bluuebunny/crossref_metadata_2025 huggingface dataset:
Control of heparinisation during cardiopulmonary bypass
Authors: KAMATH B.S.K. , FOZARD J.R.
Published: February 2007

A rational approach to the control of heparinisation during open heart surgery is advocated. Some of the possible and potential shortcomings of the time‐based heparin protocols in current use are presented.

The use of a recent, simple automated device ‘Hemochron’ to estimate the Activated Clotting Time is described and it is found to be an economical and efficient method to monitor heparinisation during cardiopulmonary bypass.
Transcutaneous nerve stimulation in labour
Authors: Jones C.M.H. Miller
Published: February 2007

Transcutaneous nerve stimulation was assessed as a method of relieving pain in labour in 51 patients.

The majority of patients found it sufficiently helpful to want to use it again in any subsequent labour, and it reduced the overall pethidine requirement compared with controls. It did not have an effect on Apgar neonatal scores or length of labour.
Temazepam as premedication in day surgery
Authors: BEECHEY A.P.G. , ELTRINGHAM R.J. , STUDD C.
Published: February 2007

Sixty patients scheduled for day case surgery were allocated into two groups in a double‐blind study. One group received temazepam 20 mg or 30 mg orally 1 hour before surgery whilst the second group receiiled a placebo of identical appearance.

The use of temazepam was followed by a greater frequency of sedation and anxiolysis and with fewer problems at induction. The time to awaken, the level of postoperative sedation and the ability to walk unaided were similar in both groups. Postoperative sequelae were less frequent in the temazepam group. Temazepam is advocated as a suitable drug for premedication in day case surgery.
Acute onset facial oedema
Authors: CONACHER I.D.
Published: February 2007

A case of sudden onset facial swelling which occurred in association with extubation is presented. Factors are suggested that may have made this patient—a known sufferer from chronic liver disease—more susceptible to the development of such a reaction, but the principle cause is thought to have been the changes in capillary hydrostatic pressure induced by the patient ‘fighting’on the tracheal tube whilst regaining consciousness after an anaesthetic for the injection of her oesophageal varices.
Epidural morphine in terminal care
Authors: HOWARD R.P. , MILNE L.A. , WILLIAMS N.E.
Published: February 2007

Case histories of three patients with intractable pain, all of whom responded to epidural morphine, are presented. Drug tolerance appeared to develop in two patients who survivied longer than 10 days. Nevertheless this method of pain relief may be a useful adjunct to terminal care and in certain circumstances may allow for easier management in the patient's own home.
A survey of anaesthetic misadventures
Authors: CRAIG JANET , WILSON M.E.
Published: February 2007

Reports of anaesthetic misadventures were regularly collected in the Anaesthetic Department of a district general hospital, to identify recurring problems. Eighty‐one misadventures, none of which had serious outcome, were reported during a 6‐month period, in which 8312 anaesthetics were administered. Human error was more frequently responsible than equipment failure, and failure to perform a normal check was the factor most frequently associated. Local hazard warnings were circulated when necessary to members of the Department, and the reports formed the basis of departmental discussion and teaching.
Postoperative analgesia in major orthopaedic surgery
Authors: BARRON DAVID W. , STRONG JOHN E.
Published: February 2007

Sixty‐two patients were given morphine 2 mg and 69 patients were given diamorphine 0·5 mg by either the epidural or intrathecal route. All had undergone either total hip replacement or spinal disc surgery. Forty‐nine out of 131 patients required no further analgesia. Diamorphine was superior to morphine and the intrathecal route more effective than the epidural. Headache, pruritus, urinary retention and nausea and vomiting were recorded, the incidence of the latter being unacceptably high, particularly when the drugs were administered by the intrathecal route: one patient required resuscitation. It is suggested that previously reported respiratory depression using these techniques is associated with the administration of other analgesics co‐temporaneously; that dosage should be limited to one‐fifth of the estimated intramuscular dose; and that patients should be observed in a recovery ward for 24 hours.
Test of delayed memory recall suitable for assessing postoperative amnesia
Authors: BETHUNE D.W.
Published: February 2007

The application of a test of delayed memory recall to determine the extent of postoperative (anterograde) amnesia is described. Results from studies following the application of different anaesthetic techniques to patients undergoing minor surgery suggests that a period of anterograde amnesia is inevitable following general anaesthesia.

The anterograde amnesia persists after apparent full clinical recovery and the possibility of clinical and medico‐legal problems from this cause must be recognised in the overall management of the patient.
Fixed performance oxygen masks
Authors: COX DOMINIC , GILLBE CHARLES
Published: February 2007

Four recently introduced low‐capacity fixed performance oxygen therapy masks have been compared with the established Ventimask design. Under conditions of varying peak inspiratory flow rate the low‐capacity devices all permit a variable amount of air admixture with a consequent fall in the inspired oxygen concentration. It is concluded that low‐capacity venturi masks are not true fixed performance devices under all circumstances. The Ventimasks satisfy their specifications under all test conditions. A case is made for more rigorous assessment of new so‐called ‘fixed performance’ oxygen therapy devices before marketing is permitted.
Treatment of stress response to laryngoscopy and intubation with fentanyl
Authors: DAHLGREN N. , MESSETER K.
Published: February 2007

The cardiovascular response to laryngoscopy and intubation was investigated in lightly anaesthetised patients admitted to hospital for elective intracranial surgery. One group of patients was given fentanyl 5 μg/kg body weight before induction with thiopentone and suxamethonium. The other group served as controls. Fentanyl treatment caused a significant attenuation of the blood pressure and pulse response to laryngoscopy and intubation.

