bluuebunny/crossref_metadata_2025 huggingface dataset:
Venous pressure and arm volume changes during simulated Bier's block
Authors: EL‐HASSAN K. M. , HUTTON P. , BLACK A. M. S.
Published: February 2007

In investigating the possible causes of an observed complication of intravenous regional anaesthesia, cubital fossa venous pressures were measured distal to an inflated tourniquet as standard 40 ml volumes of normal saline were injected. The maximal pressures obtainable were limited by tourniquet pressure since the veins compressed under the tourniquet acted as ‘Starling’ spillover resistors. Once the compressing pressures were reached, with continued injection, fluid passed easily into the systemic circulation with little further increase in venous pressure. The rates of rise and maximum values of venous pressures tended to be increased by increased injection rates, and by failure to exsanguinate the arm, but the choice of injection site was paramount. Compared with more distal injections, cubital fossa venous injections are more likely to lead to leakage under the tourniquet and should never be used for intravenous regional anaesthesia.
Pre‐operative alcohol infusion
Authors: St HAXHOLDT O. , KRINTEL J. J. , JOHANSSON G.
Published: February 2007

The influence of pre‐operative alcohol infusion on the requirement for analgesic supplementation with fentanyl in chronic alcoholic patients was studied. The chronic alcoholic was defined as a person having a regular daily alcohol consumption of over 70 g pure alcohol for at least 3 years. The mean annual consumption in the patients studied was 52 litres pure alcohol.

A positive correlation between requirement for fentanyl and alcohol consumption was found. The amount of fentanyl required to achieve satisfactory analgesia (the ‘saturation dose’) was significantly higher (61%) in alcoholic than in non‐alcoholic patients. Once stable anaesthesia was achieved the maintenance dose was the same in alcoholic and non‐alcoholic patients.

Preoperative infusion of alcohol significantly reduced the amount of fentanyl required to achieve anaesthesia in both alcoholic and non‐alcoholic patients (by 25% and 29% respectively). Furthermore it prevented some of the catecholamine mediated effects, such as increase in blood pressure, heart rate and blood glucose.
Valvular glottic obstruction following extubation
Authors: CHATTERJI S. , GUPTA N. R. , MISHRA T. R.
Published: February 2007

A case of glottic valvular obstruction following extubation is reported. The cause was bilateral dislocation of arytenoidr due to coughing on the tracheal tube, which resolved automatically following a further bout of coughing.
Pruritus following spinal anaesthesia
Authors: CASHMAN J. N.
Published: February 2007

A case report of severe pruritus following spinal anaesthesia in an 80‐year‐old man is presented. The pathophysiology of pruritus is discussed and the possible causes in the case reported are outlined.
Ocular muscular dystrophy
Authors: ROBERTSON J. A.
Published: February 2007

A case is described of a child with ocular muscular dystrophy, who demonstrated the extreme sensitivity to non‐depolarising muscle relaxants, with luck of reversal by anticholinesterases, characteristic of this condition.
Forced acid diuresis and stellate ganglion block in the treatment of quinine poisoning
Authors: THOMAS D.
Published: February 2007

A case of quinine poisoning with associated amblyopia is reported. Treatment with a forced acid diuresis and bilateral stellate ganglion blocks is described.
Reduction of postoperative vomiting in high‐risk patients
Authors: Fisher M. McD. , Chin K. C.
Published: February 2007

Twenty‐eight patients who had a history of severe postoperative vomiting were divided into two groups. The first group received various anaesthetic drugs and the second group received a pethidine promethazine premedication and thiopentone, alcuronium, fentanyl and droperidol. There was a significant reduction in postoperative vomiting as assessed by vomiting score in both groups of patients, with the second group having a greater reduction in vomiting score than the control group. Nine of the patients in the second group have received the same anaesthetic uneventfully on a subsequent occasion. We propose that reassurance and the anaesthetic technique described can significantly reduce the incidence of postoperative vomiting in a high risk group.
Expectations and experiences of anaesthesia in a District General Hospital
Authors: Clifton P.J.M.
Published: February 2007

Patients were asked about their pre‐anaesthetic assessment, expectations and experiences of anaesthesia, during the first postoperative day. Of the 100 patients interviewed, 95 were visitedpre‐operatively by an anaesthetist, 46 patients denied being anxious, and nine said they were very anxious. Middle‐aged patients seemed to be more apprehensive, and older patients less apprehensive. Thirty‐nine patients had specific worries about anaesthesia, and nine patients expected to have problems on this occasion. Of the 70 patients premedicated, 61 became less anxious andlor drowsy. Of the 55 patients receiving postoperative analgesia, 53 received good to moderate pain relief. Only five patients remembered being visited postoperatively. Despite 86 patients showing 171 well recognised anaesthetic sequelae, 99 patients said that they were satisfied with their anaesthetic.
Radionuclide assessment of cardiac function
Authors: COMMIN P. , CORIAT P. , FAUCHET M. , KURAL S. , MENASCHE P. , ROMARY D. , ECHTER E.
Published: February 2007

Pre‐operative radionuclide angiography, a non‐invasive technique for evaluating ventricular function, was performed on 34 consecutive patients undergoing aortobifemoral bypass grafting for abdominal aortic occlusive disease, to determine whether pre‐existing coronary artery disease causes significant modification of cardiac function.

