bluuebunny/crossref_metadata_2025 huggingface dataset:
Intra‐articular morphine and bupivacaine analgesia after arthroscopic knee surgery
Authors: Haynes T. K. , Appadurai I. R. , Power I. , Rosen M. , Grant A.
Published: February 2007

We assessed the effectiveness of intra‐articular solutions of morphine, bupivacaine with adrenaline and a combination of both, compared with placebo in facilitating mobilisation and reducing postoperative pain and analgesic requirements for 24 h after operation. Forty patients undergoing arthroscopic knee surgery were studied in a double‐blind, randomised, controlled trial. All treatments proved more effective than placebo in facilitating earlier mobilisation and in decreasing postoperative pain as measured by visual analogue scale. Morphine alone provided the best analgesia and significantly decreased analgesic consumption for 24 h after surgery. We conclude that 1 mg of intra‐articular morphine provides effective pain relief following arthroscopic knee surgery and that the addition of bupivacaine is of no benefit.
Postoperative pain relief in children
Authors: Ryhänen P. , Adamski J. , Puhakka K. , Leppäluoto J. , Vuolteenaho O. , Ryhänen J.
Published: February 2007

Two hundred and fifty children undergoing herniotomy or orchidopexy under general anaesthesia were randomly allocated to receive pre‐operatively either diclofenac sodium 1 mg.kg‐1 given intramuscularly or a caudal injection of bupivacaine 0.25% 1 ml.kg‐1 with or without adrenaline or no analgesia. Plasma diclofenac and beta‐endorphin concentrations were determined in eight and 21 patients respectively. Postoperative pain was assessed by ward nurses who were blinded to the group allocation. Comparison with the control group showed diclofenac to be an effective analgesic. Caudal bupivacaine provided more pain‐free children during the early postoperative hours, but later the need for pethidine as rescue analgesic was lower among the children who had received intramuscular diclofenac. Caudal analgesia abolished the stress‐induced increase in plasma beta‐endorphin level which was found in the children given diclofenac and in those who served as controls. Total plasma clearance of intramuscular diclofenac sodium appears to be higher in children than in adults. A single intramuscular dose of diclofenac significantly reduces the need for an opioid analgesic in children after inguinal herniotomy or orchidopexy, and owing to its long duration of action, it offers an alternative or complementary method of pain relief to caudal analgesia.
The use of a visual aid to check anaesthetic machines
Authors: GROVES J. , EDWARDS N. , CARR B.
Published: February 2007

We asked 20 anaesthetists and seven operating department assistants to check three anaesthetic machines‘doctored’to contain errors of varying seriousness, and recorded their performances. Two weeks later we asked the same group to repeat the test. On the second occasion they followed a visual aid and filled in a questionnaire about the test. Participants showed a significant improvement in the rate of fault detection when using the aid (p < 0.05). The visual aid was most useful at increasing the detection rate of machine leaks. Of the participants, 60% considered that the visual aid was helpful and 74% thought that such an aid should be available in our theatre complex. Sixty‐six percent of those questioned felt that a formal check list would be of use.
Cuffed nasopharyngeal tube as‘dedicated airway’in difficult intubation
Authors: RALSTON S. J. , CHARTERS P.
Published: February 2007

A cuffed nasopharyngeal airway was used in five cases of difficult intubation, initially to maintain anaesthesia, and subsequently to act as a landmark for the passage of a fibreoptic laryngoscope loaded with a tracheal tube. In all cases, airway patency was well preserved with the device and there were no significant problems with its use. The notion of a‘dedicated airway’for difficult intubation cases is developed. A trouble‐free airway will permit time to consider solutions for difficult cases and time for the novice to learn fibreoptic laryngoscopy technique.
Transporting patients with overwhelming pain
Authors: NOTCUTT W. G.
Published: February 2007

The use of ketamine anaesthesia is described for the transport from home to hospital of patients in severe pain secondary to malignant disease. The technique is simple and highly effective and introduces a new role for anaesthetists and pain relief specialists.
The Sparklet carbon dioxide Resuscitator
Authors: WRIGLEY M. , NANDI P.
Published: February 2007

The use of carbon dioxide in resuscitation was advocated in the 1920s and 1930s. A device, the Sparklet Resuscitator, was marketed to allow the administration of carbon dioxide gas. This piece of equipment is described and the indications for its use in resuscitation reviewed. The use of carbon dioxide appeared to have a degree of support and success as a‘universal’aid to resuscitation.
Routine pre‐oxygenation using a Hudson mask A comparison with a conventional pre‐oxygenation technique
Authors: Hett D. A. , Geraghty I. F. , Radford R. , House J. R.
Published: February 2007

