bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnesium flux and cardiac surgery
Authors: Vyvyan H.A.L. , Mayne P. N. , Cutfield G. R.
Published: July 2010

A prospective study of 128 adult cardiac surgical patients was undertaken in order to quantify net magnesium loss and its relationship to serum magnesium levels and postoperative problems, particularly arrhythmias. Peri‐operative magnesium flux on the first day was calculated from the administered magnesium (in cardioplegia solution and intravenous infusion) and urinary magnesium loss. Magnesium input ranged from 24 mmol to 40 mmol, resulting in a net magnesium gain in 94% of patients. Hypomagnesaemia, identified in 34% of patients pre‐operatively and 30% of patients postoperatively, had no significant correlation with the measured peri‐operative magnesium flux or the electrocardiograph corrected‐QT interval. Fifty‐three patients developed postoperative arrhythmias, but there was no significant correlation with the serum total magnesium concentration, or with the peri‐operative change in serum magnesium level, magnesium flux, or QT interval. The data suggest that serum total magnesium is not a useful measurement upon which to base preventive or therapeutic measures in cardiac surgical patients.
A new method of veno‐venous bypass during human orthotopic liver transplantation
Authors: SCHERER R. , GIEBLER R. , ERHARD J. , LANGE R. , GÜNNICKER M. , SCHMUTZLER M. , PAAR D. , KOX W. J.
Published: July 2010

Veno‐venous bypass is commonly used during orthotopic liver transplantation, but there is some controversy as to whether it contributes to a better outcome. Low shunt flows frequently reduce the efficacy of portofemoro‐axillary systems and so a percutaneous cannulation technique for the subclavian and femoral vein with large bore catheters was developed in order to facilitate bypass management. This study reports the performance and complications of a portofemoro‐subclavian bypass system during the anhepatic phase of human orthotopic liver transplantation in 85 patients. A percutaneous cannulation technique and two 7 mm (subclavian and femoral) catheters, inserted pre‐operatively, were used in a pump driven portofemoro‐subclavian bypass system. Coagulation profiles, shunt flows, haemodynamic parameters, and peri‐operative complications associated with bypass were recorded for each patient. Percutaneous cannulation of the left femoral and subclavian vein was successful in 78 patients (91.8%). Mean femoro‐subclavian shunt flow was 1.45 1.min‐1 (SD 0.37), and mean portofemoro‐subclavian flow was 4.28 1.min‐1 (SD 1.03). Although oxygen delivery was not maintained at pre‐shunt levels (559.7 (SD 147) vs 506 (SD 107) ml.min‐1.m‐2, p < 0.05) renal perfusion pressure stayed above 50 mmHg (during shunt it was 56 (SD 9) mmHg). One intra‐operative air embolism was observed (1.2%), and in one patient a myocardial infarction occurred during the anhepatic phase; neither complication was considered to be related to the percutaneous cannulation technique. There were no bleeding complications. After operation, all chest X rays were normal and clinical examination revealed no adverse effects of portofemoro‐subclavian bypass. Percutaneous cannulation for portofemoro‐subclavian bypass using 7 mm catheters for the femoral and subclavian vein is a rapid, simple, effective, and safe method for management of adverse haemodynamic effects during the anhepatic phase of orthtopic liver transplantation.
Anaesthesia for Caesarean section in a patient receiving high dose amiodarone for fetal supraventricular tachycardia
Authors: FULGENCIO J. P. , HAMZA J.
Published: July 2010

We report the anaesthetic management of a Caesarean section in a woman treated with high dose amiodarone for fetal supraventricular tachycardia. Most of the interactions between anaesthesia and amiodarone therapy previously reported were observed during general anaesthesia. We therefore chose epidural anaesthesia using incremental doses of lignocaine 2% with adrenaline and fentanyl. This technique appeared to be safe, but since severe refractory vasodilatation with hypotension may occur, potent vasopressor agents should be immediately available.
An unusual complication of Cornelia de Lange syndrome
Authors: VEALL G. R. Q.
Published: July 2010

A previously undescribed complication of Cornelia de Lange syndrome is reported. The patient developed severe chronic pericarditis with subsequent fatal postoperative cardiac tamponade.
Apparent massive tongue swelling A complication of orotracheal intubation on the Intensive Care Unit
Authors: HUEHNS T. Y. , YENTIS S. M. , CUMBERWORTH V.
Published: July 2010

The trachea of an 81‐year‐old woman was intubated with an orotracheal tube for emergency abdominal surgery and the tube was left in place for postoperative management on the Intensive Care Unit. After 36 h, she developed apparent massive tongue swelling. On closer examination, a normal sized tongue was found to be displaced by oedema of the floor of the mouth and submandibular space, secondary to purulent sialadenitis from right submandibular duct obstruction by the tracheal tube.
Laboratory assessment of a user‐assembled oxygen generation kit
Authors: BHIMSAN N. R. , ROUT C. C. , MURRAY W. B.
Published: July 2010

A laboratory assessment was made of a user‐assembled oxygen generation kit designed for use in medical emergencies in the community. Twenty‐five kits were studied at five different water temperatures and the rate of oxygen generation and its concentration were measured. The apparatus produced a mean (SD) oxygen volume of 37 (1.98) I which was not affected by the starting water temperature. The mean (SD) rate of flow varied from 2.2 (0.04) l.min‐1 at 16°C to 10.3 (2.74) l.min‐1 at 40°C but the duration of flow varied inversely. Oxygenation concentrations ranging from 30–51% were produced at starting water temperatures from 22°C‐40°C, respectively.
Spinal anaesthesia for patients with previous lower limb amputations
Authors: Tessler M. J. , Kleiman S. J.
Published: July 2010

