bluuebunny/crossref_metadata_2025 huggingface dataset:
Tramadol: pain relief by an opioid without depression of respiration
Authors: VICKERS M. D. , O'FLAHERTY D. , SZEKELY S. M. , READ M. , YOSHIZUMI J.
Published: February 2007

Two independent clinical trials were conducted simultaneously. In one, tramadol and pethidine were compared in 30 patients by patient‐controlled analgesia during the first 24 h following abdominal surgery. The mean 24 h consumption of tramadol and pethidine was 642 mg and 606 mg respectively, giving a potency estimate of tramadol relative to pethidine of 0.94 (95% confidence interval 0.72–1.17). In the second trial, the effect on respiration of three doses of tramadol (0.5, 1.0, and 2.0 mg.kg−1) was compared with that of morphine sulphate (0.143 mg.kg−1) by intravenous injection during stable halothane anaesthesia. At approximately 1.5 times the equipotent dose, as estimated from the first trial, tramadol transiently depressed the rate of respiration but had no effect on end‐tidal carbon dioxide tension. Morphine caused apnoea or considerable depression of ventilation. The results suggest that mechanisms other than opioid receptor activity play a significant role in the analgesia produced by tramadol.
Nasal CPAP after coronary artery surgery
Authors: THOMAS A. N. , RYAN J. P. , DORAN B. R. H. , POLLARD B. J.
Published: February 2007

Two groups of 14 patients were compared after coronary artery bypass surgery where the left internal mammary artery had been used as a conduit. One group received nasal continuous positive airway pressure for 1 h, the other group acted as a control. Mean pulmonary shunt fraction was 16.3% before, 12.6% during and 15.7% after continuous positive airways pressure. In the control group the shunt fraction fell from 17.3% to 16.8%. The reduction in shunt fraction was significantly greater with nasal continuous positive airways pressure than in the control group (p = 0.016). There was a significant reduction (p = 0.025) in respiratory rate from 18.3 to 16.7 breath.min–1 during continuous positive airway pressure. Other measured cardiorespiratory variables did not differ significantly between the groups. Visual analogue scores showed no significant difference in chest pain or mask comfort between the groups. The ease of breathing score was, however, significantly better in the continuous positive airways pressure group, 7.5 (SD 1.8) cm and control 5.6 (SD 2.6) cm.
Nosocomial sinusitis in ventilated patients
Authors: BACH A. , BOEHRER H. , SCHMIDT H. , GEISS H. K.
Published: February 2007

A total of 68 postoperative patients whose lungs were ventilated for more than 4 days were studied prospectively during a one‐year study period to investigate the effect of the mode of intubation on the paranasal sinuses. After an initial X ray of the skull showing no pathological findings, patients were assigned randomly to one of the study groups; the lungs of patients in group A were ventilated via an orotracheal tube (n = 32), and patients in group B via a nasotracheal tube (n = 36). X ray examinations of the sinuses were performed at regular intervals. Diagnosis of sinusitis was confirmed by transantral needle puncture and culture of fluids obtained. Antibiotic regimens were altered according to laboratory testing. Two patients in group A developed signs of sinusitis in comparison to 15 patients in group B (p < 0.01). However, there were significantly more airway complications in the orotracheal group, particularly during the period of weaning from ventilation. We conclude that orotracheal intubation should be preferred as the routine route of intubation.
Measurement of forces during laryngoscopy
Authors: BUCX M. J. L. , SCHECK P. A. E. , VAN GEEL R. T. M. , DEN OUDEN A. H. , NIESING R.
Published: February 2007

The forces transmitted by the laryngoscope blade onto the base of the tongue are assumed to be a major cardiovascular stimulus. This study investigates the various forces applied onto a Macintosh laryngoscope during laryngoscopy. The forces acting along the axis of the handle are described, as well as the forces exerted by the anaesthetist to prevent the laryngoscope from turning. Based on a relatively simple technique, a modified laryngoscope has been designed to measure these forces. Four different laryngoscopic parameters are determined: (1) the duration of laryngoscopy, (2) the maximally applied force, (3) the mean force and (4) the integral of the force over the time (area under the curve). The force measurements of 49 anatomically normal patients undergoing uncomplicated intubation are included in the study. The duration of laryngoscopy was 16.3s (SD 11.8), the applied peak force was 35N (SD 12) and mean force necessary was 20N (SD 6) while the force‐time integral was 324N (SD 194).
A comparison of the filtration properties of heat and moisture exchangers
Authors: HEDLEY R. M. , ALLT‐GRAHAM J.
Published: February 2007

Heat and Moisture Exchangers are used increasingly as filters to prevent the contamination of breathing apparatus and to limit cross‐infection. A series of laboratory tests has been developed to evaluate the microbial filtration and air flow resistance properties of these devices. The tests were designed to simulate the clinical situation and therefore evaluated devices in both dry and wet conditions. The devices tested (Engstrom Edith, Pall BB50T, Dar Hygrobac, Intersurgical Filtatherm and Intersurgical Filtaguard) were each representative of a particular type of construction. The simple hygroscopic device (Engstrom Edith) showed poor airborne and liquid‐borne filtration efficiency, but its resistance to air flow remained low in all conditions. The composite devices (Dar Hygrobac, Intersurgical Filtatherm and Intersurgical Filtaguard), which all possessed relatively large pores, performed well in terms of dry airborne filtration efficiency, but showed substantial increases in airflow resistance and poor filtration efficiency in the presence of liquid. The pleated membrane filter (Pall BB50T), which possessed small pores, showed good airborne filtration efficiency and prevented the passage of liquid. The latter property enabled this device to prevent the passage of liquid‐borne contamination and to maintain a low resistance to airflow in wet conditions. It would appear that in terms of contamination control and air flow resistance the pleated membrane filter provides a wider margin of safety than either the hygroscopic or composite devices.
Recovery characteristics using isoflurane or propofol for maintenance of anaesthesia: a double‐blind controlled trial
Authors: MARSHALL C. A. , JONES R. M. , BAJOREK P. K. , CASHMAN J. N.
Published: February 2007