Two techniques of pre‐oxygenation were studied by continuous analysis of respired gases using a mass spectrometer in 10 healthy volunteers. The first was a conventional technique as commonly used in anaesthesia with a Bain system and tightly‐fitting anaesthetic facemask and an oxygen flow of 8 l.min‐1. The second technique also used a Bain system with an oxygen flow of ‐8 l.min‐1, but with a Hudson mask attached. The mean fractional end‐tidal oxygen concentrations after 3 min were 0.812 and 0.46 respectively for each of the pre‐oxygenation techniques against 0.16 for subjects breathing air. This represents a considerable increase in pulmonary oxygen reserve for both techniques. The second technique is not an alternative to conventional pre‐oxygenation for emergency anaesthesia, but is a useful and simple method that is acceptable to both patient and anaesthetist in routine cases.
Patients’desire for information about anaesthesia: Australian attitudes
Authors: Farnill D. , Inglis S.
Published: February 2007

Patients in a medium‐sized Australian suburban general hospital were asked to complete a pre‐operative questionnaire concerning their desire for information about their impending anaesthesia. The results are compared with those of Canadian and Scottish studies published recently. The Australian patients had a higher preference for information about complications, although some patients, mainly elderly, did not want to know about unpleasant aspects of peri‐operative procedures or potential complications. As in the other countries, patients under the age of 50 years had a greater desire for information than those who were older (p < 0.05). All national groups accorded highest priority to meeting the anaesthetist before surgery. The results are discussed in relationship to the requirements for informed consent.
The influence of nasal obstruction and its relief on oxygen saturation during sleep and the early postoperative period
Authors: Serpell M. G. , Padgham N. , McQueen F. , Block R. , Thomson M.
Published: February 2007

Nasal obstruction causes abnormal breathing patterns during sleep which often result in hypoxaemia. We studied the effect of nasal obstruction on arterial oxygen saturation in 20 healthy patients undergoing elective surgery which required bilateral nasal packing. Ten patients were subject to complete nasal obstruction while the remaining half had the obstruction relieved by the insertion of nasal cannulae. We found that nasal obstruction did not have any detrimental effect on the already low incidence of oxygen desaturation. There was no effect of the cannulae on the degree or frequency of hypoxaemia, although they did appear to improve the quality of sleep during the first postoperative night. They were more comfortable by day than simple packing alone and no adverse effects were observed.
Risk factors for postoperative nausea and vomiting
Authors: KENNY G. N. C.
Published: February 2007

Although the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. The inhalational agents are variably associated with postoperative nausea and vomiting, and nitrous oxide is particularly emetogenic. Older inhalational anaesthetics, such as cyclopropane, are associated with a high incidence, while the currently used agents, isoflurane, enflurane and halothane, cause less, but still significant postoperative nausea and vomiting. Intravenous anaesthetics are also associated with differing degrees of emesis, though the newer agent, propofol, may be less emetogenic than the older anaesthetics. Opioids, used extensively throughout surgery, are further strong emetogens. Patient factors are also important — postoperative nausea and vomiting is three times more prevalent in adult females than in males, and children are around twice as susceptible as adults. Furthermore, a previous history of postoperative nausea and vomiting or motion sickness is a known risk factor. Superimposed on this is the type of surgery — abdominal and gynaecological surgery are particularly emetogenic, and the incidence of postoperative nausea and vomiting following strabismus surgery is high. Increased quality of healthcare, and a growing awareness of the importance of patient satisfaction, are providing new incentives to ensure that postoperative nausea and vomiting is dealt with adequately.
Single dose intravenous ondansetron for the 24‐hour treatment of postoperative nausea and vomiting
Authors: CLAYBON L.
Published: February 2007

