bluuebunny/crossref_metadata_2025 huggingface dataset:
The Cech filtration and monodromy in log crystalline cohomology
Authors: Grosse-Klönne Elmar
Published: February 2007

For a strictly semistable log scheme

Y
Y

over a perfect field

k
k

of characteristic

p
p

we investigate the canonical Čech spectral sequence

(
C

)
T

(C)_T

abutting the Hyodo-Kato (log crystalline) cohomology

H

c
r
y
s

∗

(
Y

/

T

)

Q

H_{crys}^*(Y/T)_{\mathbb {Q}}

of

Y
Y

and beginning with the log convergent cohomology of its various component intersections

Y
i

Y^i

. We compare the filtration on

H

c
r
y
s

∗

(
Y

/

T

)

Q

H_{crys}^*(Y/T)_{\mathbb {Q}}

arising from

(
C

)
T

(C)_T

with the monodromy operator

N
N

on

H

c
r
y
s

∗

(
Y

/

T

)

Q

H_{crys}^*(Y/T)_{\mathbb {Q}}

. We also express

N
N

through residue maps and study relations with singular cohomology. If

Y
Y

lifts to a proper strictly semistable (formal) scheme

X
X

over a finite totally ramified extension of

W
(
k
)

W(k)

, with generic fibre

X
K

X_K

, we obtain results on how the simplicial structure of

X
K

a
n

X_K^{an}

(as analytic space) is reflected in
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="upper H Subscript d upper R Superscript asterisk Baseline left-parenthesis upper X Subscript upper K Baseline right-parenthesis equals upper H Subscript d upper R Superscript asterisk Baseline left-parenthesis upper X Subscript upper K Superscript a n Baseline right-parenthesis">

H

d
R

∗

(

X
K

)
=

H

d
R

∗

(

X
K

a
n

)

H_{dR}^*(X_K)=H_{dR}^*(X_K^{an})

.
Asymptotic estimates of multi-dimensional stable densities and their applications
Authors: Watanabe Toshiro
Published: February 2007

The relation between the upper and lower asymptotic estimates of the density and the fractal dimensions on the sphere of the spectral measure for a multivariate stable distribution is discussed. In particular, the problem and the conjecture on the asymptotic estimates of multivariate stable densities in the work of Pruitt and Taylor in 1969 are solved. The proper asymptotic orders of the stable densities in the case where the spectral measure is absolutely continuous on the sphere, or discrete with the support being a finite set, or a mixture of such cases are obtained. Those results are applied to the moment of the last exit time from a ball and the Spitzer type limit theorem involving capacity for a multi-dimensional transient stable process.
Anaesthetists and the Common Market
Authors: ZORAB JOHNS M.
Published: February 2007

The Medical Directives of the E.E.C. are now in force. Those relating to basic registration and specialist registration in anaesthesia are considered. Problems arising from the implementation of these Directives are discussed together with their impact on British anaesthetists wishing to work in other E.E.C. States as well as on E.E.C. anaesthetists wishing to work here. Sources of further information are listed in the appendices.
Epidural morphine
Authors: JOHNSTON J.R. , McCAUGHEY W.
Published: February 2007

Epidural injection of morphine 2 mg in 10 ml was used as a method of analgesia in treatment of fractured ribs in six patients. This method was effective and appears to have advantages over the use of bupivacaine, both in terms of duration of action and lack of side effects such as hypotension.
Minaxolone or Althesin supplemented by nitrous oxide
Authors: SEAR J.W. , COOPER G.M. , WILLIAMS N.B. , SIMPSON P.J. , PRYS‐ROBERTS C.
Published: February 2007

Minaxolone citrate, a new water‐soluble steroid intravenous anaesthetic, has been compared with Althesin as an induction agent and subsequently intermittently supplemented by nitrous oxide and oxygen alone for anaesthesia for short surgical procedures. Short term recovery following Minaxolone was significantly slower than after Althesin, but 1 h after the end of anaesthesia, no differences could be detected between the two groups of patients. Minaxolone, given by intravenous increments to supplement nitrous oxide following an induction dose of 0·5 mg/kg, appears to provide satisfactory anaesthesia for short surgical procedures.
Anaesthetic techniques for surgical correction of fractured neck of femur A comparative study of ketamine and relaxant anaesthesia in elderly women
Authors: FFARCS T.H. Spreadbury , Hospital Warwick
Published: February 2007

Ketamine has been compared with ‘relaxant’ anaesthesia in operations for fractured neck of femur in elderly women. Ketamine was found to reduce early mortality principally by a reduction in thromboembolic complications, but at the expense of more unsatisfactory surgical results. It is suggested that the mortality after relaxant anaesthesia for these operations is unacceptable.
Initial experience with Minaxolone
Authors: Punchihewa V. G. , Morgan M. , Lumley Jean , Whitwam J. G.
Published: February 2007

Minaxolone has been used to induce anaesthesia, and in incremental doses to supplement nitrous oxide, in 100 patients undergoing minor surgical procedures. Half the patients received a small dose of fentanyl before induction. Minaxolone proved to be a satisfactory induction agent. The commonest complications were an increase in muscle tone and imoluntary muscle movements, which in some patients occurred in the recovery period: their incidence was reduced by fentanyl. There was a notably low incidence of nausea and romiting.
Alcohol abuse, anaesthesia, and intensive care
Authors: EDWARDS ROGER , MOSHER VAUGHAN B.
Published: February 2007

The biochemistry, pharmaco‐kinetics, and pathophysiology of alcohol and alcoholism are reviewed and approaches to the clinical management of coma, alcohol withdrawal, and anaesthesin are considered.
Anaesthetists and Dutch Elm Disease
Authors: SCOTT PETER V.
Published: February 2007

Undiagnosed tetanus can be a rare cause of acute intestinal obstruction followed by respiratory failure after surgery and general anaesthesia.

