bluuebunny/crossref_metadata_2025 huggingface dataset:
Abscess following cannulation of the radial artery
Authors: LINDSAY S. L. , KERRIDGE R. , COLLETT B‐J.
Published: February 2007

Local abscess formation, septicaemia and median nerve patsy occurred as complications of radial artery cannulation in a 24‐year‐old man with malaria. The case is described and the nosocomial infection hazard of arterial cannulation is discussed.
Comparison of conventional intermittent positive pressure ventilation with high frequency jet ventilation
Authors: NORMANDALE J. , PATRICK M. , SHERRY K. M. , FENECK R. O.
Published: February 2007

This study was designed to compare the cardiorespiratory effects of high frequency jet ventilation at 150 breaths/minute with and without added positive end expiratory pressure, with conventional intermittent positive pressure ventilation in 20 patients following aortocoronary bypass graft surgery. On comparison with intermittent positive pressure ventilation, there was a decrease in peak airway pressure during high frequency jet ventilation when positive end expiratory pressure of 0 or 0.5 k Pa was applied, but not with 1 k Pa. and an increase in mean airway pressure with positive end expiratory pressures of 0.5 and 1 k Pa. On changing from intermittent positive pressure to high frequency jet ventilation with no added end expiratory pressure, there was an acute decrease in arterial oxygen tension and increases in cardiac output and total tissue oxygen delivery. On changing from intermittent positive pressure ventilation to high frequency jet ventilation with I k Pa of positive end expiratory pressure, there was an acute decrease in arterial oxygen tension, cardiac output and oxygen delivery, and increases in pulmonary arterial, right atrial and pulmonary capillary wedge pressures. The addition of positive end expiratory pressure did not prevent the acute decrease in arterial oxygen tension which occurred on transfer to high frequency jet ventilation.
Intranasal nitroglycerine attenuates pressor response to tracheal intubation in beta‐blocker treated hypertensive patients
Authors: Grover V. K. , Sharma S. , Mahajan R. P. , Singh H.
Published: February 2007

The effect of intranasal nitroglycerine on the pressor response to laryngoscopy and tracheal intubation was studied in 40 adult hypertensive patients treated with beta‐blocking drugs. Nitroglycerine 0.75 mg, administered intranasally 30 seconds before induction of anaesthesia, was compared with a placebo solution of saline. Haemodynamic variables were measured for 10 minutes after laryngoscopy and tracheal intubation. Heart rate did not change significantly in either group. Systolic as well as mean arterial blood pressure increased significantly for the first 5 minutes in the control group, whereas patients in the nitroglycerine group showed a decrease in systolic as well as in mean arterial pressure. No patient in the nitroglycerine group showed a decrease in systolic arterial pressure greater than 20 mmHg. In conclusion, intranasal nitroglycerine ameliorates the pressor response to laryngoscopy and tracheal intubation in beta‐blocked patients.
Anaphylactoid reactions to prilocaine
Authors: RUIZ K. , STEVENS J. D. , TRAIN J. J. A. , WATKINS J.
Published: February 2007

Two cases of severe adverse reaction to prilocaine are presented and the immunological basis of the responses is explored.
Closed‐loop administration of atracurium
Authors: WEBSTER N. R. , COHEN A. T.
Published: February 2007

The advent of newer muscle relaxants with predictable rates of metabolism and times of offset of neuromuscular blockade now makes it possible to use intravenous infusion safely as a mode of delivery. This has many advantages over administration by intermittent bolus. Moreover, it is feasible to use a servo system for their delivery. We have developed and evaluated such a system which is portable and requires little computer expertise to set up and use. It is a useful adjunct to routine anaesthesia, as well as a potentially powerful research tool.
An epidural infusion technique for labour
Authors: Gaylard D.G. , Wilson I.H. , Balmer H.G.R.
Published: February 2007

A regimen to facilitate control of epidural infusions in labour has been developed which allows midwives to alter infusion rates to maintain satisfactory analgesia. The technique was used successfully in 30 patients and, in a prospective study, was compared with women who received conventional top‐up epidurals. It was found that infusions provided comparable analgesia and decreased midwife workload but resulted in a higher dosage of bupivacaine.
Antiemetic studies with traditional Chinese acupuncture
Authors: Ghaly R.G. , Fitzpatrick K.T.J. , Dundee J.W.
Published: February 2007

The application of low frequency (10 Hz) electrical current for 5 minutes to an acupuncture needle placed at the P6 (Neiguan) point is as effective as manual needling in the reduction of emetic sequelae in women premedicated with nalbuphine 10 mg for a minor gynaecological operation carried out under a standard anaesthetic. Both were slightly, but not significantly, better than the antiemetic properties of cyclizine 50 mg.
High frequency ventilation and afferent vagal activity
Authors: HARROP‐GRIFFITHS A.W. , CHAKRABARTI M.K. , WHITWAM J. G.
Published: February 2007

Recordings were made from pulmonary afferent fibres in the vagus nerves of anaesthetised dogs during conventional and high frequency ventilation. In single and multiple fibre preparations, the mean spike counts per minute at 14 breaths/minute were in the ranges 36.9–155.3 and 755–1921, respectively. These counts decreased by up to 61 and 44% respectively at 100 breaths/minute, and by 27–89% and 22–51% at 200 breaths/minute. At this frequency there was a further decrease of between 19 and 65% when the positive end expiratory pressure was removed. The findings of this study are intuitively acceptable, since pulmonary stretch receptor activity is proportional to tidal volume, and are in keeping with the clinical impression that high frequency ventilation per se does not eliminate respiratory drive.
Alfentanil infusions. Comparison of bolus administration of fentanyl with three alfentanil infusion regimens
Authors: Stuart‐Taylor M.E. , Sleigh J.W.
Published: February 2007