Postoperative nausea and vomiting is a major concern for patients undergoing outpatient surgery under general anaesthesia, and may complicate and delay discharge from hospital. This paper evaluates the safety and efficacy of ondansetron, a 5‐HT3 receptor antagonist, in the treatment of postoperative nausea and vomiting. One thousand patients in 30 centres in the United States who received general anaesthesia and developed postoperative nausea and vomiting were studied. In a randomised, double‐blind, stratified and parallel designed protocol, patients received either ondansetron 1, 4, 8mg or placebo for nausea or vomiting occurring within 2 h of entry into the Post Anaesthesia Care Unit. Subsequent episodes of vomiting, nausea scores, laboratory and clinical safety data and adverse events were evaluated during the 24‐h study period. In a separate study, pharmacokinetic data were compared for intramuscularly and intravenously administered ondansetron. Each dose of ondansetron was significantly better than placebo in reducing nausea from control values during the initial 2‐h study period, and in preventing further emesis over 24 h. There were no significant differences in the incidence of adverse events, changes in laboratory values or measures of vital signs in the ondansetron groups compared to the placebo group. Dose comparisons between the three treatment groups showed that ondansetron 4 mg is the optimal dose to treat postoperative nausea and vomiting. Ondansetron is a well tolerated, efficacious antiemetic which has a similar side effect profile to placebo. Intramuscular administration has the same systemic availability as intravenous administration. Ondansetron 4mg appears to be the optimal dose for the treatment of postoperative nausea and vomiting in patients with or without a positive history.
The effect on laryngoscopy of different cervical spine immobilization techniques
Authors: HEATH K. J.
Published: February 2007

Fifty patients underwent laryngoscopy with two different cervical spine immobilisation techniques. First the cervical spine was immobilised in a rigid collar with tape across the forehead and sandbags on either side of the neck, then with an assistant providing manual in‐line immobilisation. Finally, patients underwent laryngoscopy in the routine intubating position. In 56% of patients the view of the larynx improved by one grade and in 10% the view improved by two grades when manual immobilisation was substituted for the collar, tape and sandbags (p < 0.0001). There was a poor view on laryngoscopy (grade 3 or 4) in 64% of patients when immobilised in a collar, tape and sandbags compared to 22% of patients undergoing in‐line manual immobilisation (p < 0.001). Mouth opening was significantly reduced when patients were wearing cervical collars and this was the main factor contributing to the increased difficulty of laryngoscopy in this particular form of cervical spine immobilisation. It is recommended that manual in‐line immobilisation should be the method of choice for cervical spine stabilisation during tracheal intubation.
Acid aspiration prophylaxis in elective biliary surgery A comparison of omeprazole and famotidine using manually aided gastric aspiration
Authors: Vila P. , Espachs P. , Echevarria V. , Garcia M. , Rincón R. , Vidal F.
Published: February 2007

We have compared the effects of single oral doses of omeprazole 40 mg, famotidine 40 mg or placebo on gastric secretion in 45 non‐obese patients the night before elective biliary surgery. After stable anaesthesia had been established, a Salem orogastric tube was introduced and gastric contents were aspirated by a blinded observer. The volume and pH were noted. After the abdomen was opened aspiration was repeated but on this occasion with the surgeon's manual assistance. We found that the initial aspirate volume underestimated total gastric volume by an average (SD) of 7.1 (6.6) ml. Famotidine, but not omeprazole, produced a significant decrease in gastric volume and acidity. Patients were considered to be at risk if pH < 2.5 and volume > 0.4ml.kg‐1. Three patients in the omeprazole group, three in the placebo group and none in the famotidine group came into this category. We conclude that a single oral dose of omeprazole 40 mg given the night before surgery does not afford adequate prophylaxis for acid aspiration syndrome.
A multilumen catheter guide for difficult airway management
Authors: DHARA S. S.
Published: February 2007

A multilumen catheter guide (jet stylet) with an adapter has been used for various manoeuvres in the upper airway. With the split length, procedures such as change of tracheal tube from oral to nasal or nasal to oral position, are possible while the patient's lungs are ventilated by means of high frequency jet ventilation. During high frequency jet ventilation for longer periods of time, for example for microlaryngeal surgery, the central channel of the catheter is used as a conduit for jet delivery, whilst the other channels are used for continuous monitoring of airway pressure and concentration of carbon dioxide in the upper airway.
Parents in the anaesthetic room—parents’and anaesthetists’views
Authors: McEwen A. W. , Caldicott L. D. , Barker I.
Published: February 2007

In this study parents’and anaesthetists’views were compared, by means of a questionnaire, to assess the benefit of parental presence at induction. One hundred and ninety four unpremedicated children aged 1–16 years underwent daycase surgery. One hundred and eighty four parents accompanied their child and felt that their child benefited from this. Anaesthetists rated only 72% of parents as being helpful. Parents who had undergone anaesthesia in the past were less likely, 60% compared with 79% (p < 0.01), to consider themselves as upset than parents who had not. Thirty one percent (44/140) of anaesthetists, compared with 43% (60/140) of parents, felt the child was upset at induction (p < 0.01). Parents judging themselves to be upset at induction were significantly more likely to consider their child as upset (p < 0.01). Most parents feel that they are of help in the anaesthetic room regardless of whether or not they find it an upsetting experience. Ninety eight per cent would want to accompany their child in the future and we believe this should be allowed unless there are overriding considerations.
A new technique for fibreoptic intubation in children
Authors: HASAN M. A. , BLACK A. E.
Published: February 2007