Patients were divided into two groups according to medical history. Group I had 23 patients with no symptoms of coronary artery disease and Group II had 11 patients, six with previous myocardial infarction and five with angina pectoris. There was a significant difference in left ventricular ejection fraction and in cardiac output between these two groups. A flow‐directed pulmonary artery catheter was inserted in eight patients in Group II who had an ejection fraction less than 50% and a nitroglycerin infusion was used in six cases to maintain pulmonary capillary wedge pressure below 20 mmHg. In the other patients, only central venous pressure was monitored. All patients had uneventful operative courses.

It is concluded that left ventricular function is significantly altered in patients with symptoms of both abdominal aortic occlusive disease and coronary artery disease. By contrast, cardiac function is normal in patients free from symptoms of coronary artery disease, and central venous pressure monitoring seems sufficient in the management of these patients during aortobifemoral bypass grafting.
Mandatory sublingual buprenorphine for postoperative pain
Authors: BULLINGHAM R. E. S. , O'SULLIVAN G. , McQUAY H. J. , POPPLETON P. , ROLFE M. , WEIR L. , MOORE R. A.
Published: February 2007

This study examined the analgesic effect, vital signs and side effects when 0.4 mg doses of buprenorphine were given pre‐emptively for the treatment of postoperative pain after elective total hip replacement. Pain intensity, pain relief, retrospective peak pain intensity and pain relief, sedation, vital signs and side effects were measured 1 hour after surgery and then in the morning and evening of the first 2 postoperative days. There was a significant improvement in pain measured over the 3 days, with concomitant reduction in side effects and sedation. However, there was a significant increase in the number of patients with a pulse rate greater than 100 beats per minute. No particular benefit for postoperative pain relief was observed in patients receiving buprenorphine premedication in comparison with those who had received morphine or placebo.
Thyroid storm during beta blockade
Authors: STRUBE P. J.
Published: February 2007

A thyrotoxic patient who had received beta‐adrenoceptor blockers pre‐operatively suffered an episode of severe heart failure immediately following thyroidectomy and required artificial ventilation of the lungs for six hours. The possible causes are discussed and the likelihood of thyroid storm unmitigated by beta adrenergic blockade suggested.
Respiratory failure following intercostal nerve blockade
Authors: CASEY W. F.
Published: February 2007

A case of respiratory failure following postoperative intercostal nerve blockade is described. A possible mechanism is postulated and the evidence in favour of intercostal blockade in patients with chronic airways disease is questioned. The need for caution when managing such patients with regional blockade is emphasised.
Oral or nasal intubation after cardiac surgery? A comparison of effects on heart rate, blood pressure and sedation requirements
Authors: Fletcher R. , Olsson K. , Helbo‐Hansen S. , Nihlson C. , Hederstrom P.
Published: February 2007

The aim of this study was to observe the effects of the position of the tracheal tube on cardiac performance or sedation requirements after cardiac surgery. There were no significant differences in heart rate, systolic blood pressure, or rate‐pressure product during the first 16 hours postoperatively when 41 orally intubated patients were compared with 32 patients who were reintubated nasally. The two groups received similar amounts of sedative drugs postoperatively. During attempted nasal intubation, bleeding developed in four patients, and in three of these and four others the tube could not be passed. Failed nasal intubation gave rise to nasal discomfort in three of seven patients. Orally intubated patients complained more often of sore throat after extubation, whereas those who had been nasally intubated complained of discomfort in the nose and throat. We conclude that nasal re‐intubation carries no advantage over oral intubation for ventilation after cardiac surgery.
Insulin‐dependent diabetic patients during surgery and labour
Authors: BOWEN D. J. , DAYKIN A. P. , NANCEKIEVILL M. L. , NORMAN J.
Published: February 2007

Twenty seven insulin‐dependent diabetic patients received a continuous intravenous infusion of an insulin‐glucose‐potassium solution whilst undergoing elective surgical or obstetric procedures. The dose of insulin was adjusted according to blood glucose values. It was concluded that the regimen is safe and simple to manage and should result in good control of blood glucose levels.
Intravenous regional analgesia
Authors: DAVIES J. A. H. , HALL I. D. , WILKEY A. D. , SMITH J. E. , WALFORD A. J. , KALE V. R.
Published: February 2007

Two cases are described in which congestion of the arm occurred during intravenous regional analgesia. One case exhibited signs of serious local anaesthetic toxicity, while a significant plasma bupivacaine level was demonstrated in the other. In a study in a volunteer, leakage of contrast medium past the cuff was demonstrated radiologically only when congestion of the arm was produced. The Hoyle double cuff apparatus has narrow runs producing less tissue compression than a standard blood pressure cuff inflated to the same pressure. It may sometimes not occlude the brachial artery when inflated to a pressure based on the systolic arterial pressure measured with a standard cuff and congestion of the arm may then result. Increases in arterial blood pressure occurring during the procedure can also lead to congestion of the arm. Congestion may increase the risk of local anaesthetic agent leaking past the tourniquet into the systemic circulation. Recommendations are made about the choice of cuff gauge pressure and the prevention of arm congestion occurring during intravenous regional analgesia.
Effect of premedication on the induction dose of thiopentone in children
Authors: DUNCAN B. B. A. , ZAIMI F. , NEWMAN G. B. , JENKINS J. G. , AVELING W.
Published: February 2007

The effective dose of thiopentone in 90% (ED90) of unpremedicated children is 10.5 mg/kg. This is significantly greater (p < 0.01) than in premedicated children. The ED90 in children premedicated with TDP (a mixture of trimeprazine, droperidol and physeptone with atropine) is 4.2 mg/kg which is significantly less (p < 0.05) than with trimeprazine and atropine (ED90 5.2 mg/kg) or papaveretum and hyoscine (ED90 5.0 mg/kg).
Acute pulmonary oedema
Authors: KAMAL R. S. , AGHA S.
Published: February 2007