Different techniques for induction of anaesthesia are discussed in relation to the demands of neuroanaesthesia.
Tolerance to rectal ketamine in paediatric anaesthesia
Authors: STEVENS R.W. , HAIN W.R.
Published: February 2007

The use of rectal ketamine as the sole anaesthetic for short, minor procedures in young children is discussed. A case in which 18 anaesthetics were administered by this route, to facilitate radiotherapy, is reported and the subsequent development of tolerance and its possible mechanisms are discussed.
Cardiovascular changes during controlled blood loss and replacement
Authors: Kirwan T. , Scurr C.F. , Smith G. Brindle
Published: February 2007

Changes in central venous pressure, systolic arterial pressure and pulse rate were recorded in 31 patients undergoing surgery involving withdrawal of 1 litre of blood and subsequent transfusion. Central venous pressure gave immediate and consistent indications of blood loss and replacement but blood volume changes could not be correlated numerically with central venous pressure. No difference was found between patients anaesthetised using spontaneous ventilation with halothane and intermittent positive pressure ventilation.
Anticonvulsant drugs used in the treatment of lancinating pain. A comparison
Authors: Swerdlow Mark , Cundill J.G.
Published: February 2007

The value of anticonvulsant drugs in the treatment of some cases of lancinating pain is now established. The results in 170 consecutive cases in an ongoing series are reported with special reference to the efficacy of four anticonvulsants–carbamazepine, clonazepam, phenytoin and valproate. The findings are discussed.
The prevention of hypertension at intubation
Authors: DAVIES MICHAEL J. , CRONIN KEITH D. , COWIE ROBERT W.
Published: February 2007

Arterial blood pressure and pulse rate changes following tracheal intubation were studied in 20 patients undergoing intracranial surgery who received a thiopentone/suxamethonium anaesthetic induction sequence. Ten of the patients were pretreated with 0.4 mg/kg of hydrallazine and 10 with saline to determine whether hydrallazine prevents intubation hypertension. The results show that the incidence of intubation hypertension can be reduced using this dose of hydrallazine. Hydrallazine pretreatment is therefore recommended in patients at risk from hypertension following tracheal intubation.
Ketamine for induction and intubation in Treacher‐Collins syndrome
Authors: MACLENNAN FIONA M. , ROBERTSON GEORGE S.
Published: February 2007

A patient with the Treacher‐Collins syndrome is described, in whom intubation of the trachea was achieved using ketamine as the sole anaesthetic agent. Intubation was aided by blind location of the glottis with a gum‐elastic stylet.
The oesophageal obturator airway
Authors: MERRIFIELD A.J. , KING S.J.
Published: February 2007

Ventilation of cadaver lungs using a Pneupac ventilator through oesophageal obturator airways (EOA), oesophageal gastric tube airways (EGTA), and tracheal tubes was studied in 23 subjects. The mean tidal volume obtained through tracheal tubes was 381 ml compared with a mean tidal volume of 156 ml obtained through the EOA and a mean tidal volume of 237 ml through the EGTA. Considerable leakage occurred at the pressure relief valve of the ventilator and at the face mask. With the pressure relief valve occluded and better mask fit achieved by observation of maximum possible tidal volume, the mean tidal volume obtained through obturator gastric airways was 606 ml compared with 906 ml obtained through tracheal tubes. This represents adequate ventilation in these very stiff lungs. Subject to modification of the device and prevention of leakage the oesophageal gastric tube airway is a useful alternative to tracheal intubation in certain adverse conditions.
Intubation problem in a case of cystic hygroma complicated by a laryngotracheal haemangioma
Authors: EVANS P.
Published: February 2007

In dealing with this case of cystic hygroma a non‐routine intubation was expected and some of the possible problems anticipated. However, the unusual nature of the difficulty encountered was not initially apparent and presented special problems, both with initial and subsequent management of the patient.

The presence of a primary laryngeal condition in this case presented another life‐threatening feature. Not only was the airway narrowed, but intubation could not be easily achieved and the possibility of haemorrhage into the respiratory tract existed.

The outcome of the case reflects the high mortality associated with this essentially benign condition.1,2,8
Total intravenous anaesthesia with low dose ketamine and Althesin Assessment of a technique for minor surgery in difficult situations
Authors: Keith Ian , Shenoy B. J.
Published: February 2007

In 38 patients subjected to minor surgery, totally intravenous anaesthesia with low dose ketamine and Althesin produced adequate operating conditions in 92% of patients with minimal cardiorespiratory disturbance. Problems arose from muscular hyper tonus, spontaneous movement and occasionally salivation. Initial recovery was quicker and the incidence of side‐effects lower, than those reported when ketamine was used as the sole agent. The technique could be useful in difficult situations as an alternative to inhalation anaesthesia or other intravenous techniques.
Epidural space pressures during pregnancy
Authors: MESSIH MORAD N.A.
Published: February 2007