We studied 114 female patients (ASA 1 or 2) who were within 20% of ideal body weight and who were scheduled to undergo gynaecological laparoscopy which required supplementation with an opiold (groups I A and PA), or dental procedures which did not require opioid supplementation (groups IO and PO). A computerised package of psychomotor tests was performed before surgery. Anaesthesia was induced with propofol 2.5 mg.kg−1 and all patients received atracurium 0.3 mg.kg−1 and 67% nitrous oxide in oxygen. Patients in group I A received isoflurane 1% (inspired), and alfentanil 10 μg.kg−1 as a bolus and 10 μg.kg−1.h−1 as an infusion. Patients in group PA received propofol 9 mg.kg−1.h−1 as an infusion, decreasing to 6 mg.kg−1.h−1 after 15 min, together with alfentanil 10 μg.kg−1.h−1. Patients in groups IO and PO received isoflurane and propofol in the regimens described for groups 1A and PA, but without alfentanil. Recovery was assessed by a blinded observer who recorded times to awakening (eye opening) and orientation (giving date of birth), and who repeated the psychomotor tests at 1,3 and 5 h. Linear analogue scales of mood, nausea and pain were obtained and other side effects were noted in the succeeding 48 h. A matched control group of 25 females (who were not anaesthetised) underwent psychomotor testing on four occasions in order to assess the ‘learning effect’ of repeated recovery testing. The analysis of recovery tests did not assume a normal distribution. There were no significant differences in awakening or orientation times among the groups (median values IO: 4.92 and 6.06 min; PO: 3.88 and 5.11 min; IA: 6.90 and 7.98 min; PA: 6.24 and 7.30 min). There were also no differences among groups in respect of the results of psychomotor testing during recovery. There was significantly less nausea in group PO (6132 patients) than in group IO (13/32 patients). There was also a significant difference between the performance of the control group compared with those of the study groups in most of the tests, and this emphasises the importance of including a control group in studies which involve recovery testing. We conclude that, after induction of anaesthesia with propofol in unpremedicated outpatients, maintenance of anaesthesia with nitrous oxide and either isoflurane or propofol, with or without alfentanil, provides reasonably rapid and reliable recovery and are equally acceptable to the patient.
Admixture of propofol and alfentanil
Authors: SHERRY E.
Published: February 2007

An admixture of propofol and alfentanil provides adequate sedation and analgesia during transvaginal oocyte retrieval in the absence of a paracervical block. In 100 patients the technique provided haemodynamic stability, sedation which was easily controlled, rapid recovery and universal patient acceptance.
Anaesthesia for bullectomy
Authors: KAN A. F. , OH T. E.
Published: February 2007

A patient with a single large bulla occupying 50% of the right hemithorax was anaesthetised successfully with a combination of techniques not previously described. The technique consisted of extradural analgesia and intravenous infusion of propofol, while ventilation was maintained with high frequency jet ventilation through a single lumen tracheal tube. The advantages of this technique are a reduced risk of barotrauma, good operating conditions and good analgesia.
Functionally crossed pipelines
Authors: WEIGHTMAN W. M. , FENTON‐MAY V. , SAUNDERS R. , LEWIS A. , WISE C. C.
Published: February 2007

Unexpectedly high blood oxygen tension in intensive care patients occurring over a 5‐year period were found to have been caused by an apparently normally functioning ventilator which was intermittently acting as a conduit between the oxygen and air pipelines. Responses to a circular letter sent to Quality Control Pharmacists in England and Wales suggest that similar faults may have occurred at least five times in the past 10 years. Recommendations are given for the prevention of this problem, including monitoring of gas pipeline composition.
Spinal epidural anaesthesia
Authors: LIFSCHITZ R. , JEDEIKIN R.
Published: February 2007

We present our experience with a new combined spinal epidural system through which regional anaesthesia was performed in 30 male patients undergoing suprapubic prostatectomy. The technique consists of two needles, a 17 G Tuohy needle with a hole in its distal curve (back eye) and a 29 G spinal needle which is passed through the back eye before being introduced into the subarachnoid space. We found the back eye combined spinal‐epidural system effective and simple to use. The Tuohy needle with its back eye did not impede insertion of the epidural catheter and was a suitable introducer for the thin 29 G spinal needle.
Modification to the Sprotte spinal needle
Authors: AGLAN M. Y. , STANSBY P. K.
Published: February 2007