The anaesthetist should always read the general practitioner's referring letter (so should the surgeon). Equally, the general practitioner's letter should record normal physiological values for that patient, such as pulse rate and blood pressure.

The current shortage of anaesthetists might partly be related to inadequate exposure of medical students to the specialty.

The anaesthetist's prime task is the relief of pain during surgery: but his contract must allow sufficient time outside the operating theatre for the nurture of diagnostic skills basic to clinical competence and survival of the patient inside the operating theatre.
Epidural analgesia and cardiac output in severe pre‐eclamptics
Authors: Graham Charles , Goldstein Arthur
Published: February 2007

Labour and delivery cardiac output was assessed by thermal dilution in ten severe pre‐eclamptics who received lumbar epidural analgesia. Control cardiac output was 8·8 litres/min which remained statistically unchanged following administration of lumbar epidural analgesia. At birth and delivery of the placenta, there was a moderate increase in cardiac output which increased significantly (28%) by 15 min after delivery of the placenta. Subsequently over the next hour, cardiac output returned toward baseline levels. Mother and fetus were stable throughout and infant Apgar scores were good. These results emphasise that lumbar epidural analgesia has little effect on cardiac output in severe pre‐eclamptics.
Temazepam as a premedicant in minor surgery
Authors: AMARASEKERA KANTHIE
Published: February 2007

Temazepam, a benzodiazepine, hitherto used only as a hypnotic, was studied as a pre‐anaesthetic medication in adult women undergoing minor gynaecological surgery in a dose of 30 mg and compared to 10 mg of diazepam. The sedative effect of temazepam was found to be superior to that of diazepam, using both objective and subjective criteria for assessment. There was also a highly significant degree of patient acceptance of the drug. It is suggested that temazepam is a suitable drug for premedication for minor surgery.
Anaesthesia for transurethral prostatectomy
Authors: McGOWAN S.W. , SMITH GORDON F.N.
Published: February 2007

One hundred and fifty patients who presented for transurethral prostatectomy were randomly allocated to one of three groups for the purpose of anaesthesia. Group A received spinal intradural analgesia, Group B general anaesthesia with spontaneous ventilation and Group C general anaesthesia with controlled ventilation. The comparability of the three groups was established.

There were no significant differences in the corrected blood loss, postoperative morbidity or mortality in the three groups. Dysrhythmias were significantly higher in Group B.

The results support the conclusion that the methods of choice for anaesthesia for transurethral prostatectomy are spinal analgesia or general anaesthesia using muscle relaxants and controlled ventilation. The final decision is a matter of personal preference.
Metabolic indices of pulmonary damage
Authors: CLAREMONT D.J. , BRANTHWAITE M.A.
Published: February 2007

The activity of angiotensin‐converting enzyme was measured in patients undergoing cardiopulmonary bypass and in a control group requiring thoracotomy for pulmonary surgery. The activity of the enzyme was higher in patients with cardiac disease, fell during operations involving cardiopulmonary bypass, but did not change during thoracotomy for pulmonary surgery. Possible reasons for these differences are discussed. The activity of another enzyme, alpha1 anti‐trypsin, did not change during cardiopulmonary bypass and no arteriovenous difference could be detected during or after operation.
Hypotension and myocardial metabolism
Authors: CHAMBERLAIN J.H. , SWAN P.C. , WEDLEY J.R.
Published: February 2007

This study investigated the effect of hypotension produced by nitroprusside or halothane on haemodynamics and myocardial metabolism. It is postulated that halothane might influence the balance of supply and demand of oxygen to the heart more favourably than nitroprusside. The results in six open‐chested dogs do not support this view. Despite the fact that the two drugs lowered the mean arterial pressure by radically different mechanisms, the reduction in demand for oxygen by the heart seemed to be matched by a similar reduction in supply with both drugs. No evidence of anaerobic metabolism or increased a‐v O2 content differences was found. It is concluded that the reduction in mean arterial pressure to these levels by either method is not likely to impair myocardial energetics in healthy hearts with normal coronary anatomy.
Ventilatory support for children with whooping cough
Authors: LEWIS MARGO , BUSH G.H.
Published: February 2007

Twenty‐four patients with pertussis admitted to a paediatric Intensive Care Unit over a period of 42 months are reviewed. It is concluded that pertussis affects the young baby most severely, the majority of the children admitted were under the age of 3 months. Many required long term intubation and pulmonary supportive therapy and the percentage of those admitted to the Intensive Care Unit who have needed mechanical ventilation has steadily increased over the period reviewed from 25 to 71‰. The youngest infant died from overwhelming respiratory infection. The other 23 patients recovered but three children developed neurological complications and their recovery is still being assessed. The importance of maintenance of the immunisation programme is stressed in view of the evidence of the severity of the disease in the very young infant.
The Cape Bristol ventilator
Authors: SCOTT PETER V.
Published: February 2007

The Bromsgrove Conversion has been developed for use on the Cape Bristol series of automatic lung ventilators; it enables the patient to take a spontaneous breath between mandatory mechanical breaths. The conversion will also permit entirely spontaneous breathing and continuously positive airway pressure.
Sedation for ventilation
Authors: Miller‐Jones C.M.H. , Williams J.H.
Published: February 2007

A retrospective survey of the sedation requirements of the last 50 patients needing ventilation in a provincial Intensive Therapy Unit (ITU) showed a wide variation in regimes used.