A case of postoperative laryngeal spasm is presented in which severe pulmonary oedema developed after the laryngeal spasm was relieved. The management is discussed and some suggestions for prevention of pulmonary oedema in similar circumstances made. The pathophysiology of pulmonary oedema after acute upper airway obstruction is described.
Diabetic gastroparesis
Authors: MULHALL B. P. , O'FEARGHAIL M.
Published: February 2007

A case report is presented of a diabetic patient who vomited unsuspected stomach contents peri‐operatively due to gastroparesis. A short review of this condition is presented, together with suggestions for pre‐operative management.
Intercostal nerve block by jet injection
Authors: Seddon S. J. , Clayton K. C.
Published: February 2007

A jet injector was used to perform intercostal nerve block as a method of intra‐operative and postoperative pain relief at cholecystectomy, using a concentrated solution of local analgesic. This method was shown to be as successful as the conventional needle technique. The risk of pneumothorax, and the problems of the local analgesic solution used are discussed.
Pituitary alcohol injection for cancer pain
Authors: COOK P. R. , CAMPBELL F. N. , PUDDY B. R.
Published: February 2007

The use of trans‐sphenoidal pituitary alcohol injection was assessed in a district general hospital for the treatment of diffuse bilateral cancer pain in 26 patients. Fourteen patients received a total of 43 injections. Hormonal and non‐hormonal dependent cancers were treated, with complete pain relief in ten patients and partial relief in a further seven patients. The duration of relief was variable, and usually less than 6 weeks, although two patients had complete pain relief for 5 and 7 months respectively.

No cases of meningitis or cerebrospinal fluid rhinorrhoea occurred. Nasal antiseptics and vasoconstrictors were not used. Temporary pupil dilatation occurred in eight patients, of whom one had prolonged blurred vision for small print. Transient diabetes insipidus was common (53%), although only five patients needed permanent treatment. Death from their disease occurred in 65% of patients within 3 months. Survival was shorter than in series from specialist centres, suggesting later referral for pain relief. The technique is an inexpensive and valid form of treatment for cancer pain in a district hospital, but should not be undertaken lightly in view of the possible complications.
Infusion analgesia for acute war injuries A comparison of pentazocine and ketamine
Authors: BION J. F.
Published: February 2007

Continuous intravenous infusions of ketamine and pentazocine have been used to provide analgesia in 18 patients with acute war injuries. The drugs were given alternately. Both drugs produced effective pain relief, but the quality of analgesia was superior following pentazocine because of its sedative properties. Arterial blood pressure and respiratory rate were maintained following ketamine but tended to fall after pentazocine. It is suggested that ketamine would be the better agent in patients with hypovolaemia or respiratory depression.
A comparison between the midline and paramedian approaches to the extradural space
Authors: Griffin R.M. , Scott R.P.F.
Published: February 2007

A prospective, randomised study was devised to compare the midline and paramedian approaches to the extradural space in women during labour. The two approaches were equally successful with respect to catheter insertion and analgesia and had a similar incidence of complications, although the paramedian approach caused patients more discomfort. Since only 2 ml of 1% lignocaine with adrenaline were infiltrated prior to insertion of the Tuohy needle, a greater volume of the local anaesthetic may reduce the discomfort of using the paramedian approach.
Vertebrovertebral arteriovenous fistula
Authors: ROBINSON P. N. , JEWKES D. A. , KENDALL B.
Published: February 2007

A case is presented to demonstrate the complication of vertebrovertebral arteriovenous fistula following attempted internal jugular cannulation. The symptoms, incidence and treatment of such a complication are discussed and certain recommendations made.
Neuromuscular blockade in myasthenia gravis with atracurium besylate
Authors: WARD S. , WRIGHT D. J.
Published: February 2007

The use of atracurium besylate, in small incremental doses, with continuous monitoring of neuromuscular function, is described during upper abdominal surgery in a patient with myasthenia gravis.
Ventilatory effects of pre‐ and postoperative diamorphine
Authors: MALINS A. F. , GOODMAN N. W. , COOPER G. M. , PRYS‐ROBERTS C. , BAIRD R. N.
Published: February 2007

Twenty‐two patients were studied before and after major abdominal vascular surgery to determine the effect on ventilation of 5 mg diamorphine given either extradurally or intramuscularly. Diamorphine depressed ventilation maximally at 30 minutes when given by either route. Before operation resting ventilation was reduced by 37% after extradural and 17% after intramuscular diamorphine; Paco2 increased by an average Of 0.5 kPa (either route); ventilation at 7.3 kPa Paco2, was reduced 40% after extradural and 33% after intramuscular diamorphine.