The large lateral hole of the Sprotte needle is claimed to aid cerebrospinal fluid efflux during the performance of spinal anaesthesia. Using theoretical calculations and practical measurement we have shown that reducing the area of the lateral hole to that of the cross sectional area of the needle does not affect the flow rate. We suggest this modified Sprotte needle is an improved design which has the potential advantages of reducing the incidence of inadequate spinal anaesthesia and strengthening the needle tip.
Induction of anaesthesia with propofol using a target‐controlled infusion system
Authors: CHAUDHRI S. , WHITE M. , KENNY G. N. C.
Published: February 2007

Sixty patients premedicated with temazepam were allocated randomly to receive an infusion of propofol designed to achieve and maintain a target blood concentration of 3, 4 or 5 μg.ml−1. Induction time was measured from the start of infusion to loss of verbal contact. The success rate of inducing anaesthesia within 3 min of achieving the target concentration was 40% when the predicted target concentration was 3 μg.ml−1, 75% when the predicted target was 4 μg.ml−1 and 90% when the target was 5 μg.ml−1. There were no significant differences between the three groups for time to loss of verbal contact in patients who were induced successfully within 3 min. There were significant reductions in arterial pressure 3 min after achieving the target concentrations within the groups but not between them. The frequency of apnoea and pain on injection was small in all groups. Selecting a target concentration of 5 μg.ml−1 would successfully induce anaesthesia in the majority of patients premedicated with temazepam without major haemodynamic or respiratory side effects.
A pressure regulator for the cuff of a tracheal tube
Authors: MILLER D. M.
Published: February 2007

A regulator is described for the maintenance of a constant pressure difference above airway pressure during positive pressure ventilation in a cuffed tracheal tube. It comprises a tubular threshold valve which is powered by the anaesthetic gas supply source to a breathing system. The valve is interposed between the anaesthetic gas supply machine and the breathing system creating a pressure differential. The upstream pressure is transmitted to the pilot tube supplying the cuff of a tracheal tube via an upstream connection. The valve is suitable only for breathing systems that require a constant gas supply. The regulator was evaluated during anaesthesia, using a modified Mallinkrodt Hi‐Lojet ventilation tube to obtain simultaneous pressure measurements within the cuff and the lumen of the tracheal tube. A greater pressure was demonstrated in the cuff than in the airway and the two traces were approximately parallel throughout the respiratory cycle. The device should prevent excessive cuff inflation pressure and solves the problem of forgetting to let the cuff down before extubation.
The minimum effective dose of lignocaine to prevent injection pain due to propofol in children
Authors: Cameron E. , Johnston G. , Crofts S. , Morton N. S.
Published: February 2007

In a single‐blind study of 100 children aged 1 to 10 years, the minimum effective dose of lignocaine required to prevent injection pain due to propofol was 0.2mg.kg−1 when veins on the dorsum of the hand were used. This is more than twice the adult value. We concluded that injection pain should not limit the use of propofol in children if an adequate amount of lignocaine is mixed immediately prior to injection.
Continuous paravertebral block in children
Authors: Lönnqvist P.‐A.
Published: February 2007

Continuous paravertebral block has not previously been described for use in children. This study reports the use of this technique in five patients (aged 7 months to 8 years) scheduled for renal surgery or cholecystectomy. The block was not difficult to perform and provided good intra‐ and postoperative analgesia. Continuous paravertebral block appears to be a promising technique for pain management in children and might prove a valuable addition in the field of paediatric regional anaesthesia.
Low dose amitriptyline in the treatment of chronic pain
Authors: MCQUAY H. J. , CARROLL D. , GLYNN C. J.
Published: February 2007

The analgesic efficacy of amitriptyline 25 mg was compared with placebo in 41 patients with chronic (more than 3 months) nonmalignant pain, using a double‐blind randomised multiple‐dose 3‐week treatment period crossover design. Amitriptyline 25 mg provided significantly greater efficacy than placebo, with significant differences evident within the first week. There was no significant difference on mood scores between amitriptyline and placebo. The results suggest that surprisingly low doses of amitriptyline may be effective without substantial adverse effects, that the effect is evident early, and that the effect is distinguishable from any effect of the amitriptyline on mood.
Phenytoin reduces suxamethonium‐induced myalgia
Authors: HATTA V. , SAXENA A. , KAUL H. L.
Published: February 2007

A prospective, randomised trial was undertaken in 60 healthy adults to determine the efficacy of intravenously administered phenytoin in doses of 5 mg.kg−1 for the prevention of suxamethonium‐induced fasciculations, a rise in serum K+ and myalgia. This was compared with tubocurarine pretreatment and no pretreatment (control group). Phenytoin pretreatment significantly reduced myalgia from 45% (nine patients) in the control group to 10% (two patients) (p < 0.05). It also decreased the duration and mean intensity of fasciculations. Incidentally, phenytoin was also found to decrease significantly mean serum Na+ levels (p < 0.001) both at 5 and 20 min after administration. Tubocurarine pretreatment (3 mg) resulted in a significant decrease in fasciculations, but myalgia, which occurred in five patients, remained the same. No significant correlation was found between muscle fasciculations, postoperative myalgia and K+ changes, but patients with myalgia had a significant decrease in mean serum Na + levels at 5 and 20 min after suxamethonium (p < 0.01).
Light anaesthesia with propofol for paediatric MRI
Authors: Vangerven M. , Van Hemelrijck J. , Wouters P. , Vandermeersch E. , Van Aken H.
Published: February 2007

