bluuebunny/crossref_metadata_2025 huggingface dataset:
Bleomycin therapy and Anaesthesia
Authors: ALLEN S.C. , RIDDELL G.S. , BUTCHART E.G.
Published: February 2007

Bleomycin is a cytotoxic drug used in the treatment of teratoma of the testis. This drug appears to sensitise the lungs so that acute lung damage occurs with concentrations of oxygen normally considered free from toxic effects. Two anaesthetics administered to the same patient undergoing thoracotomy are reported. No postoperative lung damage was produced on either occasion.
Temporary blindness following anaesthesia after translumbar aortography
Authors: JOHNSON R.C. , MOSS P.J.
Published: February 2007

A case is reported of temporary blindness following general anaesthesia for translumbar aortography. The possible causes and precipitating factors are discussed.
Congenital complete heart block
Authors: DUFFY BRIAN L.
Published: February 2007

A female patient aged 14 years with known congenital heart block presented for appendicectomy. The successful management under general anaesthesia without use of a pacemaker is described. Alternative methods including local anaesthesia are discussed.
Forum
Authors: Carrie L.E.S. , O'Sullivan G.M. , Seegobin R.
Published: February 2007

Thirty‐eight patients with a normal obstetric history who had not received intramuscular sedation and who requested or required analgesia were given 150–200 μg of fentanyl into the epidural space. Excellent pain relief was achieved until late in the first stage of labour but analgesia was inadequate during the latter part of the 1st stage and during the 2nd stage of labour. No serious side‐effects were noted in any of the mothers but one baby required treatment for respiratory depression.
Cryoanalgesia
Authors: EVANS P.J.D.
Published: February 2007

The introduction of cryoanalgesia has reawakened interest in the therapeutic use of cold as a means of producing pain relief. The historical background to both local cooling and nerve freezing is recorded and the advances since the introduction of cryoprobes in 1961 are described. The possible mechanisms of freeze damage, the physical changes occurring in tissues as a result of ice crystal formation and the influence of the probe design on the size of individual cryolesions are all discussed. Gas expansion cryoprobes are described and the application of nerve freezing in the control of both post operative and chronic pain reported.
Molecular mechanisms of general anaesthesia
Authors: BURNIE JAMES P.
Published: February 2007

This review aims to give a balanced view of the various mechanisms which have been proposed to explain the phenomenon of general anaesthesia on both a molecular and whole animal level. An attempt is made to interrelate these and produce one cohesive model.
Spinal narcotics and central nervous system depression
Authors: SIDI AVNER , DAVIDSON JOSEPH T. , BEHAR MORT , OLSHWANG DAVID
Published: February 2007

A case of central nervous system depression which developed 7 hours after an intrathecal injection of 4 mg of morphine is described. The patient lapsed into coma with bradypnoea and ‘pin‐point’ pupils and there was no response to naloxone 0·4 mg. Treatment was continued for 3 hours. No postoperative analgesics were required for 126 hours. The problems associated with the use of intrathecal opiates are reviewed, delay in onset being the usual feature. Use of hyperbaric solutions of the narcotic and maintenance of a head‐up posture may protect against respiratory depression.
Anaesthesia under civil war conditions
Authors: CARMICHAEL G.L. MURRAY
Published: February 2007

The work of British Red Cross surgical teams during the Cambodian civil war in 1975 and the Angolan war of 1976 is described. The medical, social and military situations are discussed. The problems caused by the deteriorating conditions in the working environments of these teams during the collapse of the governing regimes within which they were operating are outlined and some of the methods which were used to solve these are considered.
Sydney Ringer (1834–1910) and Alexis Hartmann (1898–1964)
Authors: LEE J. ALFRED
Published: February 2007

This article outlines the careers and the achievements of Sydney Ringer (1834–1910) and Alexis Hartmann (1898–1964), both of whom gave their names to well‐known solutions for intravenous infusions.
Liver enzyme studies with continuous intravenous anaesthesia
Authors: BLUNNIE W.P. , ZACHARIAS M. , DUNDEE J.W. , DOGGART J.R. , MOORE J. , McILROY P.D.A.
Published: February 2007

A battery of liver function tests was carried out before operation and on the 3rd–5th and 13th–15th postoperative days in patients anaesthetised with continuous infusion of thiopentone, Althesin or etomidate for an intermediate operation. Some derangement of enzyme activity was found in one quarter to one third of the patients, and was most marked after Althesin. The findings are compared with published data on ketamine, which had an effect on enzyme activities similar to that of Althesin. On pooling data from different studies it became very apparent that large doses of intravenous anaesthetics cause a greater derangement of liver function than that which occurs using a balanced technique for the same operation.
Experiences with epidular morphine in obstetrics
Authors: Crawford J. Selwyn
Published: February 2007

Morphine (2–6 mg) injected into the epidural space was ineffective in relieving the pain of labour in eight patients. Morphine (2 mg) injected into the epidular space of 60 patients whilst they were undergoing caesarean section was associated only modestly, if at all, with a diminished incident of postoperative pain and discomfort, when compared with the epidular injection of saline in 60 patients matched for type of operation and type of Anaesthesia. A relatively high incident of postoperative vomiting was noted among the patients who received morphine.
Amitriptyline and perphenazine (Triptafen DA) in chronic pain
Authors: Clarke Ian M.C.
Published: February 2007

