 l.min−1 from the flowmeter block resulted in an inspired oxygen concentration of 6% when the anaesthetic machine was used with a minute volume divider ventilator.
Plasma concentrations of lignocaine after thoracic paravertebral blockade in infants and children
Authors: LÖNNQVIST P.A.
Published: July 2010

Plasma concentrations of lignocaine were determined in six ASA I children treated with thoracic paravertebral blockade. Peak concentrations ranged between 1.7 and 3.0 μg.ml−1 after a bolus injection of lignocaine 0.5 ml.kg−1 (lignocaine 10 mg.ml−1 with adrenaline 5 μg.ml−1) and peak plasma concentrations were reached 15–30 min after injection. Two hours after the initial bolus a continuous infusion of the same lignocaine solution was started (0.25 ml.kg−1.h−1). Steady state levels of lignocaine were reached 8–10 h after the start of the infusion and ranged from 2.1–3.2 μg.ml−1. This regimen for paravertebral block in children resulted in moderate plasma concentrations of lignocaine, well below those which might result in side effects or systemic toxicity.
An ethnic comparison of the sympathetic response to tracheal intubation
Authors: HOUGHTON I. T. , LOW J. M. , LAU J. T. F. , OH T. E.
Published: July 2010

The sympathetic response to orotracheal intubation was examined in five Europeans, 15 Chinese, and seven Nepalese male patients. Plasma adrenaline and noradrenaline concentrations were assayed using high performance liquid chromatography with colometric detection. There was a significant rise in noradrenaline concentrations following intubation in the Chinese and the concentrations decreased over 5 min. Similar increases were seen in the Europeans and Nepalese. The mean plasma catecholamine concentrations were comparable, which suggests that there are no ethnic differences in the groups studied. A wide inter individual variation of catecholamine concentrations was found.
Postoperative bilateral diaphragmatic paralysis and subsequent anaesthesia
Authors: MORGAN R. J.
Published: July 2010

A case is described of a 56‐year‐old man who developed bilateral diaphragmatic paralysis following surgery remote from the course of the phrenic nerves. This rare complication is reviewed and the management of subsequent anaesthesia described.
The intraosseous route for induction of anaesthesia
Authors: SELBY I. R. , JAMES M. R.
Published: July 2010

A 6‐week‐old baby, who had sustained a head injury, resulting in a fractured skull and scalp haematoma, was successfully resuscitated and anaesthetised with colloid, blood, midazolam, suxamethonium and atracurium via the intraosseous route.
Combined continuous spinal‐epidural anaesthesia with a single interspace, double‐catheter technique
Authors: Vercauteren M. P. , Geernaert K. , Vandeput D. M. , Adriaensen H.
Published: July 2010

A double catheter, single interspace combined spinal‐epidural anaesthetic was performed in 12 ASA grade 3 patients. The technique failed in one patient in whom the intrathecal catheter could not be inserted satisfactorily. In another patient, the epidural catheter was accidentally placed intrathecally. The maximum height of the block obtained with hyperbaric lignocaine or bupivacaine was below T10 in all patients and there were no adverse cardiovascular changes. As opposed to a classical combined spinal‐epidural block, this technique is most suitable for very debilitated patients. The advantages are the ability to titrate the intrathecal dose of the local anaesthetic to achieve the desired dermatomal level and to test the correct position of the epidural catheter before injecting drugs intrathecally.
Elderly patients' preferences concerning life‐support treatment
Authors: HEAP M. J. , MUNGLANI R. , KLINCK J. R. , Males A. G.
Published: July 2010

The preferences of 118 elderly patients, aged from 70 to 97 years, concerning the institution of artificial ventilation in the event of an overwhelming illness, were investigated using a questionnaire. Most patients wanted treatment if the outcome was likely to be good, but in approximately half, the desire for treatment declined as anticipated quality of life or chances of recovery fell. Forty percent wanted to make the decision about institution of artificial ventilation themselves if mentally competent and 24% wanted to use some form of advance directive if mentally incompetent.
Respiratory arrest following extradural sufentanil
Authors: STIENSTRA R. , PANNEKOEK B. J. M.
Published: July 2010