Three different dosage regimens of alfentanil were compared with boluses of fentanyl in 80 patients who underwent a variety of surgical procedures. Alfentanil given by infusion at a rate of 7.5 μg/kg/minute for 10 minutes followed by 0.75 μg/kg/minute, was shown to provide a stable anaesthetic which minimises the use of a volatile agent for surgery that lasts more than 45 minutes.
Spinal anaesthesia following facet joint injection
Authors: GOLDSTONE J. C. , PENNANT J. H.
Published: February 2007

Case histories of two patients who developed spinal anaesthesia following facet joint injections are described and the possible mechanisms discussed.
Combined unilateral high frequency jet ventilation and contralateral intermittent positive pressure ventilation
Authors: MORGAN B. A. , PERKS D. , CONACHER I. D. , PAES M. L.
Published: February 2007

The anaesthetic management of a patient who required right lower lobectomy for bronchial carcinoma associated with emphysema, pneumoconiosis and a previous thoracoplasty for pulmonary tuberculosis, is described. A technique of unilateral high frequency jet ventilation plus conventional intermittent positive pressure ventilation to the contralateral lung was used.
Tracheal tubes in neuroanaesthesia. Nylon reinforced latex rubber tracheal tubes *
Authors: P. J. Wright FFARCS Consultant  , Mundy J. V. B.
Published: February 2007

An exercise in quality assurance during neuroanaesthetic procedures identified uncontrolled re‐use of armoured latex rubber tracheal tubes as a risk factor associated with equipment failure. We recommend that such lubes should be used once only. Alternatively, tubes made from more stable materials, such as polyvinyl chloride and silicone rubber, are available for clinical evaluation.
Pre‐eclampsia in a parturient with a history of myocardial infarction
Authors: DAWSON P. J. , ROSS A. W.
Published: February 2007

A mother with pre‐eclamptic toxaemia and severe coronary artery disease was managed with epidural analgesia accompanied by invasive cardiovascular monitoring. Caesarean section was carried out uneventfully using the epidural. The literature is reviewed.
Clinical trial of the Continucath intra‐arterial oxygen monitor
Authors: PFEIFER P. M. , PEARSON D. T. , CLAYTON R. H.
Published: February 2007

An intra‐arterial continuous display oxygen electrode for radial artery cannulation is now available in the UK. Nine catheters were used in patients during and after hypothermic cardiac surgery. Results obtained were compared with those from conventional intermittent blood gas samples. Slow temperature response times negate its use during hypothermic surgery. A good correlation was found during the postoperative period. Indications for its use are discussed.
Low volume, high concentration block of the sciatic nerve
Authors: SMITH B. E. , SIGGINS D.
Published: February 2007

Sciatic nerve block was performed in two groups of patients using a low power peripheral nerve stimulator to aid nerve location. In group A 1% prilocaine with felypressin was used as the local anaesthetic agent in a volume of 0.25 ml/kg body weight. In group B 3% prilocaine with felypressin was used in a volume of 0.08 ml/kg body weight (i.e. equal total drug dosages). Use of the 3% solution resulted in highly significant reductions in the mean latency for analgesia of the nerve block and in the latency and degree of motor block achieved (p < 0.005 in each case). The clinical value of high concentration, low volume nerve block is discussed.
A combined oxygen concentrator and compressed air unit
Authors: EASY W. R. , DOUGLAS G. A. , MERRIFIELD A.J.
Published: February 2007

A prototype combined oxygen concentrator and air compressor is described. Laboratory assessment demonstrated satisfactory oxygen concentrations, flows, pressures and reliability. Its various modes of use in clinical practice are described. It is likely to be a valuable method to provide oxygen for anaesthesia both in remote areas and where nitrous oxide‐free anaesthesia is required, as well as a reliable alternative to commercially produced oxygen for therapeutic purposes.
Some observations of levels of plasma cholinesterase activity within an obstetric population
Authors: WHITTAKER M. , CRAWFORD J. S. , LEWIS M.
Published: February 2007

An account of plasma cholinesterase activity in samples of maternal and cord blood is presented. It is confirmed that plasma exchange markedly reduces the level of activity in maternal blood, and that the level is further reduced during the first 3–4 postnatal days. A particularly marked decrease was found in those cases in which spontaneous mid‐trimester abortion occurred. The level of activity in maternal blood (excluding mothers subjected to plasma exchange) at the time of delivery, was higher than that in cord blood in 61% of cases. In 23% of cases the level of activity was appreciably (0.05 units) higher in cord blood, and two‐thirds of these cord samples contained the E2+ electrophoretic variant of plasma cholinesterase. The mean levels of activity in maternal and cord blood of Rhesus negative patients were significantly lower than those among Rhesus positive patients but there was no such distinction between Rhesus positive and Rhesus negative males and nonpregnant females. We encountered an incidence of 1:228 abnormal phenotypes in a series of 1593 mothers who underwent Caesarean section under a technique of general anaesthesia which included a suxamethonium infusion. However, probably only two of the seven patients would definitely be sensitive when not pregnant.
Postoperative recovery after general anaesthesia with and without retrobulbar block in retinal detachment surgery
Authors: CHUNG F. , WESTERLING D. , CHISHOLM L. D. J. , SQUIRES G. W.
Published: February 2007

