bluuebunny/crossref_metadata_2025 huggingface dataset:
Meta‐analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first‐line therapies for Helicobacter pylori
Authors: FISCHBACH L. , EVANS E. L.
Published: July 2010

Background  Information regarding the effects of drug resistance on therapies for Helicobacter pylori is limited.

Aims  To determine the effect of drug resistance on the efficacy of first‐line treatment regimens for H. pylori and identify the most efficacious treatments in the presence of drug resistance.

Methods  We searched for studies using the keywords: ‘Helicobacter pylori’,‘resistance’ and ‘treatment’ or ‘therapy’. Multilevel meta‐regression models were used to determine the effect of drug resistance on treatment efficacy.

Results  We analysed data from 93 studies with 10 178 participants. For triple therapies, clarithromycin resistance had a greater effect on treatment efficacy than nitroimidazole resistance. Metronidazole resistance reduced efficacy by 26% in triple therapies containing a nitroimidazole, tetracycline and bismuth, while efficacy was reduced by only 14% when a gastric acid inhibitor was added to the regimen. Quadruple therapies containing both clarithromycin and metronidazole were the most efficacious; >80% of H. pylori infections were consistently eradicated with these regimens.

Conclusions  Drug resistance was a strong predictor of efficacy across triple therapies for the eradication of H. pylori in adults. Resistance to either clarithromycin or metronidazole, but not both simultaneously, may be overcome by using quadruple therapies, especially those containing both clarithromycin and metronidazole.
Cardiac transplantation at Harefield
Authors: GREBENIK CATHERINE R. , ROBINSON P. N.
Published: July 2010

In the period January 1980 to February 1984, 91 heart transplant operations were performed at Harefield Hospital. The current statistics of the transplantation programme are presented. The survival rate since the introduction of the immunosuppressive agent Cyclosporin A is 78% at one year. This paper summarises the special care required for these patients with particular reference to the anaesthetic management.
Patient monitoring in the operating theatre
Authors: MACKENZIE N. , FORREST A.L.
Published: July 2010

The vital importance of patient monitoring during anaesthesia is well recognised. There is little information available, however, on the actual practice of instrumental monitoring in the operating theatre. This study examined present‐day practice and compared it with that of 1976. The main findings were an increase in frequency of electrocurdiographic monitoring, especially for non‐major surgery, and a smaller increase in blood pressure recording. Monitoring of other variables remained essentially unchanged. Possible reasons for this are given and suggestions made for improvements.
Thumb paraesthesia after neuromuscular twitch monitoring
Authors: SIA R. L. , STRAATMAN N. J. A.
Published: July 2010

Nine patients, who had operations for ear and nose pathology and developed left thumb paraesthesia after neuromuscular twitch monitoring with the Gould Statham UC3 force displacement transducer are described. The pathophysiology and prevention of the complication is discussed.
Electrocardiographical changes in the peri‐operative period, A pilot study
Authors: Griffin R.M. , Phipps J.A. , Evans J.M.
Published: July 2010

The value of continuous electrocardiogram recording in the peri‐operative period has been examined. In a group of 15 patients. 14 developed changes two of which persisted into the postoperative period. Dysrhythmias, ST segment and T‐wave changes occurred frequently. Continuous recording is of potential benefit in the study of cardiovascular disease and therapy in the peri‐operative period.
The effect of magnesium trisilicate mixture, metoclopramide and ranitidine on gastric pH, volume and serum gastrin
Authors: O'SULLIVAN G. , SEAR J. W. , BULLINGHAM R. E. S. , CARRIE L. E. S.
Published: July 2010

Eighty women (40 for elective Caesarean section and 40 for elective gynaecological surgery) were randomly assigned to one of five treatment groups and received pre‐operatively either no medication; magnesium trisilicate mixture (BP) 30 ml; metoclopramide 10 mg intramuscularly; ranitidine 150 mg orally on the night prior to, and the morning of, surgery; or metoclopramide 10 mg intramuscularly in combination with oral ranitidine 150 mg (the latter again given on the night prior, and the morning, of surgery). The effect of these medications on intragastric pH. volume and serum gastrin‐17 was measured. No patient receiving ranitidine had a pH of less than 4. Magnesium trisilicate mixture resulted in the largest intragastric pH change although one woman in this group had a pH of 1.7. The largest intragastric volumes were seen in the patients who had received magnesium trisilicate mixture, whilst the patients who had received metoclopramide in combination with ranitidine had the smallest intragastric volumes. Magnesium trisilicate mixture and metoclopramide resulted in no change in serum gastrin levels. However, in the subjects who had received ranitidine on the night prior to surgery, the fasting serum gastrin was significantly higher (p < 0.01) than the values in the remaining subjects, the mean (SEM values being 60.3(6.3) pg/ml in those not receiving ranitidine and 111.3(19.5) pg/ml in those who had been given ranitidine.
Ludwig's Angina. The anaesthetic management of nine cases
Authors: Loughnan T.E. , Allen D.E.
Published: July 2010