The results were more random than expected: some patients were given six drugs for control of ventilation. There was greater reliance on pancuronium than anticipated.

Patients' requirements varied greatly, as did each individual's daily requirements.

The need to ensure adequate sedation is emphasised.
ICI 35868 (Diprivan): a new intravenous induction agent
Authors: RUTTER D.V. , MORGAN M. , LUMLEY JEAN , OWEN RUTH
Published: February 2007

ICI 35868 (Diprivan) has been used as an induction agent in patients undergoing minor gynaecological surgery and as the sole anaesthetic agent during bronchoscopy, and its effects were compared with those of methohexitone. The new agent proved to be satisfactory, although induction of anaesthesia was significantly longer than following methohexitone. Complications were similar with both drugs. ICI 35868 deserves full investigation as an intravenous anaesthetic agent.
Prolonged neuromuscular blockade following trimetaphan infusion
Authors: NAKAMURA KUMI , KOIDE MASAHARU , IMANAGA TERUAKI , OGASAWARA HIROKO , TAKAHASHI MAKIKO , YOSHIKAWA MASATO
Published: February 2007

This is a case report with postoperative prolonged neuromuscular blockade of 17 hours duration suspected to be caused by trimetaphan. Inhibitory action of trimetaphan to true cholinesterase (human red cell cholinesterase) was estimated in vitro, and it is concluded that this action is too weak to cause neuromuscular disturbances by acetylcholine excess in clinical doses. Trimetaphan is considered to have a neuromuscular blocking action of a non‐depolarising type.
End‐tidal carbon dioxide during thoracotomy
Authors: HENEGHAN C.P.H. , SCALLAN M.J.H. , BRANTHWAITE M.A.
Published: February 2007

The concentration of carbon dioxide in end‐tidal gas was compared with the tension in arterial or superior vena caval blood during thoracotomy in twelve patients. In six adults requiring pulmonary resection, one‐lung anaesthesia did not change the difference between the two measurements. In six children in whom a systemic to pulmonary arterial anastomosis was being created to improve pulmonary blood flow impaired by cyanotic congenital heart disease, occlusion of the pulmonary artery caused an increase in the blood‐end‐tidal carbon dioxide gradient. This change was particularly marked in two neonates and was of sufficient magnitude to render end‐tidal monitoring unreliable in these circumstances.
An evaluation of a pre‐operative anaesthetic assessment questionnaire
Authors: Pearson R.M.G. , Jago R.H.
Published: February 2007

A total of 400 patients was invited to complete a pre‐operative anaesthetic assessment questionnaire. On analysis 74.3% had undergone a previous general anaesthetic, 60.8% had taken some form of medication in the preceding 6 months, and 53.8% gave a significant medical history. The questionnaire is designed to focus attention on those patients at risk, to allow more efficient use of the time available for the pre‐operative visit, and to provide a permanent record of the patient's medical history relevant to anaesthesia.
Pethidine, metoclopramide and the gastro‐oesophageal sphincter
Authors: HEY V.M.F. , OSTICK D.G. , MAZUMDER J.K. , LORD W.D.
Published: February 2007

The effects of intramuscular pethidine (1·0–3·0 mg/kg) followed by metoclopramide 10 mg intravenously, and those of a combination of pethidine 1·5 mg/kg and metoclopramide 10 mg given intramuscularly, on the lower oesophageal sphinct pressure have been studied manometrically in human volunteers. In the former group, the mean effect of all the doses of pethidine was a reduction of the lower oesophageal barrier pressure by 6·8 cm H2O from control values (p < 0·0002), while the intravenous administration of metoclopramide resulted in a mean increase in barrier pressure of 8·75 cmH2O above the depressed level (p < 0·0001). Following the combination of pethidine and metoclopramide given intramuscularly depression of the sphincter pressure was not totally prevented, but there was a reduction in its incidence and severity.

It is suggested that pethidine is likely to increase the possibility of gastro‐oesophageal reflux, and that metoclopramide is a useful adjunct in the prevention of reflux in preparation for, and after, surgery in patients who have been given pethidine for pain relief.
Halothane uptake and nitrous oxide concentration
Authors: Tunstall M.E. , HAWKSWORTH GABRIELLE M.
Published: February 2007

The effect on halothane uptake of changing the nitrous oxide concentration during the first few minutes of a general anaesthetic for Caesarean section was investigated. In 10 mothers Anaesthesia was maintained with halothane 0·4%, nitrous oxide 33% and oxygen 66%. In 10 others the sole difference in onaesthetic technique was that the ratio of nitrous oxide to oxygen was reversed for the first 3 minutes only. Serial maternal arterial blood samples showed a significant increase in halothane levels in the group where the nitrous oxide was increased, with p < 0·02 at 1 and 2 minutes and p < 0·05 at 3, 4 and 5 minutes. After 5 minutes there was no significant difference between the two groups. Cord blood concentrations between the two groups were comparable. The difference in halothane levels is a demonstration of the influence of the concentration effect of nitrous oxide on the uptake of halothane, the second gas effect. The relevance of anaesthetic uptake to obstetric Anaesthesia and awareness is discussed.
Renal transplantation in diabetes mellitus
Authors: CHARTERS P.
Published: February 2007

Renal failure is common in patients with diabetes mellitus, and renal transplantation has been used in its treatment. There are indications that the operation may be hazardous in these circumstances, and a report is presented in which careful biochemical monitoring of a diabetic patient undergoing transplantation revealed two episodes of hyperkalaemia which might go some way to explain the hazards of this operation.