This study was to determine whether general anaesthesia plus retrobulbar block would be a better anaesthetic technique than general anaesthesia alone in retinal detachment surgery. Twenty‐eight patients were allocated randomly to either general anaesthesia with retrobulbar block or general anaesthesia alone. The anaesthetist involved was blinded as to whether a retrobulbar block was performed or not. Significantly fewer patients in the general anaesthesia plus block group complained of postoperative pain than patients in the general anaesthesia group (21.4% as compared with 64.3%, p < 0.05). Those who received general anaesthesia plus block recovered significantly more rapidly than those receiving general anaesthesia alone. The time to opening of eyes on command (p < 0.05), telling the correct date of birth (p < 0.01), reaching a full recovery score (p < 0.005) and performing a simple motor task (p < 0.025) was shorter in patients with general anaesthesia plus block. Thus general anaesthesia plus retrobulbar block was superior to general anaesthesia alone in terms of pain and recovery after operation.
The antigravity suit in neurosurgery
Authors: BRODRICK P. M. , INGRAM G. S.
Published: February 2007

The haemodynamic responses associated with inflation of the antigravity suit (G suit, aviation type) to 8.0 kPa were studied in a series of 40 patients who underwent neurosurgical operations in the sitting position. The study showed statistically significant increases in systolic arterial pressure (p < 0.005) and mean central venous pressure (p < 0.001) with inflation of the suit. The systolic arterial and mean central venous pressures remained significantly elevated immediately before deflation of the suit at the end of the operation (p < 0.001 and p < 0.005 respectively). The addition of 0.8–1.0 kPa positive end expiratory pressure during suit inflation was also investigated. A further increase in central venous pressure occurred but this did not achieve statistical significance.
The development of the anaesthetic vaporizer
Authors: ZUCK D.
Published: February 2007

The innovatory features incorporated into A.G. Levy's regulating chloroform inhaler, and their contribution to modern vaporizer design, are examined. Levy may be credited with the important realisation that the gas mixture which leaves the vaporizing chamber is fully saturated at all flow rates; with the concept of the splitting ratio; with appreciation of the importance of the application of Reynolds' researches on laminar and turbulent flow to the design of anaesthetic apparatus; and with the provision of a facility to compensate for changes of temperature in the vaporizing chamber.
Cricoid pressure and the pressor response to tracheal intubation
Authors: Mills P. , Poole T. , Curran J.
Published: February 2007

Forty healthy adults who underwent rapid sequence induction of anaesthesia were allocated randomly to receive either cricoid pressure or its simulation. The anticipated increase in systolic arterial pressure and heart rate after laryngoscopy and tracheal intubation were not altered significantly by the application of cricoid pressure.
Nifedipine and surgical removal of phaeochromocytoma
Authors: Chari P. , Katariya R. N. , Venkataraman R. K. , Trikha A.
Published: February 2007

The management of five patients with phaeochromocytoma undergoing surgical removal is described. Pre‐operative preparation with phenoxybenzamine and nifedipine for 7 days before surgery prevented excessive fluctuations in cardiovascular parameters in the peri‐operative period and resulted in an uneventful recovery.
Effects of beta‐adrenoceptor antagonism on the cardiovascular and catecholamine responses to tracheal intubation
Authors: ACHOLA K. J. , JONES M. J. , MITCHELL R. W. D. , SMITH G.
Published: February 2007

The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation were studied in 20 patients who underwent elective gynaecological surgery and who were allocated randomly to receive either practolol 10 mg or saline intravenously prior to induction of anaesthesia. Anaesthesia was induced with fentanyl and thiopentone; atracurium was administered and the lungs were ventilated artificially with 67% nitrous oxide in oxygen. Tracheal intubation was performed when muscle relaxation was adequate. Arterial pressure, heart rate, plasma noradrenaline and adrenaline concentrations were measured before and after tracheal intubation. A significant increase in catecholamine concentrations occurred in both groups in response to tracheal intubation but the magnitude of the increase in adrenaline was greater in the practolol group. There were no significant differences in arterial pressure or heart rate changes between the groups. We conclude that pretreatment with practolol is of no value in the attenuation of the hypertensive response to direct laryngoscopy and tracheal intubation in previously normotensive patients.
Plasma lignocaine levels during paediatric endoscopy of the upper respiratory tract
Authors: WHITTET H. B. , HAYWARD A. W. , BATTERSBY E.
Published: February 2007

Plasma lignocaine levels were measured at 5, 10 and 15 minutes following local application (4 mg/kg) to the upper airway in children who underwent endoscopy under general anaesthesia. These levels were then correlated with the appearance of the moistness of the airway mucosa secondary to premedication with atropine. This latter assessment was carried out by one anaesthetist who used a predetermined scale of 1–5, where I was very dry and 5 very wet. Significantly higher (p < 0.05) plasma levels of lignocaine were achieved when the mucosa was ‘very dry’ especially in children under 2 years of age. The total dose of lignocaine applied to the upper airway of children should probably be reduced, in the presence of a ‘dry’ mucosa after effective antisialogogue premedication, and especially when less than 2 years of age.
The effect of changes in arm temperature on neuromuscular monitoring in the presence of atracurium blockade
Authors: THORNBERRY E. A. , MAZUMDAR B.
Published: February 2007