Anaesthetic techniques and monitoring equipment may interfere with the technical demands of magnetic resonance imaging. The purpose of this study was to evaluate the safety and efficacy of a light anaesthetic technique with intravenous propofol in nonintubated children. In 20 neuropaediatric patients sedation was induced with propofol 1 mg.kg−1, followed by a continuous infusion titrated to produce adequate immobilisation. Oxygen, 4 l.min−1, was administrated by paediatric face mask. Respiratory rate, end‐tidal carbon dioxide tension and oxygen saturation were continuously monitored. In 10 patients capillary blood gas tensions were determined 3 and 20 min after the procedure. Data are reported as mean (SD) and the mean (SD) total propofol dose was 5 (2) mg.kg−1.h−1. Oxygen saturation remained constantly higher than 96% in all patients. End‐tidal carbon dioxide tension varied between 35 (7) mmHg 3 min after induction, and 41 (6) mmHg 30 min after the start of the procedure. End‐tidal to capillary PCO2 difference was 4 (3) mmHg. Within 20 min after the end of the procedure all patients were fit for dismissal to the ward. One imaging sequence out of 49 was repeated because of movement artefacts. In conclusion, intravenous propofol sedation appears to be a safe and reliable technique for paediatric sedation during magnetic resonance imaging.
Unconscious learning during anaesthesia
Authors: JELICIC M. , DE ROODE A. , BOVILL J. G. , BONKE B.
Published: February 2007

Forty‐three surgical patients were, during general anaesthesia, presented (via headphones) with either statements about common facts of some years ago (group A), or new verbal associations, i.e. the names of fictitious, nonfamous people (group B). None had any recall of intra‐operative events. In a postoperative test of indirect memory, patients in group A answered more questions about the ‘common facts’ correctly than those in group B (p < 0.005), which reflects the activation of pre‐existing knowledge. Furthermore, patients in group B designated more ‘nonfamous names’ as famous (thus falsely attributing fame) than patients in group A (p < 0.001), which demonstrates that information‐processing during anaesthesia can also take place as unconscious learning.
Spinal anaesthesia for urological surgery
Authors: Harrison D. A. , Langham B. T.
Published: February 2007

A survey was conducted on 100 consecutive patients who underwent spinal anaesthesia in our urology operating theatres. Details of the spinal technique were recorded in the operating theatre. In 25% of patients, more than one attempt at subarachnoid puncture was required and 16% of this group went on to require general anaesthesia. The patients were visited between 24 and 48 h postoperatively by one of the authors. On questioning, 24% of patients reported a headache, which had the characteristics associated with dural puncture; 62% of these headaches were described as moderate or severe and lasted between 12 and 24 h. Patients were significantly (p < 0.05) more likely to develop a postdural puncture headache if more than one attempt at subarachoid puncture was made.
Peri‐operative liver graft function: monitoring using the relationship between blood glucose and oxygen consumption during anaesthesia
Authors: Steltzer H. , Tuchy G. , Hiesmayr M. , Muller C. , Germann P. , Zimpfer M.
Published: February 2007

The purpose of our study was to test the hypothesis that the quotient between plasma glucose and whole body oxygen consumption (V̇o2) as a ‘metabolic index’ is a sensitive indicator of early graft function. Arterial levels of glucose and oxygen consumption were determined in 100 consecutive patients during orthotopic liver transplantation performed without anhepatic veno‐venous bypass. Patients were divided into survivors with no obvious problems related to graft function and those with primary nonfunction of the graft. The neohepatic increase in V̇o2 was significantly higher in survivors (112 + 4 vs 88 + 11 ml.min−1.m2; p < 0.05), whereas blood glucose levels after reperfusion were higher (352 + 18 vs. 287+36 mg dl−1) in those with primary non‐function of the graft. The calculated metabolic index was also higher (4.02 + 0.93 vs 2.67+ 0.45, p < 0.05) in patients with primary nonfunction of the graft. Our principal conclusion was that 92% of normal functioning liver grafts could be classified correctly by the metabolic index immediately after reperfusion, whereas glucose levels and V̇o2 alone classified only 67% and 70% of normal functioning liver grafts correctly.
Cimetidine‐dobutamine interaction?
Authors: Baraka A. , Nauphal M. , Arab W.
Published: February 2007

The report describes a patient during induction of anaesthesia for coronary artery by‐pass grafting, in whom the infusion of dohutamine at a rate of 5 fig.kg−1.min−1 resulted in unanticipated severe hypertension. The exaggerated response may be attributed to cimetidine‐dobutamine interaction.
Acute isoniazid poisoning
Authors: GURNANI A. , CHAWLA R. , KUNDRA P. , Bhattacharya A.
Published: February 2007

We present two cases of acute isoniazid poisoning in patients who ingested 7.5 g and 5.0 g of isoniazid respectively, with the intention of committing suicide. Both were admitted unconscious, with ventilatory insufficiency and convulsions. Hepatic dysfunction and peripheral neuropathy were notable complications.
Prolonged resuscitation in acute deep hypothermia
Authors: STONEHAM M. D. , SQUIRES S. J.
Published: February 2007

A case report is described with successful outcome of prolonged cardiopulmonary resuscitation in a 30‐year‐old man suffering from acute deep hypothermia. His lowest temperature recorded was 23°C. Continuous external cardiac massage was required for a total of 4,5 h whilst rewarming was instituted. The patient eventually left hospital with no permanent sequelae. A review of hypothermia follows, emphasising some important management principals and pitfalls.
Managing the airway in cervical spine injury
Authors: WOOD P. R. , LAWLER P. G. P.
Published: February 2007