The relevance of the concept of glucose‐induced hyperkalaemia is discussed and it is suggested that intravenous infusion of insulin during and after operation might have decreased the rises in serum potassium. The report emphasises the need for careful biochemical monitoring of diabetics undergoing renal transplantation.
The prevention of pain on injection
Authors: MILLAR JEAN M. , BARR A. MARSHALL
Published: February 2007

The effect ofpre‐injection of lignocaine 10 mg or physiological saline was assessed in a double blind trial on 100 unpremedicated day cases having a methohexitone induction. The incidence of pain was reduced from 64% to 22% using lignocaine.
Termination of cardiopulmonary bypass facilitated by insulin
Authors: JONES R.M. , KNIGHT PAUL R. , HILL ANNE B. , NAHRWOLD MICHAEL L. , KIRSH MARVIN M.
Published: February 2007

A 61‐year old woman with severe coronary artery disease underwent three‐vessel coronary bypass surgery. Difficulty was encountered in terminating cardiopulmonary bypass, but there was dramatic improvement following the administration of intravenous insulin. The use of insulin to facilitate termination of cardiopulmonary bypass is discussed.
The Hospital Calculair
Authors: KNIGHT R.J.
Published: February 2007

A compact portable electronic spirometer was tested in the laboratory and on patients with respiratory disease. The results suggest that the instrument could find a place in the monitoring of respiratory function.
Teaching the uptake and distribution of halothane
Authors: HEFFERNAN P. B. , GIBBS J. M. , McKINNON A. E.
Published: February 2007

A computer aided learning program for teaching the kinetics of uptake and distribution of the inhalational anaesthetic halothane is described. The program is based on a seven‐compartment model which simulates the action of halothane on ventilation and on the cardiovascular system. The program is available to the student in four forms: one with no changes in circulation or respiration, one with the cardiovascular effects of halothane included, one with respiratory effects only, and one with both of these effects combined. The student can study the importance of the influence of halothane on respiration and blood circulation by comparing results from simulations on different models. The simulation is presented as graphs which are continuously displayed on an alphanumeric visual display terminal. Interaction with the program is possible at all times to change the simulation speed, the variables being graphed, the inspired halothane fraction, and the fresh gas flow.
Editorial
Authors: Eliot Thomas Stearns , Wilson M. E.
Published: February 2007

Or when, under ether, the mind is conscious but conscious of nothing—…

…Or barbituric acids, or dissect

The recurrent image into preconscious terrors—

To explore the womb, or tomb, or dreams; all these are usual

Pastimes and drugs, and features of the press:…
A pilot study of the changes of skin electrical conductance in patients undergoing general anaesthesia and surgery
Authors: GODDARD G. F.
Published: February 2007

Changes of skin electrical conductance have been monitored from induction of anaesthesia to recovery in two groups of patients. The first group receiving inhalational anaesthesia with halothane and spontaneous respiration demonstrated no changes in response to surgical stimulus. Some patients from the second group receiving muscle relaxation and ventilation with nitrous oxide and oxygen without halothane demonstrated changes in response to surgery. The changes are mediated by the sympathetic nervous system and the technique forms a simple monitor of sympathetic activity during surgery.
Plasma noradrenaline levels during labour
Authors: FALCONER A. D. , POWLES A. B.
Published: February 2007

Plasma noradrenaline was assayed during augmented labour in nine patients receiving elective lumbar epidural blockade and in 11 patients using other forms of pain relief. Similar noradrenaline levels were seen in each group before induction of labour (epidural subjects 1.28; SEM 0.45 nmol/litre and nonepidural subjects 1.53; SEM 0.44 nmol/litre). At the onset of the second stage of labour the non‐epidural patients showed a significant rise in plasma noradrenaline to 2.91; SEM 0.56 nmol/litre (p < 0.01). The rise to 1.88; SEM 0.55 nmol/litre in the epidural group was not significant. Elective lumbar epidural block may influence plasma noradrenaline during labour.
A laboratory investigation of a multigas monitor for anaesthesia (EMMA)
Authors: KAY B. , COHEN A. T. , WHEELER M. F.
Published: February 2007

A new volatile anaesthetic gas analyser (EMMA) was tested in the laboratory, It was shown to have an accurate, linear response, with minimal zero drift and to be almost unaffected by carrier gases. It is a versatile and sensitive machine with a fast response time indicating that it might be used for breath‐by‐breath monitoring.

The EMMA is a useful new anaesthetic gas analyser that should find widespread clinical usage.
Translumbar amputation
Authors: ELLIOTT P. , ALEXANDER J. P.
Published: February 2007

A case of translumbar amputation for giant cell tumour of the sacrum is reported. Anaesthetic management and postoperative problems are discussed and the literature is reviewed.
A new anaesthetic record
Authors: LUNN J. N. , VICKERS M. D.
Published: February 2007

Record‐keeping is part of the proper practice of anaesthesia and a record should be able to be quickly and easily completed. Two types of information need to be recorded: clinical, for use both immediately or subsequently and epidemiological, for detailed study of a large number of anaesthetics. A design which answers both these aims is described.
Prevention of accidents associated with air‐oxygen mixers
Authors: KARMANN U. , ROTH F.
Published: February 2007