One‐hundred and twenty patients with chronic pain, who had all failed to obtain relief with traditional medical treatment, were given a standard psychotropic drug mixture consisting of amitriptyline 25 mg and perphenazine 2 mg. Of those who completed 2 months of treatment, 33·68% were pain free, while 8·3% had unacceptable side‐effects. The best results were obtained in patients with postherpetic neuralgia and postoperative scar pain.
Accidental intrathecal injection of bupivacaine and dextran
Authors: EVANS P.J.D. , LLOYD J.W. , WOOD G.J.
Published: February 2007

The case is reported of a patient who received an accidental intrathecal injection of a mixture containing 0.375% plain bupivacaine in dextran following a paravertebral block. From the duration of anaesthesia produced, it is suggested that the addition of dextran to a solution of bupivacaine does not potentiate the action of subarachnoid bupivacaine.
Obstetric pain relief in a district hospital.
Authors: DAVIES H.F.
Published: February 2007

The effectiveness of the various methods used to provide obstetric pain relief in a District General Hospital was assessed. More than 70% of mothers were generally satisfied with the pain relief they received, but the majority would, in retrospect, have liked some additional analgesia at some stage. Seventeen per cent would have liked an epidural. Neither the social group of the mothers nor their duration of residence in the area of the hospital affected the demand for additional pain relief. The demand for epidurals was greater in social groups I and II.

The effect of the obstetric pain relief service on the workload of available trained staff was assessed: most of the demands were made between the hours of 0900 and 2100 hours.
Reduction of pain on injection of etomidate
Authors: Brown P.M. , Moss E.
Published: February 2007

The effect of the addition of lignocaine or saline to etomidate was studied in a randomised, double‐blind trial involving 98 patients attending for day case surgery under general anaesthesia. The incidence of pain on injection of etomidate was significantly reduced by the addition oflignocaine in a strength of 1 mg/ml.
Ketamine‐diazepam anaesthesia in a patient with carcinoid syndrome
Authors: EISENKRAFT JAMES B. , DIMICH IVAN , MILLER RAYMOND
Published: February 2007

The use of ketamine in patients with carcinoid syndrome is controversial because of the catecholamine response to this agent. Prior administration of diazepam modifies the catecholamine response to ketamine and may make its use in such patients safe. The successful use of a diazepam–ketamine technique for anaesthesia of a patient with malignant carcinoid syndrome and associated tricuspid valve disease who underwent laparotomy and hepatic artery ligation is described. The theoretical advantages of safe ketamine anaesthesia in carcinoid patients are discussed and the relevant literature reviewed. To the authors' knowledge the successful use of ketamine anaesthesia in carcinoid syndrome has not previously been reported.
Calibration of a Floscope peak flow meter and a Vitalograph pulmonary monitor
Authors: FISHER J. , SHAW A.
Published: February 2007

The performance of a Floscope peak flow meter and the Vitalograph pulmonary monitor are assessed using an absolute calibration method. Both instruments have good repeatability. For peak flows greater than 150 litres/minute, the Floscope showed errors of between −12.4% and +7.1%. For flows below 150 litres/minute the percentage errors were greater.

The pulmonary monitor showed errors of between −20% and −5.5%. Its high resistance makes it an inappropriate instrument to use for absolute measurement of peak flows. It is useful for assessing trends.
A pharyngeal pack fixed on to the tracheal tube
Authors: SCHECK PAUL A.E.
Published: February 2007

In 205 patients undergoing surgery of the nose, throat or dental surgery, a gauze pack was used fixed onto the tracheal tube, remaining during surgery above the vocal cords. Advantages in adults as well as children are discussed: laryngoscopy has to be performed only once, a free operating field is secured for the surgeon in the throat, the tube cannot be inserted too far into the trachea and the pack cannot be forgotten in the pharynx.

The only disadvantage noticed so far was that in about 10% of the patients intubation was somewhat more difficult for the less experienced anaesthetist.
What might have been. Investigations into the administration of inhalation agents
Authors: Cole W.H.J. , Jenkins T.
Published: February 2007

Work on some unusual techniques employing inhalation agents, some of which are now rarely used, is described, collated and assessed.
Nitrous oxide concentrations in the dental surgery
Authors: HILLMAN K.M. , SALOOJEE Y. , BRETT I.I. , COLE P.V.
Published: February 2007

Pollution in the dental outpatient surgery was assessed by measuring atmospheric nitrous oxide levels and comparing these with the venous blood concentrations in the operator‐anaesthetist and his assistant.

The effects of scavenging on both measurements have also been determined. Without scavenging the nitrous oxide level in the blood of the dentist was over four times that of the average anaesthetist working in an operating theatre. Some of the factors contributing to these high levels, and the effectiveness of scavenging are discussed.
Teaching anaesthetics to medical students
Authors: NEWELL J.P. , OGG T.W. , WAKEFORD R.E.
Published: February 2007

The paper describes the rationale and implementation of anaesthetics teaching in the new 2½1/2‐year clinical medical course at Cambridge University. A programme designed to monitor and evaluate the teaching was established, and the results are reported.