The epidural space pressure in the lumbar region was monitored and recorded in 21 full term pregnant patients, before and during labour and 6–12 hours postpartum, in different positions. The pre‐labour epidural pressure was found to be above atmospheric in all patients, being highest when supine, and lowest in the lateral position. Three patients with twin pregnancy showed a greater rise in epidural space pressure in the supine position even with the use of lateral tilt, compared with patients with single fetus pregnancy. It is suggested that the epidural space pressure in the full term pregnant patient is closely related to the degree of inferior vena caval obstruction imposed by the gravid uterus. It is also suggested that when the patient is aware of a uterine contraction, the synchronous rise of the epidural space pressure with the contraction is a result of reflex increase in abdominal muscle tone. With established epidural block, and the parturient unaware of a contraction, such a rise was minimal, and was replaced by a drop in pressure in patients with a single fetus who developed loss of muscle power. The magnitude of the drop in the epidural space pressure immediately after delivery was found to be related to the duration of labour and to the mode of delivery. Epidural pressures measured 6–12 hours after delivery were comparable in all patients.
Control of ventilation by continuous infusion of pancuronium bromide
Authors: CLYBURN P.A. , MARSHALL R.D.
Published: February 2007

Certain groups of patients who require prolonged intermittent positive pressure ventilation in the Intensive Therapy Unit are difficult to manage with conventional sedative and narcotic drugs, and require muscle paralysis. In such cases, the authors have preferred a continuous infusion of a long‐acting muscle relaxant using a syringe pump rather than intermittent injections. The technique and apparatus employed in the Intensive Therapy Unit at Northampton General Hospital are described.
A combined oropharyngeal airway and dental pack
Authors: GREEN RONALD A. , AKESTER JOHN
Published: February 2007

The construction and method of use of a combined oropharyngeal airway andpharyngealpack for use in dental surgery is described.
Postoperative pain control with intrathecal morphine
Authors: GJESSING JON , TOMLIN PETER J.
Published: February 2007

A clinical study of the use of intrathecal morphine in two groups of surgical patients, 32 in all, showed that the morphine provided very powerful and prolonged analgesia with little disturbance of cerebral function. When combined with a spinal block it did not interfere with the action of the spinal anaesthetic. When combined with a relaxant technique of anaesthesia some persistent curarisation was seen.

The only complication to emerge from the study was respiratory depression which could be very delayed in its onset. The depression was sufficient to induce carbon dioxide narcosis in two patients. It is suggested that the dose of intrathecal morphine in the very elderly should be very severely restricted as they appeared to be unduly sensitive to the respiratory depressant effect of morphine when given intrathecally.
An indication for hypnosis
Authors: RUTTER D.V.
Published: February 2007

A case of idiopathic pulmonary hypertension in a girl who refused local anaesthesia for dental treatment is described. Her dental work was successfully managed utilising hypnosis.
Spinal analgesia using bupivacaine 0·5% plain Variation in the extent of the block with patient age
Authors: Cameron A.E. , Arnold R.W. , Ghoris M.W. , Jamieson Virginia
Published: February 2007

Bupivacaine 0·5% plain solution was used to produce spinal analgesia on 63 occasions. In 33 patients a fixed dose of 4 ml injected at the L2/3 interspace at 0·5 ml/second produced an extent of analgesia which was directly related to patient age (P < 0·005). The latency was 17·3 minutes (SD 8·4) and duration of action was 286 minutes (SD 62). A second group receiving only 1 ml of solution had a much shorter duration of action (mean 154 minutes, SD 30). In 90% of patients the analgesia obtained was fully sufficient for surgery to be performed and no form of analgesic supplementation was given. On two occasions no analgesia occurred at all. Bupivacaine 0·5% plain proved to be an effective agent for subarachnoid block. The extent of analgesia was, however, poorly predictable, and even with low doses unacceptably high levels of block were sometimes achieved.
The effect of suxamethonium on intraocular pressure
Authors: COOK J.H.
Published: February 2007

A method is described of measuring the elevation of the intraocular pressure (IOP) caused by suxamethonium in patients in whom other factors which may cause a change in IOP are kept constant. Use of this method confirms that suxamethonium 1 mg/kg causes a statistically significant rise in IOP which lasts for 10 minutes. A rise in IOP which is not significantly different from this is caused by suxamethonium 2–5 mg/kg, suxamethonium 1 mg/kg immediately preceded by thiopentone 3 mg/kg and by suxamethonium 1 mg/kg, 3 minutes after tubocurarine 0–1 mg/kg.
Haemodilution in an eight‐month‐old infant
Authors: KRAFT M. , DEDRICK D. , GOUDSOUZIAN N.
Published: February 2007

Transient haemodilution was carried out in an 8‐month‐old infant whose parents were Jehovah's Witnesses during an abdominoperineal pull‐through procedure. Adult ACD blood packs were altered to suit the needs of the child. With judicious fluid management, the child was extubated and did well postoperatively.
Anaphylactic‐like reaction to suxamethonium
Authors: ASSEM E.S.K. , FROST P.G. , LEVIS R.D.
Published: February 2007