Some time ago three patients were threatened by severe hypoxia. They did not demonstrate any adverse late effects, though the situation could as well have brought a fatal outcome. The incidents were related to the use of an oxygen‐air mixing device. As this apparatus is widely used it is worthy of comment regarding its potential danger.
Editorial
Authors: Wordsworth W. , Gilbertson A.A.
Published: February 2007

And now I see with eye serene

The very pulse of the machine;

A Being breathing thoughtful breath,

A Traveller between life and death
Acute cardiovascular changes following disoprofol
Authors: AL‐KHUDHAIRI D. , GORDON G. , MORGAN M. , WHITWAM J. G.
Published: February 2007

The acute cardiovascular changes following induction of anaesthesia with disoprofol 2 mg/kg have been studied in eight heavily premedicated patients with coronary artery disease. There was a significant increase in heart rate (+ 19%) and significant falls in mean arterial blood pressure (− 23%), peripheral vascular resistance (− 19%) and stroke volume (− 26%). Cardiac output did not change significantly. The extent and pattern of these changes are very similar to those seen after other intravenous induction agents.
Ventilation at high respiratory frequencies
Authors: SMITH R. B.
Published: February 2007

This paper reviews the development of different methods of ventilation at respiratory rates higher than 60 per minute (1 Hz) along with data on experimental and clinical uses of the techniques. The definitions and terms that have been used for these high rates at the present time are confusing. An attempt to clarify the terms has been made. Whereas high frequency positive pressure ventilation (HFPPV) refers to respiratory rates between 60–110 per minute (1–1.8 Hz), high frequency jet ventilation (HFJV) usually refers to rates between 110–400 per minute (1.8–6.7 Hz) and high frequency oscillation (HFO) refers to rates above 400 and up to 2400 per minute (40 Hz). It should be recognised that this differentiation in terminology is rather arbitrary and does not necessarily represent a sudden switch to different physiological methods of ventilation.

In view of the various techniques which are involved in ventilation methods utilising rates greater than 60 per minute (1 Hz), it is the purpose of the present work to review the literature. In so doing, the contrasting rates, mechanical equipment, and experimental and clinical uses of these different methods will be discussed in order to clarify their potential contribution to clinical medicine.
Spinal cord injuries
Authors: FRASER A. , EDMONDS‐SEAL J.
Published: February 2007

The major problems of spinal cord injuries which may involve an anaesthetist are described. The mechanisms of injury, the results and pathophysiology together with some aspects of management are reviewed.
The sick sinus syndrome
Authors: BURT D. E. R.
Published: February 2007

An unusual presentation of the sick sinus syndrome is cardiac arrest occurring during anaesthesia. A case report is presented and features and management of the condition are discussed.
The anaesthetists and distinction awards
Authors: LODER R. E.
Published: February 2007

The author retired from active practice as a consultant anaesthetist in the british National Health Service during 1980 at the age of 60. He kept a detailed diary for the last full year as a consultant. One of the editors suggested that the diary, augmented by his considered views culled from the experiences of a professional lifetime, could form the basis of a series of essays on various aspects of the life and practice a, a consultant anaesthetist during the second half of the twentieth century. This essay considers the history and me cranks of the distribution of distinction awards in the British National Health Service as it has affected anaesthetists.
Intensive care after fresh water immersion accidents in children
Authors: PFENNINGER J. , SUTTER M.
Published: February 2007

Six children who remained in deep coma after immersion accidents in fresh water received therapy to maintain normal intracranial pressure (ICP). This involved controlled ventilation to ensure hypocapnia and hyperoxaemia, maintenance of low normothermia, fluid restriction, dexamethasone (1–1.5 mg/kg initially, 1–1.5 mg/kg/day as maintenance) and barbiturates (phenoharbitone and thiopentone). The latter were given in a wide range of dosage. Increased ICP was common to all patients, but could always be kept at acceptable levels. All patients suffered from pulmonary oedema; three developed bronchopneumonia and two developed adult respiratory distress syndrome. All children survived with good recovery, two needed active rehabilitation for several months.
Recovery from intravenous anaesthesia
Authors: BAHAR M. , DUNDEE J. W. , O'NEILL M. P. , BRIGGS L. P. , MOORE J. , MERRETT J. D.
Published: February 2007

Using the endpoints of spontaneous opening of eyes, giving date of birth, sitting up unaided and normal pegboard time, recovery from 2 and 3 mg/kg disoprofol was compared with that from 4 and 6 mg/kg thiopentone and 1.5 mg/kg methohexitone in groups each of 10 unpremedicated patients. The study method differentiated between recovery from the two doses of disoprofol and thiopentone at the first two endpoints only. A between‐drug comparison showed early recovery was slightly faster with thiopentone than with equivalent doses of the new drug while no differences were detected between the recovery from equivalent doses of methohexitone and thiopentone. The differences found in this study are felt to be of no clinical significance and recovery from anaesthesia with disoprofol would not be expected to be any slower than that from equivalent doses of thiopentone.
Caudal analgesia in children
Authors: McGOWN R. G.
Published: February 2007

The author's first 500 caudal anaesthetics in children up to the age of 10 years are reviewed. Emphasis is laid upon sedation, both by premedication and by the anaesthetic technique. Nearly all the children were anaesthetised briefly for the sacral injection. Despite high levels of blockade, cardiovascular stability was well maintained, particularly in the younger children. There was a good correlation between volume of injection per unit of body weight and level of blockade. Dosage can be calculated on this basis for operations on the perineum, lower limb and groin with 97 to 98% confidence. The volume of solution appeared to be more important than its concentration in determining extent of blockade.
A rare intra‐operative complication in a child with Von Recklinghausen's neurofibromatosis
Authors: VAN AKEN H. , SCHERER R. , LAWIN P.
Published: February 2007