The American College of Surgeons' Advanced Trauma Life Support protocol for managing the airway in patients with a cervical spine injury is reviewed. The relative risks and benefits of oral and nasotracheal intubation are discussed and the potential hazards of alternative methods of airway control are considered with particular respect to British practice.
The relationship of blood lactate concentrations, oxygen delivery and oxygen consumption in septic shock and the adult respiratory distress syndrome
Authors: NIMMO G. R. , MACKENZIE S. J. , WALKER S. W. , CATNACH J. , NICOL M. , ARMSTRONG I. R. , GRANT I. S.
Published: February 2007

Tissue hypoxia is thought to be pivotal to the development of multiple organ failure, but cannot be measured directly in clinical practice. We assessed the relationship between initial arterial blood lactate concentrations and the presence of the phenomenon of delivery‐dependent oxygen consumption, both of which may indicate tissue hypoxia. Twenty‐three critically ill patients with septic shock and adult respiratory distress syndrome were studied prospectively and allocated to one of two groups according to blood lactate concentrations. In group 1, blood lactate concentration was less than the level widely accepted as significant (2 mmol.l−1); in group 2, the concentration exceeded 2 mmol.l−1. In both groups, resuscitation with colloid, blood and vasoactive drugs resulted in significant increases in oxygen delivery; in group 1 (n = 13), mean (SEM) oxygen delivery increased from 484 (36) to 730 (44) ml.min−1.m−2 (p < 0.005) and in group 2 (n = 10) from 550 (54) to 780 (54) ml.min−1.m−2 (p < 0.05). In neither group was there a significant change in oxygen consumption. However, there were individuals in both groups who exhibited pathological delivery dependence. This suggests that the absence of hyperlactataemia does not preclude delivery dependence of oxygen consumption with the attendant potential for tissue hypoxia.
Anaesthesia for thoracoscopic pleurectomy and ligation of bullae
Authors: Millar F. A. , Hutchison G. L. , Wood R. A. B.
Published: February 2007

A patient is described who, despite severe pre‐operative respiratory disability, had her persistent pneumothorax successfully managed by thoracoscopic pleurectomy. The technique causes considerably less pain and interference with respiratory function postoperatively than does conventional thoracotomy. Potential anaesthetic problems arise because of the necessity of insufflating carbon dioxide at pressures of up to 1 kPa to maintain a pneumothorax during surgery.
EMLA for postoperative analgesia for day case circumcision in children
Authors: Lee J. J. , Forrester P.
Published: February 2007

A randomised study was designed to evaluate and compare the analgesic efficacy of EMLA with dorsal nerve of penis block, in children undergoing day case circumcision. The mean (SD) duration of analgesia for EMLA and dorsal nerve block were 0.5 (0.1) h and 6.4 (1.2) h respectively (p < 0.001). It is concluded that EMLA is not as effective as dorsal nerve of penis block with regard to postoperative analgesia. No adverse effects were observed.
Brainstem auditory evoked response during propofol anaesthesia in children
Authors: PURDIE J. A. M. , CULLEN P. M.
Published: February 2007

The effect of propofol on the brainstem auditory response was studied in 10 healthy children presenting for elective general surgery. A computer‐controlled infusion of propofol was used to induce and maintain anaesthesia. Basal brainstem auditory evoked responses were recorded in the awake child and at different infusion rates of propofol. Significant increases in the latencies of the brainstem waves III and V and the interpeak intervals I‐V and III‐V were seen and were dose dependent. The changes were small and would not preclude the use of propofol anaesthesia for brainstem auditory evoked response testing in children.
Continuous spinal anaesthesia in acute respiratory failure
Authors: GRACE D. , ORR D. A.
Published: February 2007

A patient with an obstructed femoral hernia and intercurrent respiratory failure was successfully anaesthetised with a continuous spinal technique. The technique provided excellent intra‐operative anaesthesia and early postoperative analgesia, whilst avoiding further respiratory compromise. Disconnection of the catheter hub from the catheter prevented prolonged provision of postoperative analgesia by this route. Fixing of both the catheter and the hub to the patient are advocated to avoid this problem.
A very small dose of suxamethonium relieves laryngospasm
Authors: CHUNG D. C. , ROWBOTTOM S. J.
Published: February 2007

Intravenous suxamethonium, in a dose as small as 0.1 mg.kg−1, has been found to be reliable in the treatment of laryngeal spasm. Three episodes of vocal cord spasm observed during direct laryngoscopy were relieved by this dose of suxamethonium.
A comparison of the laryngeal mask airway and Guedel airway, bag and facemask for manual ventilation following formal training
Authors: ALEXANDER R. , HODGSON P. , LOMAX D. , BULLEN C.
Published: February 2007

Ten volunteers, with no previous experience of resuscitation, were formally trained in the use of the laryngeal mask airway and the oropharyngeal airway (Guedel), bag and facemask for manual ventilation of the lungs in 104 fit, anaesthetised adults. They then used both airways in turn. The order of insertion was randomly allocated, and the times taken for insertion were also recorded. Ventilation for each airway was deemed to be successful if an increase in end‐tidal carbon dioxide partial pressure did not occur and arterial oxygen saturation remained greater than 90%. Success rates for the laryngeal mask airway and the Guedel airway, bag and facemask were 87% and 43% respectively (p < 0.001) and the average insertion times were 27.4 s (SEM 1.5) and 15.8 s (SEM 0.50) (no significant difference), respectively. The laryngeal mask airway proved to be easier to use for manual ventilation than the Guedel airway, bag and mask for inexperienced personnel who had received a period of formal training in both techniques.
Patient‐controlled analgesia with and without background infusion. Analgesia assessed using the demand: delivery ratio
Authors: McCoy E. P. , Furness G. , Wright P. M. C.
Published: February 2007