Phantom limb pain has been reported as a transient phenomenon in patients with lower limb amputations during subsequent spinal anaesthesia. In order to determine its incidence and to define any predisposing factors we prospectively studied 23 spinal anaesthetics in 17 patients with previous lower limb amputation. Only one patient developed clinically significant phantom limb pain and we were unable to define any predisposing factors. Given the low incidence of recurrent phantom limb with spinal anaesthesia, its transient nature, and the fact that it can be treated if it occurs, we conclude that spinal anaesthesia is not contraindicated in patients with previous lower limb amputation.
A simple method for the maintenance of oxygen saturation following intravenous induction of anaesthesia with propofol
Authors: RUGGIER R. , BAILEY C. R. , GROUNDS R. M. , CLARKE J. T.
Published: July 2010

One hundred unpremedicated fit adult patients having elective minor day‐stay surgery and general anaesthesia were randomly allocated to one of two groups. During 30 s of intravenous propofol administration (2.5 mg.kg‐1), study group patients (n = 50) were instructed to take three vital capacity breaths of room air, whilst control group patients (n = 50) were given no specific instructions. Pulse oximetry was continuously recorded over the next 5 min and the lowest oxygen saturation was noted. Pre‐induction oxygen saturation was the same for both groups, but the lowest median oxygen saturation in the study group patients was 94% versus 88% in the control group patients (p < 0.001). Oxygen saturation returned to the pre‐induction value significantly earlier in the study group patients compared with controls (97 s vs 135 s, p < 0.01). These results demonstrate that significant desaturation occurs in patients following intravenous induction of anaesthesia with propofol. This desaturation may be attenuated by asking patients to take three vital capacity breaths of room air during induction of anaesthesia.
Patient‐controlled epidural analgesia with sufentanil following Caesarean section: the effect of adrenaline and clonidine admixture
Authors: VERCAUTEREN M. P. , VANDEPUT D. M. , MEERT T. F. , ADRIAENSEN H. A.
Published: July 2010

Sixty patients, scheduled for Caesarean section were randomly allocated to receive by the epidural route in a double‐blind fashion one of the following patient‐controlled analgesia mixtures for the relief of postoperative pain: sufentanil 2 μg.ml‐1 in 0.9% sodium chloride, sufentanil 2 μg.ml‐1+ adrenaline 2.5 μg.ml‐1, or sufentanil 2 μg.ml‐1+ clonidine 3 μg.ml‐1. Patient‐controlled analgesia settings were a basal infusion rate of 2.5 ml.h‐1, an incremental dose of 2.5 ml, a lockout interval of 10 min and a 1‐h limit of 10 ml. Whereas patient demographics and pain scores between the groups were not different, the 24‐h consumption of sufentanil was significantly lower in the groups receiving a combination (167.5 SD 45 and 139.1 SD 31.9 μg for the adrenaline and clonidine groups respectively) as compared to the plain sufentanil regimen (208.2 SD 38.9 μg). Although sufentanil requirements were the lowest in the clonidine admixture group, there were no differences with regard to sedation as compared to the plain sufentanil group. The quality of sleep appeared to be significantly better in the sufentanil/adrenaline group despite a significantly lower degree of sedation and higher incidence of pruritus. Treatment of pruritus with naloxone did not seem to influence the quality of analgesia.
Oral administration of midazolam as a premedicant for paediatric day‐case anaesthesia
Authors: McCLUSKEY A. , MEAKIN G. H.
Published: July 2010

Fifty‐four children aged 1–10 years, scheduled for day‐case anaesthesia were prescribed either oral midazolam 0.5 mg.kg‐1 or a placebo preparation 30‐60 min pre‐operatively on a double‐blind basis. On arrival at the induction room, anxiolysis was satisfactory in 23 out of 24 (96%) children who received midazolam compared with 12 out of 27 (44%) of those who received placebo (p < 0.001); at induction of anaesthesia these proportions were 21 out of 24 (88%) and nine out of 27 (33%) respectively (p < 0.001). The time to early recovery from anaesthesia was somewhat longer in children premedicated with midazolam compared with controls (28.2 vs 21.9 min) (p < 0.05). Similarly, the time to hospital discharge was longer in the midazolam group (244 vs 185 min) (p < 0.01). Analysis of behavioural questionnaires completed by parents 2 weeks after hospitalisation indicated that there were fewer postoperative behavioural disturbances in children premedicated with midazolam compared with controls (p < 0.05).
Paralytic ileus as a complication of atropine therapy following severe organophosphate poisoning
Authors: BEARDS S. C. , KRAUS P. , LIPMAN J.
Published: July 2010

A 32‐year‐old man presented with symptoms of severe organophosphate poisoning and required an atropine infusion for 5 weeks. We believe the development of a paralytic ileus occurred as a rare feature of atropine toxicity when other signs were masked by the underlying condition. The onset of a paralytic ileus coincided with a spontaneous increase in red cell cholinesterase levels and may be an early sign of recovery from organophosphate poisoning.
Subdural block—further points
Authors: BELL G. T. , TAYLOR J. C.
Published: July 2010