A case of a boy with neurofibromatosis including unsuspected cerebral involvement and subsequent development of severe neurogenic pulmonary oedema during surgery in the prone position is reported. The importance of careful positioning is emphasised.
Airflow obstruction after smoke inhalation
Authors: COOKE N. T. , COBLEY A. J. , ARMSTRONG R. F.
Published: February 2007

A case of persisting airflow obstruction following the acute effects of smoke inhalation injury is reported. Despite severe persistent abnormalities of pulmonary function the patient complained of no major disability. Serial pulmonary function tests should be performed after smoke inhalation injury as residual lung damage may have been underestimated.
Failure of a Fluotec Mk II
Authors: LEIMAN B. C. , KAPLAN S.
Published: February 2007

The sump of a Fluotec Mk II vaporiser separated from the upper portion of the vaporiser during an anaesthetic, and fell off. The danger to the patient is discussed, as well as the possible causes for this occurrence.
High frequency venturi jet ventilation
Authors: DAVEY A. J. , LAY G. R. , LEIGH J. M.
Published: February 2007

A tracheal tube with a facility for delivering a jet of gas near its tip (Portex Profile tube incorporating gas delivery line) has been used in high frequency jet ventilation. It appears to be more efficient at pulmonary gas exchange than the system using a short catheter jet placed co‐axially in the tracheal tube. It also provides a facility for tracheal toilet without interruption of ventilation.
Pre‐operative ranitidine
Authors: MAILE C. J. D. , FRANCIS R. N.
Published: February 2007

Ninety‐four patients undergoing elective surgery received ranitidine 100 mg or 50 mg intravenously one hour pre‐operatively, or acted as controls. A gastric aspirate pH in excess of 2.5 one to two hours after administration was achieved in 93% of patients given 100 mg. 88% of those given 50 mg, and 61%, of controls. There were no significant differences in the volumes of gastric aspirate.
Surgical emphysema resulting from a ventilator malfunction
Authors: HILTON P. J. , CLEMENT J. A.
Published: February 2007

A case of surgical emphysema, associated with pneumothorax, mediastinal emphysema and pneumoperitoneum, resulting from a ventilator malfunction, is described. Several recommendations are suggested to prevent this mishap.
Exsanguination in a Jehovah's Witness
Authors: HARRIS T. J. B. , PARIKH N. R. , RAO Y. K. , OLIVER R. H. P.
Published: February 2007

A case is reported in which death occurred after a patient's adamant refusal to accept blood transfusion, despite prompt control of blood loss. The management of this situation is discussed. Reconstitution of the circulating volume was followed by survival for 2 hours after surgery. The haemoglobin level fell to 1.8g/dl.
Changes in body heat during transvesical prostatectomy
Authors: JENKINS J. , FOX J. , SHARWOOD‐SMITH G.
Published: February 2007

The superficial and deep body temperatures of 15 patients were measured before, during and for 6 hours after transvesical prostatectomy. The patients were divided randomly into two groups who received either a standard general anaesthetic or epidural analgesia. Total body heat and mean body temperature fell more rapidly in the epidural group, reaching statistical significance in the early postoperative period. Both groups showed a net heat gain 6 hours postoperatively. One patient in each group became hypothermic (core temperature <35°C). Warming of both intravenous and bladder irrigation fluids to body temperature is recommended for patients receiving epidural or general anaesthesia.
Long‐term tracheal intubation practice in the United Kingdom
Authors: Pippin Lynne K. , Short D. H. , Bowes J. B.
Published: February 2007

A questionnaire was circulated to members of the Intensive Care Society and hospitals with more than 120 acute beds in the United Kingdom. The object was to determine the usage of the various types of cuffs on tracheal tubes and the practice of long‐term tracheal intubation in contrast to tracheostomy. One hundred and fifty two replies were received (a 55% response rate). The majority of units favoured the high volume cuff for long term ventilation (61% for tracheal tubes and 69.2% for tracheostomy tubes). The cuffs were mainly inflated to ‘no‐leak' ventilation and pressure was not measured. The majority of units changed from tracheal lubes to tracheostomy after about one week but, for children, a longer period of tracheal intubation is employed. The results are discussed.
Plasma cholinesterase and trophoblastic disease
Authors: DAVIES J. M. , CARMICHAEL D. , DYMOND C.
Published: February 2007

A case of prolonged action of suxamethonium in a patient with gestational trophoblastic disease is reported. Postoperatively the patient was found to have markedly reduced plasma cholinesterase activity (363 IU/litre) with a normal cholinesterase phenotype. Consequently plasma cholinesterase activity and phenotype were measured in six other patients with the condition and these results compared with those of 22 patients with normal first trimester pregnancies undergoing therapeutic abortion. Plasma cholinesterase phenotype was normal in all patients studied. The activity was significantly decreased (p < 0.05) from the normal range (620–1370 lU/litre) in all patients with trophoblastic disease. In the 22 patients with normal pregnancies, 14 had activity values in the abnormal range (< 620 IU/litre) while the mean cholinesterase activity of the group as a whole was significantly decreased (561.8 IU/litre, p < 0.05) below the normal range. These results confirm the presence of a decrease in plasma cholinesterase activity in early pregnancy and provide new evidence for a decrease in activity in a pseudopregnancy state.
The effect of age on recovery
Authors: SEAR J. W. , COOPER G. M. , KUMAR V.
Published: February 2007