We describe a technique involving the use of a laryngeal mask airway, fibreoptic bronchoscope and a guide wire to manage the intubation of a child who was known to be a difficult intubation. The technique is simple, atraumatic, permits the use of an adult bronchoscope for infants and children, and allows control of the airway and ventilation throughout the period of intubation.
Effect of ketorolac, ketoprofen and nefopam on platelet function
Authors: DORDONI P. L. , VENTURA M. DELLA , STEFANELLI A. , IANNACE E. , PAPARELLA P. , ROCCA B. , ACCORRA F.
Published: February 2007

Ketorolac, ketoprofen and nefopam are often used in the treatment of postoperative pain. While nefopam is a non‐narcotic, non‐opioid central analgesic agent, ketorolac and ketoprofen are non‐steroidal anti‐inflammatory drugs, which, due to their prostaglandin‐synthetase inhibiting activity, have antiplatelet effects. In this study we investigated the effect of ketorolac, ketoprofen and nefopam on platelet function by performing bleeding time and in vitro platelet aggregation in 30 healthy volunteers (10 for each treatment) before and 3h after drug administration. Nefopam did not affect bleeding time and platelet aggregation, while ketorolac and ketoprofen significantly prolonged bleeding time without significantly inhibiting platelet aggregation in response to adenosine diphosphate. The prolongation of bleeding time observed after ketorolac and ketoprofen may have clinical relevance and suggests that nefopam could be more safely administered for the treatment of postoperative pain, especially in patients with haemostatic defects or after high bleeding risk surgery.
Scapular and proximal humeral head fractures
Authors: KAM A. C. A. , KAM P. C. A.
Published: February 2007

We report a patient who sustained fractures of the scapula and proximal humeral head as a result of cardioversion during cardiopulmonary resuscitation. It is postulated that the fractures were the result of tetanic muscular contractions involving the proximal humeral heads and the shoulder girdles. This appears to be a previously unreported injury.
Low dose bupivacaine/fentanyl epidural infusions in labour and mode of delivery
Authors: Stoddart A. P. , Nicholson K. E. A. , Popham P. A.
Published: February 2007

The aim of this study was to determine the effect on the instrumental delivery rate of two different concentrations of bupivacaine combined with fentanyl in epidural infusions during labour. Only primiparous women in whom a spontaneous vaginal delivery was anticipated, were included in the study. Those women receiving a higher concentration of bupivacaine and therefore a greater amount of local anaesthetic agent during labour were significantly more likely to have an instrumental delivery with Kielland's rotational forceps (p < 0.01). Those women receiving a lower concentration and smaller amount of bupivacaine were significantly more likely to have an instrumental delivery with Neville‐Barnes forceps (p < 0.05). This provides evidence to support the theory that epidural analgesia may contribute to inadequate rotation of the presenting fetal part due to weakened pelvic floor muscles and that this is more likely to occur when higher concentrations of bupivacaine are used and a greater degree of motor block occurs.
A changing role for intensive therapy: is there a case for high dependency care?
Authors: KILPATRICK A. , RIDLEY S. , PLENDERLEITH L.
Published: February 2007

This observational study examined whether specific characteristics of 1168 patients admitted to a general intensive therapy unit had changed over 4 years. The patients’age, diagnosis, severity of illness on admission (APACHE score), duration of management and outcome were recorded prospectively. The risk of hospital mortality was calculated using the APACHE score modified by the appropriate coefficient for presenting diagnosis. The numbers of admissions increased over the study period from 240 patients in the first year to 344 in the last year. The pattern of diagnoses varied significantly with an increasing proportion of patients being admitted for postoperative observation in later years. There was a significant reduction in duration of admission with 70% of patients being admitted for ≤ 3 days in 1988–89 while a similar proportion were admitted for a week in 1985–86. Approximately 40% of patients in each year were admitted with a risk of hospital mortality of ≤ 10%; such patients received only a short period of intensive care and had a low mortality in the intensive therapy unit. A group of patients with a low predicted (and actual) mortality rate was identified; such patients may be more appropriately managed on a high dependency unit.
Emergency intubation through the laryngeal mask airway The effective application of cricoid pressure
Authors: SWAYNE P. , GREENSLADE G. L.
Published: February 2007