An obstetric epidural performed for analgesia showed a changing pattern of neurological block. The original features suggestive of a subdural block were complicated when aspiration of cerebrospinal fluid from the catheter became possible. Subsequent management as a continuous subarachnoid catheter allowed delivery.
Propofol as sole agent for paediatric day‐case dental surgery
Authors: Moore W. J. , Underwood S.
Published: July 2010

After intravenous induction of anaesthesia with propofol (4 mg.kg‐1) 80 unpremedicated children admitted for day‐case dental extractions were randomly allocated to receive either an intravenous propofol infusion whilst breathing 100% oxygen, or inhalational nitrous oxide, oxygen and halothane for maintenance of anaesthesia. In both groups, the quality of anaesthesia was acceptable to both anaesthetist and surgeon. Recovery times and postoperative analgesia requirements did not differ significantly between the two groups. No child vomited. Propofol appears to be suitable for use as a sole agent in paediatric day case dental surgery.
The addition of triamcinolone acetonide to bupivacaine has no effect on the quality of analgesia produced by ilioinguinal nerve block
Authors: McCleane G. , Mackle E. , Stirling I.
Published: July 2010

In a study of 30 men undergoing elective inguinal hernia repair under general anaesthesia no difference in postoperative pain, patient rating score or morphine consumption was found between patients who had pre‐operative ilioinguinal nerve block with bupivacaine 0.5% plain and those who received a similar block with bupivacaine 0.5% plain and triamcinolone acetonide 40 mg. Mean (SD) morphine requirements using a patient‐controlled analgesia system were 37 (22.2) mg and 32 (20.3) mg in the bupivacaine and bupivacaine/triamcinolone groups respectively (p > 0.05). The addition of triamcinolone 40 mg to bupivacaine 0.5% offers no advantages over unsupplemented bupivacaine when used for ilioinguinal block.
Sevoflurane anaesthesia for major intra‐abdominal surgery
Authors: QUINN A. C. , NEWMAN P. J. , HALL G. M. , GROUNDS R. M.
Published: July 2010

The cardiovascular effects and recovery characteristics of sevoflurane and isoflurane anaesthesia were compared in 30 gynaecological and 20 general surgical patients undergoing elective intra‐abdominal surgery. Patients were randomly allocated to receive either sevofurane or isofurane as the volatile agent, in a balanced anaesthetic technique including morphine and atropine prernedication and thiopentone, fentanyl. vecuronium and nitrous oxide. The concentration of volatile agent was titrated according to clinical variables. Mean heart rate, systolic and diastolic arterial pressure and duration of surgery did not differ between the two groups. Time to emergence from anaesthesia in the gynaecological patients was significantly faster after sevoflurane compared with isoflurane (p < 0.005). Sevoflurane provided stable anaesthesia during major intra‐abdominal surgery.
Anaesthesia and the new generation monoamine oxidase inhibitors
Authors: McFARLANE H. J.
Published: July 2010

The new generation monoamine oxidase inhibitors are short acting and specific for monamine oxidase A. Evidence to date suggests that there is little potential for significant interaction with most drugs used in anaesthesia.
Anaesthesia in a child with Schwartz‐Jampel syndrome
Authors: RAY S. , RUBIN A. P.
Published: July 2010

We have described the clinical features and principles of anaesthetic management of a child with Schwartz. Jampel syndrome, with specific reference to thermoregulatory problems.
Hypertrophic obsrrucitve cardiomyopathy complicating surgery for cerebral artery aneursysm clipping
Authors: EDMENDS S. , GHOSH S.
Published: July 2010

The anesthetic management of a patient with hypertrophic obstructive cardiomyopathy undergoing cerebral artery aneurysm clipping is described.
Improtance of components of the curriculum vitae in determining appointment to senior registrar posts
Authors: Conn D. A. , Asbury A. J.
Published: July 2010

To evaluate the opinions of regional education advisers, academics and other consultants about features of the curriculum vitae, we undertook a small attitude survey. The response rate was 73%, which provided data from a total of 78 influential anaesthetists. The respondents’ attitude to each feature of the curriculum vitae was reported using a linear visual analogue scale. The three groups had similar attitude scores to most features, but not to research time, training time, higher degrees and abstracts of papers presented to the Anaesthetic Research Society. Publications in the main anaesthesia journals, time in other major medical specialties, research and the possession of a higher degree were scored highly by all respondents. Papers in non‐peer‐reviewed journals, letters, unsubmitted papers, and time in training for general practice attracted lower scores. The free text comments of the many respondents indicated a considerable disillusionment about the whole appointments process.
Analgesic effect of intra‐articular morphine after arthroscopic meniscectomy
Authors: Dierking G. W. , Øtergaard H. T. , Dissing C. K. , Kristensen J. E. , Dalhl J. B.
Published: July 2010