Eighty unpremedicated patients undergoing dilatation and curettage were randomly allocated to receive induction of anaesthesia with either Althesin or thiopentone prior to maintenance with nitrous oxide, oxygen and halothane. Patients in each group were divided into those under 50 years (‘young’) or over SO years (‘old’). Recovery was assessed by the time taken to opening their eyes, to give correct date of birth and to achieve their baseline ability of manipulative skill with a children's post box toy. There was no difference in the time taken to open eyes or give correct birth date whether the patients received Althesin or thiopentone, or whether they were ‘young’ or ‘old’. An age‐related difference emerged with the post box test inpatients who had received thiopentone, the older patients recovery time being increased from 28.5 minutes to 45.1 minutes. There was no difference between the old and young patients who received Althesin in the time taken to complete the post box test.
Cardiac dysrhythmia associated with general anaesthesia for oral surgery
Authors: HANNA M. H. , HEAP D. G. , KIMBERLEY A. P. S.
Published: February 2007

Ninety patients, divided randomly into three groups, received either no metoprolol, 50 mg or 100 mg metoprolol as an oral premedication. The electrocardiogram was monitored throughout the procedure. It was found that both doses of metoprolol significantly reduced the incidence of cardiac dysrhythmia.
Narcotic antagonism by naloxone
Authors: MAGNUSSON J. , WERNER O. , CARLSSON C. , PETTERSSON K. I.
Published: February 2007

Twenty patients undergoing microlaryngoscopy were anaesthetised with thiopentone and nitrous oxide. Half of the patients received 1.0–1.5 mg of fentanyl during anaesthesia, the effect of which was antagonised by naloxone 0.4 mg intravenously and 0.4 mg subcutaneously. The other patients served as controls and received saline instead of fentanyl and naloxone. Fentanyl markedly reduced mean arterial pressure and the heart rate‐systolic arterial pressure product during microlaryngoscopy. Conversely, there were significant increases in these measurements after naloxone had been given. However, there were no significant differences between patients given fentanyl with naloxone, and those given saline, in respect of arterial pressure, heart rate or dysrhythmia during recovery. No patient vomited, or appeared nauseated when observed afterwards in the operating room. One patient vomited several hours after naloxone.
Pneumoretroperitoneum
Authors: HILLMAN K. M.
Published: February 2007

Pneumoretroperitoneum is rare, but sometimes seen in association with pneumoperitoneum as a result of barotrauma to the lungs. However, there have only been two previous cases of pneumoretroperitoneum without pneunoperitoneum following barotrauma. This case discusses several of the possible mechanisms by which this could occur and what associated signs, especially on chest X‐ray, one should look for to confirm the aetiology of gas in the retroperitoneal space.
Subdural haematoma and spinal anaesthesia
Authors: JONSSON L. O. , EINARSSON P. , OLSSON G. L.
Published: February 2007

A case report of an intracranial subdural haematoma following spinal anaesthesia in a 63‐year‐old man is presented. The pathophysiology of this possible complication seems similar to that of post‐spinal headache. A survey of patients in this hospital failed to reveal any likely case of subdural haematoma as a complication of spinal anaesthesia in almost 24000 anaesthetics.
Sequential use of thiopentone and etomidate in anaesthesia for termination of pregnancy
Authors: Cundy J.M. , Scott Wendy E.
Published: February 2007

A study has been undertaken of a combined thiopentone‐etomidate sequence of anaesthesia for termination of pregnancy. The side‐effects of pain on injection and abnormal movements have been minimised by the technique. The pattern of recovery is satisfactory but the optimum dosage of thiopentone requires further study.
Peer modelling and paediatric anaesthesia
Authors: Hain W.R.
Published: February 2007

The use of filmed peer modelling as a means of reducing pre‐operative anxiety in children awaiting surgery is discussed. The potential benefits are listed. The author's involvement and experience in developing an appropriate videotape is described. Although some benefits are already apparent there are aspects of using this technique which require further investigation.
Epidural analgesia and anticoagulant therapy
Authors: ODOOM J. A. , SIH I. L.
Published: February 2007

One thousand lumbar epidural blocks in 950 patients undergoing vascular surgery are reported. All patients were receiving oral anticoagulants pre‐operatively. Mean thrombotest (TT) was 19.3% (normal range 70–130%). During surgery intravascular heparin was administered. At the end of surgery, the kaolin cephalin clotting time (KCCT) was 68 (±0.8) seconds (normal range 35–60 seconds), and partial thromboplastin time (PTT) was 536 (77.9%, normal control of 100%). Despite the anticoagulant therapy, no side effects were observed in any patient which could be related to haemorrhage or haematoma formation in the epidural space. It is concluded that, provided adequate precautions are taken, epidural analgesia can be safely used in patients receiving anticoagulant therapy.
Alfentanil and recovery
Authors: SINCLAIR M. E. , COOPER G. M.
Published: February 2007

Forty patients were given alfentanil 8 μg/kg as a supplement to either methohexitone or Althesin anaesthesia. Satisfactory anaesthesia and recovery were seen in all patients. Testing revealed very rapid recovery of psychomotor function. There were no differences between the two groups.
The application of cricoid pressure
Authors: HOWELLS T. H. , CHAMNEY ANNE R. , WRAIGHT W. J. , SIMONS R. S.
Published: February 2007

A simple test rig was developed to assess the force applied during the application of cricoid pressure. Anaesthetists and paramedical personnel familiar with Sellick's manoeuvre were tested yielding results which indicate an unacceptably wide variation in performance in each group. The mean force was 46.4 N but 47% failed to reach a force of 44 N.