A patient is described in whom respiratory arrest occurred 55 min after thoracic extradural administration of 11 ml of a solution containing 25 mg bupivacaine and 50 μg sufentanil.
Concealed Wolff‐Parkinson‐White syndrome detected during spinal anaesthesia
Authors: NISHIKAWA K. , MIZOGUCHI M. , YUKIOKA H. , ASADA A. , FUJIMORI M.
Published: July 2010

We report a case of concealed Wolff‐Parkinson‐White syndrome detected for the first time during spinal anaesthesia in an adult male. Episodes of tachy'arrhythmia with a heart rate of approximately 115 beat.min−1, wide QRS complexes and negative T waves which lasted 30–60 s, but were unassociated with hypotension, occurred three times after spinal anaesthesia. Postoperative Holler ECG monitoring showed the frequent occurrence of supraventricular premature contractions and paroxysmal supraventricular tachycardias with the same electrophysiological characteristics as those noted during spinal anaesthesia. The patient was diagnosed as having concealed Wolff‐Parkinson‐White syndrome. Since this condition is asymptomatic and undetectable by routine pre‐operative screening it is likely that other unsuspected cases will arise. When episodes of tachyarrhythmia occur unexpectedly during anaesthesia, as was the case in this patient, postoperative examination including Holler ECG monitoring will be necessary to determine the nature and severity of the tachyarrhythmia.
A modified sensor for pulse oximetry in children
Authors: HOWELL S. J. , BLOGG C. E. , ASHBY M. W.
Published: July 2010

Pulse oximetry is a powerful tool for patient monitoring but there are practical problems with its application in small children. Standard probes may be too large to be used easily and dedicated paediatric probes may be awkward to apply. The authors describe a modification of the Nellcor ‘Oxiband’ probe which simplifies its use in children. The modified probe was compared in 27 children with the conventional ‘clothes‐peg’ type of device and found to under‐read by 1.5% with 95% confidence intervals of ±3.1%. This is comparable to the error of the ‘Oxiband’ probe in normal use of ±3% over the range of saturations 70–95%. It is concluded that the modified probe may safely be used in clinical practice.
A comparison of epidural diamorphine with intravenous patient‐controlled analgesia using the Baxter infusor following Caesarean section
Authors: Stoddart P. A. , Cooper A. , Russell R. , Reynolds F.
Published: July 2010

In a randomised study of analgesia following Caesarean section, we compared the efficacy and side effects of on‐demand epidural diamorphine 2.5 mg with intravenous patient‐controlled analgesia using diamorphine from the Baxter infusor system. Pain scores fell more rapidly in the epidural group, but by the fourth hour, and thereafter, both techniques had a similar analgesic effect. The patient‐controlled analgesia group used significantly more diamorphine (p < 0.001), median 62 mg (range 18–120 mg) compared to the epidural group, median 10 mg (range 2.5–20 mg), over a significantly longer time period (p < 0.001), median 54.25 h (range 38–68 h) compared to the epidural group, median 40.75 h (range 6–70 h). The frequency and severity of nausea, vomiting and pruritus were similar in the two groups, however the patient‐controlled analgesia group were more sedated during the first postoperative day. This reached statistical significance (p < 0.05) between 9–24 h. Overall satisfaction scores (0–100) were high, but the patient‐controlled analgesia group scored significantly higher: mean 85.5 (SD 12.2) compared to mean 77.0 (SD 11.7) in the epidural group.
The respiratory depressant effect of morphine
Authors: HOUGHTON I. T. , AUN C. S. T. , WONG Y. C. , CHAN K. , LAU J. T. F. , OH T. E.
Published: July 2010