A study was performed to assess the analgesic effect of intra‐articular morphine 2 mg in 33 patients undergoing elective arthroscopic meniscectomy. Patients were randomly allocated to receive either 2 mg of morphine hydrochloride in 40 ml of normal saline intra‐articularly and I ml of normal saline intraniuscularly (n = 18), or 40 ml of normal saline intra‐articularly and 2 mg of morphine hydrochloride intramuscularly (n = 15). The latter group was to act as a control for any potential systemic effects of the morphine. All patients received an identical general anaesthesia consisting of propofol, alfentanil, enflurane and nitrous oxide/oxygen. No significant differences between the groups were found in pain scores at rest or during active flexion of the knee at 1‐6 h postoperatively, or during walking at 6 h postoperatively (p > 0.05). Six and two patients in the intra‐articular and intramuscular morphine group, respectively, requested supplemental morphine given intravenously (p > 0.05). In conclusion, no significant differences in pain scores or in requirements for supplemental morphine were observed between patients receiving intra‐articular versus intramuscular morphine 2 mg after elective arthroscopic meniscectomy and consequently no specific local analgesic effect of intra‐articular morphine could be demonstrated.
Pre‐oxygenation: a comparison of two techniques using a Bain system
Authors: Ronney M. J.
Published: July 2010

Pre‐oxygenation using a standard technique of tidal breathing for 3 min through a Bain system with a fresh gas flow of 8 1.min−1 was compared with up to six vital capacity breaths from the same system. The technique of vital capacity breaths involved initial expiration to residual volume and use of the oxygen flush throughout controlled full inspirations, ensuring that the reservoir bag remained full. No significant problems were encountered using this method. Although three vital capacity breaths produced significantly inferior pre‐oxygenation compared to 3 min of normal breathing, four and five vital capacity breaths were equally effective. With six vital capacity breaths, superior pre‐oxygenation was produced. The use of four or more vital capacity breaths with this technique is a reliable and rapid alternative to 3 min of tidal breathing.
Lignocaine 0.5% for spinal anaesthesia in gynaecological day surgery
Authors: Liew Q. Y. , Tay D. H. B. , Thomas E.
Published: July 2010

Spinal anaesthesia with 5 ml of lignocaine 0.5% was administered to 30 women presenting for day case minor gynaecological surgery. They were allocated at random to receive the anaesthetic via either a 26‐gauge Atraucan (pencil point) or a 29‐gauge Spinocan (cutting bevel) spinal needle. Onset, duration, spread and regression of sensory and motor blockade, haemodynamic parameters and postoperative complicatons were studies. An upper sensory level of T10 (93.3%) was obtained in all except two patients. No patient complained of discomfort during surgery. The mean onset time was less than 8 min and the mean duration of sensory block was 32.5 min. All patients had complete return of motor power within 1 h and were discharged the same day. Only one patient had a transient episode of hypotension which was easily treated with intravenous fluids. Three were no serious side effects seen postoperatively. We conclude that spinal anaeshtesia with 5 ml of lignocaine 0.5% provides a useful alternative to general anaesthesia for day case minor gynaecological surgery.
Mortality associated with anaesthesia: a qualitative analysis to identify risk factors
Authors: Arbous M. S. , Grobbee D. E. , Van Kleef J. W. , De Lange J. J. , Spoormans H. H. A. J. M. , Touw P. , Werner F. M. , Meursing A. E. E.
Published: July 2010

From a prospectively defined cohort of patients who underwent either general, regional or combined anaesthesia from 1 January 1995 to 1 January 1997 (n = 869 483), all consecutive patients (n = 811) who died within 24 h or remained unintentionally comatose 24 h after anaesthesia were classified to determine a relationship with anaesthesia. These deaths (n = 119; 15%) were further analysed to identify contributing aspects of the anaesthetic management, other factors and the appropriateness of care. The incidence of 24‐h peri‐operative death per 10 000 anaesthetics was 8.8 (95% CI 8.2–9.5), of peri‐operative coma was 0.5 (0.3–0.6) and of anaesthesia‐related death 1.4 (1.1–1.6). Of the 119 anaesthesia‐related deaths, 62 (52%) were associated with cardiovascular management, 57 (48%) with other anaesthetic management, 12 (10%) with ventilatory management and 12 (10%) with patient monitoring. Inadequate preparation of the patient contributed to 30 (25%) of the anaesthesia‐related deaths. During induction of anaesthesia, choice of anaesthetic technique (n = 18 (15%)) and performance of the anaesthesiologist (n = 8 (7%)) were most commonly associated with death. During maintenance, the most common factors were cardiovascular management (n = 43 (36%)), ventilatory management (n = 12 (10%)) and patient monitoring (n = 12 (10%)). In both the recovery and the postoperative phases, patient monitoring was the most common factor (n = 12 (10%) for both). For cardiovascular, ventilatory and other anaesthetic management, human failure contributed to 89 (75%) deaths and organisational factors to 12 (10%). For inadequate patient monitoring, human factors contributed to 71 (60%) deaths and organisational factors to 48 (40%). Other contributing factors were inadequate communication (30 deaths (25%) for all four aspects of the anaesthetic management) and lack of supervision (particularly for ventilatory management). Inadequate care was delivered in 19 (16%) of the anaesthesia‐related deaths with respect to cardiovascular management, in 20 (17%) with respect to ventilatory management, in 18 (15%) with respect to patient monitoring and in 23 (19%) with respect to other anaesthetic management.
Speed of collapse of the non‐ventilated lung during one‐lung anaesthesia: the effects of the use of nitrous oxide in sheep
Authors: Pfitzner J. , Peacock M. J. , Pfitzner L.
Published: July 2010