A young woman developed an anaphylactic‐type reaction during induction of anaesthesia, which was later shown to be due to suxamethonium, to which the patient had not been previously exposed. In vitro testing identified not only suxamethonium as the causative agent, but also other potentially hazardous agents, pharmacologically and chemically related to suxamethonium. Furthermore, ‘unrelated’ neuromuscular blocking drugs elicited no reaction from the patient's leucocytes, suggesting that in future anaesthesia these agents may be used with little risk. The leucocytes of the patient's parents and brother were also tested, the brother showing a minimal positive reaction. Skin testing confirmed the significance of the in vitro histamine release by the patient's leucocytes.
Anaesthetic safety with the carbon dioxide laser
Authors: Wainwright A.C. , Moody R.A. , Carruth J.A.S.
Published: February 2007

The carbon dioxide laser, when used in the airway, poses the problem for the anaesthetist of the possibility of ignition of the tracheal tube. The means available to prevent this disaster are discussed.
Experiences with fibre‐optic bronchoscopic positioning of single‐lumen endobronchial tubes
Authors: Aps C. , Towey R.M.
Published: February 2007

The use of flexible fibre‐optic devices for positioning single‐lumen endobronchial tubes in one‐lung anaesthesia has been assessed. The technique is safe, easily learnt and provides a useful alternative to existing methods of establishing one‐lung anaesthesia.
Minaxolone, clinical effects and pharmacokinetics
Authors: MATHER L.E. , SEOW L.T. , GOURLAY G.K. , ROBERTS J.G. , COUSINS M.J.
Published: February 2007

Minaxolone, infused at a constant rate of 0·01 mg/kg/min produced drowsiness followed by a sleep‐like state from which subjects could be easily awakened. After the infusion was stopped, initial recovery was rapid, and completed within 45 minutes. The ability to produce this state rapidly and reversibly would have great value in outpatient surgery, short operative procedures and for basal sedation during procedures performed under regional anaesthesia. In common with many intravenous induction agents, involuntary skeletal muscle movement and twitching during the latter part of the infusion regimen was observed in some subjects. The rapid recovery was consistent with the pharmacokinetic characteristics of Minaxolone, i.e. high total body clearance (near or even exceeding that of indocyanine green) and rapid redistribution. However, renal clearance of unchanged Minaxolone was negligible.
Cardioversion in late pregnancy
Authors: KLEPPER I.
Published: February 2007

A case history is presented of a woman with known Wolff‐Parkinson‐White syndrome who, in late pregnancy, developed repeated supraventricular tachycardia, requiring direct current cardioversion.

The anaesthetic problems and some pharmacological aspects of the management are discussed.
Nitrous oxide analgesia and altitude
Authors: JAMES M. F. M. , MANSON E. D. M. , DENNETT J. E.
Published: February 2007

The analgesic effectiveness of 50% nitrous oxide and oxygen or oxygen‐enriched air, measured by variations in pain threshold, was studied at an altitude of 1460 m and simulated altitudes of sea level and 3300 m.

At sea level pressures, 50% nitrous oxide exerted a similar analgesic effect to that found for morphine, raising the pain thresholds by a mean of 71.5%. At 1460 m, the increase in pain threshold produced was 40% and at 3300 m the increase in pain threshold was only 19%.

The difference between the analgesic effects of nitrous oxide at each altitude was statistically significant. It is concluded that moderate altitudes significantly reduce the effectiveness of nitrous oxide in a manner directly related to the partial pressure of nitrous oxide at each altitude.
Continuous thoracic epidural fentanyl
Authors: WELCHEW E. A. , THORNTON J. A.
Published: February 2007

A prospective open trial was conducted to compare the analgesic and side‐effects of continuously infused fentanyl into the thoracic epidural space with those of intramuscular papaveretum given 4 hourly as required. It was demonstrated that during the first 24 hours after upper abdominal surgery thoracic epidural fentanyl produced better analgesia with less sedation than intramuscular papaveretum. However, the epidural group suffered more nausea. Likewise, postoperative respiratory function tests were statistically significantly better in those patients who received epidural fentanyl. Despite a significantly greater volume of nasogastric aspirate during the period of study, the epidural fentanyl group also had a significantly greater urine output than did the patients receiving papaveretum. Hypotension and respiratory depression were not problems, but pruritus occurred in two patients given fentanyl. It is concluded that epidural fentanyl delivered by continuous infusion offers significant advantages over a conventional intramuscular narcotic regime.
Blood disoprofol levels in anaesthetised patients
Authors: ADAM H. K. , KAY B. , DOUGLAS E. J.
Published: February 2007

The blood concentrations of disoprofol (Diprivan) after single intravenous doses of 1, 2 or 3 mg/kg have been examined in a subpopulation from previously reported clinical studies. The linear relationship between sleep time and dose could be explained by the linearity of the pharmacokinetics at these doses. After a single injection the awakening concentration was independent of dose, with a mean value of 1.04 μg/ml. No acute tolerance occurred with disoprofol. On repeated 1 mg/kg bolus injections the sleeping time rose initially but stabilised after four doses. The waking concentration was independent of the number of doses administered. The clinical findings fitted an agent with a very rapid distribution phase and a short elimination half‐life.
Cardiopulmonary bypass and complement activation
Authors: JONES H. M. , MATTHEWS N. , VAUGHAN R. S. , STARK J. M.
Published: February 2007

Complement is activated during cardiopulmonary bypass with consumption of the complement components C3, C4 and factor B. This takes place when either a bubble or membrane oxygenator is used and is not affected by steroid therapy. Complement activation is predominantly by the classical pathway and may be related to the aggregation of IgM found in bypass sera.
Anaesthesia for Caesarean section. The potential for regional block
Authors: Davis A.G.
Published: February 2007