Significant improvements in students' knowledge of anaesthetics and their experiences of practical procedures were noted, as compared to a control group. It is concluded that the course achieves the dual aims of providing an introduction to the scope and vocabulary of modern anaesthesia and giving students the opportunity to practise a variety of specified practical skills.
Alternative method of intercostal blockade
Authors: SEDDON S.J. , DORAN B.R.H.
Published: February 2007

An injector gun of the type developed for vaccinations was used to perform intercostal nerve blocks. Analgesia was achieved in all patients to some degree, but the effectiveness of the technique was limited by the currently available local anaesthestics.
Myocardial depression by ketamine
Authors: CHAMBERLAIN J.H. , SEED R.G.F.L. , UNDRE N.
Published: February 2007

This study investigated the effect of ketamine on myocardial function. In dogs the drug was infused directly into the left main coronary artery. The concentration chosen was similar to the peak concentration found following a bolus intravenous injection. A mild depression of inotropic state was found which recovered completely after stopping the infusion. Myocardial depression was confirmed in a guinea pig Langendorff preparation. No changes in high energy phosphates were found in these hearts after 45–60 minutes of perfusion with ketamine in the perfusion medium. This study confirms that myocardial depression occurs with ketamine but suggests that it is unlikely to be of clinical significance. Depletion of high energy phosphates did not seem to be the cause of the depression.
Survival from DIC following amniotic fluid embolism
Authors: TAENAKA N. , SHIMADA Y. , KAWAI M. , YOSHIYA I. , KOSAKI G.
Published: February 2007

A 30‐year‐old multigravida of 38 weeks gestation bled profusely at delivery. Coagulation studies revealed disseminated intravascular coagulation and a diagnosis of amniotic fluid embolism was made. Treatment consisted of transfusion of whole blood and administration of a synthetic serine proteinase inhibitor, FOY. Approximately two hours after administration of the latter, bleeding began to cease and vital signs became stable. The patient survived without sequelae.
Pressures on endotracheal tube cuffs
Authors: BLACK A.M.S. , SEEGOBIN R.D.
Published: February 2007

The general relationships between the pressure inside an endotracheal tube cuff, the pressure exerted by that cuff on the tracheal wall and the airway pressure have been re‐examined in a model system. In relatively recent literature, the tracheal wall pressure at a given cuff volume has been calculated as the difference between intracuff pressures at that volume when the cuff is infated inside the trachea and when it is inflated whilst suspended freely in air. This has been used as a general relationship, as an alternative to direct measurement in real and model tracheas. In this study, the directly measured pressure was not generally equal to the pressure as calculated above.
Accidental intrapulmonary Clinifeed
Authors: HARVEY P.B. , BULL P.T. , HARRIS D.L.
Published: February 2007

A case is described in which a narrow bore nasogastric tube was passed into the bronchial tree and feeding with half‐strength Clinifeed commenced before the malposition was recognised. The management of the resulting acute respiratory failure is discussed, and the successful outcome attributed to the bland nature of the Clinifeed. The need for radiological confirmation of the position of narrow bore nasogastric tubes before feeding is emphasised.
A bed‐mounted unit for the movement of critically ill patients
Authors: PARK GILBERT R. , JOHNSON SELWYN
Published: February 2007

A small inexpensive unit is described which facilitates the movement of critically ill patients within hospitals while allowing monitoring and treatment to continue.
Maternal fetal and placental gastrin concentrations
Authors: ATTIA R. R. , EBEID A. M. , FISCHER J. E. , GOLDSOUZIAN N. G.
Published: February 2007

The radioimmunoassay technique was used to measure maternal, placental and fetal serum gastrin levels. A progressive increase in gastrin levels occurred with the advance of pregnancy reaching mean peak levels of 62 (SEM 12) pg/ml during labour. Umbilical artery (74 pg/ml: SEM 7) or vein (73 pg/ml: SEM 7) gastrin concentration was higher than maternal gastrin levels. Placental gastrin concentration was 840 pg/g (SEM 96) and amniotic fluid contained 22 pg/ml (SEM 2). This study implies that one of the reasons for increased maternal gastric residue seen during pregnancy is due to an increased serum gastrin concentration. Also the advanced stage of development of gastrointestinal system of the newborn is in accord with high fetal gastrin concentration.
Severe hypertension and flushing in a patient with a non‐metastatic carcinoid tumour
Authors: JONES R. M. , KNIGHT DANA
Published: February 2007

A case of multiple endocrine adenopathy type I associated with a solitary carcinoid tumour is described. During anaesthesia the characteristic syndrome consisting of hypertension, tachycardia and flushing occurred. The possible mechanisms for this are discussed.
Anaesthesia and amyloidosis
Authors: WELCH D. B.
Published: February 2007

This case report concerns a man with undiagnosed primary amyloidosis who developed resistant cardiac failure after a minor surgical procedure.
Blood loss during transurethral resection of the prostate
Authors: Abrams P.H. , Shah P.J.R. , Bryning K. , Gaches C.G.C. , Ashken M.H. , Green N.A.
Published: February 2007

Blood loss during operation was measured in 106 patients undergoing transurethral resection of the prostate, using a colorimetric technique. The total blood loss was related to the length of operation and the weight of prostate resected. There was no relationship between blood pressure and the blood loss during operation. However there was a significant reduction in blood loss if the patient received a regional rather than a general anaesthetic. Blood loss was lower in those patients undergoing prostatectomy for carcinomatous disease.
Editorial
Authors: Cromwell Oliver , Horsey P.J.
Published: February 2007