By enhancing gaseous uptake from the non‐ventilated lung during procedures performed thoracoscopically, the rapid diffusion properties of nitrous oxide would be expected to speed lung collapse and so facilitate surgery. To assess the effect of nitrous oxide on the speed of absorptive lung collapse, a study was conducted using 11 anaesthetised sheep. Speed of collapse was assessed in an indirect manner by recording the time required in a closed‐chest situation for the airway pressure distal to a single lung airway occlusion to decrease to − 1.0 kPa. The influence of nitrous oxide was assessed by comparing the time taken for this decrease in airway pressure when the animal was being mechanically ventilated with 50% nitrous oxide in oxygen with the time taken when using 100% oxygen. In all assessments, it was found that the decrease in airway pressure to − 1.0 kPa occurred in a shorter time when nitrous oxide was used. The findings lend support to the hypothesis that during thoracoscopic surgery, mechanical lung ventilation with an oxygen/nitrous oxide mixture will increase the rate of gaseous uptake from the non‐ventilated lung and so hasten its absorptive collapse.
Speed of collapse of the non‐ventilated lung during single‐lung ventilation for thoracoscopic surgery: the effect of transient increases in pleural pressure on the venting of gas from the non‐ventilated lung
Authors: Pfitzner J. , Peacock M. J. , Harris R. J. D.
Published: July 2010

A study of 10 anaesthetised patients placed in the lateral position for thoracoscopic surgery assessed whether transient increases in pleural pressure on the side of the non‐ventilated lung might increase the speed at which gas vents from that lung. The transient increases in pleural pressure were generated by the mediastinal displacement that occurs with each inspiratory phase of positive pressure ventilation of the dependent lung. When combined with a unidirectional valve allowing gas to flow out of the non‐ventilated lung, and a second valve allowing ambient airflow into, but not out of, the thoracic cavity via an initial thoracoscopy access site, this mediastinal displacement could conceivably serve to ‘pump’ gas out of the non‐ventilated lung. Using the four different combinations of valve inclusion or omission, the volume of gas that vented from the non‐ventilated lung into a measuring spirometer was recorded during a 120‐s measurement sequence. It was found that the speed of venting was not increased by the transient increases in pleural pressure, and that in all but one of a total of 34 measurement sequences, venting had ceased by the end of the sequence. Gas venting was a mean (SD) of 85.5 (11.9)% complete in 25 s (five breaths), and 96.6 (6.1)% complete in 60 s. This prompt partial lung collapse very likely reflected the passive elastic recoil of the lung, while the failure of transient increases in pleural pressure to result in ongoing venting of gas was probably a consequence of airways closure as the lung collapsed. It is concluded that techniques that aim to speed lung collapse by increasing pleural pressure are unlikely to be effective.
Pharmaceutics for the anaesthetist
Authors: MacPherson R. D.
Published: July 2010

Pharmaceutics is that branch of science concerned with the manufacture and formulation of pharmaceutical products, and is a subject almost exclusively in the domain of pharmacists and those concerned with pharmaceutical manufacture. However, there are some aspects of pharmaceutics that are of particular importance to the anaesthetist, such as the pharmacology of the various preservatives, antimicrobials and other additives found in anaesthetic products, and an understanding of basic processes such as emulsification and lyophylisation. This review aims to survey those areas.
Evaluation of the Pneupac Ventipac portable ventilator in critically ill patients
Authors: McCluskey A. , Gwinnutt C. L. , Hardy L. , Haslett R. , Bowles B. , Kishen R.
Published: July 2010

We assessed adequacy of ventilation in 20 critically ill patients with multiple organ failure using a Pneupac Ventipac portable ventilator and the effects on patients' haemodynamic stability. Baseline data were recorded over 15 min for a range of respiratory, haemodynamic and oxygen transport variables during ventilation with a standard intensive care ventilator (Engström Erica). Patients were then ventilated for 40 min using the portable ventilator. Finally, they were ventilated for a further 40 min using the standard intensive care ventilator. Heart rate, arterial and pulmonary artery pressures were recorded at 5‐min intervals throughout the study period. Cardiac index and other haemodynamic data derived from a pulmonary artery catheter were recorded at 20‐min intervals. Blood gas analysis was performed and oxygen transport data (oxygen delivery, oxygen consumption and physiological shunt) were calculated at the end of each of the three periods of ventilation. In general, no significant adverse effects of ventilation using the portable ventilator were observed for any of the variables studied. Arterial Po2 increased significantly during ventilation with the portable ventilator, reflecting the use of a higher inspired oxygen fraction during this part of the study. Oxygen consumption decreased significantly in one patient during ventilation by the portable ventilator although none of the other variables measured in this patient was altered. We conclude that ventilation of critically ill patients using the Pneupac Ventipac portable ventilator was safe, satisfactory and associated with minimal adverse effects on respiratory, haemodynamic and oxygen transport variables.
Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting
Authors: Halpenny M. , Lakshmi S. , O'Donnell A. , O'Callaghan‐Enright S. , Shorten G. D.
Published: July 2010