We reviewed nine patients with Ludwig's angina who required surgical drainage over a 24‐month period. This represents the largest series reported in world literature. All of these patients were managed successfully by a combination of tracheal intubation and early surgical intervention. None required tracheostomy, which is the previously recommended procedure of choice for airway management.
The laryngeal mask airway
Authors: BRAIN A. I. J. , McGHEE T. D. , McATEER E. J. , THOMAS A. , ABU‐SAAD M. A. W. , BUSHMAN J. A.
Published: July 2010

A new form of airway has recently been described, which is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without penetration of the larynx or oesophagus. The further development of this new airway is described and the results of 18 months' clinical experience are presented. The airway was used successfully in 118 patients, 17 of whom received controlled ventilation of their lungs. It was used in place of the facemask in routine anaesthesia, and was of particular value in ophthalmic, dental and ear, nose and throat procedures and where difficulties with the airway were expected. The incidence of sore throat and other problems was low. Experience of more than 500 cases suggests that the laryngeal mask airway may have a valuable rôle to play in all types of inhalational anaesthesia, while its proven value in some cases of difficult intubation indicates that it may contribute significantly to the safety of general anaesthesia.
Some predisposing factors to hypersensitivity reactions following first exposure to Althesin
Authors: SIMPSON P. J. , RADFORD S. G. , LOCKYER J. A. , SEAR J. W.
Published: July 2010

Three possible factors predisposing to Althesin hypersensitivity, namely total dose, method of administration, either by bolus dose or infusion, and pregnancy have been studied in patients receiving the drug for the first time. Of 137 patients given Althesin, four exhibited clinical signs of mild hypersensitivity, while C3 conversion alone, indicative of a subclinical reaction, was seen in a further six patients. No reactions were observed in two control groups in whom anaesthesia was induced with thiopentone. Neither the total dose nor method of administration appeared consistently to influence the incidence of reactions, but eight of the ten patients producing an altered response to Althesin were pregnant.
Anaesthetic experience with percutaneous lithotripsy
Authors: PETERSON G. N. , KRIEGER J. N. , GLAUBER D. T.
Published: July 2010

Percutaneous lithotripsy has evolved over the last several years as a procedure for removing renal calculi via percutaneous puncture of the renal collecting system. This article reviews our initial anaesthetic experience with 48 procedures and identifies both actual and potential complications. The most significant complication identified is instillation of large volumes of irrigation fluid into the retroperitoneal space. Two cases of metabolic acidosis and abdominal distension are presented. One responded to treatment while the other progressed to a fatal disseminated intravascular coagulopathy. Recommendations to prevent this are given.
Prolonged sedation and paralysis in a pregnant patient
Authors: THOMAS D. , WINDSOR J. P. W.
Published: July 2010

The spontaneous delivery of an infant with normal Apgar scores following 16 hours of maternal paralysis and sedation with atracurium and Althesin is described. A coincidental complication of subclavian vein thrombosis possibly due to the infusion of Althesin through the central venous catheter is also discussed.
A resuscitation box for every anaesthetist?
Authors: Hilton P.J.
Published: July 2010

The results are reported of a questionnaire which asks whether or not anaesthetisis routinely carry any resuscitaiion equipment in iheir cars. A small, simple resuscitation box is described which is adequate for the majority of life‐threatening situarions.
Mortality following surgery for fractures of the neck of femur
Authors: Goucke C. R.
Published: July 2010

The mortality following surgery for hip fractures during 1982 is reviewed. 91 procedures were performed on 89 patients. The mortality rate at 4 weeks following general anaesthesia was 2.7%. This is much lower than previously reported. Possible reasons for the variation in mortality between this series and others, are discussed.
Subarachnoid anaesthesia for elective Caesarean section
Authors: MICHIE A. R. , FREEMAN R. M. , DUTTON D. A. , HOWIE H. B.
Published: July 2010

Forty patients who underwent elective lower segment Caesarean section under subarachnoid anaesthesia received either 2.0 ml 0.5% cinchocaine in 6% dextrose or 2.5 ml 0.5% bupivacaine in 8% dextrose via a 26‐gauge needle with the patient in the left lateral position. Onset time was rapid in both groups and the distribution of maximum ascent of sensory analgesia was T1 T6. Efficacy of analgesia was greater in the bupivacaine group, although the duration of both sensory and motor blockade was shorter than following cinchocaine. There were no significant differences between the two groups either in the incidence and severity of complications or in the condition of the neonates. The high incidence (50 65%) and often profound extent of hypotension seen throughout the trial, confirm the ineffectiveness of crystalloid preload of 1500 ml as a single prophylaxis against hypotension.
Acute inversion of the uterus at Caesarean section
Authors: EMMOTT R. S. , BENNETT A.
Published: July 2010

Two cases of acute inversion of the uterus that occurred through the uterine incision at the time of Caesarean section are described. These represent only the sixth and seventh cases reported in the literature at this time. The implications for the anaesthetist are discussed.
Penetrating tracheal injury in a child
Authors: HAMILTON‐FARRELL M. R. , EDMONDSON L. , CANTRELL W. D. J.
Published: July 2010

A case is reported of a 3.5‐year‐old child with a stab wound in the neck, that penetrated the trachea. A pneumomediastinum was present. The anaesthetic problems are discussed and the child's management outlined.
The Ruben circle anaesthesia System
Authors: SIK M. J. , EVELEIGH D. J. , LEWIS R. B.
Published: July 2010