This study was designed to investigate the relationship between arm temperature and the degree of blockade as monitored by peripheral nerve stimulation by a comparison of both arms of each patient; one exposed to the environment and the other wrapped to maintain its temperature. The decrease in the temperatures of the exposed arms were significantly more than the wrapped arms. A discrepancy was noted proportional to the temperature difference between the two arms, when the train‐of‐four counts were compared. A recommendation is made to maintain the temperature of the monitored arm above 32°C.
Hypnosis and daycase anaesthesia
Authors: GOLDMANN L. , OGG T. W. , LEVEY A. B.
Published: February 2007

Fifty‐two female patients who underwent gynaecological operations as day cases received either a short pre‐operative hypnotic induction or a brief discussion of equal duration. Hypnotised patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anaesthesia. They were also significantly more relaxed as judged by their visual analogue scores for anxiety. Less than half of the patients were satisfied with their knowledge about the operative procedure even after discussions with the surgeon and anaesthetist. A significant correlation was found between anxiety and perceived knowledge of procedures. The results suggest that pre‐operative hypnosis can provide a quick and effective wav to reduce pre‐operative patient anxiety and anaesthetic requirements for gynaecological daycase surgery.
A comparison of two anaesthetic techniques for daycase arthroscopy
Authors: DICKSON D. M. , PRINGLE H. M. , BAMBER D. B.
Published: February 2007

A randomised, double‐blind study of 100 patients admitted for daycase arthroscopy was undertaken. Fifty patients received alfentanil 500 μg and midazolam 5 mg, and 50 received alfentanil 500 μg alone, in each case 2 minutes before induction of anaesthesia with methohexitone. Anaesthesia was maintained in both groups with nitrous oxide, oxygen and enflurane. Recovery was assessed quantitatively by measuring time to when they awoke and by a comparison of pre‐ and postoperative performance of p‐deletion and postbox tests. Qualitative assessment of recovery and of postoperative pain was also undertaken. Patients completed a questionnaire to record the incidence of any anaesthetic‐related symptoms on the first and second postoperative days. Patients who received midazolam required a reduced dose of methohexitone but their initial recovery time was prolonged significantly. The incidences of anaesthetic‐related side effects and postoperative pain were similar in the two groups and while the questionnaires did not reveal any statistically significant differences in symptoms on the first 2 postoperative days, the results indicated that patients who received a larger induction dose of methohexitone were subjectively drowsier on the first day after operation.
Suxamethonium dosage in electroconvulsive therapy
Authors: KONARZEWSKI W. H. , MILOSAVLJEVIC D. , ROBINSON M. , BANHAM W. , BEALES F.
Published: February 2007

A double‐blind study was conducted in 52 patients who received a total of 180 electroconvulsive therapy treatments. Patients‐were allocated randomly to receive doses of 15 mg, 25 mg or 50 mg of suxamethonium. Those who received suxamethonium 50 mg took significantly longer to breathe again compared with patients who received the lower doses, and were significantly more likely to have a very well modified convulsion than patients who received suxamethonium 15 mg. There were no differences among the groups in the incidences of muscle pains after treatment. We conclude that all three doses were acceptable; however, a dose of 25 mg had practical advantages over 50 mg and theoretical advantages over 15 mg.
Absorption of buccal morphine
Authors: FISHER A. P. , FUNG C. , HANNA M.
Published: February 2007

The absorption of buccal morphine was compared with that of slow‐release morphine sulphate in human volunteers. Morphine concentration was assayed by high pressure liquid chromatography in serum samples obtained at intervals up to 8 hours after administration of morphine 20 mg. Similar mean maximum concentrations were obtained by either route, hut the mean time to maximum concentration was longer after buccal than after enteral administration.
Recovery after single‐breath halothane induction of anaesthesia in daycase patients
Authors: NIGHTINGALE J. J. , STOCK J. G. L. , McKIERNAN E. P. , WILTON N. C. T.
Published: February 2007

A single‐breath technique of inhalational induction of anaesthesia allows intravenous induction agents to be avoided. We have investigated recovery from anaesthesia in 40 daycase patients, using tests of psychomotor function. Patients anaesthetised with inhalational induction awaken earlier than those who receive thiopentone, but not significantly earlier. There were no significant differences in postoperative psychomotor function between patients who received thiopentone and those who had inhalational inductions. Single‐breath halothane, nitrous‐oxide, oxygen induction is an alternative to intravenous induction in cooperative adults, but does not confer significant benefits in terms of recovery.
Cocaine absorption from the nasal mucosa
Authors: BROMLEY L. , HAYWARD A.
Published: February 2007

The absorption of cocaine from the nasal mucosa was measured by serial plasma analysis in patients who received nasal cocaine for routine nasal surgery using the modified Moffett's method. Two groups were compared: one received cocaine alone and one with adrenaline 1:1000 added. Changes in pulse rate and blood pressure were recorded in each group. The group that received intranasal cocaine and adrenaline solution had significantly lower plasma cocaine levels. There was no significant difference in cardiovascular parameters between the two groups.
The effects of injected solution temperature on intravenous regional anaesthesia
Authors: PAUL D. L. , LOGAN M. R. , WILDSMITH J. A. W.
Published: February 2007