I beseech you,…

think it possible you may be mistaken.
Hypoxic pulmonary vasoconstriction and the pharmacologically denervated lung
Authors: OHMURA A. , PACE N. L. , WONG K. C. , JOHANSEN R. K.
Published: February 2007

The roles of the autonomic nervous system and cardiac output on hypoxic pulmonary vasoconstriction were studied in 15 mongrel dogs anaesthetised with intravenous pentoharbitone (30 mg/kg) and the lungs mechanically ventilated to maintain normal arterial blood gases. After a hypoxic challenge in Group I (n =6) and Group II (n =3) animals, autonomic denervation was achieved by total spinal block with tetracaine (20 mg) injected into the cisterna magna. Group I animals received a large volume of intravenous fluid (80 ml/kg normal saline) before the block while Group II animals were given minimum fluid. When Group I animals were exposed to 10% inspired oxygen, mean pulmonary arterial pressure increased by 88 and by 72% before and after the block, respectively. The cardiac output increased by 27% with hypoxia before the block while it did not change significantly with hypoxia after the block. The pulmonary vascular resistance increased by 65 and by 152% with hypoxia before and after the block. Group II animals were also exposed to 10% inspired oxygen. They showed a similar response to Group I animals before the block. However, after the block irreversible hypotension developed with hypoxia.

In Group III animals (n =6), the same anaesthesia and hypoxic challenge protocol was used. Immediately after measurements at 10 minutes of hypoxia, the inferior vena cava was constricted to reduce the cardiac output to the control level and another set of measurements were made. The cardiac output increased by 30% with hypoxia and then was reduced to the control level with vena caval constriction. The mean pulmonary arterial pressure increased by 125% with hypoxia and then it decreased slightly with the inferior vena cava constriction. The pulmonary vascular resistance increased by 95% with hypoxia and then it further increased by 28% with the vena caval constriction. These results suggest that sympathectomy accentuates rather than attenuates the hypoxic pulmonary vasoconstriction and that an increase in cardiac output counteracts hypoxic pulmonary vasoconstriction. The results also suggest that adequate intravascular volume and oxygenation are extremely important for maintaining homeostasis when reflex sympathetic stimulation to the cardiovascular system has been eliminated.
Current management of patients after cardiopulmonary bypass
Authors: HINDS C. J.
Published: February 2007

The postoperative management of cardiac surgical patients is reviewed with particular reference to some of the recent advances and current controversies. It is emphasised that there has been a marked decrease in the incidence of many of the major problems associated with cardiopulmonary bypass and that, in the majority of cases, cardiac surgery is now a routine procedure associated with a very low morbidity and mortality.
Doxapram and the fractured femur
Authors: OWEN H. , HUTTON P.
Published: February 2007

In a double‐blind trial the effects of a single dose of doxapram (1–1.5 mg/kg) on the postoperative arterial oxygen tension of patients who had undergone surgical fixation of a fractured neck of femur was measured. In contrast to other reports of the effect of a single dose of doxapram, there was no improvement in arterial oxygen tension with respect to the control group. It is reasoned that doxapram may exert its effect by increasing the functional residual capacity in the immediate postoperative period. The central analeptic properties of doxapram may be grossly underestimated.

The widely held assumption that patients with a fractured neck of femur are significantly hypoxic pre‐operatively is questioned.
Ocular displacement during mechanical ventilation
Authors: HARDY P. A. J.
Published: February 2007

A case is described of unilateral ocular displacement in phase with ventilation during intermittent positive pressure ventilation in the Trendelenburg position. This was found to be an effect of venous pressure.
Reduced plasma cholinesterase following haemodilutional cardiopulmonary bypass
Authors: JACKSON S. H. , BAILEY G. W. H. , STEVENS G.
Published: February 2007

This case report presents a prolonged apnoea following the administration of suxamethonium to a patient whose plasma cholinesterase concentration was reduced as a consequence of haemodilutional cardiopulmonary bypass.
Althesin infusions for maintenance of anaesthesia
Authors: TOWLER C. M. , GARRETT R. T. , SEAR J. W.
Published: February 2007

The intravenous anaesthetic Althesin may be administered by continuous intravenous infusion for maintenance of general anaesthesia, sedation in patients in intensive care units or during investigational procedures. Published reports of experience with this technique are reviewed, with particular attention to the rates of administration employed and the influence of other anaesthetics and analgesic agents used concurrently.
Abuse of trichloroethylene by oral self‐administration
Authors: WELLS J. C. D.
Published: February 2007

A case is described of a man who took deliberately a dose of trichloroethylene by mouth which caused coma and seizures. The patient made a full recovery.
Editorial
Authors: Morgan M.
Published: February 2007

Quidquid agas, prudenter agas, et respice finem*
Prostaglandin E1 as a hypotensive drug during general anaesthesia
Authors: GOTO F. , OTANI E. , KATO S. , FUJITA T.
Published: February 2007

Hypotension induced by prostaglandin E1 (PGE1) infusion (100–150 ng/kg/minute) during halothane anaesthesia to reduce operative blood loss during mastectomy was investigated. PGE1 decreased systolic arterial pressure approximately 34% from pre‐administration values. The duration of induced hypotension was about 75 minutes. When the infusion was stopped, blood pressure returned to within 15% of the control with 15 minutes. Heart rate did not change significantly during PGE1 infusion; the pre‐ejection period and left ventricular ejection period were shortened. Renal function during the hypotensive period was well maintained. Blood loss during surgery was significantly decreased. These findings suggest that PGE1 can be used safely to control arterial pressure during surgery.
Anaesthesia for cystectomy
Authors: RYAN D. W.
Published: February 2007

Sixty‐two patients who underwent radical cystectomy for deeply infiltrating cancer of the bladder were reviewed. Twenty‐four received an epidural anaesthetic and 38 a conventional muscle relaxant and fentanyl anaesthetic. The epidural technique was found to offer advantages because of its hypotensive effects reducing blood loss intra‐operatively and its use to provide analgesia after surgery.