This study of the obstetric and anaesthetic circumstances relating to 100 consecutive Caesarean sections under general anaesthesia suggests that the general anaesthesia rate for Caesarean section could he reduced from the present 37 to 22% by making maximum use of epidural block and to 16% by using subarachnoid block in addition. The need for general anaesthesia on account of urgency to deliver can be greatly reduced by the administration of epidural analgesia during labour in patients identified as being more likely than average to require Caesarean section, and by the use of subarachnoid block when the need for section arises unexpectedly. Patients' objections to undergoing Caesarean section while conscious were analysed, and suggestions are made for minimising the number of patients who decline. Technical problems with blocks may sometimes be overcome without resort to general anaesthesia, while patients at risk from haemorrhage or coagulopathy will continue to require general anaesthesia.
Hypotensive anaesthesia for microsurgery of the middle ear. A comparison between enflurane and halothane
Authors: Eltringham R.J. , Young P.N. , Fairbairn M.L. , Robinson J.M.
Published: February 2007

One hundred patients undergoing microsurgery of the ear were anaesthetised using thiopentone, nitrous oxide, oxygen and either halothane or enflurane with spontaneous respiration. Blood pressure was reduced to approximately 70 mmHg by the use of hypotensive agents.

The efficacy of halothane and enflurane in producing good operating conditions was compared during this technique. Haemostasis was assessed by the surgeon who was unaware which volatile agent was being used. Both agents were found to be satisfactory and enflurane was shown to be a safe and reliable agent with this technique should an alternative to halothane be required. No impairment of renal function was seen with either agent in combination with hypotension.
Haloperidol as an adjunct analgesic in the management of postoperative pain
Authors: Judkins K.C. , Harmer M.
Published: February 2007

Thirty‐four patients have been studied to evaluate the effect on postoperative analgesia of haloperidol in two doses as a premedicant compared with a placebo. Analgesia was provided by tin on‐demand system and assessed by visual analogue score. No significant difference was noted between the groups in regard to analgesic requirements or degree of pain relief. However, potent anti‐emesis was clearly demonstrated.
The ‘induction’ dose of thiopentone
Authors: DUNDEE J. W. , HASSARD T. H. , McGOWAN W. A. W. , HENSHAW J.
Published: February 2007

Study of the minimal dose requirements for induction of anaesthesia poses great problems which are solved by the use of a standard administration technique and the abolition of the eyelash reflex as an endpoint. This has been used in 2206 consecutive unselected inductions, in which variables considered to be likely to influence the dosage were recorded. Milligram per kilogram is the most acceptable method of expressing the average dosage of thiopentone. Doses follow a right skew distribution. Women required a significantly lower average dose of thiopentone than men, while obese patients required less than others. Moderate or heavy drinking increased the induction dose but the use of tobacco did not have any influence. The most important factors governing dosage are the physical fitness of the patient and the premedication used. Patients in ASA grades 1 and 2 required significantly more thiopentone than those in grades 3 and 4. This effect is as great as that of premedication in which an opiate with a phenothiazine or hyoscine markedly reduced the induction dose. It was more important than the patient's pre‐operative condition with respect to sedation or apprehension. Small doses of opiates or benzodiazepines do not have as much effect on dosage.
Attitudes to intravenous infusion anaesthesia
Authors: Wright P.J. , Dundee J.W.
Published: February 2007

The results of a survey of anaesthetic practice within the United Kingdom with special reference to intravenous infusion anaesthesia, are reported.
Peri‐operative management of insulin‐dependent diabetic patients. Use of continuous intravenous infusion of insulin‐gluocose‐postassium solution
Authors: Bowen D.J. , Nancekievill M.L. , Proctor E.A. , Norman J.
Published: February 2007

The effect of a constant intravenous infusion of an insulin‐glucose‐potassium mixture was studied on 20 insulin‐dependent patients undergoing elective surgery. The infusion provided insulin 2 units, glucose 10 g and potassium 4 mmol every hour.

It was concluded that the infusion was simple to use and could be administered safely for periods up to 4 hours. After that time the insulin dosage should be reassessed to maintain good control of the blood glucose levels.
The influence of haemoglobin and plasma urea levels on the induction dose of thiopentone
Authors: DUNDEE J. W. , HASSARD T. H.
Published: February 2007

A standard method was used for estimating the induction dose of thiopentone. In 1812 patients there was a positive relationship between the induction dose and the haemoglobin levels of patients. In 1711 patients an inverse relationship was found between the induction dose and plasma urea. Both of these findings can be explained by alterations in plasma binding of thiopentone.
Respiratory injury in the burned patient
Authors: CLARK C. J. , REID W. H. , TELFER A. B. M. , CAMPBELL D.
Published: February 2007