After operation the effect of diamorphine on ventilation was qualitatively similar but resting baseline ventilation was increased from 9.4 to 10.9 litres/minute. The highest individual Paco2 values were found during the pre‐operative study: 6.5 kPa after extradural diamorphine, 6.4 kPa after intramuscular diamorphine. Pain relief was unsatisfactory after intramuscular diamorphine. Four out of sir patients requested further analgesia by 3 hours after administration. No patient who received extradurul diamorphine required further analgesia for at least 6 hours.
Idiopathic pulmonary haemosiderosis
Authors: WHITEHURST P. , PAGE R. L. , WILL E. J.
Published: February 2007

The peri‐operative anaesthetic management and hazards of a patient with idiopathic pulmonary haemosiderosis are described in association with the relevant known clinical and pathological data.
Anaesthesia for colobronchial fistula
Authors: SWERDLOW B. , JENKINS J. G.
Published: February 2007

The case of a patient with a colobronchial fistula is presented. The anaesthetic management using endobronchial intubation and one‐lung anaesthesia is described and the problems presented by this rare condition discussed.
The need for analgesic cover after ENT surgery—comparison of nefopam and papaveretum
Authors: Hannington‐Kiff J.G.
Published: February 2007

Intra‐operative intramuscular injections of either papaveretum 0.3 mg/kg or nefopam 0.4 mg/kg were given to alternate patients to promote smooth emergence from ENT anaesthesia in a consecutive series of 40 children. Observations over a period of 30 minutes following completion of surgery showed that emergence was satisfactory in 19 out of 20 children given papaveretum, and in 15 out of 20 children given nefopam. The study confirms that this indication for papaveretum is justifiably popular and that nefopam is a useful alternative mainly because it does not cause respiratory depression. There are no previous reports of the use of nefopam in children.
Comparison of propofol and thiopentone for induction of anaesthesia in premedicated patients
Authors: ROLLY G. , VERSICHELEN L.
Published: February 2007

Thirty premedicated ASA I or II patients scheduled for minor gynaecological surgery, were randomly allocated to receive either 1.5 mg/kg or 2 mg/kg propofol of the new emulsion formulation, or 4 mg/kg thiopentone, given over 20 seconds. Anaesthesia was successfully induced in all 30 patients. The mean (SEM) induction times were for propofol 1.5 mg/kg 33.3(3.2) second.7, for 2 mg/kg 30.5(2.7) seconds and for thiopentone 34.6(2.7) seconds. The incidence of apnoeu greater than 10 seconds, was respectively 60, 80 and 80%, and the mean duration of apnoea 30.8(5.3). 37.1(5.0) and 23.7(5.0) seconds. The mean systolic blood pressure decreased after propofol 1.5 mg/kg by 16.0 mmHg, after 2 mg/kg by 18.6 mmHg, and increased after thiopentone by 1 mmHg, 2 minutes after injection. Heart rate increased significantly 2 minutes after thiopentone by an average of 15.1 beats/minute, but not after propogol. Pain was not reported during or after the injection. No major adverse reactions occurred at induction or during maintenance of anaesthesia with an inhalation agent. One patient who received 2 mg/kg propofol and isoflurane vomited for 24 hours. The recovery of anaesthesia after propofol induction, was quicker than after thiopentone.
Rectal premedication in children
Authors: HAAGENSEN R. E.
Published: February 2007

Two hundred and eight healthy children who were to undergo minor elective surgery during halothane, nitrous oxide, oxygen anaesthesia were studied in a double blind investigation to evaluate the sedative and anticholinergic effects of two rectal premedications. Group I received diazepam 0.75 mg/kg rectally; Group II received a mixture of diazepam 0.5 mg/kg, morphine 0.15 mg/kg and hyoscine 0.01 mg/kg rectally. No significant difference was found between the two groups in sedative or anticholinergic effects during induction of anaesthesia or in the postoperative period. No adverse effects were seen.
Anaesthesia for bullectomy
Authors: HASENBOS M. A. W. M. , GIELEN M. J. M.
Published: February 2007

A patient with severe bullous emphysema in whom one bulla occupied more than 25% of the hemithorax. with a shift of the mediastinum to the opposite side, was anaesthetised for bullectomy with a combination of intravenous gamma‐hydroxybutyric acid and a high thoracic extradural catheter technique. During the operation the patient breathed 100% oxygen through a double‐lumen endobronchial tube in the lateral thoracotomy position. Extradural analgesia during the operation was provided by bupivacaine 0.25%, with adrenaline 1:200 000 and, postoperatively, with nicomorphine diluted in dextrose 5%. The advantages of this technique are described.
Franz Kuhn
Authors: SWEENEY B.
Published: February 2007

The history of tracheal intubotion has been described before, but earlier accounts have overlooked several aspects and, in particular, the part played by Kuhn, who also deserves to be recognised for a number of other original contributions to anaesthesia.
Extradural block. Confirmation of the injection site by X‐ray monitoring
Authors: Mehta M. , Salmon N.
Published: February 2007

X‐ray monitoring was used to confirm the accuracy of extradural block in 100 patients who attended the Pain Relief Clinic for treatment of a variety of different conditions. A Tuohy needle was introduced by the central or paramedian approach and conventional physical signs, notably loss of resistance, used to identify entry into the estradural space. A radio‐opaque dye was introduced prior to the analgesic solution, to display the injection site. X‐ray screening confirmed the accuracy of the block in 83 patients, but unexpectedly in 17 the point of the needle was either just outside the spinal canal or only partly in the extradural space. There was no difficulty in correcting the needle position with the X‐ray facilities available. Imprecise needle siting is only partially explained by technical problems. Imprecise siting of the needle may be responsible for at least some cases of inadequate analgesia or unexpected complications. In our view X‐ray confirmation of site is essential for difficult extradural blocks, or when neurolytic solutions are introduced into the spinal canal. It may also be useful in teaching and research.
Anaesthesia for extracorporeal shock wave lithotripsy
Authors: ABBOTT M. A. , SAMUEL J. R. , WEBB D. R.
Published: February 2007