Ten healthy volunteers received three standard Bier's blocks. Prilocaine 0.5%, 40 ml was injected at a solution temperature of 0°C. 22°C or 37°C. Recordings were made of sensory block, motor block, intravenous pressure, limb temperature and pain on injection. There were no differences between the three treatments in the rate of development or in the quality of block but there was a significant difference in the comfort of injection. Cold solutions caused most, and warm solutions least discomfort.
Isoflurane for conscious sedation
Authors: RODRIGO M. R. C. , ROSENQUIST J. B.
Published: February 2007

Isoflurane 0.5% in oxygen for conscious sedation was compared with placebo (oxygen) and with an equipotent concentration of nitrous oxide in oxygen, in patients scheduled for surgical removal of bilateral, similarly impacted lower third molars. The majority of patients were sedated with 0.5% isoflurane in oxygen and preferred it to both placebo and nitrous oxide in oxygen. It produced good operating conditions with cooperative patients and had no significant effect on vital signs. There were no significant intra‐ or postoperative adverse effects. Patients were street fit within 10 minutes after the end of the operation.
A drawover Boyle's machine
Authors: SINCLAIR J. R. , WILSON I. H.
Published: February 2007

A standard Boyle International anaesthetic machine was modified to allow operation in either a continuous flow or a drawover mode. This was achieved by fitting a valve in the backbar which allows entrainment of air under drawover conditions. The details of the valve and modification are discussed and an evaluation of the machine in a Central African hospital is presented.
Comparison of propofol and methohexitone anaesthesia for thermocoagulation therapy of trigeminal neuralgia
Authors: KYTTÄ J. , ROSENBERG P. H.
Published: February 2007

Propofol and methohexitone given in equipatent doses were compared for anaesthesia for thermocoagulation of trigeminal rootlets. Thirty‐eight patients received two to six injections of the induction agents in one therapy session. The increase in arterial blood pressure during coagulation was significantly lower in the propofol group. Respiratory problems were encountered more often in those who received methohexitone (7/19 patients) than propofol (2/19 patients). There was a small but significant increase in blood propofol concentrations as well as in methohexitone plasma concentrations after repeated injections. Individual wake‐up times increased to a statistically significant extent in relation to the number of doses of the induction agent but the increases were clinically unimportant (maximal mean change approximately 2 minutes). There were no differences in wake‐up times between the two anaesthetic groups.
Propofol in total intravenous anaesthesia without nitrous oxide
Authors: Steegers P. A. , Foster P. A.
Published: February 2007

Propofol and methohexitone were evaluated as hypnotics in a total intravenous anaesthesia technique without nitrous oxide in 50 patients of ASA grade 1 or 2. Analgesia was provided by a constant alfentanil infusion and the depth of anaesthesia was controlled by varying the infusion rate of propofol or methohexitone. Induction and intubation responses were smooth and moderate in the propofol group and side effects were few. Control of depth of anaesthesia, blood pressure and pulse rate was relatively easy in this group but more difficult and sometimes inadequate in the methohexitone group, in which side effects were more frequent. The mean infusion rate for propofol was 0.12 mg/kg/minute, similar to those found in studies using nitrous oxide without an opioid. Recovery times were short in both groups but those in the propofol group tended to be shorter. Postoperatively 96% of the propofol patients were clear‐headed within 20 minutes, in contrast to only 48% in the methohexitone group.

We conclude that propofol together with alfentanil, both given by a bolus plus infusion technique, provide controllable and satisfactory total intravenous anaesthesia without recourse to nitrous oxide or other inhalational agents. Methohexitone was not as satisfactory as propofol.
An open comparison of propofol and enflurane for prolonged abdominal operations
Authors: Hartung E. , Freye E.
Published: February 2007

Anaesthesia in 15 patients scheduled for prolonged abdominal surgery was induced with hexobarbitone and maintained with nitrous oxide and enflurane, while in a further 15 patients propofol was used for induction and maintenance. Three patients in the latter group required additional fentanyl but cardiovascular responses were, otherwise similar in the two groups. Return of consciousness, response to verbal command, ability to answer questions and adequate spontaneous ventilation was more rapid in the propofol patients. EEG power spectra also returned to baseline more rapidly in the propofol group.
Awake fibreoptic intubation for a rare cause of upper airway obstruction‐an infected laryngocoele
Authors: RASHID J. , WARLTIER B.
Published: February 2007

The anaesthetic management of a patient with an infected laryngocoele is presented. The relevance of this condition to the anaesthetist is discussed.
Emergency resection of phaeochromocytoma presenting with hyperamylasaemia and pulmonary oedema after abdominal trauma
Authors: GREAVES D. J. , BARROW P. M.
Published: February 2007

Phaeochromocytoma may present as an acute emergency with a perplexing variety of symptoms. We report a case in which a tumour of the organ of Zuckerkandl was removed after its unexpected discovery during laparotomy for abdominal trauma. A patient is described in whom a history of abdominal trauma coupled with collapse, pulmonary oedema, raised serum amylase and a positive peritoneal tap for blood, led to laparotomy at which an extramedullary phaeochromocytoma was found unexpectedly. The tumour was successfully resected, but immediate hypotension was life threatening. The inadvisability of resecting a phaeochromocytoma discovered at operation is discussed.
The detection of intra‐operative myocardial ischaemia Preliminary experience with the right‐sided precordial lead
Authors: DE HERT S. G. , DE JONGH R. F. , VAN DEN BOSSCHE A. O. , DEBYRNE P. L. , ADRIAENSEN H. F.
Published: February 2007