Sixty adult patients following general surgical operation were treated with patient‐controlled analgesia using morphine. Patients were allocated into three groups to receive: no background infusion, a 1 mg.h−1 or a 2 mg.h−1 background infusion. The other controls on the patient‐controlled analgesia machine were set to allow a maximum dose of morphine of 6 mg.h−1 to each group. Analgesia was assessed after 4 and 24 h using a 100 mm horizontal visual analogue scale. The number of analgesic requests made by the patient and the number of those requests which resulted in successful deliveries was recorded. Patients who received a regimen including a background infusion had improved pain relief, particularly in the first 4 h of treatment (p < 0.05). Patients who received a background infusion of 2 mg.h−1 had an increased incidence of nausea (p < 0.05). A background infusion of I mg.h−1, with a 1 mg bolus dose and a 12 min lockout interval provided acceptable pain relief without excessive nausea. In all three groups the ratio of analgesic requests to successful deliveries correlated with the degree of pain reported by visual analogue score (p = 0.0001).
Delayed cutaneous fluid leak from the puncture hole after removal of an epidural catheter
Authors: EENNIS M. , BROCK‐UTNE J. G.
Published: February 2007

A case of a delayed but persistent cutaneous fluid leak from a puncture hole following removal of an epidural catheter is presented. The fluid was subsequentlv found not to be cerebrospinal but interstitial oedema fluid. This case demonstrates the importance of performing simple investigations on any such fluid before ordering more complex tests.
Intermittent thiopentone for teaching fibreoptic nasotracheal intubation
Authors: Yentis S. M. , Jankowski S. , Gregory I. C.
Published: February 2007

A technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubating fibrescope. During endoscopy patients breathed spontaneously oxygen‐enriched air and passage of the tracheal tube was facilitated by suxamethonium. Arterial blood pressure, heart rate and arterial oxygen saturation were monitored continuously. Time from loss of eyelash reflex to successful intubation was 113 (90) (35–480) s (mean (SD) (range)). Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients: the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.
Anaesthesia for airway obstruction in laryngo‐onycho‐cutaneous syndrome
Authors: HODGES U. M. , LLOYD‐THOMAS A.
Published: February 2007

A 4‐year‐old boy with laryngo‐onycho‐cutaneous syndrome underwent excision of an obstructive vocal cord lesion. There is only one previous case report of laryngeal involvement in this syndrome but the anaesthetic management has not been reported. The anaesthetic management for microlaryngobronchoscopy and laser surgery in this child with upper airway obstruction is described.
Fresh frozen plasma and edrophonium in a patient with a plasma cholinesterase deficiency
Authors: SMITH D. C. , RIDLEY S. A. , DONALDSON K. F.
Published: February 2007

A 35‐year‐old woman undergoing laparoscopic sterilisation developed prolonged apnoea after suxamethonium. Fresh frozen plasma was given to replenish plasma cholinesterase, but recovery of neuromuscular transmission was not accelerated. Routine use of quantitative neuromuscular monitoring simplified her postoperative management.
Bacterial filters protect anaesthetic equipment in a low‐flow system
Authors: LUTTROPP H. H. , BERNTMAN L.
Published: February 2007

We have recently described a low‐flow system with mechanical ventilation in which there was an open connection between the circle and ventilator. In the present study bacterial contamination and the role of bacterial filters at different points in the system were studied. Filters between the tracheal tube and circle are an effective barrier, but their absence did not increase contamination of either the circle or the ventilator. Some filters are also effective as heat and moisture exchangers if situated at the tracheal tube. Because of the lack of bacterial contamination, a prolonged interval between disinfection of the open connection and ventilator is acceptable, which reduces wear and costs.
The nasopharyngeal airway
Authors: STONEHAM M. D.
Published: February 2007

Artificial nasopharyngeal airway position and performance were assessed in 120 anaesthetised adult patients. Using a fibreoptic laryngoscope mean distances from nares to larynx were measured at 209 mm (SD 11) in males and 180 mm (SD 11) in females; those from nares to epiglottis were 159 mm (SD 12) in males and 140 mm (SD 11) in females. Nasopharyngeal airways were frequently misplaced, 60% lying beyond the tip of the epiglottis and 13% lodged in the vallecula. Forty‐two percent of subjects had clinical evidence of respiratory obstruction. Nasopharyngeal airway compression in the nasopharynx and obstruction by the tongue and soft palate were common causes of respiratory obstruction. Regression analysis revealed that nares‐epiglottis length correlated significantly with subject height (t = 3.9, p = 0.0002), but not with three external measurements made around the head and neck. Head flexion and extension resulted in comparatively little relative movement of the nasopharyngeal airway. Nasopharyngeal airway length and diameter should be standardised to optimise performance.
The Genius infrared tympanic thermometer
Authors: EDGE G. , MORGAN M.
Published: February 2007