The respiratory response to carbon dioxide was measured in 130 ASA 1 adult male patients from three ethnic groups, European, Nepalese, and Chinese, both before and after premedication with intramuscular morphine sulphate (200 μg.kg‐1 body weight). Satisfactory results were obtained from 125 patients. Overall, there was no ethnic difference in the effect of morphine on the respiratory response to carbon dioxide, but initially the Chinese group appeared to be more sensitive in their response to carbon dioxide than the Europeans and Nepalese. However, there was a significant correlation between respiratory response to carbon dioxide and pulse rate and on restricting analysis to those patients with a pulse rate equal to or less than 72 beat.min‐1, the ethnic difference in carbon dioxide response disappeared. It was concluded that there were no ethnic differences in the respiratory response to carbon dioxide before or after morphine in male Europeans, Nepalese and Chinese but that the respiratory response to carbon dioxide may be influenced by long term physical training.
Neutral head position for placement of internal jugular vein catheters
Authors: WILLEFORD K. L. , REITAN J. A.
Published: July 2010

A new approach to the internal jugular vein is described which keeps the head and neck in the neutral position and uses bony and cartilaginous landmarks for guidelines. Venous puncture is made along an axial line drawn superiorly from the lateral edge of the bony depression caused by the insertion of the sternocleidomastoid muscle on the superior edge of the clavicle. This line, at the level of the cricoid cartilage, lies directly over the internal jugular vein. In 55 patients initially studied, the mean (SEM) number of puncture attempts to locate the vein was 1.4 (0.2) per patient, with an overall success rate of 98%. In 84%, the internal jugular vein was located exactly where predicted, the others were just lateral to the point. The complication rate (all short‐term) was 3.6%. Subsequently the internal jugular vein was cannulated successfully using the developed technique in 20 consecutive trauma patients with suspected cervical instability. An average of 1.2 (0.2) (range 1–3) attempts were made per patient to locate the vein and there were no complications. We propose this technique as a safe and reliable method of gaining central venous access in patients with possible cervical spine injury following trauma.
The intensity of postoperative shivering is unrelated to axillary temperature
Authors: CROSSLEY A. W. A. , MAHAJAN R. P.
Published: July 2010

The relationship between axillary temperature and postoperative shivering was examined in 302 patients who entered one recovery room in the Derbyshire Royal Infirmary over a one‐month period. No relationship was found between temperature and the occurrence of shivering, or between conscious level and the occurrence of shivering.
The relationship between oxygen delivery and uptake in the critically ill: is there a critical or optimal therapeutic value?
Authors: STELTZER H. , HIESMAYR M. , MAYER N. , KRAFFT P. , HAMMERLE A. F.
Published: July 2010

In order to identify a critical or an optimal therapeutic value for oxygen delivery and oxygen uptake, we analysed data from 40 publications concerning the relationship between oxygen delivery and consumption in patients with adult respiratory distress syndrome, trauma or during sepsis, and in nonseptic controls. According to the outcome, the patients were allocated to either group 1 (survivors) or group 2 (nonsurvivors). While oxygen delivery and uptake (mean, SEM) were significantly higher in patients with adult respiratory distress syndrome (636, SEM 31 ml.min‐1.m‐2and 155, SEM 5 ml.min‐1.m‐2), trauma (782, SEM 77 ml.min‐1.m‐2 and 167, SEM 10 ml.min‐1.m‐2) and sepsis (654, SEM 28 ml.min‐1.m‐2 and 163, SEM 5 ml.min‐1.m‐2) than in nonseptic controls (452, SEM 18 ml.min‐1.m‐2 and 126, SEM 3 ml.min‐1.m‐2, p < 0.05), there were no significant differences in these parameters between survivors and nonsurvivors. Although therapeutic manoeuvres were effective in increasing both oxygen delivery and consumption, these improvements were not parallelled by an increase in survival rate. The correlation between oxygen delivery and uptake is generally a result of the use of pooled data and therefore prone to mathematical coupling. This is true particularly for patients with adult respiratory distress syndrome and sepsis. Thus, our study failed to identify either an optimal or a critical value of oxygen delivery or oxygen consumption in critically ill patients.