The Ruben circle anaesthesia System was studied in the spontaneous breathing mode, and under certain conditions there was incompetence of the replaceable mushroom control valve. This causes a reverse flow of gas which results in rebreathing of expired gas when the System is used on spontaneously breathing patients. A patient Simulator was used to investigate the way in which the reverse flow of gas depends on ventilatory parameters and fresh gas flow. The inspired concentration of carbon dioxide increased for increased fresh gas flow and for decreased tidal volume. These results were confirmed by observations on anaesthetised adult and paediatric patients during spontaneous breathing. We conclude that the System in its present form, is not suitable for use on spontaneously breathing paediatric patients.
Anaphylactoid reaction to vecuronium followed by systemic reaction to skin testing
Authors: FARRELL A. M. , GOWLAND G. , McDOWELL J. M. , SIMPSON K.H. , WATKINS J.
Published: July 2010

An unusual case is presented of a systemic anaphylactoid reaction to tubocurarine and subsequently to vecuronium. Intradermal testing with vecuronium following the latter response was negative at recommended test dose levels but at a higher concentration it initiated a hazardous systemic response. The laboratory investigations and possible mechanisms involved in this unusual case are discussed in detail since they may relate to other patients who experience anaphylactoid responses to anaesthetic drugs and who then undergo intradermal testing.
Fatal paradoxical thrombo‐embolism during anaesthesia
Authors: COLEMAN S. A. , WILSON‐MACDONALD J.
Published: July 2010

Deep venous thrombosis is a recognised complication of trauma to the leg and may lead to pulmonary thrombo‐embolism, but paradoxical thrombo‐embolism is rare. A case of fatal paradoxical thrombo‐embolism which followed a leg injury in a previously fit 36‐year‐old male is presented and contributory factors are reviewed.
Pneumonectomy in a patient with ventricular septal defect
Authors: MacGILLIVRAY R. G. , ROCKE D. A. , SHAMA D. M. , MITHA A. S.
Published: July 2010

A young man with severe unilateral bronchiectasis and a ventricular septal defect presented for pneumonectomy. Intra‐operative monitoring, which included continuous measurement of systemic and pulmonary oxygen saturations by oximetry, revealed transient reversal of the intracardiac shunt across the defect. The implications of this combination of cardiac and pulmonary disease for anaesthetic management are discussed.
An unusual case of stridor
Authors: BLACK A. , LLOYD‐THOMAS A. R.
Published: July 2010

A case is reported in which stridor was the presenting symptom of acute superior vena cava obstruction, after attempted insertion of a Hickman catheter.
Differential flow from multihole epidural catheters
Authors: POWER I. , THORBURN J.
Published: July 2010

This pressures used in vivo to administer epidural doses of local anaesthetic were recorded for 16‐ and 18‐gauge multihole catheters. Observations were made on 10 patients in labour for each catheter gauge. The pressure range for the 16‐gange catheters was 39.9–266 kPa, with a mean of 167.2 kPa, and for 18‐gauge, a range of 53.2–266 kPa, mean. 159 kPa. Similar pressures were then applied in vitro to 10 catheters of each gauge, and the flow of fluid observed from the three holes. For each size of catheter, with increasing pressure, flow appeared at the proximal, then the middle, and finally the distal hole. This emphasises that the effect of epidural doses can vary depending on the pressure of injection, especially if the catheter had been passed partially through the dura.
Intra‐ocular pressure changes during rapid sequence induction of anaesthesia
Authors: EDMONDSON L. , LINDSAY S. L. , LANIGAN L. P. , WOODS M. , CHEW H. E. R.
Published: July 2010

The changes in intra‐ocular pressure associated with two different anaesthetic induction and tracheal intubation techniques were compared (n = 30). After pre‐oxygenation, Group A received thiopentone (5 mg/kg) followed by suxamethonium (1.5 mg/kg), both within 25 seconds, and Group B atracurium (0.5 mg/kg) followed by thiopentone (5 mg/kg) again both within 25 seconds. Tracheal intubation occurred after one minute in Group A and 2 minutes in Group B to allow for full paralysis. In Group A intra‐ocular pressure did not alter significantly from baseline and the maximum increase was only 0.93 mmHg. The statistical type II error risk was consistently below 55% and all 95% confidence limits included negative values. Intra‐ocular pressure in Group B was consistently lower than baseline (p < 0.05) but with a longer induction‐intubation interval. These results therefore provide valuable information about the‘balance of risks' when choosing a muscle relaxant for an inadequately starved patient with a penetrating eye injury.
Prophylaxis against acid aspiration syndrome
Authors: GALLAGHER E. G. , WHITE M. , WARD S. , COTTRELL J. , MANN S. G.
Published: July 2010