A clinical tympanic thermometer was evaluated. In vitro it was found to be accurate over the temperature range 28°C to 40°C. Clinical assessment was made during the cooling and rewarming phases of patients undergoing surgery with the aid of cardiopulmonary bypass and compared with the results obtained with an Ellab thermocouple thermometer. It was also used in patients in the intensive care unit in whom core temperature was being measured using the thermistor incorporated in a pulmonary artery catheter. The infrared thermometer was found to be accurate, rapidly responding and easy to use.
Noninvasive monitoring of respiratory volume
Authors: AMIN H. M. , CICADA M. , FORDYCE W. E. , CAMPORESI E. M.
Published: February 2007

The authors studied the accuracy of the noninvasive breath monitor (Voltek Enterprise, Willowdale, Ontario, Canada) in predicting the tidal volumes in five healthy human volunteers. The signals of the breath monitor were compared with the volumes estimated by a calibrated pneumotachograph. The results show that the breath monitor is considerably accurate and can be accepted as a reliable device for clinical applications.
Breast feeding and anaesthesia
Authors: LEE J. J. , RUBIN A. P.
Published: February 2007

Anaesthetists require a good knowledge of the excretion of drugs in breast milk and the potential hazards to suckling infants of drug ingestion via breast milk. A brief account of the physiology of lactation is given. The mechanisms of drug passage into breast milk are discussed followed by a review of the excretion in breast milk of drugs used in anaesthetic practice. Suggestions for the management of anaesthesia in breast feeding mothers are offered.
Myalgia and biochemical changes following suxamethonium after induction of anaesthesia with thiopentone or propofol
Authors: Maddineni V. R. , Mirakhur R. K. , Cooper A. R.
Published: February 2007

The incidence and severity of muscle pains and changes in creatine kinase were assessed following administration of 1 mg.kg−1 suxamethonium either immediately or 2 min after induction of anaesthesia with propofol or thiopentone in patients undergoing elective dental and ophthalmic surgery. The incidence of muscle pains was 35 and 60% respectively in the groups given suxamethonium immediately and 2 min after propofol, and 35 and 55% when given immediately and 2 min after thiopentone, with no statistically significant differences among the groups. Creatine kinase levels increased in all the groups after operation with the least average increase in the group receiving suxamethonium immediately after propofol and the highest increase in the group receiving suxamethonium 2 min after thiopentone. There was no correlation between the incidence and severity of fasciculations, muscle pains and changes in creatine kinase within or between the groups. It is concluded that neither the induction agent nor the time between the induction agent and suxamethonium administration has any significant influence on the incidence of muscle pains or creatine kinase elevation following suxamethonium.
Does a bloody tap prevent postdural puncture headache?
Authors: Khan K. J. , Stride P. C. , Cooper G. M.
Published: February 2007

The regional anaesthesia records of 274 obstetric patients who had inadvertent dural puncture were reviewed to see whether a bloody dural tap resulted in a lower incidence of postdural puncture headache. No such influence was found.
Implicit memory during balanced anaesthesia
Authors: BONEBAKKER A. E. , BONKE B. , KLEIN J. , WOLTERS G. , HOP W. C. J.
Published: February 2007

The effect of the number of presentations on implicit memory for words was studied in anaesthetised patients. During standardised, balanced anaesthesia, 81 surgical patients were presented with less common specimens of familiar word categories. For each of three word categories the number of word presentations varied between the patients (0 (control), 5, or 30 presentations). Postoperatively, repetition priming was tested by asking patients to generate exemplars for each of the word categories. No implicit memory for the words presented during anaesthesia was found and consequently no effect of number of word presentations could be demonstrated. It is suggested that this finding, which contradicts previous results, may be caused by the relatively low familiarity of the words used.
Propofol‐fentanyl anaesthesia in cardiac surgery: a comparison in patients with good and impaired ventricular function
Authors: PHILLIPS A. S. , McMURRAY T. J. , MIRAKHUR R. K. , GIBSON F. M. , ELLIOTT P.
Published: February 2007

The haemodynamic effects of propofol‐fentanyl anaesthesia for elective cardiac surgery were compared in 24 patients with good left ventricular function (ejection fraction > 45%, left ventricular end‐diastolic pressure < 16 mmHg) and nine patients with impaired function. Anaesthesia was induced withfentanyl 25 μg.kg−1 and pancuronium 0.1 mg.kg−1 and was maintained with a variable rate propofol infusion, mean rate 2.61 mg.kg−1.h−1 in the good ventricular function group and 2.71 mg.kg−1.h−1 in the impaired function group. Additional fentanyl 7.5 μg.kg−1 was given before sternotomy. Ventilation to normocarbia was with air and oxygen (Fio2 0.6). Haemodynamic measurements were made before induction, after tracheal intubation, before and after sternotomy and before aortic cannulation. There were no significant differences between the groups in any haemodynamic variables during the study. Twenty minutes after intubation both groups showed a decrease from pre‐induction values in mean arterial pressure (p < 0.05) and left ventricular stroke work index (p < 0.05), the reduction in left ventricular stroke work index remaining significant during the prebypass period in both groups. There were no significant changes in right or left sided filling pressures, systemic vascular resistance or heart rate. The technique decreased cardiac work and effectively controlled the autonomic responses to sternotomy in both groups. This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with impaired ventricular function having cardiac surgery.
Laryngeal mask airway insertion
Authors: BRIMACOMBE J. , BERRY A.
Published: February 2007