A patient with Kugelberg‐Welander disease presented as an unexpected difficult intubation. Tracheal intubation was achieved through the laryngeal mask airway, while regurgitation was prevented with continuous cricoid pressure. Regurgitation occurred after cricoid pressure was released.
Arterial oxygenation and mean arterial blood pressure in patients undergoing total hip replacement: cemented versus uncemented components
Authors: NOLAN J. P.
Published: February 2007

Arterial oxygen tension and mean arterial blood pressure were measured during total hip replacement with either cemented n = 10) or uncemented components (n = 10). All surgery was performed under general anaesthesia. Compared with baseline values, mean arterial oxygen tension decreased by 16% (p < 0.05) and mean arterial pressure increased by 23% (p < 0.05) and 20% (p < 0.05) after insertion of cemented acetabular and femoral components, respectively. In the uncemented group, arterial oxygen tension and mean arterial pressure remained unchanged after insertion of both components. This implies that for some patients, particularly those with cardiovascular or respiratory disease, the risk of significant immediate complications may be lower with the insertion of uncemented, rather than cemented, components.
End‐tidal carbon dioxide tension during laparoscopic cholecystectomy
Authors: BARAKA A. , JABBOUR S. , HAMMOUD R. , AOUAD M. , NAJJAR F. , KHOURY G. , SIBAI A.
Published: February 2007

An investigation of end‐tidal carbon dioxide tension changes was carried out in 19 healthy adult patients undergoing laparoscopic cholecystectomy. Following induction of anaesthesia, and throughout surgery, the end‐tidal carbon dioxide tension was continuously monitored by capnography. The value following carbon dioxide insufflation increased with time to reach a maximum value after 40 min. Correlation of the individual maximum end‐tidal carbon dioxide tension during laparoscopy with the corresponding baseline value prior to carbon dioxide insufflation showed a positive linear relationship (correlation coefficient 0.86). The correlation showed that an end‐tidal carbon dioxide tension of 5.32 kPa (40 mmHg) can be achieved during laparoscopy when the baseline value is adjusted to around 4.0 kPa (30 mmHg).
Suxamethonium apnoea and the isolated leg
Authors: MITCHELL J. B. , HARROP‐GRIFFITHS W.
Published: February 2007

The anaesthetic management of a patient with an unsuspected homozygous atypical pseudocholinesterase genotype is described. Suxamethonium was administered after an arterial tourniquet had been applied to the patient's right leg. After release of the tourniquet and termination of the anaesthetic it was noted that the patient was able to move his right leg but no other part of his body. This observation was confirmed by the use of a peripheral nerve stimulator and by the patient's own recollections. It is suggested that this occurrence shows that the slow offset of neuromuscular block in patients with atypical pseudocholinesterases who have received suxamethonium is caused by long lasting effects at the neuromuscular junction rather than the continuing presence of suxamethonium in the plasma.
The effect of insufflation leaks upon ventilation
Authors: WATT J. W. H. , FRASER M. H.
Published: February 2007

Some ventilator‐dependent patients use uncuffed tracheostomy tubes, resulting in fluctuations in the minute volume of ventilation. Bedside measurement of ventilation is difficult because of the insufflation and exsufflation leaks. This laboratory study of five different ventilators measured the tidal volumes achieved with three insufflation leaks introduced in an increasing order of magnitude and at three levels of compliance. The largest leak reduced the peak inflation pressure from 26 to 14 cmH2O in two pressure‐limited ventilators with a 35% loss of the initial tidal volume of 800 ml. The turbine‐driven pressure‐limited ventilator retained a peak pressure of 20.5 cmH2O and lost only 14% of the volume, whereas the volume ventilators lost 65% of the tidal volume. The loss of volume was 3% for every cmH2O decrease in airway pressure due to a leak, regardless of the ventilator or compliance. Using the Friedman test, the differences between the volume ventilators and the pressure ventilators were significant whilst the three pressure‐limited ventilators did not perform significantly differently from each other.
Intra‐ocular pressure during cardiopulmonary bypass‐a comparison of crystalloid and colloid priming solutions.
Authors: Abbott M. A. , McLaren A. D. , Algie T.
Published: February 2007