The anaesthetic considerations of patients presenting for extracorporeal shock wave lithotripsy are described. Regional anaesthesia with sedation may be preferable to general anaesthesia for patients undergoing this form of therapy. If regional anaesthesia is contra‐indicated, general anaesthesia using controlled ventilation with muscle relaxation, supplemented with a narcotic and a low concentration of volatile anaesthetic has been found to be a suitable alternative. The additional epidural preparation time has to be balanced against the benefits of easier patient transfer. especially during multi‐stage procedures, and better postoperative analgesia. The epidural catheter can be left in situ in patients who require multiple treatments or who may experience severe ureteric pain as the resulting ‘sand mass’ is passed. Epidural space localisation using a ‘loss of resistance to saline’ technique is recommended, in order to avoid the possible risk of damage to the spinal cord and emerging nerves (due to the presence of an air‐water interface). Patients with cardiac insufficiency need special consideration, in view of the effects of immersion on right and left heart filling pressures.
A comparison of nalbuphine and morphine as premedication agents for minor gynaecological surgery
Authors: PINNOCK C. A. , BELL A. , SMITH G.
Published: February 2007

Nalbuphine 10 mg and morphine 10 mg were compared in a randomised double‐blind trial as intramuscular premedication in 50 patients undergoing minor gynaecological surgery. Both nalbuphine and morphine produced significant sedation without anxiolysis as assessed by patient linear analogue scales, but there were no significant differences between the two drugs. Observer ratings demonstrated that nalbuphine produced calm/sleepy patients to a greater extent than morphine. There were no differences in untoward effects produced by each drug.
Continuous subcutaneous infusion of morphine for postoperative pain relief
Authors: GOUDIE T. A. , ALLAN M. W. B. , LONSDALE M. , BURROW L. M. , MACRAE W. A. , GRANT I. S.
Published: February 2007

A double‐blind randomised study of 48 patients in whom continuous subcutaneous infusion and regular intramuscular injection of morphine were compared as analgesic regimens after upper abdominal surgery, is described. Over a 48‐hour period, no difference in pain intensity between the two groups was found by comparing linear analogue scores, assessments on a four‐point rank scale, peak expiratory flow rates or requirement for additional analgesia. Nausea and sedation were assessed using a four‐point rank scale. These side effects were less frequent with subcutaneous infusion (p<0.05). Two patients from each group were judged to have received an overdose. The infusion apparatus was simple and convenient to use. Continuous subcutaneous infusion of morphine is a practical and effective means of achieving postoperative analgesia but, as with other mandatory dosing regimens, relative overdosage may occur.
The first anaesthetic in Central Africa
Authors: CONACHER I. D.
Published: February 2007

The Reverend Doctor Robert Laws (1851–1934) followed in the footsteps of David Livingstone to Central Africa. At the beginning of a long and distinguished career as a medical missionary in Christian service to the country that has since become the Republic of Malawi, he was a prime mover in the setting up of a mission station at Cape Maclear, on the shores of Lake Malawi (formerly known as Lake Nyasa and closely associated with the discoveries of Doctor Livingstone). There, on 2 March 1876, Laws used chloroform to produce surgical anaesthesia when he operated on a young African male who had a cystic tumour above his left eye.
Clinical anaesthetic knowledge amongst surgical house staff
Authors: Carnie J. , Johnson R.A.
Published: February 2007

Knowledge of common anaesthetic drugs, techniques and complications amongst junior surgical staff at a typical district general hospital is assessed. The implications for patient care are discussed and suggestions made for improved education.
Anaesthesia for carotid body tumour resection in a patient with the Eisenmenger syndrome
Authors: KRAAYENBRINK M. A. , STEVEN C. M.
Published: February 2007

A patient with the Eisenmenger syndrome presented for removal of a carotid body tumour under general anaesthesia. The presentation and management of the case are described and some of the anaesthetic problems associated with these two uncommon conditions are discussed. The case is reported because of its rarity and because some of the complications of carotid body surgery may be particularly hazardous in the presence of the Eisenmenger syndrome. The importance of monitoring, of maintaining a stable heart rate and blood volume, and the danger of paradoxical systemic air embolism are stressed.
Respiratory depression complicating epidural diamorphine
Authors: CORKE C. F. , WHEATLEY R. G.
Published: February 2007

Two cases of severe respiratory depression complicating epidural diamorphine administration are reported. In both cases, the dura had been punctured. The risk of epidural opiate administration in association with a breach in the dura is reiterated.
Metal tube anaesthesia for ear, nose and throat carbon dioxide laser surgery
Authors: HUNTON J. , OSWAL V. H.
Published: February 2007

Tracheal tube anaesthesia in ear, nose and throat surgery using the carbon dioxide laser is reviewed. The development of metal tubes and techniques is described.
The Afya anaesthesia system
Authors: SWAI E.A. , BROOKS A.M. , MECKLENBURGH J.S.
Published: February 2007

The design of and the results of laboratory performance tests on the Afya anaesthesia system are described. The system has a low inspiratory and expiratory resistance and the concentrations of ether delivered ranged from 75 to 130% of the vaporizer setting. The error was maximum at vaporizer settings of between 15 to 20%. The system is suitable for spontaneous and controlled ventilation of the lungs in both adults and infants.
Some maternal complications of epidural analgesia for labour
Authors: CRAWFORD J. S.
Published: February 2007