The ease of insertion of the laryngeal mask airway with the patient's head in the standard position and the neutral position was compared, in a study of 80 healthy patients. Successful insertion was assessed byfibreoptic bronchoscopy and the functioning of the airway. In terms of function the successful insertion rate for the standard position was 100% (40/40) and for the neutral position 95% (38/40). There were no significant differences in scores as assessed by fibreoptic bronchoscopy. The laryngeal mask airway may have a role in the management of some patients with cervical spine instability, although confirmation of this ultimately depends on the results of outcome studies.
Evaluation of pulse oximetry during cardiopulmonary resuscitation
Authors: SPITTAL M. J.
Published: February 2007

This study evaluates whether the pulse oximeter is useful during cardiopulmonary resuscitation. The instrument was of undoubted benefit in the management of primary respiratory arrest, but of equivocable value in cardiac arrest. Data were displayed during external chest compressions, but were generally unreliable. The ear probe was not able to produce a consistently good signal during cardiopulmonary resuscitation. Nevertheless, the provision of an oximeter amongst the first‐line resuscitation equipment available at a cardiopulmonary arrest significantly altered the management of seven out of 20 patients, five of whom survived.
The uptake of isoflurane during anaesthesia
Authors: LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

The uptake of isoflurane at a constant end‐expired concentration of 1.5% in oxygen was studied in 15 women, ASA 1 or 2, undergoing elective total abdominal hysterectomy. The anaesthetic was administered by a simple computer‐controlled to‐and‐fro closed system. After an initial period of wash‐in to the system, the rate of uptake of isoflurane decreased bi‐exponentially with a rapid reduction during the first 15 min. Perturbations from this bi‐exponential decline reflect changes in cardiac output. The mean (SD) cumulative use of isoflurane was 4.5 (0.43) ml after 30 min and 7.3 (0.79) ml after 60 min.
Implicit learning during enflurane anaesthesia in spontaneously breathing patients?
Authors: JELICIC M. , ASBURY A. J. , MILLAR K. , BONKE B.
Published: February 2007

Forty‐one patients breathing spontaneously during enflurane anaesthesia were presented (via headphones) either with statements about common facts of some years ago, or new verbal associations, i.e. names of fictitious people. Postoperatively, there were no differences between the two groups in the responses to questions about the common facts or attribution of fame to the fictitious people. This finding suggests that unconscious learning and activation may not occur during enflurane anaesthesia without neuromuscular block.
Repeated doses of suxamethonium in the myasthenic patient
Authors: BARAKA A. , BAROODY M. , YAZBECK V.
Published: February 2007

The neuromuscular block of successive doses of suxamethonium 100 mg, monitored by electromyography, was investigated in a myasthenic patient (class IIB), undergoing thymectomy. The results suggest that successive doses of suxamethonium in the myasthenic patient are followed by a progressive prolongation of the neuromuscular block. This may be attributed to rapid desensitisation of the myasthenic endplate receptors and the rapid development of phase II block, as evidenced by a progressive decrease of the T4/T1 ratio.
A new epidural catheter
Authors: COLLIER C. B. , GATT S. P.
Published: February 2007

A new design of epidural catheter with three lateral eyes placed in close proximity to its closed end is described. Prototype models of this catheter were tested in 200 obstetric and surgical patients. In a single‐blind randomised study it was found to be easy to insert and highly satisfactory in use, when compared to the current catheter type, with three widely spaced lateral eyes. It is hoped that the close spacing of the eyes will eliminate the complication of multicompartment block, as seen with earlier multihole catheters, and improve the safety of epidural block.
Epidural bupivacaine for aortic surgery The effect of dilution on the quality of analgesia
Authors: SLADE J. M.
Published: February 2007

Twenty patients undergoing elective abdominal aortic aneurysm repair were randomly allocated to two groups and studied for 24 h following surgery. Postoperative analgesia was provided by epidural bupivacaine infusion and intravenous patient‐controlled 0.05 mg boluses of alfentanil. One treatment group received 7 ml.h‐1 of a 0.25% solution of bupivacaine, the other 25 ml.h‐1 of a 0.07% solution. The rate of infusion was thus 17.5 mg.h‐1 in both groups. Patients receiving 7 ml.h‐1 of epidural infusate required more doses of alfentanil (median 26.5, range 0‐50) than the group receiving 25 ml.h‐1 of the dilute infusion (median 3.0, range 0–16). It is concluded that 17.5 mg.h‐1 of bupivacaine infused into the epidural space produces better analgesia when infused in a volume of 25 ml.h‐1 (0.07%) than when given in a volume of 7ml.h‐1 of solution (0.25%).
Laryngotracheal stenosis: a serious complication of percutaneous tracheostomy
Authors: McFARLANE C. , DENHOLM S. W. , SUDLOW C. L. M. , MORALEE S. J. , GRANT I. S. , LEE A.
Published: February 2007

Tracheostomy in patients requiring prolonged artificial ventilation in intensive care is increasingly being performed by a percutaneous dilatational technique, in preference to the standard surgical method. Since its introduction numerous series have reported favourably on its general safety in the short‐term, but there have been few reports of longer term follow‐up of patients. We present four cases of laryngotracheal stenosis, a previously unreported complication associated with the technique, and discuss the relevance of these to the future practice of percutaneous tracheostomy.