A high incidence of complications accompanied the surgery and frail patients (below 50 kg) and those with symptomatic respiratory disease had a high mortality. Greater attention to pre‐operative care of such patients is indicated.
Hypoxia due to air in the oxygen pipeline
Authors: THORP JOSEPHINE M. , RAILTON R.
Published: February 2007

A patient received an hypoxic anaesthetic gas mixture and made an uneventful recovery. The fault was traced to an air‐oxygen mixer valve in the Intensive Care Unit. An oxygen monitor in theatre would have detected the fault before the patient was anaesthetised.
Function of the Oxford Ventilator at high pressure
Authors: SAYWOOD A. M. , HOWARD R. , GOAD R. F. , SCOTT C.
Published: February 2007

The Penlon Oxford Ventilator functioned well to 6 atmospheres absolute in an air environment and to 31 atmospheres absolute in an oxyhelium environment, as assessed remotely utilising a lung ventilator performance analyser. It features easily comprehensible controls and functions, and its use in prolonged ventilatory support could be taught to non‐anaesthetists with relative ease. In addition to its relative simplicity, it is reliable, readily available, and requires only fitting with a male Schrader valve for use at high pressures. The ventilator is recommended for ventilatory support under extreme hyperbaric conditions.
Anaesthesia and intra‐ocular pressure: a comparison of total intravenous anaesthesia using etomidate with conventional inhalation anaesthesia
Authors: Thomson M.F. , Brock‐Utne J.G. , Bean P. , Welsh N. , Downing J.W.
Published: February 2007

Intra‐ocular pressure (IOP) was measured in two comparable groups of anaesthetised patients under standardised conditions. Group 1 received etomidate 0.3 mg/kg fentanyl 100 μg and droperidol 5 mg, with etomidate 20 μg/kg/minute for maintenance. Group 2 received thiopentone 3.5 mg/kg and were maintained with halothane 0.5% in nitrous oxide (60%) with oxygen.

Both groups of patients were ventilated to normocapnia. Blood pressure, heart rate, central venous pressure and 10P were measured at 5 minute intervals from pre‐induction to 30 minutes postinduction.

A significantly greater reduction in mean IOP (p < 0.05) occurred in group I. A maximum fall in IOP of 61% was obtained, compared to a maximum fall of 45% in group 2.

Blood pressure fell in both groups. The fall was greater (23%) in group 2 than in group 1 (18% and in no case was considered excessive.

Total intravenous anaesthesia using etomidate is suggested as a useful technique for open eye surgery.
The respiratory depression of epidural morphine
Authors: McCAUGHEY W. , GRAHAM JOAN L.
Published: February 2007

In order to investigate the time course of the late respiratory depression which has been reported following epidural opiates, the response to CO2 was measured in 11 patients. Epidural morphine 2 mg was given 1 hour after operation under bupivacaine epidural anaesthesia, and the patients nursed supine. The results show a consistent pattern of respiratory depression commencing at approximately 4–8 hours, and continuing until 18–24 hours after administration of morphine. A similar group of 10 patients nursed in a sitting position did not show the same degree of depression, and a modifying effect of posture on the development of central effects is suggested.
Postextubation laryngospasm abolished by doxapram
Authors: OWEN H.
Published: February 2007

The successful treatment with doxapram of five cases of postextubation laryngospasm is described. The increased respiratory drive from doxapram is suggested as the mechanism of action. Doxapram is a new adjunct in the treatment of this condition.
Scoliosis correction and epidural analgesia
Authors: PURNELL R. J.
Published: February 2007

This case report illustrates the problems which may arise when an epidural block is used during an operation to correct a spinal deformity. In this case, the block was more profound and persistent than expected. This could have been due to spinal cord compression or to ischaemia following the correction with Harrington rods, so the rods had to be removed and re‐inserted later, after the paraparesis had resolved.
A ventilator for use during mobile intensive care and total intravenous anaesthesia
Authors: PARK G. R. , JOHNSON S.
Published: February 2007

A fluid logic ventilator with significant advantages over other compact portable ventilators is described. The variable Flo2, airway pressure gauge and versatility of the ventilator make it suited to mobile intensive care units and use during total intravenous anaesthesia.
Mean intravascular pressure without tears
Authors: WERNER O. , BENTHIN M.
Published: February 2007

A simple device is presented which provides a written record of both the unfiltered pressure curve and a damped curve, representing mean pressure, simultaneously using the same recorder channel.
Mortality associated with anaesthesia
Authors: Lunn J.N. , Mushin W.W.
Published: February 2007