We have compared famotidine 40 mg, ranitidine 300 mg and placebo given in a single oral dose at 2200 hours as the sole means of prophylaxis in 286 patients who underwent elective surgery the following day. Standardised premedication was administered and anaesthesia induced. Gastric contents were aspirated by nasogastric suction and the pH and volume measured. Median values of pH after famotidine, ranitidine and placebo were 6.17, 6.74 and 2.45 respectively; median aspirate volumes were 8, 8 and 10 ml respectively. The proportions of patients considered ‘not at risk’ (pH > 2.5) were 90% after famotidine, 91% after ranitidine and 52% after placebo. We conclude that the administration of a potent H2‐antagonist in a single oral dose at night offers a convenient routine means of providing extensive prophylactic cover in patients scheduled to undergo elective surgery the following day.
Alkalinised bupivacaine and adrenaline for epidural Caesarean section
Authors: TACKLEY R. M. , COE A. J.
Published: July 2010

Twenty‐four mothers received either 0.5% bupivacaine (group 1, n = 14), or alkalinised 0.5% bupivacaine and 1 in 200 000 adrenaline (group 2, n = 10), as an epidural local anaesthetic for elective lower segment Caesarean section in a randomised, double blind study. The two groups were prepared for surgery according to an identical technique. Onset of analgesia to pinprick was significantly faster in group 2 (p < 0.02). Group 1 required additional analgesia during surgery significantly more often than those in group 2 (p = 0.04). Significantly more patients in group 2 were ready for surgery by the time limit for the study (45 minutes, p = 0.002). Onset of motor blockade was significantly faster in group 2 (p = 0.01). There were no significant differences between the two groups with regard to duration of surgery, or Apgar scores at 1 and 5 minutes. Alkalinised 0.5% bupivacaine and adrenaline was superior to 0.5% bupivacaine for epidural Caesarean section.
Delayed recovery from general anaesthesia
Authors: JOHNSTON K. R. , VAUGHAN R. S.
Published: July 2010

A case of postoperative coma associated with diabetes insipidus and hypothermia is presented. Some recommendations are offered for the future management of similar cases.
Pain after spinal intrathecal clonidine
Authors: HARDY P. A. J. , WELLS J. C. D.
Published: July 2010

A case is reported in which spinal intrathecal administration of clonidine produced pain. The interaction between clonidine and tricyclic antidepressants is discussed, and is suggested as the basis for this observation.
Dependence of the output of a halothane vaporizer on thymol concentration
Authors: GRAY W.M.
Published: July 2010

The effect of thymol accumulation inside a Fluotec 3 vaporizer on the concentration of halothane delivered by the vaporizer was investigated. The vaporizer output was reduced progressively as the thymol concentration increased, but the reduction was less than that predicted by Raoult 's Law. A reduction of 5% in output required an increase in thymol concentration of a factor of 650 compared to the concentration in fresh halothane, while a reduction of 10% required a 1100‐fold increase in thymol concentration. The equilibration of the thymol from the wicks throughout the vaporizing chamber was very slow after the vaporizer was drained and filled with fresh halothane; the half‐time was 2.7 days.
Transverse myelitis following general anaesthesia
Authors: GUTOWSKI N. J. , DAVIES A. O.
Published: July 2010

A 47‐year‐old woman developed a complete transverse myelitis 2 weeks after an uncomplicated general anaesthetic for total abdominal hysterectomy and bilateral salpingo‐oophrectomy. If spinal or epidural anaesthesia had been used, a causal relationship might have been assumed. This case emphasises the danger of attributing all cases of transverse myelitis which have a close temporal relationship to spinal or epidural anaesthesia, to the anaesthetic technique itself.
Prospective survey of the use of the laryngeal mask airway in 2359 patients
Authors: Verghese C. , Smith T. G. C. , Young E.
Published: July 2010

Patients undergoing anaesthesia in which the laryngeal mask airway was used were prospectively audited over a 6‐month period. A simple record sheet was completed at the time of anaesthetic administration and 2359 completed forms were analysed to assess problems encountered with its use. It was used successfully in 2350 patients (99.61%); of these, 1399 patients (59%) breathed spontaneously through the airway and 960 patients (41%) underwent intermittent positive pressure ventilation of the lungs. Two patients (0.08%) were reported to have regurgitated during the use of the laryngeal mask airway, but no serious sequelae associated with its use were encountered.
Incidence and magnitude of hypoxaemia with ketamine in a rural African hospital
Authors: Pederson L. , Benumof J.
Published: July 2010

The incidence of hypoxaemia with ketumine anaesthesia in unpremedicated, spontaneously breathing patients without oxygen supplementation at high altitudes has never been investigated. Twenty‐three consenting patients received ketamine (2 mg.kg−1 intravenously in adults or 8 mg.kg−1 intramuscularly in children supplemented with 0.5 mg.kg−1 intravenously when clinically indicated) as the sole anaesthetic agent in a small, rural hospital in central Kenya (altitude 6000 ft; Pio2 127 mmHg). Oxygen saturation (Spo2) was measured with pulse oximetry. The Spo2 values were grouped in time epochs of pre‐induction, postinduction but presurgery, every 1–2 min after start of surgery, and at the end of the case. The mean Spo2 values reached 90.8% during the first min following start of surgery and this was significantly different from pre‐induction levels (p < 0.01). In four patients (17%) Spo2 decreased to 90% or less, in two patients (9%) Spo2 decreased to 85% or less, and in two patients (9%) Spo2 decreased to 75% or less. Mean values returned to near baseline by the end of the surgery. It is concluded that ketamine anaesthesia is acceptable in this setting if monitored by vigilant personnel who are capable of providing supplemental oxygen (if available) and manual support of the airway (i.e. jaw thrust) if airway obstruction occurs.
Effects of omeprazole, with and without metoclopramide, in elective obstetric anaesthesia
Authors: ORR D. A. , BILL K. M. , GILLON K. R. W. , WILSON C. M. , FOGARTY D. J. , MOORE J.
Published: July 2010