Impairment of renal and splanchnic perfusion during and after cardiopulmonary bypass may be responsible for acute renal failure and endotoxin‐mediated systemic inflammation, respectively. We hypothesised that fenoldopam, a selective dopamine receptor agonist, would preserve renal function after cardiopulmonary bypass through its selective renal vasodilatory and natriuretic effects, and increase gastrointestinal mucosal perfusion by selective splanchnic vasodilation. We examined the effects of fenoldopam on haemodynamic parameters, creatinine clearance, fractional excretion of sodium, urine output, free water clearance and gastric mucosal pH in 31 patients undergoing elective coronary revascularisation. Patients were randomly assigned to receive continuous infusions of fenoldopam 0.1 µg.kg−1.min−1(n = 16) or placebo (n = 15). Renal parameters were measured: during a 24‐h period before hospital admission, during cardiopulmonary bypass, from completion of cardiopulmonary bypass until 4 h later, from 4 to 8 h after cardiopulmonary bypass, and from 8 to 14 h after cardiopulmonary bypass. Gastric intramucosal pH was measured using a gastric tonometer before, during and after cardiopulmonary bypass. In the placebo group, but not the fenoldopam group, mean (SD) creatinine clearance decreased after separation from cardiopulmonary bypass, from 107 (36) to 71 (22) ml.min−1(p < 0.01) and from 107 (36) to 79 (26) ml.min−1(p < 0.01) for the 0–4 h and 4–8 h intervals after cardiopulmonary bypass, respectively. Changes in intramucosal pH were similar in both groups. The findings are consistent with the hypothesis that fenoldopam possesses a renoprotective effect in patients undergoing cardiopulmonary bypass.
Bloodletting acupuncture for the prevention of stridor in children after tracheal extubation: a randomised, controlled study
Authors: Saghaei M. , Razavi S.
Published: July 2010

Bloodletting acupuncture has been used for the treatment of a variety of upper respiratory tract problems, especially those of laryngeal origin. This study assesses its efficacy in reducing the incidence of stridor after tracheal extubation in children undergoing general anaesthesia with halothane. Sixty children were randomly allocated to an acupuncture group and a control group. In the acupuncture group, bloodletting acupuncture was performed before extubation. A blinded observer determined the presence and severity of postextubation stridor. The incidence of stridor in the acupuncture group was significantly higher than in the control group. In addition, the severity of stridor was significantly greater in the acupuncture group. It is concluded that in children undergoing halothane anaesthesia, the incidence of postextubation stridor cannot be reduced by bloodletting acupuncture.
Post‐tonsillectomy pain: a prospective, randomised and double‐blinded study to compare an ultrasonically activated scalpel technique with the blunt dissection technique
Authors: Akural E. I. , Koivunen P. T. , Teppo H. , Alahuhta S. M. , Löppönen H. J.
Published: July 2010

Thirty‐two patients participated in a study to compare the use of an ultrasonically activated scalpel (Harmonic scalpel) for tonsillectomy on one side and a blunt dissection tonsillectomy on the other. Pain scores at rest and on swallowing expressed as the area under curves (AUC) during the 10 h after surgery, intra‐operative blood loss and the need for electrocoagulation for haemostasis were significantly higher on the blunt dissection side than on the Harmonic scalpel side (p < 0.05). However, pain scores expressed as AUC at rest, on swallowing, the day's least, average and worst levels of pain, and the day's worst otalgia during the second week after surgery were significantly higher on the Harmonic scalpel side than on the blunt dissection side. In conclusion, we found that Harmonic scalpel tonsillectomy was associated with decreased severity in pharyngeal pain on the day of the operation but increased pharyngeal pain and otalgia during the second postoperative week.
Poisoning due to Abrus precatorius (jequirity bean)
Authors: Fernando C.
Published: July 2010

The management of a patient with poisoning due to ingestion of the jequirity bean (Abrus precatorius) is presented. The clinical features of this case included pulmonary oedema and hypertension; this has not been recorded previously in the literature associated with jequirity bean poisoning.
Evaluation of diagonal earlobe crease as a marker of coronary artery disease: the use of this sign in pre‐operative assessment*
Authors: Kuri M. , Hayashi Y. , Kagawa K. , Takada K. , Kamibayashi T. , Mashimo T.
Published: July 2010

In this study, we examined the usefulness of the earlobe crease sign as a marker of coronary artery disease in the pre‐operative assessment of patients. We were interested in evaluating this sign for use in emergency patients. We investigated 530 patients, aged > 40 years, undergoing elective surgery. If the electrocardiogram was abnormal or the patient reported symptoms suggesting coronary artery disease, further cardiac examinations were performed. Patients who demonstrated evidence of coronary artery disease in the additional investigations or had a clear history of coronary artery disease were classified as the abnormal coronary group. Other patients with no history and/or normal investigations were classified as the normal coronary group. The assessment of earlobe crease sign was performed prior to anaesthesia, and the sensitivity, specificity and positive predictive value of this sign were calculated. We found that the sensitivity and specificity was high regardless of age, except for specificity in patients > 70 years old. The data suggest that the earlobe crease sign may be a useful marker for the presence of coronary artery disease in patients undergoing emergency operations in which little or no history and investigations are available. However, more work is required to assess the use of this sign in other ethnic groups.
The effect of an infusion of esmolol on the incidence of myocardial ischaemia during tracheal extubation following coronary artery surgery
Authors: Kurian S. M. , Evans R. , Fernandes N. O. , Sherry K. M.
Published: July 2010