A review of the maternal complications encountered in a consecutive series of over 27000 lumbar epidural blocks (exclusive ofepidurals administered for elective Caesarean section and complications of a relatively minor or fleeting nature) in a single obstetric unit is presented. There were nine potentially life threatening complications. of which only three caused real concern for the mother's safety. Six of these occurred with the jirst top‐up, as given by the anaesthetist. The others were the result of three out of the approximately 100000 top‐ups administered by midwives. There were two serious, but not life‐threatening complications. each of which led to the requirement of a laminectomy. In addition, there were 13 moderately serious and 17 mildly disturbing complications. All the mothers concerned made a full recovery. There was a large number of inconsequential or pseudocomplications which, although initially blamed upon the epidural, were later demonstrated to have been of a dyferent origin. Consideration of this experience leah to the conclusion that is the rules of management are rigorously followed, epidural analgesia for labour and delivery, including topping‐up by well‐informed midwives, is characterised by an extremely high level of safety for the mother.
Free‐standing vaporizers
Authors: KELLY D. A.
Published: February 2007

A previously unreported hazard of free‐standing ‘Tec’ type vaporizers relating to their positioning downstream of the oxygen jlush is presented. Three Enfluratec Mark III vaporizers were studied; measurement of delivered enjlurane concentration was performed at a flow rate of 8 litres/minute, during and after the application of the oxygen flush upstream of the vaporizer. The maximum difference between the dial setting and the measured vapour concentration occurred when a 5‐second flush was applied to a vaporizer set at 0.2 volume %, the peak vapour concentration recorded being 2.3%. Other hazards of free‐standing vaporizers are discussed and ways of avoiding these hazards considered.
Mental function and morbidity after acute hip surgery during spinal and general anaesthesia
Authors: Bigler D. , Adelhøj B. , Petring O.U. , Pederson N.O. , Busch P. , Kalhke P.
Published: February 2007

Forty elderly patients (mean age 78.9 years) undergoing acute surgery for hip fracture were given at random either spinal analgesia with bupivacaine 0.75% or general anaesthesia with diazepam, fentanly and N2O/O2. Mental function was studied pre‐operatively with an abbreviated mental test and 1 week and 3 months postoperatively in both groups. Mortality and number of complications was similar in the two groups, but a shorter time of ambulation was seen in the spinal group compared to the general anaesthetic group. No persistent impairment in mental function was found after acute hip surgery under spinal or general anaesthesia and the only advantage of regional technique was a shorter time of ambulation.
Anaesthesia for translumbar aortography
Authors: Smith M. , Myatt J. K. , Harris M. N. E. , Plantevin O. M.
Published: February 2007

Fifty patients presenting for elective translumbar aortography were randomly allocated to one of two groups receiving either enflurane or isoflurane. Premedication was with oral lorazepam. The patients' tracheas were intubated and they were allowed to breathe spontaneously in the prone position during the procedure. There was no significant difference in heart rate during the investigation but there was a statistically significant fall in the blood pressure from its pre‐induction level. Arterial oxygenation was adequate throughout the procedure. Arterial carbon dioxide tension was significantly lower in the isoflurane group at the beginning and at end of the procedure (p < 0.01), but there was no significant change in carbon dioxide tension within the groups during the procedure. Spontaneous ventilation with enflurane or isoflurane is a satisfactory anaesthetic technique for translumbar aortography.
Antagonism of fentanyl and alfentanil by intravenous plus subcutaneous naloxone
Authors: VALGARDSSON A. , WERNER O. , SVENSSON G.
Published: February 2007

Twenty patients undergoing microlaryngoscopy were anaesthetised with thiopentone. Half received fentanyl supplementation (about 8.5 μg/kg) and the other half alfentanil (about 65 μg/kg). Both groups were given naloxone 0.4 mg intravenously plus 0.4 mg subcutaneously shortly after the procedure which lasted some 12 minutes. The degree of ventilatory depression was assessed by a CO2 rebreathing test. The ventilation at an end‐tidal Pco2 of 8.0 κPa (V̇8.0) was noted, and the findings related to u control value obtained on the day before anaesthesia. In the fentanyl group, V̇8.0 was significantly (p < 0.05) less one hour after naloxone than 15 minutes after, and remained significantly below the control value for the first 8 hours after microlaryngoscopy. A second peak in plasma fentanyl concentration was observed four hours postoperatively in three patients. Respiratory depression in the alfentanil group was less pronounced and of shorter duration than in the fentanyl group. Postoperative plasma alfentanil concentration decreased progressively with time in every patient.
Atracurium in clinical anaesthesia: effect of dosage on onset, duration and conditions for tracheal intubation
Authors: Mirakhur R.K. , Lavery G.G. , Clarke R.S.J. , Lavery G. G. , Clarke R.S.J. , Gibson F.M. , McAteer E.
Published: February 2007

Conditions for tracheal intubation at 90 seconds, time to onset of maximum block and duration of clinical relaxation after jive different doses of atracurium, which ranged from 0.4 to 1.0 mg/kg were studied in 200 adult patients who were anaesthetised with nitrous oxide, oxygen and halothane or fentanyl. The conditions for intubation improved significantly with increasing doses, and were acceptable in 55% patients with a 0.4 mg/kg dose and in about 90% of those who received the two higher doses. The time to onset of complete block was 257 seconds with 0.4 mg/kg and decreased progressively to 124 seconds with 1.0 mg/kg. The duration of clinical relaxation under fentanyl anaesthesia averaged 29 minutes with 0.4 mg/kg and increased in a dose‐related manner to 57 minutes with 1.0 mg/kg: halothane anaesthesia produced only a marginal increase. There was no evidence of cumulation with up to six repeat doses of 0.125 mglkg. The only side effect noticed was cutaneous flushing observed in 42% of patients. This was again dose dependent, being 18% with 0.4 mg/kg and increasing to 73% after 1.0 mg/kg. There was associated hypotension and bronchospasm in one patient.
Absorption of lignocaine through split‐skin donor sites
Authors: Bulmer J.N.
Published: February 2007