We report the results of a study comparing two dose regimens of the gastric antisecretory agent, omeprazole, used as prophylaxis against pulmonary aspiration of gastric contents during general anaesthesia for elective Caesarean section. Since antisecretory agents do not clear stomach contents already present at the start of treatment, two groups of patients who had received both omeprazole and a prokinetic drug, metoclopramide, were also studied. Thirty patients received oral omeprazole 40 mg on the evening before and on the morning of the operation (group 1), 33 received oral omeprazole 80 mg on the morning of the operation (group 2), and 15 (group 3) and 16 (group 4) patients respectively received the oral omeprazole doses stated above and in addition metoclopramide 10 mg given intramuscularly at least 20 min before induction of anaesthesia. Gastric aspirate pH and volume were measured at induction of anaesthesia and on completion of surgery. At induction of anaesthesia, treatment was judged successful (pH ≥2.5 and volume < 25 ml) in 87%, 73%, 100% and 81% of patients in groups 1–4 respectively. The corresponding results on completion of surgery were 100%, 88%, 100% and 100%. While omeprazole is useful as prophylaxis against pulmonary aspiration during general anaesthesia for elective Caesarean section, the addition of a prokinetic agent seems to be necessary la maximise its effects.
Epidural anaesthesia through caudal catheters for inguinal herniotomies in awake ex‐premature babies
Authors: PEUTRELL J. M. , HUGHES D. G.
Published: July 2010

Ex‐premature babies are at risk of apnoea after surgery. Regional anaesthesia has been used as an alternative to general anaesthesia for some surgical procedures in the belief that it may be safer. However, single dose caudal epidural and subarachnoid anaesthetics have a duration of action which may be insufficient for some operations. The level and duration of anaesthesia can be extended ij local anaesthetic is given through an epidural catheter. In addition, the dose needed to provide adequate anaesthesia may be lower because the local anaesthetic is given at an appropriate segmental level. We report our experience of caudal epidural anaesthesia in nine, awake ex‐premature babies who were having inguinal herniotomies. The anaesthesia was excellent in six babies. Two babies cried briefly with peritoneal or spermatic cord traction. One other baby needed supplementation with nitrous oxide in oxygen in order to complete the surgery. The majority of babies slept throughout surgery. There were no reported postoperative complications.
Coeliac plexus block with bupivacaine reduces intestinal dysfunction in neurosurgical ICU patients
Authors: Weinstabl C. , Forges P. , Plainer B. , Werba A. , Spiss C. K. , Seitz H.
Published: July 2010

Coeliac plexus block, an established method of treatment for pain associated with pancreatitis and cancer, was used in neurosurgical patients with gastrointestinal dysfunction. The study was performed in 16 patients whose gastric reflux volume exceeded 600 ml per day for 3 consecutive days. Patients were allocated to a block group (n = 8) or a control group (n = 8). Coeliac plexus block was accomplished with a modified Moore technique using 50 ml bupivacaine 0.25%. In the block group, gastric reflux volumes for 3 days preceding coeliac plexus block and 3 consecutive days following coeliac plexus block were analysed. In the control group, gastric reflux volumes were observed over a period of 6 days. Mean (Sem) gastric reflux volume decreased significantly following coeliac plexus block from 770 (50) ml to 60 (30) ml (p > 0.01). In the control group, gastric reflux remained unchanged over the corresponding periods (730 (60) ml c.f. 670 (50) ml). The response of gastric reflux volume to coeliac plexus block suggests that the mechanism is related to inhibition of sympathetic activity in patients whose sympathetic drive is increased due to the underlying neurological disease, and possibly due to sedation withdrawal symptoms.
Personality traits as predictors of anxiety prior to Caesarean section under regional anaesthesia
Authors: THORP J. M. , KENNEDY B. W. , MILLAR K. , FITCH W.
Published: July 2010

One hundred and fifteen patients scheduled for elective Caesarean section under regional anaesthesia were questioned to determine their personality profiles and anxiety state. Positive correlations were found between neuroticism and anxiety scores (p < 0.05). Patients with tendencies towards both neuroticism and introversion had higher pre‐operative anxiety scores than other personality types (p = 0.015). In general, previous experience did not reduce pre‐operative anxiety and personality appeared to be a better predictor of anxiety prior to Caesarean section under regional anaesthesia. Some personality types might benefit from additional support to improve their ability to cope with this stressful event.
Eltanolone for induction of anaesthesia and to supplement nitrous oxide for minor gynaecological surgery
Authors: RAJAH A. , POWELL H. , MORGAN M.
Published: July 2010