The purpose of the study was to investigate the role of flexible bronchoscopy in the management of patients admitted to a busy Regional burns unit, with particular reference to possible smoke inhalation injury. The basic procedure employed was that used in routine bronchoscopy for the diagnosis of bronchial carcinoma, with modification of the premedication required in view of the shorter duration of the technique and the lack of a requirement for bronchial biopsy. We have found the procedure easy to perform, well tolerated by the patients and not associated with any complications. It provides additional information not otherwise available, which can influence the subsequent management of the patient. An experienced bronchoscopist and additional personnel skilled in resuscitation techniques are required. It should be performed in patients with clear evidence of smoke inhalation injury and in particular with facial burns in order to visualise the extent of airway injury, remove debris and give some indication of the likelihood of subsequent complications such as acute upper airways obstruction.
Effects of nitrous oxide on pressure changes of tracheal tube cuffs following inflation with air and saline
Authors: PATEL R. I. , OH T. H. , EPSTEIN B. S.
Published: February 2007

The effects of nitrous oxide diffusion on tracheal tube cuff pressure following inflation with air and saline were studied at a temperature of 37°C. The pressure in the cuff inflated with air increased more rapidly and to a higher level (about 200 mmHg) than pressure in the cuffs inflated with saline (about 12 mmHg).
Closed system enflurane in oxygen
Authors: Robins D. W.
Published: February 2007

A safe method of administering enflurane from a Goldman vaporizer in a closed system is described, using a fresh gas, flow of 0.5 litres/minute of oxygen. There was a drawback, in that, until the system was closed, insufficient concentration of enflurane was achieved in seven out of 20 patients, who then moved on surgical incision, When the system was closed, the concentration of enflurane increased so that satisfactory anaesthesia occurred. The maximum inspired concentration of enflurane in the system was 4.5% which occurred in one patient on the 3rd notch of the Goldman. A portable interference refractometer was used to measure the percentage of enflurane.
Cardiac output and the recumbent position in late pregnancy
Authors: NEWMAN B. , DERRINGTON C. , DORE C.
Published: February 2007

Changes in cardiac output were measured by transcutaneous aortovelography in 30 pregnant patients and in 30 control subjects with change of position from the supine. When compared to the supine position, the left and right lateral and left 15 till positions caused statistically significant increases in cardiac output, whereas the right 15 tilt position did not. Neither fetal head engagement nor the lime spent in each position had significant effects on the changes in cardiac output. It was not possible to identify a subgroup of pregnant patients who were particularly sensitive to changes in posture.
Adrenal suppression following extradural steroids
Authors: JACOBS S. , PULLAN P. T. , POTTER JULIA M. , SHENFIELD G. M.
Published: February 2007

Adrenocortical function was tested in 12 patients following a single lumbar extradural injection ofmethyl‐prednisolone acetate (‘Depo‐Medrol’) 80 mg as treatment for chronic sciatica. There was no absorption of the corticosteroid into the systemic circulation, but marked suppression of plasma Cortisol levels was documented for up to 3 weeks following the injection and the capacity of the adrenal cortex to secrete Cortisol in response to synthetic adrenocorticotrophin (ACTH) was diminished. These results suggest that the dose and frequency of extradural steroid administration should be kept to a minimum to prevent suppression of the hypothalamicjpituitaryladrenocortical axis and that patients thus treated should he considered candidates for steroid cover during surgery and other stressful procedures.
A comparison of intramuscular and sublingual buprenorphine, intramuscular morphine and placebo as premedication
Authors: O'SULLIVAN G. , BULLINGHAM R. E. S. , MCQUAY H. J. , POPPLETON P. , ROLFE M. , WEIR L. , MOORE R. A.
Published: February 2007

Buprenorphine premedication by two routes, 0.4 mg sublingual and 0.3 mg intramuscular was compared double‐blind, double‐dummy with intramuscular morphine 10 mg and placebo in 74 patients undergoing elective total hip replacement.

Anxiety, depressive mood, sedation, vital signs and side‐effects were measured before surgery. All patients then received a standardised general anaesthetic using a muscle relaxant and ventilation. The effects of the premedication on the anaesthetic were assessed by a scoring system. Intra‐ and postoperative blood gases, plasma Cortisol and glucose were measured and the 1 hour postoperative pain intensity, side‐effects and sedation were assessed.

No differences between the premedications were seen on any of the pre‐, intra‐ or postoperative measurements, suggesting that even with adequate measurement sensitivity it is difficult to distinguish opiate from placebo premedication.
Acute renal failure in an intensive care unit: incidence, prediction and outcome
Authors: WILKINS R. G. , FARAGHER E. B.
Published: February 2007

A review of the case notes of 475 patients with no history of renal disorder admitted to an intensive care unit, showed that 23% (109) developed acute renal failure. This complication occurred more commonly in patients with major burns (75%), and following surgery to the abdominal aorta (38%), but less commonly after self‐poisoning episodes (5%).

Scores were provided from stepwise multiple regression analysis which were derived from the diagnostic group, the presence of sepsis, the presence of systolic hypotension and age, and correctly predicted development of acute renal failure in 79% of the cases studied. Attempted prophylaxis appears to have little effect on the incidence of acute renal failure whilst dialysis reduced the mortality from 95% to 72%. Use of the scoring system to allow earlier diagnosis and treatment of acute renal failure could reduce the present mortality by 43%.
Narcotics and spasm of the sphincter of Oddi. A retrospective study of operative cholangiograms
Authors: Chisholm R.J. , Davis F.M. , Billings J.D. , Gibbs J.M.
Published: February 2007