Members of the Association can obtain a copy of the report from the Association Office, Rooms 475–478, Tavistock House South, Tavistock Square, London WC1H 9LG for £1 to cover postage, packing and handling. Others should obtain their copies from the publishers—Nuffield Provincial Hospital Trust, 3 Prince Albert Road, London NW1 7SP (price £3.00 including postage and packing).
Adverse reactions to intravenous codeine phosphate in children
Authors: SHANAHAN E. C. , MARSHALL A. G. , GARRETT C. P. O.
Published: February 2007

Adverse reactions ranging from tachycardia and cutaneous vasodilatation to severe hypotension and apnoea occurred in three children who were given codeine phosphate intravenously. The cause of these reactions is discussed and a review of the literature on the parenteral use of codeine phosphate is presented. The findings indicate that the standard reference formularies and pharmacopeoiae, with one exception, deal inadequately with the parenteral use of codeine phosphate. On the evidence of the cases presented we would support the conclusion of the American Medical Association's drug evaluations, that codeine phosphate should not be used intravenously in children.
Rectal ketamine for induction of anaesthesia in children
Authors: Idvall Jan , Holasek Jiri , Pål Stenberg Värnamo
Published: February 2007

Rectal premedication with atropine and diazepam and rectal induction of anaesthesia with ketamine have been used in 30 healthy children undergoing minor surgetv. The anticholinerigic and sedative effects of the premedication were satisfactory. Induction of anaesthesia was smooth with no adverse circulatory or respiratory effects. No psychotomimetic side‐effects were seen, and analgesia persisted into the recovery period. Plasma concentrations of ketamine and norketamine were measured in eight childrer: and revealed a pharmacokinetic pattern indicating comparatively low bioavailability probably due to incomplete absorption from the rectum and a high ‘first‐pass’ metabolism. The technique of rectal administration of ketamine needs further pharmacokinetic evaluation before it can be generally recommended.
Mechanical ventilation with air‐oxygen mixtures during total intravenous anaesthesia
Authors: DAVEY A. J. , RILEY B.
Published: February 2007

Mechanical ventilation with air‐oxygen mixtures during total intravenous anaesthesia is discussed with the associated problem of obtaining a medically suitable source of air in British rooms. Independently powered ventilators capable of entraining filtered room air were thought to be the best solution.

The Penlon Nuffield Series 400 ventilator was modified and assessed for use in this mode. An entrapment adapter and circuit was devised which allowed the ventilator to entrain more than sufficient ambient air. premixed with added oxygen for patient ventilation even under adverse conditions. The entrainment system ensured good mixing of the entrained air and oxygen and allowed accurate determination of oxygen concentration in the patient system using a suitable nomogram and without an oxygen analyser.

An assessment of one‐way patient valves was also undertaken. The Laerdal valve was found to be the most suitable for use with the system described.
Does obesity affect recovery?
Authors: KUMAR V. , HARVEY J. , COOPER G. M.
Published: February 2007

One hundred and twenty unpremedicated patients, scheduled for minor gynaecological procedures, were randomly allocated to receive Althesin or methohexitone to supplement N2O and O2 anaesthesia. Patients were assessed as thin, medium or fat according to the degree of obesity as measured by skinfold calipers. The range of mean times for the patients to open their eyes was 3.1–4.0 minutes, to be orientated was 4.4–6.7 minutes and to perform a manipulative test was 27.7–32.1 minutes. No statistically significant differences were seen in these indices of recovery whether they received Althesin or methohexitone or whether they were thin, medium or fat. A paper and pencil test was also performed.

Induction doses of the intravenous agent were calculated on a body weight basis and increments given only in response to movement. The mean total dose of Althesin was decreased from 1.33 mg total steroid 1 kg for thin patients to 1.06 mg total steroid/kg for fat patients (p < 0.01). The mean total dose of methohexitone was decreased from 3.4 mg/kg for thin patients to 2.9 mg/kg for fat patients which was not significant.
Femoral neck surgery using a local anaesthetic technique
Authors: Howard C.B. , Mackie I.G. , Fairclough J. , Austin T.R.
Published: February 2007

Thirty cases of femoral sub‐capital fractures, Garden grades 1–4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.
Formalin toxicity in hydatid liver disease
Authors: AGGARWAL A. R. , GARG R. L.
Published: February 2007

Two cases of formalin toxicity developed within 5 to 10 minutes of the placement of packs soaked in formalin within hepatic hydatid cysts. Hypotension, severe tachycardia, postoperative anuria, tachypnoea, restlessness, unconsciousness and coma developed. There was no response to the treatment given. Treatment was continued for about 12 hours. The problems associated with the use of formalin are discussed.
Nitrous oxide in Bristol in 1836
Authors: WELLER R. M.
Published: February 2007

A course of lectures, given by William Herapath in Bristol in 1836, during which nitrous oxide was administered on six occasions, is described.
Breathing system disconnexions and misconnexions
Authors: SPURRING P. W. , SMALL L. F. G.
Published: February 2007

Reports of breathing system disconnexions and misconnexions suggest that such occurrences are now amongst the most frequent causes of accident or near accident during anaesthesia or lung ventilation in which equipment is involved. These reports usually blame the breathing system connectors for failing to make a secure joint but much of the evidence suggests that the choice of an unsuitable or unsatisfactory component or the manner in which it is used may be more likely to be at fault. Several previous articles in Health Equipment Information1,2 have drawn attention to these problems. The purpose of this one is to review the various types of connector that are available, to explain how some accidents have occurred, and to mention some developments intended to provide better security.
Inhalational anaesthesia in developing countries
Authors: EZI‐ASHI T. I. , PAPWORTH D. P. , NUNN J. F.
Published: February 2007