The aim of this randomised controlled study was to determine whether an esmolol infusion affected the incidence of ST segment changes during weaning from intermittent positive pressure ventilation and tracheal extubation after coronary artery surgery. Thirty‐one patients received an infusion of esmolol 0–300 µg.kg−1.min−1 and 37 patients comprised the control group. ST segment changes were monitored using a continuous ambulatory surveillance system. The electrocardiogram, direct arterial pressure and pulse oximetry were monitored continuously. The period of analysis was from 120 min before until 180 min after tracheal extubation. Three patients in the esmolol group developed myocardial ischaemia during the study period compared with 12 in the control group (p = 0.05). Heart rate increased with time during the study period (p = 0.002) in the control group but was unchanged in the esmolol group. Mean heart rate was significantly higher in the control group than in the esmolol group from 40 min before until 180 min after tracheal extubation. Seven patients in the esmolol group suffered adverse events related to the esmolol infusion. Although the use of esmolol reduced the incidence of myocardial ischaemia, the incidence of adverse effects makes it unsuitable prophylaxis for patients after coronary artery surgery.
Parturient‐controlled epidural analgesia during labour: bupivacaine vs. ropivacaine
Authors: Chua N. P. , Sia A. T. , Ocampo C. E.
Published: July 2010

In this randomised, controlled study, we compared the hourly dose requirement of ropivacaine 0.125% (group R, n = 16) with bupivacaine 0.125% (group B, n = 16) provided by demand‐only (bolus 5 ml, lockout 10 min) parturient‐controlled epidural analgesia during labour. The hourly dose requirement was comparable although group R had a lower successful to total demands ratio (p < 0.05). We also found that both groups were clinically indistinguishable in terms of pain relief and side‐effects. No difference in maternal or fetal outcome was detected. We conclude that, at a concentration of 0.125%, ropivacaine and bupivacaine were equally effective when self‐administered using this patient‐controlled regimen.
Patient‐controlled pethidine after major upper abdominal surgery: comparison of the epidural and intravenous routes*†
Authors: Chen P. P. , Cheam E. W. , Ma M. , Lam K. K. , Ngan Kee W. D. , Gin T.
Published: July 2010

We compared epidural (n = 17) and intravenous (n = 20) patient‐controlled analgesia (PCA) using pethidine (bolus 10 mg, lockout interval 10 min, 4‐h maximum dose 3 mg.kg−1) after total gastrectomy. We found that mean (SD) pethidine consumption in the first 24 h was 33% less in the epidural group [255 (85) mg] than in the intravenous group [379 (129) mg, p = 0.002], although most of this difference occurred in the first 8 h. Plasma concentrations of pethidine were lower at 8 h (p < 0.01) in the epidural group, but were similar at 24 h. Pain scores, side‐effects, patient satisfaction and patient outcome were similar between groups. Epidural and intravenous pethidine PCA provided similar efficacy after major abdominal surgery, although the epidural route can reduce the amount of pethidine used initially.
Effect of nitrous oxide on the bispectral index and the 95% spectral edge frequency of the electroencephalogram during surgery
Authors: Hans P. , Bonhomme V. , Benmansour H. , Dewandre P. Y. , Brichant J. F. , Lamy M.
Published: July 2010

We studied the effect of nitrous oxide on the bispectral index and 95% spectral edge frequency of the electroencephalogram in 20 patients undergoing lumbar surgery under general anaesthesia combined with epidural administration of 5 mg morphine. Anaesthesia was induced with propofol and sufentanil, and maintained with sevoflurane in air/oxygen adjusted to keep the bispectral index between 40 and 60. One and a half hours after the start of surgery, nitrous oxide was administered in a randomised sequence of concentrations (20, 40 and 60% end‐expired). Under steady‐state conditions, mean (SD) bispectral index and spectral edge frequency decreased as end‐tidal concentration of nitrous oxide increased, from 47.7 (4.3) and 15.6 (1.3) at 0% nitrous oxide to 39.8 (6.3) and 14.3 (1.8) at 60% nitrous oxide. A negative correlation was found between nitrous oxide concentration and bispectral index (r = −0.48; p < 0.01) and spectral edge frequency (r = −0.39; p < 0.05). We conclude that this dose‐dependent decrease in bispectral index and spectral edge frequency induced by nitrous oxide may reflect the level of analgesia associated with the anaesthetic regimen.
A national census of central neuraxial block in the UK: results of the snapshot phase of the Third National Audit Project of the Royal College of Anaesthetists*
Authors: Cook T. M. , Mihai R. , Wildsmith J. A. W. ,   the Royal College of Anaesthetists Third National Audit Project Working Group
Published: July 2010

The first stage of the Royal College of Anaesthetists Third National Audit Project to assess the incidence of major complications of central neuraxial block in the UK was a 2‐week national census of block use. A reporting system was established in the 309 National Health Service hospitals believed to undertake surgical work and data were received from 304, a response rate of 98.7%. Over 90% of these were judged by the reporters to be ‘accurate’. The total number of procedures reported as being performed in the 2‐week period was 27 533: extrapolation using a multiplier of 25 suggests that nearly 700 000 major blocks are performed annually (315 000 spinals, 287 000 cervical, thoracic or lumbar epidurals, 42 000 combined spinal‐epidurals and 56 000 caudal epidurals). After the second stage of the project, which will record complications from the same hospitals over a 12‐month period, these data will be used as denominators to calculate the incidences of complications.
The inhibitory effects of local anaesthetics on the vascular flare responses to bradykinin and substance P in human skin*
Authors: Dias M. P. , Newton D. J. , McLeod G. A. , Khan F. , Belch J. J. F.
Published: July 2010