In addition a survey was undertaken of trained anaesthetic staff to identify the current status of the manoeuvre. Of those sampled 78% routinely employed Sellick s manoeuvre and over 70% had experienced a problem with its application which exposed the patient to the risk of regurgitation.
Midazolam versus atropine plus pethidine as premedication in children
Authors: SJÖVALL S. , KANTO J. , IISALO E. , HIMBERG J.‐J. , KANGAS L.
Published: February 2007

The effects of oral midazolam or intramuscular atropine and pethidine used as premedication in two groups of 35 children over 5 years of age were studied. There was some evidence that the anxiolytic effect of midazolam was rather better than that of atropine plus pethidine, but, in other respects, subjective assessments in the two patient groups were similar. Intramuscular atropine caused tachycardia and subjective side‐effects, nevertheless children appear to require anticholinergics during premedication because of excessive salivary secretion, especially during extubation. Oral midazolam is a new anxiolytic drug which can be used as an alternative to existing premedicant drugs, but, in children, it should still be combined with an anticholinergic agent. No correlation between serum levels of midazolam or atropine and their clinical effects was found.
The use of atracurium besylate for laparoscopy
Authors: Sleigh J.W. , Matheson K.H. , Boys J. E.
Published: February 2007

An anaesthetic technique is described for laparoscopy using an intravenous induction, atracurium 0.2 mg/kg for muscle relaxation and intermittent positive pressure ventilation of the lungs with nitrous oxide and oxygen. It was found to be a suitable and simple technique. Recovery of spontaneous ventilation was achieved without the use of reversal agents in all 40 patients. A 15% incidence of cutaneous histaminoid reactions was noted. This is no higher than reported in other studies of atracurium, and further clinical trials are awaited.
Non‐parenteral postoperative analgesia
Authors: DERBYSHIRE D. R. , VATER M. , MAILE C. I. D. , LARSSON I. M. , AITKENHEAD A. R. , SMITH G.
Published: February 2007

Sixty‐nine patients undergoing upper and lower abdominal surgery were studied after operation to compare the analgesic effects of sublingual buprenorphine (0.4 mg) and slow release morphine sulphate tablets (MST, 20 mg) given 6 hourly in a double‐blind, double‐dummy trial. Both MST and buprenorphine produced satisfactory postoperative analgesia but the linear analogue pain scores were significantly lower on the second post operative day with MST.
Extensive spread of local anaesthetic solution following subdural insertion of an epidural catheter during labour
Authors: SMITH G. BRINDLE , BARTON F. L. , WATT J. H.
Published: February 2007

A case is described where a small dose of bupivacaine was accidentally injected into the subdural, extra‐arachnoid space resulting in extensive unilateral block and hypotension. The spread of solution was confirmed radiologically.
Oxazepam premedication in neurosurgical patients
Authors: BARRETT R. F. , JAMES P. D. , MACLEOD K. C. A.
Published: February 2007

In a double‐blind study, a new fast‐dissolving formulation of oxazepam used as sole premedicant in patients undergoing neurosurgery, was assessed with particular reference to its effect on the levels of anxiety, consciousness and orientation of the patients pre‐ and postoperatively. The results show that when given at least one hour pre‐operatively the new preparation is a highly effective anxiolytic with minimal sedative or other side‐effects, is convenient to administer and has high patient acceptability.
Oral ranitidine in labour
Authors: McAULEY D. M. , MOORE J. , DUNDEE J. W. , McCAUGHEY W.
Published: February 2007

Ranitidine 150 mg orally was given every 6 hours to 909 women in labour, while a control group of 378 women received conventional alkali therapy. No differences in incidences of operative intervention, placental retention or post‐partum haemorrhage were observed between groups. Gastric sampling during emergency anaesthesia revealed a pH less than 2.5 in four of 51 women who received ranitidine and in two of 31 women who received magnesium trisilicate. Gastric volumes were slightly lower (mean 83 ml) in the study group than in the control group (mean 122 ml). Absorption of ranitidine was greatly slowed following narcotic administration and gastric volume was significantly higher in those patients given narcotics in labour. Apgar scores were similar in both groups of infants, and babies whose mothers were given ranitidine showed no delay in achieving high gastric acidity and no increase in bacterial colonization of the gastro‐intestinal tract. Low levels only of ranitidine were found in the blood of babies at 2—3 hours and approximately 12 hours after birth.
The anaesthetic management of bone marrow harvest for transplantation
Authors: Filshie J. , Pollock A. N. , Hughes R. G. , Omar Y. A.
Published: February 2007

The anaesthetic management of 217 donors undergoing 236 operative procedures to donate bone marrow for allogeneic transplantation or for autologous grafting is described. The procedures were those performed between November 1979 and the end of October 1982.
The oculocardiac reflex in adults
Authors: KARHUNEN U. , COZANITIS D. A. , BRANDER P.
Published: February 2007

Ninety adult patients about to undergo strabismus surgery received glycopyrrolate or atropine intramuscularly. Three doses of each anticholinergic were studied. Cardiac rate and rhythm were recorded during halothane anaesthesia. The oculocardiac reflex, defined as a fall of 20% in heart rate during traction of the extraocular muscle was inhibited in a dose‐dependent manner by the drugs studied. The potency ratio of glycopyrrolate to atropine according to the oculocardiac reflex was established as 1:2.