We have examined the requirements for inhalational anaesthesia in the developing countries with particular reference to the problems posed by difficulties in the supply of compressed gases. A scheme is proposed to circumvent these difficulties without loss of the quality of anaesthesia other than foregoing the use of nitrous oxide.
Inhalational anaesthesia in developing countries
Authors: EZI‐ASHI T. I. , PAPWORTH D. P. , NUNN J. F.
Published: February 2007

We have reviewed the availability of apparatus which permits the maximum use to be made of available supplies and services in developing countries. In particular we have stressed the use of electrically operated air compressors and oxygen concentrators to drive sophisticated anaesthetic apparatus which is not dependent on supplies of compressed gases in cylinders.
Anaesthesia during the Falklands campaign
Authors: BULL P. T. , MERRILL S. B. , MOODY R. A. , BAKER D. J. , YATES A. , GERAGHTY I. F. , TIGHE S. Q. M. , SQUIRES S.J. , STOOT C. J.
Published: February 2007

The work of nine Naval anaesthetists deployed with the Task Force during the Falklands campaign is described. The anaesthetists worked in a field hospital (Ajax Bay), a hospital ship (SS Uganda), a troop ship (SS Canberra), aircraft carriers (HMS Hermes and HMS Invincible) and a Royal Fleet Auxiliary (Tidespring). The problems of staffing and providing the stores for various teams in different locations at short notice are discussed.
Etomidate infusion in thoracic anaesthesia
Authors: Carli F. , Stribley G.C. , Clark M.
Published: February 2007

An etomidate infusion was used in the place of nitrous oxide during one lung anaesthesia for 40 patients undergoing thoracic surgery. Analgesia was provided by fentanyl. A mixture of oxygen and air was used to maintain arterial oxygen tension within normal limits despite one lung anaesthesia and enabled the use of nitrous oxide to be avoided in several patients who had lung cysts. Recovery was fairly rapid (mean (SEM) 11.5 (1.4) minutes). There was no incidence of awareness or dreams. This technique provides satisfactory anaesthesia and oxygenation during thoracic surgery when one lung only is being ventilated.
A training programme for fibreoptic nasotracheal intubation. Use of model and live patients.
Authors: Ovassapian Andranik , Dykes Michael H.M. , Golmon Melton E.
Published: February 2007

A scheme for teaching nasotracheal intubation with the aid of fibreoptic instruments on models and live patients is described and evaluated. Twelve trainees completed 74 out of 75 intubations successfully on sedated patients to the satisfaction of themselves, their patients and their instructors.
Penile block for circumcision?
Authors: YEOMAN P. M. , COOKE R. , HAIN W. R.
Published: February 2007

A prospective blind trial was conducted comparing the analgesia and adverse effects produced by caudal extradural blockade (caudal block) with blockade of the dorsal nerves of the penis (penile block) in 38 boys undergoing elective circumcision. Analgesia was assessed by senior nurses using a linear analogue scale and by the response to direct questioning over the first 7 hours after surgery. The degree and duration of postoperative analgesia was similar in the two groups. However, the caudal block group had a higher incidence of motor blockade (p = < 0.01). One technical failure occurred in the penile block group.

It is concluded that a penile block is a satisfactory alternative to caudal blockade with regard to postoperative analgesia and offers several specific advantages.
Quantitative effects of respired helium and oxygen mixtures on gas flow using conventional oxygen masks
Authors: VATER M. , HURT P. G. , AITKENHEAD A. R.
Published: February 2007

A model lung system with a variable artificial constriction was used to quantify the changes in flow produced by the addition of helium to the gas mixture in the system. The tracheal concentration of helium obtained when administering 79% helium/21% oxygen to the system via conventional, disposable face masks was determined using a resuscitation dummy. The greatest proportion of the increase inflow through the orifice occurred at concentrations of helium up to 40%. A tracheal concentration of 40% helium could be obtained with all oxygen masks at fresh gas flow rates greater than 8 litres/minute. These findings will help to rationalise the administration of 79% helium/2 /% oxygen to patients with upper respiratory tract obstruction.
Oesophageal multipurpose monitoring probe
Authors: BAKER A. B. , MCLEOD C.
Published: February 2007

An oesophageal probe which incorporates facilities for pressure, temperature, electrocardiographic and stethoscopic monitoring is described. Actual and potential uses are outlined.
The optimum concentration for epidural fentanyl
Authors: WELCHEW E.A.
Published: February 2007

A randomised, double‐blind study comparing a variety of different concentrations of fentanyl with and without 1:200000 adrenaline is described. It was shown that the quality and duration of analgesia with epidural fentanyl was concentration‐dependent below 10 fig/ml, but that the addition of adrenaline abolished this phenomenon. The rate of failure to achieve any analgesia was very high with the more dilute solutions, but adrenaline reversed this problem. In general the incidences of side effects were related to the concentrations of fentanyl used and apart from itching, the incidences of these side effects were reduced by the addition of adrenaline.
Osmolal excretion after open heart surgery
Authors: READ D. H. , MANNERS J. M.
Published: February 2007

Water and osmolal balance was investigated during the peri‐operative period in twenty unselected adult patients presenting for open heart surgery. On the day before surgery the mean urine output was 1.13 litres/sq m/24 hours and osmolal output 430 mOs/sq m/24 hours.