The operative cholangiograms of 112 patients undergoing elective cholecystectomy were reviewed independently and retrospectively by two radiologists who were not aware of the anaesthetic technique used. Fifty four patients who received opioid drugs either pre‐ and/or intra‐operatively comprised one study group whilst 58 patients who received no opioids comprised the other. Spasm of the sphincter of Oddi was observed in two patients in the opioid group and in one patient in the non‐opioid group. The use of opioid drugs as part of the anaesthetic management for cholecystectomy did not appear to interfere with the radiological interpretation of operative cholangiography nor to increase the low incidence of spasm of the sphincter of Oddi.
Acute epiglottitis and severe croup
Authors: WELCH D.B. , PRICE D.G.
Published: February 2007

The case histories of 50 children who required tracheal intubation for epiglottitis or croup in two English regions have been reviewed. The incidence of severe croup was different in the two regions. The presentation of epiglottitis was variable, and the correct diagnosis was frequently made only at laryngoscopy. Unexpected and rapid deterioration occurred in both diseases, and cyanosis was commonly present on hospital admission and at laryngoscopy. Two children required planned tracheostomy and there were two deaths. The principles of safe management are discussed.
The role of anaesthetists as seen by nurses in training
Authors: Salmon Nigel P.
Published: February 2007

A questionnaire designed to assess knowledge and altitudes towards the anaesthetist and his work was distributed to 320 nurses in training. The results of the survey are presented and discussed.
Grading of pain and anxiety
Authors: BHACHU H. S. , KAY B. , HEALY T. E. J. , BEATTY P.
Published: February 2007

Comparison of a linear analogue scale on paper and a computerised audiovisual analogue scale presented on a visual display unit is described. Pain was assessed postoperatively in 109 patients and anxiety pre‐operatively in 146 patients. Results show a strong correlation between gradings obtained using the two methods, indicating the computerised method is as reliable as the conventional one.
Techniques of tracheostomy for intensive care unit patients
Authors: Price D.G.
Published: February 2007

The author and his colleagues believe that the surgical technique used constructing a tracheostomy can have a profound effect on the safety and care of patients in the intensive care unit particularly in the first few days after the operation. The Björk procedure is commended to the surgeons.
The management of insulin dependent diabetes during cardiopulmonary bypass and general surgery
Authors: THOMAS D. J. B. , HINDS C. J. , REES G. M.
Published: February 2007

Two groups of insulin dependent diabetic subjects have been studied: six undergoing general surgical procedures und six undergoing hypothermic cardiopulmonary bypass surgery for coronary artery vein grafting. Intravenous glucose insulin mixtures were infused from the onset of surgery in both groups of patients, supplying 0.4 units of insulin per gram of glucose per hour, and 0.6 units of insulin per gram of glucose per hour in general and cardiac surgical patients respectively. Postoperatively diabetes was controlled carefully with an insulin syringe pump regulated by venous blood glucose monitoring. In cardiac surgical patients far more insulin was required to control diabetes postoperatively than in the generul surgery patients (at 1 hour 1.6 units, SEM 0.4 compared to 0.7 SEM 0.1, p < 0.05; and at 4 hours 2.0 units SEM 0.3 compared to 0.8 units SEM 0.1, p < 0.02). Five non‐diabetic subjects who underwent surgery for coronary artery venous bypass grafting were also studied. They developed significant postoperative hyperglycaemia (5.0. SEM 0.2, mmol/litre pre‐operutively, compured with 8.8. SEM 0.7, mmol/litre p < 0.03 ul I hour and 10.2, SEM 1.7, mmolilitre, p < 0.02 at 4 hours after bypass terminated).
Zebulon Mennell
Authors: HUNTER A. R.
Published: February 2007

Dr Zebulon Mennell, the first anaesthetist to devote himself largely to anaesthesia for neurosurgery, was horn on 15 June 1876. He graduated at St Thomas's Hospital in London, where he was an anaesthetist. He was also an anaesthetist at the Royal National Hospital for Nervous Diseases, Queen Square, London, a post which he held until 1945. His writings indicate that he appreciated the problems of neurosurgical anaesthesia and he was the first individual to work in this field as a specialist.
Unrecognised presentation of a meningioma
Authors: FRASER A. C. L. , GOAT VALERIE A.
Published: February 2007

A general anaesthetic was followed by a rapid progression of signs and symptoms subsequently attributable to a meningioma. The general anaesthetic had been uneventful except for a significant delay in recovery. The interaction between general anaesthesia and intracranial masses is discussed and the conclusion reached that in cases of prolonged recovery from anaesthesia underlying intracranial pathology should always be suspected.
Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis
Authors: VYAS A. B. , LYONS S. M. , DUNDEE J. W.
Published: February 2007

The anaesthetic management of patients undergoing tracheal resection for tracheal stenosis and the advantage of the maintenance of spontaneous respiration without intubation of the distal tracheal segment is discussed. The case reports of two such patients using a continuous intravenous infusion of Althesin with maintenance of spontaneous respiration are presented. The technique expedited the surgical re‐anastomosis due to lack of instrumentation in the surgical field. While some mild respiratory depression as evidenced by carbon dioxide retention did occur, the technique is worthy of consideration for the procedure.
Neurological complications following general anaesthesia
Authors: SCHREINER ELIZABETH J. , LIPSON S. F. , BROMAGE P. R. , CAMPORESI E. M.
Published: February 2007