We have used eltanolone to induce anaesthesia and by intermittent injection to supplement nitrous oxide during maintenance in 50 patients undergoing minor gynaecological surgery; opioids were not used. Induction of anaesthesia was remarkably trouble free and achieved with a single dose of 0.5 mg.kg−1 in 90% of patients. Pain on injection was not a feature. Satisfactory anaesthesia was achieved in 84% of patients; eight required addition ofisoflurane. There were minimal cardiovascular changes and apnoea on induction occurred in only one patient. Recovery times were acceptable.
Left ventricular performance and cerebral haemodynamics during xenon anaesthesia
Authors: LUTTROPP H. H. , ROMNER B. , PERHAG L. , ESKILSSON J. , FREDRIKSEN S. , WERNER O.
Published: July 2010

The effects of xenon anaesthesia on myocardial function and cerebral blood flow velocities were investigated with transoesophageal echocardiography and transcranial Doppler sonography. Seventeen ASA 1 patients undergoing open cholecystectomy (n = 16) or abdominal hysterectomy (n = 1) were studied. Anaesthesia with 65% xenon in oxygen was induced by ventilating the lungs through a circle system with minimal fresh gas flow. The echocardiographically obtained mean (SD) fractional area change in a short axis view of the left ventricle at the level of the papillary muscles was 65 (10)% (n = 14) before xenon. There was no significant change after 5, 10 and 15 min of xenon anaesthesia. Cerebral blood flow velocities were unchanged during the first 5 min of xenon anaesthesia, but were significantly increased in the left and right middle, and the right anterior, cerebral arteries after 15 and 30 min (n = 16) (p < 0.05). In conclusion, xenon anaesthesia had no adverse effect on myocardial function, but probably increased cerebral flood flow.
Bacterial growth in isoflurane vapour
Authors: SLADE J. M.
Published: July 2010

Pathogenic bacteria were grown on nutrient agar in a mixture of air and isoflurane vapour, and in air alone. The presence of isoflurane vapour in concentrations considerably in excess of those used either for anaesthesia or for sedation in intensive care had no effect either on the rate of bacterial growth or on the viability of colony forming units.
Exertional heat stroke induced by amphetamine analogues
Authors: WATSON J. D. , FERGUSON C. , HINDS C. J. , SKINNER R. , COAKLEY J. H.
Published: July 2010

There are increasing numbers of patients admitted to hospital as a result of ingesting amphetamine‐like drugs. The most severe cases exhibit hyperthermia, rhabdomyolysis, coagulopathy and renal failure. We describe six such patients with varying severity of intoxication, and have reviewed the recent literature with particular reference to the use of dantrolene. One of our patients died but the others all survived. There is little evidence that dantrolene influenced the outcome in patients reported to date. We believe that a controlled trial should be carried out in amphetamine‐related hyperthermia before the use of dantrolene becomes widespread.
Measurement of intercostal and pleural pressures by epidural catheter
Authors: KAWAMATA M. , OMOTE K. , NAMIKI A. , MIYABE M.
Published: July 2010

The pressures in the intercostal and interpleural spaces were measured in 20 patients using an 18 gauge epidural catheter to confirm accurate catheter positioning for continuous intercostal and interpleural local anaesthetic blockade. In the intercostal space the mean (SD) pressure was negative (‐1.8 (0.3)) mmHg and positive (+ 2.1 (0.3)) mmHg at the end of inspiration and expiration respectively. In contrast, in the interpleural space although the pressure varied with the respiratory cycle it remained negative both at the end of inspiration (‐8.3 (1.0)) mmHg and expiration (‐2.1 (0.8)) mmHg. We conclude that measurement of intercostal and interpleural pressures with an epidural catheter is a straightforward procedure which may be helpful in confirming accurate catheter placement for continuous intercostal or interpleural local anaesthetic blockade.
A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery
Authors: Rodrigo M. R. C. , Tong C. K. A.
Published: July 2010

Thirty healthy Hong Kong Chinese patients between the ages of 15 and 31 years with bilaterally impacted lower third molar teeth, scheduled for surgical removal were studied. All the patients presented twice (for the right and left sides) and received, on separate occasions, patient or anaesthetist‐controlled midazolam sedation allocated using a randomised, crossover design. Both techniques provided reliable sedation with verbal contact maintained, minimal changes in respiratory and cardiovascular function, good operating conditions and a high degree of patient satisfaction. The majority of patients (67%) thought they could sedate themselves better on a subsequent visit and were confident that they could do this more satisfactorily than the anaesthetist. An almost equal number preferred patient (n = 12) or anaesthetist (n = 13) controlled sedation, with the remainder having no preference. The total dose of midazolam was very similar in the two groups, 5.3 (SD 2.4) mg and 5.0 (SD 1.1) mgfor patient and anaesthetist controlled sedation respectively.
A comparison of three types of tracheal tube for use in laryngeal mask assisted blind orotracheal intubation
Authors: Lim S. L. , Tay D. H. B. , Thomas E.
Published: July 2010