Raised intra‐ocular presure secondary to alterations in plasma oncotic pressure has been implicated in the development of optic neuropathy after cardiopulmonary bypass. Patients presenting for open heart surgery received either crystalloid (n=9) or colloid (n=10) priming solutions for cardiopulmonary bypass. No differences in intra‐ocular pressure or plasma oncotic pressure occurred between the groups before the onset of cardiopulmonary bypass. Five minutes after the start of bypass the median intra‐ocular pressure increased to 31 mmHg in the crystalloid group compared with 13mmHg in the colloid group (p < 0.05). At the same time plasma oncotic pressure decreased from approximately 20mmHg in both groups to 10.6 mmHg with crystalloid and 15.7 mmHg with colloid primed cardiopulmonary bypass solutions (p < 0.05). Over the following hour of cardiopulmonary bypass, intra‐ocular pressure and plasma oncotic pressure tended to return towards their pre‐cardiopulmonary bypass values. Changes in plasma oncotic pressure, through fluid shifts, may have contributed towards this unexpected increase in intra‐ocular pressure with crystalloid primed cardiopulmonary bypass.
Epidural diamorphine
Authors: DANIEL M. , McGRADY E. M.
Published: February 2007

In a randomly allocated double blind study of 54 primigravidae, we examined the relative efficacy of the addition of diamorphine 3 mg to either an initial bolus or an infusion of bupivacaine. Both groups received an initial bolus of 10 ml of bupivacaine 0.25% followed by an infusion of bupivacaine 0.1% at 10 ml.h‐1. Group 1 received diamorphine 3 mg in the bolus and group 2 received diamorphine 3 mg in the initial 100 ml of infusion solution. Both groups had comparable total bupivacaine requirements. Analgesia, assessed by visual analogue scores, was superior at 7 h in group 2, but was similar at all other times. Sedation scores were significantly lower in group 2 for the first 3 h and the incidence of nausea was significantly lower in group 2. The addition of diamorphine, whether as a bolus or added to an infusion of bupivacaine, results in similar quality of analgesia, but there is a reduction in side effects when diamorphine is administered in an infusion.
Adrenaline administered via a nebulizer in adult patients with upper airway obstruction
Authors: MACDONNELL S. P. J. , TIMMINS A. C. , WATSON J. D.
Published: February 2007

Racemic adrenaline administered via a nebulizer has been used successfully in children with upper airway obstruction resulting from croup and postintubation oedema. We report four adult cases of upper airway obstruction of differing aetiologies successfully managed with the administration of adrenaline via a nebulizer (1 mg in 5 ml of normal saline and repeated as necessary). This appears to be safe and effective in selected cases of upper airway obstruction with immediate benefits and few cardiovascular sequelae.
The effect of midazolam premedication on implicit memory activation during alfentanil‐nitrous oxide anaesthesia
Authors: DE ROODE A. , JELICIC M. , BONKE B. , BOVILL J. G.
Published: February 2007

Eighty‐three patients were given midazolam 0.1 mg.kg‐1 by intramuscular injection as premedication before general anaesthesia with alfentanil‐nitrous oxide. During anaesthesia patients were presented (through headphones) with either statements about common facts of some years ago (group A) (n = 43) or new verbal associations, e.g. names of fictitious, nonfamous people (group B) (n = 40). In a previous study with the same anaesthetic technique, but without premedication there was significant activation of implicit memory (p < 0.001). In this study we found no explicit or implicit memory for the auditory information presented during anaesthesia. Midazolam premedication can prevent implicit memory activation during alfentanil‐nitrous oxide anaesthesia.
Magnesium deficiency in critically ill patients
Authors: ARNOLD A. , TOVEY J. , MANGAT P. , PENNY W. , JACOBS S.
Published: February 2007

A study was performed to assess the value of estimation of intracellular magnesium in peripheral blood cells (red and mononuclear blood cells) in critically ill patients as an index of tissue magnesium content. A magnesium loading test was used to diagnose magnesium depletion in 16 critically ill patients. Patients were divided into magnesium depleted and non‐depleted groups according to their response to the loading test. Pre ‐infusion plasma and intracellular (blood cell) magnesium levels were measured. There were no significant differences between the magnesium depleted (mean plasma magnesium 0.81 mmol.l‐1, red blood cell magnesium 2.34mmol.l‐1, mononuclear blood cell magnesium 25.16mmol.kg‐1dry weight) and non‐depleted groups (mean plasma magnesium 0.90mmol.l‐1, red blood cell magnesium 2.18mmol.l‐1, mononuclear blood cell magnesium 18.1 mmol.kg‐1dry weight). We conclude that the diagnosis of magnesium depletion cannot be excluded in the face of normal plasma, red blood cell or mononuclear blood cell concentrations of magnesium.
Effects of ketamine on cerebral blood flow velocity in humans Influence of pretreatment with midazolam or esmolol
Authors: STREBEL S. , KAUFMANN M. , MAÎRE L. , SCHAEFER H. G.
Published: February 2007