Seventeen patients undergoing split‐skin grafting each received 3 mg/kg of a sterile 1% lignocaine gel applied to an area of the donor site equal to 3 sq cm/kg. Serial venous blood samples were taken for one hour following application and analysed for serum lignocaine concentration by high pressure liquid chromatography. The concentrations in all the patients were well below those associated with systemic toxicity. Clinical assessment included haemodynamic monitoring during the procedure, and postoperative evaluation of possible central nervous effects and of the degree of donor site analgesia obtained. No untoward effects were noted and the degree of analgesia, although difficult to assess, appeared good.
Vecuronium in the myasthenic patient
Authors: HUNTER J. M. , BELL C. F. , FLORENCE A. M. , JONES R. S. , UTTING J. E.
Published: February 2007

The use of vecuronium in six patients with myasthenia gravis undergoing thymectomy is described; the train‐of‐four twitch technique was used to monitor neuromuscular function. The first two patients received an initial dose of 0.02 mg/kg and incremental doses of 4 μg/kg, which is in the order of one fifth of that normally used. Satisfactory depression of the first twitch of the train‐of‐four, however, was not obtained and, therefore, in the remaining four patients the doses were doubled. At this dose satisfactory depression of the first twitch was achieved. Neostigmine 5.0 mg produced adequate reversal of residual neuromuscular blockade and the train‐of‐four twitch response recovered to normal levels. With reduced dosage and with careful neuromuscular monitoring. vecuronium can be used safely in the myasthenic patient.
Maternal mortality and manpower
Authors: ROSEN M. , FUJIMORI M.
Published: February 2007

In 1982 maternal mortality in England and Wales was given seven per 100 000 compared to 18 per 100 000 total births in Japan. This represented 160 more deaths in Japan. Perinatal mortality rates were similar in England and Wales and Japan, being 11.3 and 10.1 per 1000 respectively. The prevalence of obstetricians and paediatricians per 100 000 total births are approximately similar in England and Wales and in Japan, whereas the rates for anaesthetists are jive times less in Japan. In England and Wales, 13% of maternal deaths were related to anaesthetic misadventures, but the Japanese incidence is not known. However, more than 50% of anaesthetics for Caesarean sections in district hospitals in Japan are administered by obstetricians. A pilot study in Japan would be necessary to determine the precise role of anaesthetic provision on maternal mortality. Maternal mortality may prove a useful indicator of anaesthetic service deficiency.
Sedation and cerebral angiography. The effects of pentazocine and midazolam on arterial carbon dioxide tension
Authors: Spargo P.M. , Howard W.V. , Saunders D.A.
Published: February 2007

A study of the effects of sedation on arterial blood gases in patients undergoing cerebral angiography was performed. Twenty‐one patients received pentazocine (30 mg) and midazolam (5–22.5 mg) and arterial carbon dioxide and oxygen tensions were measured from radial arler.v samples before and during the procedure. A statistically significant rise in arterial carbon dioxide tension was demonstrated. It is suggested that this may cause a rise in intracranial pressure by increasing cerebral blood flow in a group of patients in whom there is a high incidence of raised intracranial pressure. The clinical significance of this increase in arterial carbon dioxide tension is discussed.
Three years' anaesthetic experience with the Groningen Nd YAG laser coagulation technique
Authors: Sia R.L. , Edens E.Th. , van Overbeek J.J.M. , Rashkovsky O.M.
Published: February 2007

The use of the Neodymium YAG Laser technique in the palliative treatment of tracheo‐bronchial tumors in 47 patients is described and the merits of the coagulation and anaesthetic techniques are discussed.
Oral dantrolene prevents rise of myoglobin due to suxamethonium
Authors: Laurence S.
Published: February 2007

Forty patients were studied in a randomised trial to investigate the effect of pre‐operative oral dantrolene on the incease of serum myoglobin and creatinine kinase due to suxamethonium administration. Twenty patients in the treatment group were given 1.5 mg/kg dantrolene orally 4 hours pre‐operatively.

Blood was drawn immediately pre‐induction and 5, 10 and 20 minutes after suxamethonium 1.2 mg/kg administration, following which surgery could commence. Myoglobin was measured by radioimmunoassay.

The increase in mean myoglobin values was greatly reduced following suxamethonium in the treatment group (10.6 μg/litre at 20 minutes) compared to the control group (54.8 μg/litre at 20 minutes), (p < 0.01). Total fasciculation score was not significantly reduced by the dontrolene pretreatment. No increase in creatinine kinase values occurred in any patient and the changes in mean potassium values in both groups were negligible.