Laryngeal mask assisted blind orotracheal intubation is a technique that is best mastered under controlled circumstances. The influence of the type of tracheal tube, and positioning of the head, on the success rate of this procedure was evaluated in 90 gynaecological patients presenting for elective procedures under general anaesthesia. After induction, a laryngeal mask was introduced and its position was confirmed. Up to three attempts at blind orotracheal intubation using one of three tracheal tubes (Argyle, Portex or Kendall Curity) passed through the laryngeal mask were permitted in each patient. The success rates after a single attempt at blind oral intubation were 3.3%, 70.0% and 30.0% respectively (p < 0.001 and p < 0.05 when Portex was compared to Argyle and Kendall Curity types). After a maximum of three attempts, success rates were 30.0% (Argyle), 93.3% (Portex) and 76.7% (Kendall Curity). The first attempt at tracheal intubation was performed in the 'sniffing the morning air position‘ and this was successful in 52% of successful intubations; the second attempt using extension at the atlanto‐occipital joint was successful in a further 35% of successful intubations; the third attempt used varying degrees of neck flexion and extension at the atlanto‐occipital joint and this permitted successful placement of the tracheal tube in the remaining 13% of patients in whom tracheal intubation was possible.
Emergency X ray‐guided nasotracheal intubation in a patient with a spinal epidural haematoma
Authors: KAWAGUCHI M. , SAKAMOTO T. , OHNISHI H. , KARASAWA J.
Published: July 2010

A patient with a spinal epidural haematoma who developed tetraparesis and respiratory insufficiency is described. Nasotracheal intubation was successfully and rapidly undertaken with the aid of continuous fluoroscopy.
Failure of pain relief after surgery
Authors: OATES J. D. L. , SNOWDON S. L. , JAYSON D. W. H.
Published: July 2010

Three surveys of postoperative patients and surgical ward staff were conducted in an 840‐bed university hospital to ascertain the severity of pain after surgery and the reasons why patients in pain do not receive more of the analgesia prescribed for them. In the first survey, 206 inpatients were questioned within 24 h following operation, and 25.2% of patients experienced moderate pain wnust 9.2% experienced severe pain but received only 36% of their prescribed analgesics. In the second survey, 176 staff reported that the commonest reasons why patients in pain did not receive analgesics were that they did not request analgesia, were too sleepy or refused the dose. In the final survey, of 200 inpatients questioned, 88% had experienced pain since operation, 97% had been offered analgesics, 14% refused a dose. Twenty‐nine percent were moderately or very concerned about injections. The beliefs of both ward staff and patients could have contributed to this failure of pain relief.
Twelfth cranial nerve paralysis following use of a laryngeal mask airway
Authors: KING C. , STREET M. K.
Published: July 2010

A patient developed an unusual complication, that of a unilateral twelfth cranial nerve paralysis, following the use of a laryngeal mask whilst anticoagulated with warfarin.
A new colorimetric breath indicator (Colibri)
Authors: GEDEON A. , KRILL P. , MEBIUS C.
Published: July 2010

Colorimetric carbon dioxide indicators are designed for the verification of satisfactory tracheal tube placement. However, widespread use of the device in this and other applications is hampered by limitations in its performance characteristics. A new colorimetric breath indicator (Colibri) has been developed that overcomes major shortcomings of current technology. A simple method is described that can be used to evaluate the properties of colorimetric carbon dioxide indicators in a quantitative way.
Pre‐emptive analgesia form intravenous administration of opioids
Authors: WILSON R.J.T. , LEITH. S. , LACKSON I.J.B. , HUNTER D.
Published: July 2010

Forty patients undergoing total abdominal hysterectomy were randomly allocated to reveive either 40 μ. Kg−1 of alfentanil on induction of anaesthesia or 40 μ.kg−1 of alfentanil after the skin incision, Postoperative pain relief was provided with morphine from a patient‐controlled analgesia system. The amount of morphine consumed in the poperating theatre, while in recovery and for the first 24 h postoperatively was recorded. Pain scores were assed at 24 h using a visual analogue scale. There were no differences found between the two group for morophine consumption but the ‘pre‐emptive’ group had significantly higher pain scores at rest. We conclude that there is no clinically useful pre‐emptive analgesic effect with this dose of alfentanil and that therefore systemic opioid premedication in unlikely to decrease postoperative analgesic requirements throught the mechanism of pre‐emptive analgesia.
The effect of parenteral diclofenac and morphine on duration and height of blockade of continuous epidural infusion of bupivacaine 0.5%
Authors: SCOTT N. B. , FORBES D. W. , BINNING A. R.
Published: July 2010

Twenty‐six patients undergoing abdominal hysterectomy (ASA 1‐2) were entered into a double‐blind randomised trail to determin: (a) whether diclofanac given intravenously could influence the effective duration of a continuous epidural infusion of bupivacine 0.5% and (b)0 whether morphine given intravenously altered the height of the regressing block. A block to T4 was established pre‐operatively and a continuous infusion of 0.5% bupivacaine 8 ml.h−1 ran for 14 h. Thirteen patients received 50 mg diclofenac intramuscularly before surgery repeated at 4 and 10h later and 13 patients received saline intramuscularly. the height of blockade and pain scores were measured hourly. Effectibe block duration was defined as regression to t10 or lower andlor a pain a score of 2 or more,. At this point 10 mg of morphine was given intravenously and the height of the block reassessed. Duration of blockade was not significantly prolonged (p>.05), but pain scores were significantly reduced with diclofenac (p<.01). Morphine did not alter blockade height. It is concluded that epidural bupivacaine and diclogenac act additively on postoperative pain.
The renin‐angiotensin system and angiotensin convertin enzyme (ACE) inhibitors.
Authors: KELLOW N. H.
Published: July 2010