During normoventilation and‘light’, haemodynamically stable, steady‐state anaesthesia with isoflurane 0.3%, the effect of ketamine intravenously was investigated in 24 patients randomly assigned to one of the following groups: group 1 (control group) no ketamine, group 2 (ketamine group) ketamine 2mg.kg, group 3 (ketamine/midazolam group) ketamine 2mg.kg‐1 after pretreatment with midazolam and group 4 (ketamine/esmolol group) ketamine 2mg.kg ‐1 while maintaining mean arterial blood pressure at a preketamine level with esmolol. Ketamine‐induced cerebrovascular changes were measured by means of transcranial Doppler ultrasonography. Control readings in patients without ketamine challenge demonstrated stable cardiovascular and cerebrovascular baseline conditions. Cerebral blood flow velocity and mean arterial blood pressure, however, significantly increased after administration of ketamine without pretreatment. The increase in cerebral blood flow velocity could not be blocked by maintaining mean arterial blood pressure at baseline value with esmolol. In contrast, the effects of ketamine on cerebral blood flow velocity and mean arterial blood pressure were prevented by prior administration of midazolam. The results suggest that ketamine may significantly influence intracerebral haemodynamics via a direct drug effect rather than via a secondary effect due to changes in arterial carbon dioxide and/or mean arterial blood pressure.
Forced‐air warming maintains normothermia during orthotopic liver ransplantation
Authors: MÜLER C. M. , LANGENECKER S. , ANDEL H. , NANTSCHEV I. , HÖLZENBEIN T. J. , ZIMPFER M.
Published: February 2007

We evaluated the efficacy of forced‐air warming to maintain normothermia during liver transplantation. In a prospective, clinical trial 20 patients were randomly assigned to routine thermal management (circulating‐water mattress set at 42°C, intravenous fluid warming to 37°C and passive insulation) or routine management with additional forced‐air warming of head, chest, and arms. Core temperature was measured in the pulmonary artery. Morphometric and demographic characteristics were similar in each group, as was total administered fluid volume replacement. Core temperatures in each group decreased by about 0.6°C during the first 70min of anaesthesia and then by 0.9°C within 90 to 120 min in the patients given routine thermal management, but only by 0.4°C in those warmed with forced‐air. Subsequently, core temperatures in the control group increased to only 35.7, SD 0.25°C whereas those in the patients given forced‐air warming increased to 36.5, SD 0.2°C. Despite the relatively high ambient temperature, patients warmed only with a circulating‐water mattress and passive insulation became hypothermic during surgery. In contrast, when forced‐air warming was added to this routine thermal management, patients were normothermic at the end of surgery. Forced‐air warming prevented intra‐operative hypothermia during liver transplantation.
Postoperative neuroleptic malignant syndrome
Authors: Shaw A. , Matthews E.E.
Published: February 2007

This report describes neuroleptic malignant syndrome in a previously healthy 6‐year‐old child. Droperidol and metoclopramide had been given, and hyponatraemia may have been a precipitating factor. Treatment with dantrolene sodium combined with a forced alkaline diuresis resulted in a full recovery.
Pulmonary consequences of carbon dioxide insufflation for laparoscopic cholecystectomies
Authors: KENDALL A. P. , BHATT S. , OH T. E.
Published: February 2007

Twenty patients having laparoscopic cholecystectomies were studied for changes in thoracic and lung compliance at 5, 10 and 15mmHg of intra‐abdominal pressure. Fifteen mmHg of intra‐abdominal pressure decreased the thoracic and the lung static compliance by 49 and 39% respectively. This was unaffected by the degree of head elevation. During the procedure the end‐tidal carbon dioxide increased by a mean of 1.6kPa at 1 h and 2.0kPa at 2h. This did not appear to be related to either the mean intra‐abdominal pressure or the total volume of carbon dioxide insufflated. The physiological changes and implications for anaesthetic practice are considered.
Clonidine: an adjunct in isoflurane N2O/O2 relaxant anaesthesia
Authors: GABRIEL A. H. , FARYNIAK B. , SOJKA G. , CZECH T. , FREYE E. , SPISS C. K.
Published: February 2007