Using a haemodilution cardiopulmonary bypass technique, patients received 2.62 litres/sq m and 792 mOs/sq m in the operating room. The pattern of excretion of this water and solute load was identified. Patients were still in positive balance on the day following surgery despite a considerable diuresis, with solute retention exceeding water retention.
Intravenous lignocaine in dental anaesthesia
Authors: CLAYTON D. G. , ALLT‐GRAHAM J.
Published: February 2007

The prophylactic use of intravenous lignocaine 1.5 mg/kg given 1 minute prior to induction of anaesthesia has been shown to reduce significantly the incidence of dysrhythmias during dental anaesthesia, and reduce the rise in blood pressure associated with tracheal intubation.
Anaesthesia‐related surgical mortality
Authors: LUNN J. N. , HUNTER A. R. , SCOTT D. B.
Published: February 2007

This is the report of the second of two studies conducted by the Association of Anaesthetists of Great Britain and Ireland based on anonymous reports of deaths within 6 days of anaesthesia. One hundred and ninety‐seven detailed reports were received during 1981; 43% were found by assessors to have nothing to do with anaesthesia, 41% to be partly due to, and 16% totally due to anaesthesia. These figures confirm earlier results reported by the same system. It is important to have the opinion of the two clinicians (anaesthetist and surgeon) separately and not to ignore either in a study which attempts to identify aspects of clinical medicine which might be improved.
Choice reaction time
Authors: SCOTT W. A. C. , WHITWAM J. G. , WILKINSON R. T.
Published: February 2007

Postoperative psychomotor performance changes were measured in three groups of thirteen subjects using a portable serial four‐choice reaction time apparatus. Anaesthesia consisted of either thiopentone, nitrous oxide and halothane (thiopentone subjects) or methohexitone and fentanyljnitrous oxide and incremental methohexitone (methohexitone subjects). Tests were performed on the day before operation and after 2, 4, 6, 8 and approximately 24 hours recovery on both groups of patients and at approximately the same times on nonoperated control patients. Control subjects' mean four‐choice reaction time decreased steadily with practice such that the difference between first and last tests was statistically significant. Mean four‐choice reaction times of thiopentone and methohexitone subjects increased from 515 to 550 ms and 552 to 600 ms respectively after 2 hours recovery. Subsequently four‐choice reaction times decreased in both groups although methohexitone subjects were still significantly slower than controls after 6 hours. Thiopentone subjects were slower than controls at 2, 4 and 8 hours recovery. There was no difference between the three groups of subjects after 24 hours recovery.
Epidural analgesia in labour and maternal posture
Authors: RICKFORD W. J. K. , REYNOLDS FELICITY
Published: February 2007

The effect of maternal position in the period immediately following epidural administration on analgesia and side effects was examined during labour. Patients were randomly allocated to two groups and were either turned from left to right lateral position within 5 minutes of bupivacaine administration (n = 35), or kept in the supine position, modified as appropriate, until pain relief or side effects indicated a change (n = 35). There was no significant difference between the two groups in onset or duration of analgesia, the need for supplements or in absorption of bupivacaine. Circulatory disturbances, all mild and transient, were seen in 14 patients (eight lateral, six supine). There was no significant difference betweeen the two groups either in the frequency of hypotension (four lateral, five supine) or of fetal heart deterioration (four lateral, three supine). However motor block occurred in 15 of the lateral group and five supine (p < 0.02). Such differences are not thought sufficient to counterbalance the potential circulatory disadvantage of the supine position.
Air aspirated from the venous system during total hip replacement
Authors: ANDERSEN K. H.
Published: February 2007

In order to demonstrate the presence of air embolism during total hip replacement surgery six patients, chosen at random, were examined with an ultrasound probe placed over the right atrium. In five patients, the characteristic double cardiac sound coming from the ultrasound probe changed into an irregular rattling sound as the femoral cement started generating its maximum hardering heat. In two patients this change was also heard simultaneously with the insertion of the femoral prosthesis. In four patients in whom catheters were placed in the right atrium it was possible to aspirate a maximum of 3 ml air from the right atrium. During the cementation of acetabulum, no change in the signal, coming from the ultrasound probe, was registered.

It is probable that air is formed in the venous system during the insertion and cementation of a femoral prosthesis. The resulting air embolism is presumed to be the cause of the massive, but generally very brief impairment of the central circulation and the lungs seen during a hip arthroplasty. In the case of patients undergoing anaesthesia with N20, the N20 should be removed before the cementation, it is also recommended that the right atrium be catheterised, in order to reduce the risk of this complication.
Electroconvulsive therapy and intracranial aneurysm
Authors: HUSUM B. , VESTER‐ANDERSEN T. , BUCHMANN G. , BOLWIG T. G.
Published: February 2007

A 42‐year‐old normotensive woman developed a severe mental depression 6 months after an operation for intracranial aneurysm. The use of electroconvulsive therapy (ECT) was judged to be of vital importance. By concurrent administration of intravenous hydralazine and propranolol before induction of anaesthesia the normally occurring ECT‐induced blood pressure elevation was completely prevented, and the patient received a series of ten ECTs without complications.