Anaesthetists wil encounter increasing numbers of patients who are receivng long‐term treatment with ACE inhibitors for hypertension, congestive heart fealure and prophylactically following myocardial infraction. Our understanding of the physiology and pharamacology of the renin‐angiotensin system has dramatically increased in the last decade, and has led to the discorvery of endogenous renin‐angiotensin systems which may be physiologicaly more important than the better understood circulating system. There are several reports of adverse interactions between anaesthesia and ACE inhibitors, manifestedas hyprotension and bradycardia which maybe delayed until the postoperative period. The mechanism behind them is not understood and, as yet, no published studies have attempted to address this issue. It is possible, however, that dehydration associatied with the pre‐operative fast may may play an important role. ACE inhibitors may, in the future, prove to be useful in the subspecialities of cardiac and vascular anaesthesia, where they might be used in an attempt to preserve cardiac funciton follwing periods of ischaemia and dardiopulmonary bypass, and to aviod renal damage following aortic cross‐clamping. Meanwhile. it would seem prudent to excerse caution when anaesthetishing patients tadking ACE inhibitors and to be fully prepared to treat the hypotension and brodycardia which may occur.
The influence of intraperitoneal bupivacaine on pain following major laparoscopic gynaecological procedures
Authors: Shaw I. C. , Stevens J. , Krishnamurthy S.
Published: July 2010

We present the results of a randomised, double‐blind controlled trial to determine the effect of adding bupivacaine to intraperitoneal Hartmann's solution, used to reduce the incidence of postoperative adhesions, on postoperative pain and on analgesic consumption in patients presenting for major laparoscopic gynaecological procedures. Fifty‐six women were studied and postoperative analgesic requirements and visual analogue scores were used to assess the pain experienced by the treatment group when compared with the control group. There was no statistical difference in the pain scores between the two groups at any time during the study period (Student's t‐test; p = 0.29–0.74) nor was there any difference in analgesic consumption (Mann–Whitney U‐test; p = 0.34–0.79).
Intubation of infants with Pierre Robin syndrome: the use of the paraglossal approach combined with a gum‐elastic bougie in six consecutive cases
Authors: Semjen F. , Bordes M. , Cros A.‐M.
Published: July 2010

Infants with Pierre Robin syndrome are known to be difficult to intubate. We evaluated the paraglossal approach combined with a gum elastic bougie for intubation of these infants. Whilst under general anaesthesia, a conventional laryngoscopy was performed; if it failed to obtain a laryngoscopic grade I or II view, intubation was attempted using a paraglossal approach and a gum elastic bougie. Six consecutive infants were studied. Conventional laryngoscopy failed in all infants whilst the paraglossal approach combined with a gum elastic bougie was successful in five of the cases. The paraglossal approach combined with a gum elastic bougie made intubation easy in most children with severe Pierre Robin syndrome and difficult laryngoscopy. Therefore we recommend this as the first line for airway management in such children. However, a fibreoptic bronchoscope and an anaesthetist trained in fibreoptic intubation must still be present when dealing with severe Pierre Robin syndrome infants.
Cardiac output monitoring: basic science and clinical application
Authors: Jhanji S. , Dawson J. , Pearse R. M.
Published: July 2010

Derangements in the circulation are a common feature of sepsis, trauma, major surgery and other critical illnesses. Detailed evaluation of the circulation is therefore an essential aspect of the clinical management of such patients. The use of cardiac output monitoring technology is an increasingly important aspect of evaluating patients in the operating theatre, critical care unit and elsewhere. There are now a number of different technologies available for this purpose, which use a diverse range of physiological principles. A detailed understanding of the physiological principles applied by such technology is essential for safe and effective use in clinical practice. The aim of this article is to describe the physiological principles used to measure cardiac output and their application in various monitors in common clinical use.
Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*
Authors: Hanss R. , Renner J. , Ilies C. , Moikow L. , Buell O. , Steinfath M. , Scholz J. , Bein B.
Published: July 2010

This study investigated whether heart rate variability predicts haemodynamic events in high risk patients, defined as Revised Cardiac Risk Index score = 3, scheduled for general anaesthesia. Fifty patients underwent baseline measurement of heart rate variability and were then assigned according to haemodynamic events (hypotension or bradycardia) after standardised induction of anaesthesia into ‘stable’ (n = 39) and ‘unstable’ patients (n = 11). Unstable patients had significantly lower baseline total power. Total power < 500 ms2.Hz−1 was associated with high sensitivity and specificity for the prediction of hypotension or bradycardia. Prospectively, 29 patients with total power < 500 ms2.Hz−1 were compared with 21 patients with total power > 500 ms2.Hz−1. Differences were found in the lowest mean arterial pressure and heart rate after induction of anaesthesia. We conclude that the pre‐operative total power of heart rate variability in high risk patients may indicate the occurrence of haemodynamic events with high sensitivity and specificity. Heart rate variability may be a suitable tool to identify patients at high risk of a haemodynamic event and may be used to indicate need for intensive monitoring and, perhaps, prophylactic treatment.