The value of monitoring the right precordial lead, V4R, to detect peri‐operative ischaemic events during coronary artery surgery was studied in 60 patients. Thirty‐four patients had only left‐sided coronary disease (Group I). The other 26 patients had both left‐sided occlusive coronary artery disease and significant right‐sided occlusive lesions on coronary angiography (Group 2). Lead sensitivity was estimated, assuming that all ST segment changes were true positive responses. Sensitivity using a single lead was greatest for lead V5 in the two groups (73% for Group I and 69% for Group 2). Sensitivity in Group I for lead II was intermediate (55%), whereas sensitivity for lead V4R was only 9%. In Group 2, on the other hand, lead V4R was 54% sensitive and lead 11 only 31%. The combination of leads V4R and V5 increased the sensitivity to 92% in Group 2, whereas lead II or V5 combined with V4R failed to improve sensitivity in Group 1. The monitoring of lead V4R allowed detection of 23% of the ischaemic episodes in Group 2 that would have passed undetected if only lead II and V5 were monitored. These results demonstrate the value of an additional right precordial lead during coronary artery bypass grafting in patients with right‐sided occlusive disease.
Unilateral subarachnoid anaesthesia
Authors: ARMSTRONG P. J.
Published: February 2007

The development of a unilateral block after subarachnoid anaesthesia is described. Other reported cases are discussed and the anatomy of subarachnoid space summarised.
Postoperative analgesia for haemorrhoidectomy
Authors: PRYN S. J. , CROSSE M. M. , MURISON M. S. C. , McGINN F. P.
Published: February 2007

This study compared the analgesic effectiveness of local infiltration of bupivacaine with caudal extradural bupivacaine in the first 48 hours after haemorrhoidectomy. Surgical and anaesthetic protocol was rigidly standardised. The caudal group had significantly less pain in the first 6 hours after haemorrhoidectomy. and on first bowel opening, when compared to those who received local infiltration of bupivacaine. There was no significant difference between the two groups with respect to further analgesic requirements, complications, time to first bowel action, and duration of hospital stay. The definite advantage of caudal extradural bupivacaine for haemorrhoidectomy must be balanced against the rare but potentially serious complications associated with its use.
Oropharyngeal volumes
Authors: NEWCOMBE G. N. , RUSSELL W. J.
Published: February 2007

The volume of the mouth and pharynx was measured in 20 cadavers and ranged from 25 to 202 ml with a median value of 87 ml, a mean of 90.7 ml and a geometric (logarithmic) mean of 78.3 ml. The volume that encompasses 99% of the normal population is estimated as 215 ml if the assumption of a normal Gaussian distribution is made, or 349 ml if a log‐normal distribution is assumed. Collection containers in suction equipment intended for removing vomit from the pharynx and mouth in adults should have a useable volume of at least 500 ml.
Recovery from anaesthesia in children
Authors: McConachie I. W. , Day A.
Published: February 2007

There are no published comprehensive surveys of paediatric recovery room experience and the incidence of complications. A prospective survey was made of 16 700 consecutive admissions to the recovery room at the Royal Manchester Children's Hospital during the years 1985–1988. The incidence of respiratory complications was low, with laryngospasm 0.85%. The incidence of hypotension was higher than that in adult studies; over 50% of children recorded a decrease in blood pressure in the recovery room of more than 20%, compared to values before operation. The incidence of vomiting in the recovery room was also lower than in comparable adult studies, Certain aspects of recovery room practice changed during the 4 years of the study; these included routine oxygen administration, parents in the recovery room, and our approach to postoperative analgesia. The implications of these changes are discussed.
Comparison of propofol and thiopentone for induction of anaesthesia for elective Caesarean section
Authors: VALTONEN M. , KANTO J. , ROSENBERG P.
Published: February 2007

Propofol 2.5 mg/kg was compared with thiopentone 5 mg/kg as an induction agent for elective Caesarean section. Thirty‐two healthy women with cephalopelvic disproportion were included in an open randomised study. The placental transfer of propofol was also studied in 10 other mothers given a single dose of 2.5 mg/kg. The induction characteristics and haemodynamic response to propofol and thiopentone were similar. Side effects were rare with both agents, but propofol caused more discomfort on injection compared to thiopentone. Recovery times were shorter after propofol as evaluated by time to orientation, recovery scoring after anaesthesia and measurements with the Maddox wing. Rapid placental transfer and significant fetal uptake were detected for propofol. There was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. Propofol appears to be a suitable alternative to thiopentone as an induction agent for anaesthesia in elective Caesarean section.
Suxamethonium—the relation between dose and response
Authors: CRESTNUT R. J. , HEALY T. E. J. , HARPER N. J. N. , FARAGHER E. B.
Published: February 2007

In a study which involved 120 adult patients, the ED95 of suxamethonium was shown to be 0.51 mg/kg, using an electromyographic technique. Marked individual variation in response was noted, for example a dose of 0.3 mg/kg produced a range of blockade from 4%–90%. Body surface area was shown to be more significantly related to blockade than lean body mass or total body weight.
Prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy An assessment of prophylactic epidural blood patching
Authors: Sengupta P. , Bagley G. , Lim M.
Published: February 2007

The prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy was investigated by a controlled clinical trial which compared epidural injection of 10 ml of autologous blood with 10 ml of normal saline immediately after intrathecal injection of local anaesthetic. The incidence of postdural puncture headache was 8.3% in the group that received blood compared with 45% in the group that received saline, a significant reduction (p < 0.01). The incidences of backache and lower limb paraesthesiae were similar in both groups. No serious complications were reported.
Anaphylaxis due to suxamethonium in a 7‐year‐old child: a 14‐year follow‐up with allergy testing
Authors: ASSEM E. S. K. , SYMONS I. E.
Published: February 2007

In 1973 a 7‐year‐old girl had anaphylactic reactions after two general anaesthetics. In‐vitro testing with the leucocyte challenge histamine release test showed a strong response to suxamethonium, and other tests indirectly suggested an allergic mechanism. The conclusion was that this was an allergy to suxamethonium. Further blood was sent for testing against a range of neuromuscular blockers, but the patient was‘lost’ until she re‐appeared 14 years later as an antenatal patient. In‐vitro testing was repeated against suxamethonium and all the available neuromuscular blockers after delivery. The radio‐allergosorbent test for allergen‐specific IgE antibodies was performed on newly collected serum and that which had been stored for 13‐14 years. Skin testing was also performed. The results remain positive and suggest a degree of allergy to all the neuromuscular blockers with the possible exception of vecuronium. The radio‐allergosorbent test was negative in the patient's baby.
Epidural anaesthesia for bilateral inguinal herniorrhaphy in Eisenmenger's syndrome
Authors: SELSBY D. S. , SUGDEN J. C.
Published: February 2007

The successful management of a patient with Eisenmenger's syndrome undergoing bilateral herniorrhaphy is described, and some of the anaesthetic problems associated with this condition are considered. The case is reported because epidural anaesthesia is performed rarely in these patients. The use of subcutaneous heparin, the level of monitoring required, and the value of pulse oximetry are also discussed.
Anaesthesia for patients over 90 years of age. Outcomes after regional and general anaesthetic techniques for two common surgical procedures
Authors: Hosking M. P. , Lobdell C. M. , Warner M. A. , Offord K. P. , Melton L. J.
Published: February 2007

Peri‐operative morbidity and mortality and long term outcome of patients over 90 years of age who underwent either total hip arthroplasty or transurethral prostate resection were studied retrospectively. The outcomes of patients who received regional or general anaesthesia were compared. One hundred and forty‐one patients underwent total hip arthroplasty and 44 patients underwent transurethral prostate resection during the study period (1975‐1985). Overall in‐hospital mortality was 4.9%. Mortality at 30 days was 5.3% in patients who underwent hip arthroplasty during regional anaesthesia, compared with 6.8% in those who received general anaesthesia. Long term survival was similar for these two groups and was longer than projected for age and gender‐matched general population cohorts. The 30‐day mortality rate was 3.2% for patients who underwent prostatic resection under regional anaesthesia; no deaths occurred in the general anaesthesia group. This difference was not statistically significant. Long term survival was similar for patients in both groups and was better than predicted. Anaesthetic technique did not influence short term morbidity and mortality or long term outcome for these procedures.
Confidential professional reports A method of assessing the career progress and prospects of anaesthetic senior house officers
Authors: Jago R. H.
Published: February 2007

A proforma is described which is used at 6‐monthly intervals to assess the professional progress of anaesthetic senior house ofjcers. The administration of a reporting system as part of the career counselling process is outlined, and its potential for determining the future prospects of junior staff is discussed.
Effect of vecuronium on atropine‐induced changes in heart rate
Authors: RIDLEY S. , GAYLARD D. G. , LIM M.
Published: February 2007

The effect of vecuronium on the heart rate response to atropine has been studied by comparing dose‐response relationships in two groups of patients who underwent extracorporeal shock wave lithotripsy. One group received vecuronium (0.1 mg/kg) and the other acted as control. Incremental doses of atropine (1.8, 1.8, 3.6, 7.2 and 14.4 μg/kg) were administered and changes in heart rate recorded. No significant differences were observed between the two groups following each incremental dose of atropine.
Stridor in an adult
Authors: MORTON N. S. , BARR G. W.
Published: February 2007

A 34‐year‐old woman with a recent history of a influenza‐like illness and signs of bronchopneumonia presented with many of the features of acute epiglottitis, a condition which still carries a high mortality in adults. Urgent laryngoscopy and bronchoscopy under inhalational anaesthesia were negative. The results of arterial blood gases, taken when stridor was at its worst, revealed marked hypocapnia and respiratory alkalosis. We conclude that the resultant acute reduction of serum ionised calcium produced stridor as a result of tetany of the vocal cords. Similar cases from the literature and the role of emotional factors in the aetiology are discussed.
Obstructive sleep apnoea
Authors: TIERNEY N.M. , POLLARD B.J. , DORAN B.R.H.
Published: February 2007

A patient with obstructive sleep apnoea is described, who required admission to an intensive care unit on two separate occasions within 2 months. The first admission was after anaesthesia for operation on the upper airway. The second occurred after a relative overdose of an opioid analgesic was administered. The diagnosis, treatment and anaesthetic management of patients with this syndrome are discussed.
Pre‐operative assessment of anxiety and measurement of arterial plasma catecholamine concentrations The effect of oral β‐adrenergic blockade with metoprolol
Authors: Jakobsen C.‐J. , Blom L.
Published: February 2007