A causal relationship between resulting neurological impairment and anaesthetic technique is often assumed after spinal or epidural anaesthesia, despite the rare occurrence of these complications. A postoperative neurological deficit may be closely associated with a general anaesthetic. We present three cases in which neurological sequelae followed recent general anaesthesia: all cases occurred within a period of one year at a single institution. These cases exemplify the difficulty in assuming a causal relationship between neurological deficit and anaesthetic technique.
Labetalol in tetanus
Authors: WESLEY A. G. , HARIPARSAD D. , PATHER M. , ROCKE D. A.
Published: February 2007

The cardiovascular instability in some cases of severe tetanus is due to increased circulating catecholamines. In 15 patients with this complication of tetanus, labetalol, a drug with alpha‐ and beta‐peripheral adrenergic blocking properties, was used in management. The drug was administered orally, by i.v. bolus or by continuous infusion. Wide variation in dosage was needed both from case to case and in the same patient during the course of his disease.

In most cases the pulse and blood pressure were reduced by labetalol, although their variability was not much improved. The effect on the cardiac output and systemic vascular resistance ranged from modest reduction in both, to marked effect on cardiac output without any change in systemic vascular resistance. The alpha‐adrenergic blockage of labetalol is known to be less powerful than the beta‐blocking effect, and this property could be a disadvantage in the management of sympathetic overactivity in tetanus.
Hypotension during epidural analgesia for Caesarean section
Authors: LEWIS M. , THOMAS P. , WILKES R. G.
Published: February 2007

The incidence of hypotension occurring in women undergoing Caesarean section with epidural analgesia was investigated in 60 patients receiving an intravenous preload of two litres Hartmann's solution. Hypotension occurred in only 6.7% of patients. Central venous pressure measurements in 20 patients confirmed the safety of the technique. A comparison is made with other preloading techniques.
Pituitary cryoablation
Authors: DUTHIE A. M. , INGHAM V. , DELL A. E. , DENNETT J. E.
Published: February 2007

Pituitary ablation by the injection of alcohol through a transphenoidal needle has been practised for a number of years. In order to reduce the complications resulting from the spread of alcohol to neighbouring structures, a cryoprobe has been constructed which can be passed up through the needle into the gland and a series of localised lesions produced. The degree of pain relief is as good if not better than that obtained with alcohol. Only one instance of temporary blurring of vision resulted and hormonal disturbances were not seen. No difference was observed between the results obtained from the treatment of hormone‐dependent and hormone‐insensitive tumours. Pain caused in one patient by a benign tumour was unsuccessfully treated.
The determination of an effective cricoid pressure
Authors: Wraight W. J. , Chamney Anne R. , Howells T. H.
Published: February 2007

A study of cricoid pressure was undertaken to relate the applied cricoid force with the resulting intraluminal cricopharyngeal (or oesophageal) pressure. The results indicate that whilst there was a wide range in normal adults a cricoid force of 44 N was judged to be effective in protecting the majority of adult patients from regurgitation.
Emergency extracorporeal oxygenation for an intratracheal foreign body
Authors: MAHARAJ R. J. , WHITTON I. , BLYTH D.
Published: February 2007

The emergency management of a patient presenting in respiratory failure due to critical tracheal stenosis caused by an intratracheal foreign body is described. The use of an extracorporeal oxygenator in the anaesthetic management of the patient is highlighted.
Pituitary cryoablation
Authors: DUTHIE A. M.
Published: February 2007

Transphenoidal ablation of the pituitary gland by the injection of alcohol is used for the relief of widespread cancer pain. A technique is described in which a cryoprobe is passed through a transphenoidal needle and a number of lesions produced within the gland. It is suggested that this method of pituitary ablation may prove to be as effective but accompanied by fewer complications than the injection of alcohol.
Performance of the EMO inhaler
Authors: MARSH D. R. G. , HERBERT P.
Published: February 2007

The performance of the EMO inhaler has been studied. The concentrations of ether delivered were most accurate when higher concentrations were selected and when higher tidal volumes occurred.
Chloroform anaesthesia in Liverpool
Authors: JONES I. W.
Published: February 2007

The introduction of chloroform into anaesthesia is described, together with an account of the parts played by Simpson and Waldie and their connexions with Liverpool. An account of the first chloroform anaesthetics administered in Liverpool is also given; David Waldie, who suggested the use of chloroform, was one of the administrators at the first demonstration.
The incidence of Homer's syndrome during lumbar extradural for elective Caesarean section and provision of analgesia during labour
Authors: Clayton K.C.
Published: February 2007

One hundred and fifty women in labour provided with extradural analgesia were monitored and an incidence of Homers syndrome of 1.33% was noted. Fifty women undergoing Caesarean section under extradural analgesia were also monitored and an incidence of Homer's syndrome of 4% was noted. From the results we found it impossible to predict which patients would develop a Horner's syndrome.
Epidural analgesia and instrumental delivery
Authors: WALTON P. , REYNOLDS F.
Published: February 2007

In patients given epidural analgesia who had singleton vertex vaginal deliveries the normal delivery rate was 57%, compared to 80% in all this group. The increase in instrumental delivery rate could partly be accounted for by parity (primigravidae are over‐represented in the epidural group), by obstetric and medical indications for epidurals, and by the need for sitting top‐ups to relieve perineal pain. There remained a small population of patients in whom epidurals may have contributed to the need for instrumental delivery.