Bradykinin and substance P are involved in inflammation and act through Gq‐protein‐coupled receptors. Local anaesthetics inhibit the signalling of these receptors and have potent anti‐inflammatory actions. The aim of this study was to investigate the effects of local anaesthetics on the cutaneous flare responses to bradykinin and substance P. Skin blood flow responses to intradermal injections of bradykinin and substance P were assessed in the absence and presence of anaesthetic and analgesic concentrations of lidocaine, levobupivacaine and ropivacaine. All local anaesthetics significantly attenuated the vascular responses to bradykinin (p = 0.001) and substance P (p < 0.001). There were no differences in this effect between the different agents, but anaesthetic concentrations had a greater attenuating effect than analgesic concentrations on the substance P response (p < 0.001). Local anaesthetics may therefore be useful in the suppression of inflammation and the prevention of postoperative hyperalgesia.
Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentration
Authors: Andersen L. Ø. , Gaarn‐Larsen L. , Kristensen B. B. , Husted H. , Otte K. S. , Kehlet H.
Published: July 2010

Wound administration of local anaesthetic may be effective for postoperative pain management in knee arthroplasty, but the analgesic efficacy of local anaesthetic in relation to volume vs concentration has not been determined. In a double‐blinded trial, 48 patients scheduled for total knee arthroplasty were randomly assigned to receive either a high volume/low concentration solution of ropivacaine (20 ml, 0.5%) or a low volume/high concentration solution of ropivacaine (10 ml, 1%), 6 and 24 h postoperatively through an intracapsular catheter. Pain was assessed for 2 h after administration. Pain was reduced in both groups with ropivacaine administration 24 h postoperatively (p < 0.02), but with no difference in analgesia between groups at all time intervals. No reduction in pain scores was observed with ropivacaine injection 6 h postoperatively. The median (IQR [range]) dose of oxycodone administered was 12.5 (10–19 [0–35]) mg in the high volume/low concentration group, and 20 mg (16–40 [0–65]) mg in the low volume/high concentration group (p = 0.005). In conclusion, intracapsular administration of local anaesthetic may have limited analgesic efficacy with no volume vs concentration relationship after total knee arthroplasty.
Disease ecology meets ecological immunology: understanding the links between organismal immunity and infection dynamics in natural populations
Authors: Hawley Dana M. , Altizer Sonia M.
Published: July 2010

1. Ecological immunology and disease ecology are two relatively young disciplines that apply ecological approaches and principles to traditionally non‐ecological fields. In both cases, an ecological perspective has allowed new insights to emerge by focusing attention on variation over space and time, and by emphasizing the role of the environment in shaping individual responses and the outcome of host‐pathogen interactions. Here we review the growing conceptual interface between these two rapidly evolving fields.

2. Areas of synergy between ecological immunology and disease ecology aim to translate variation in within‐host processes (e.g. immunity) into between‐host dynamics (e.g. parasite transmission). Emerging areas of synergy include potential immune mechanisms that underlie host heterogeneity in disease susceptibility, teasing apart the effects of environmental factors such as seasonality and climate on host susceptibility and pathogen dynamics, and predicting the outcome of co‐infection by functionally distinct groups of parasites that elicit different immune responses.

3. In some cases, practical limitations have constrained the merging of ideas in ecological immunology and disease ecology. We discuss several logistical challenges, including dissecting the relative roles of host exposure and susceptibility, establishing links between measures of immunity and pathogen resistance in wild populations, and incorporating relevant immune variation into prevailing disease ecology modeling frameworks.

4. Future work at the interface of these two fields should advance understanding of life‐history theory, host‐pathogen dynamics, and physiological ecology, and will also contribute to targeted approaches for wildlife health and zoonotic disease prevention.
Telephone follow‐up after treatment for breast cancer: views and experiences of patients and specialist breast care nurses
Authors: Beaver Kinta , Williamson Susan , Chalmers Karen
Published: July 2010

Aims and objectives.  To explore the views of patients and specialist breast care nurses on telephone follow‐up after treatment for breast cancer.

Background.  A recent randomised controlled trial demonstrated that nurse‐led telephone follow‐up led to high levels of patient satisfaction with no physical or psychological detriment. This study aimed to explore in more detail the views of patients randomised to telephone follow‐up and the nurses who conducted telephone appointments.

Design.  Qualitative.

Method.  Individual interviews with 28 patients and four specialist breast care nurses. Content analysis was used to analyse the interview data.

Results.  Telephone follow‐up was convenient for patients and provided continuity of care. Speaking on the telephone was perceived as a more ‘normal’ activity than attending hospital outpatient clinics. A structured approach was appreciated, instilling feelings of confidence that all questions had been asked and no errors had been made. Specialist nurses emphasised the high level of skill required to deliver the intervention and perceived that the telephone approach was well able to meet the individual needs of patients.

Conclusions.  Positive views on telephone follow‐up were reported. An experienced and skilled practitioner, with effective communication skills, is required to deliver the intervention and a period of training is recommended. Nurse‐led telephone interventions have a broader applicability to other disease conditions, although more work is needed to develop appropriate interventions and evaluate their effectiveness.

Relevance to clinical practice.  Nurses at advanced levels of practice are uniquely placed to deliver such complex interventions. However, a period of initial training with effective peer support and channels for ongoing feedback are essential for administering an intervention that relies on audio rather than visual cues.