The only side effect attributed to dantrolene was pre‐operative nausea in two patients. No interference with the action of suxamethonium, or difficulty with reversal was noticed. Oral dantrolene may be almost as effective as pretreatment with non‐depolarising neuromuscular blocking drugs in preventing suxamethonium‐induced increase in myoglobin with less interaction with other anaesthetic agents.
Lower limb blocks for children
Authors: Mcnicol L. R.
Published: February 2007

Femoral and lateral cutaneous nerve of the thigh blocks have been performed in a group of 50 children; the method has not previously been described in paediatric practice. The technique was judged to have been successful in 48 (96%) of the children. There were no early or late complications. It is concluded that these blocks are easy to perform, even in small children and infants, and that they can produce reliable postoperative analgesia for a variety of orthopaedic and plastic procedures.
Longterm treatment with epidural opioids
Authors: CARL P. , CRAWFORD M. E. , RAVLO O. , BACH V.
Published: February 2007

During a 2‐year period, 150 patients were treated with epidural opioids for more than 7 days; 89 received morphine and 61 buprenorphine. In 16 cases, medication was changed from morphine to buprenorphine. and in 6 from buprenorphine to morphine. In 19 patients in each group. the disease process was benign. The median daily dose of morphine was 17 mg given by an average of 2.9 injections; the corresponding figures in the buprenorphine group were 1.3 mg and 2.6 injections. The mean duration of treatment was 49 days (7‐397) in the morphine group and 53 days (7‐262) in the buprenorphine group. Satisfactory pain relief was achieved in 40 (45%) patients who received morphine and 41 (67%) patients given buprenorphine. Altering medication from morphine to buprenorphine improved analgesia in 32% of patients, while the reverse improved pain relief in a further 46% of the patients. Side effects were reported in 46% of patients given morphine and 20% given buprenorphine. Seventy‐one patients were treated on an outpatient basis. In these cases, buprenorphine was administered for 89% of the total duration of treatment and morphine chloride for 52%.
Acute upper airway obstruction
Authors: MACKENZIE J. W. , JELLICOE JILLIAN A.
Published: February 2007

A case is described of retropharyngeal haematoma due to spontaneous bleeding from the inferior thyroid artery and causing acute upper airway obstruction. Results of the haematological investigations were suggestive of underlying polycythaemia rubra Vera. The presentation and findings in this case are discussed.
Neonatal tracheal perforation
Authors: McLEOD B. J. , SUMNER E.
Published: February 2007

Tracheal perforation following intubation in the neonatal period is rarely reported but is a serious complication that should be considered whenever difficulty in ventilation, surgical emphysema or pneumothoraces appear following intubation. Management includes the immediate and skilled replacement of the tube within the tracheal lumen and control of the air leak. Factors which increase the likelihood of occurrence of perforation are discussed.
Remote monitoring using an induction loop
Authors: HARRISON M. J. , SLATER E. J.
Published: February 2007

An electromagnetic induction loop is used to transmit signals from a pulse and respiration monitor to a standard National Health Service hearing aid to facilitate remote monitoring
Ro 15‐1788 for postoperative recovery
Authors: WOLFF J. , CARL P. , CLAUSEN T. G. , MIKKELSEN B. O.
Published: February 2007

In a double‐blind randomised study, 100 women who underwent induced abortion under midazolam anaesthesia were given the benzodiazepine antagonist Ro 15‐1788 or placebo after termination of anaesthesia. Recovery was assessed by means of a modified Steward coma scale. Following incremental doses of Ro 15‐1788, 56% of the patients were fully awake within 3 minutes and 92% after 5 minutes, which was significant compared to the placebo group. The median duration of amnesia was 91 minutes after Ro 15‐1788 compared to 121 minutes in the placebo group (p<0.001). The median dose of Ro 15‐1788 was 0.4 mg. A slight positive correlation between total dose of Ro 15‐1788 and total amount of midazolam was found. Nausea and/or vomiting were found to be more frequent in the Ro 15‐1788 group, hut otherwise we, found no differences between groups with regard to either side effects or cardiorespiratory function. Ro 15‐1788 is evidently an effective antagonist to the sedation induced by midazolam.
Severe upper airway obstruction and difficult intubation in cicatricial pemphigoid
Authors: DRENGER B. , ZIDENBAUM M. , REIFEN E. , LEITERSDORF E.
Published: February 2007

Upper airway obstruction in cicatricial pemphigoid is rarely seen by the anaesthetist. A case of severe dyspnoea due to progressive laryngeal obstruction is presented. Tracheal intubation during induction of general anaesthesia for permanent tracheostomy was extremely difficult and was successfully performed by introducing a size 12 French suction catheter through the stenotic laryngeal orifice. Adequate ventilation was achieved by using the oxygen flush valve to deliver oxygen intermittently through the catheter.
Dinamap arm and thigh arterial pressure measurement
Authors: GOLDTHORP S. L. , CAMERON A. , ASBURY A. J.
Published: February 2007

Two automatic arterial pressure monitors (Model 1846 P) were used in 30 patients to measure arterial pressures and heart rates in the thigh and arm. Significant differences were found in thigh‐arm sytolic (p < 0.001) and diastolic pressures (p < 0.05). Arm pressures could be predicted from leg pressures and correction factors are suggested. Mean pressures in the thigh approximated more closely to the calculated mean pressures than in the arm. These differences were of little clinical importance.
The stability of preservative‐free morphine in plastic syringes
Authors: BRAY R. J. , DAVIES P. A. , SEVIOUR J. A.
Published: February 2007

The stability of preservative‐free morphine in plastic syringes over 36 hours in the range of concentrations commonly used in our hospital to provide continuous morphine infusions was investigated. The morphine concentration remained at 100% (SD 1.5 percent) of the control values over 36 hours and demonstrates that the concentration of morphine is not reduced with time in these circumstances.