A double‐blind study of 40 patients who underwent elective hysterectomy was conducted to evaluate the role of arterial plasma catecholamine concentrations as an objective index of anxiety, and to assess the effect of pre‐operative oral treatment with a beta‐adrenoceptor blocking drug. The patients were premedicated with diazepam and either metoprolol or placebo 2–3 hours before surgery, The effect on anxiety was evaluated by the anaesthetist and by visual analogue scoring by the patients. Using pooled data, a significant decrease in both adrenaline and noradrenaline concentrations was demonstrated after premedication, but no difference was found between the groups. In general, patients were less anxious after premedication, but patients who received metoprolol had greater relief of anxiety (p= 0.0007). A significant change in perceived anxiety was found in patients who received metoprolol, but there was no significant change in the placebo group. The correlation between the observers' assessment and the patients' visual analogue scores was poor, but some correlation was found between the assessed relief of anxiety and the changes in visual analogue score. We could not demonstrate any correlations between anxiety and catecholamine concentrations, between relief of anxiety and changes in catecholamine concentrations, or haemodynamics and catecholamine concentrations.
Termination of paroxysmal supraventricular tachycardia by intravenous adenosine in a child
Authors: CHOW A. E. , NOBLE‐JAMIESON C.
Published: February 2007

A fit 6‐year‐old child developed paroxysmal supraventricular tachycardia at the end of an operation for adenotonsillectomy. Sinus rhythm was rapidly restored with intravenous adenosine.
Carbon dioxide—a survey of its use in anaesthesia in the UK
Authors: Razis P. A.
Published: February 2007

A random postal survey of 1528 anaesthetists in the UK was performed to assess their use of carbon dioxide in anaesthesia and opinion on its safety. Of 1100 replies (72% response rate), 60.9% used it daily and 77.1% would object to its exclusion from future anaesthetic machines. There was no consistent age‐related trend with regard to its use or opinion on its removal. 62.9% of anaesthetists did not regard its presence on the anaesthetic machine as hazardous, but 81.8% agreed that a limit to the maximum flow of carbon dioxide delivered to one litre/minute would improve safety.
Daycase anaesthesia and anxiety A study of anxiety profiles amongst patients attending a Day Bed Unit
Authors: Mackenzie J. W.
Published: February 2007

Two hundred adult patients aged 16–65 years scheduled to undergo operation under general anaesthesia in a Day Bed Unit were assessed for anxiety at the time of booking and on the day of operation. The nature of previous anaesthetic experience was the prime determinant of the anxiety scores obtained at booking. The score at booking was the prime determinant of the score on the day of operation, with previous experience and type of operation as secondary independent factors. Patients scheduled to undergo oral surgery were particularly anxious. Nineteen percent of patients would have liked to have received something to relieve their anxiety.
Comparison of hyperbaric and plain bupivacaine with hyperbaric cinchocaine as spinal anaesthetic agents
Authors: ROBERTS F. L. , BROWN E. C. , DAVIS R. , COUSINS M. J.
Published: February 2007

In a double‐blind study, 90 patients (ASA 1 or 2) received spinal anaesthesia with 2 ml hyperbaric cinchocaine 0.5%, 4 ml hyperbaric bupivacaine 0.5% or 4 ml plain bupivacaine 0.5%. All injections were made in the left lateral position, and the patients turned supine immediately. Hyperbaric bupivacaine produced a significantly faster and a higher dermatomal level of bilateral complete sensory blockade than the other solutions (p < 0.005 for each). The duration of sensory blockade was significantly longer with plain bupivacaine than with either hyperbaric solution (p < 0.0005). The intensity of sensory blockade was significantly greater with both bupivacaine solutions than with hyperbaric cinchocaine (p < 0.05). Onset and intensity of motor blockade were similar with all agents, but motor blockade was of significantly shorter duration with hyperbaric bupivacaine than the other agents (p < 0.0005). Hyperbaric bupivacaine appears to be the best agent for rapid and intense sensory blockade of intermediate duration. Plain bupivacaine is more appropriate if a longer duration of action but a lower height of blockade are required, and has the advantage of less cardiovascular disturbance.
Changes in cardiac output during epidural anaesthesia for Caesarean section
Authors: ROBSON S. , HUNTER S. , BOYS R. , DUNLOP W. , BRYSON M.
Published: February 2007

Serial haemodynamic investigations were performed in 20 women who had epidural anaesthesia before elective Caesarean section. Cardiac output was measured by Doppler and cross‐sectional echocardiography at the aortic valve. Measurements were performed after preloading the circulation with Ringer lactate solution (mean volume 805 ml) and then 10, 20, 30 and 40 minutes after administration of 0.5% bupivacaine. Preloading increased mean stroke volume from 84 to 94 ml and mean cardiac output from 7.01 to 7.70 litres/minute. Relative to basal values, mean arterial pressure decreased in all subjects after administration of bupivacaine (mean –14%, range –1 to –33%). Five subjects were given ephedrine because of hypotension. In three of these subjects hypotension was associated with a marked decrease in cardiac output. No significant changes in arterial blood pressure or cardiac output were demonstrated relative to basal values in the remaining 15 subjects. Ephedrine induced consistent increases in blood pressure and cardiac output.