We investigated the effect of clonidine in 19 patients having lumbar disc surgery under nitrous oxide/isoflurane/relaxant anaesthesia. The EEG, spinal and cortical somatosensory evoked potentials, and the brainstem auditory evoked potentials were recorded. After equilibration of the general anaesthetic, two successive infusions of clonidine (5μg.kg‐1) were given. After the second infusion of clonidine, the plasma concentration increased from 0.2(SEM 0.05) to 6.4(SEM 0.06) ng.ml‐1 (p < 0.05). In the EEG, δ‐activity was maintained, but the β‐fraction, and the 95% and 50% spectral frequencies were reduced. Total EEG power progressively decreased from 296(152‐397) μV2 to 108(51‐240) μV2. The somatosensory evoked spinal potential (N13) decreased in amplitude, (1.77(SEM 0.35) μV to 1.59(SEM 0.35) μV, p < 0.05) and increased in latency (14.37(SEM 0.29)ms to 14.69(SEM 0.31)ms, p < 0.05). The central conduction time increased from 6.47(SEM 0.16)ms to 6.92(SEM 0.25)ms, ns. There was no effect on the cortical somatosensory potentials, or the brainstem auditory evoked potentials. According to the EEG spectral indices, anaesthesia appeared to deepen despite a reduction in the end expiratory isoflurane concentration from 0.53(SEM 0.07) to 0.28(SEM 0.06)vol%, which indicated a reduction in anaesthetic requirements following clonidine.
A comparison of vital capacity breath and tidal breathing techniques for induction of anaesthesia with high sevoflurane concentrations in nitrous oxide and oxygen
Authors: YURINO M. , KIMURA H.
Published: February 2007

Vital capacity breath and tidal breathing techniques were compared for induction of anaesthesia with 7.5% sevoflurane in nitrous oxide, and oxygen. Thirty five subjects were randomly assigned to a vital capacity breath group (19) or to a tidal breathing group (16). The mean time for induction was faster with vital capacity breath (41 s) than with tidal breathing (52s, p < 0.05). Some involuntary movements were seen in the tidal breathing group but none in the vital capacity breath group. Coughing was seen in a quarter of the subjects in the tidal breathing group and in one subject of the vital capacity breath group. The vital capacity group showed excellent characteristics: rapid, and pleasant induction without premedication. We conclude that the vital capacity breath technique is necessary for the inhalation induction of anaesthesia; it provides enough overpressure to allow the subject to pass reliably and rapidly through the initial stages of excitement.
Cardiac arrest and resuscitation of a 6‐month old achondroplastic baby undergoing neurosurgery in the prone position
Authors: Kelleher A. , Mackersie A.
Published: February 2007

We describe the case of a 6‐month‐old achondroplastic baby who underwent foramen magnum decompression to relieve congenital cervical cord compression. During the procedure, acute hypotension occurred secondary to cord compression, and following attempts to alleviate this, torrential haemorrhage ensued and air was entrained into the circulation through large venous channels in the surgical field. This resulted in an asystolic cardiac arrest from which the baby was resuscitated whilst remaining in the prone position. Haemorrhage remained difficult to control and a second episode of air embolism occurred 5min later leading to a profound bradycardia and hypotension again requiring full cardiorespiratory resuscitation in the prone position. In total, 11 min elapsed before an adequate spontaneous cardiac output was re‐established. The procedure was abandoned and the patient transferred to the intensive care unit for postoperative management. An electroencephalogram performed after 24 h was reported as normal, and clinically the child made a full neurological recovery.
Maternal position during induction of spinal anaesthesia for Caesarean section
Authors: Inglis A. , Daniel M. , McGrady E.
Published: February 2007

Forty women presenting for elective Caesarean section under spinal anaesthesia were randomly assigned to have anaesthesia induced in either the sitting or right lateral positions; 2.5 ml 0.5% hyperbaric bupivacaine was injected over 10 s before the mother was placed in a supine position with a 20° lateral tilt. The onset time and height of the subsequent analgesic and anaesthetic block was measured. It took longer to site spinal needles in the lateral position (240 vs 115 s, p < 0.001). There was a faster onset of sensory block to the sixth thoracic dermatomal level (8 vs 10 min, p < 0.001), in the lateral group, although onset time to T4 was comparable. There was no difference in maximum block height or degree of motor block. Mothers in the lateral group required more ephedrine in the first 10m after siting the spinal (13.5 vs 10.5 mg, p < 0.05).
Compliance with an incident report scheme in anaesthesia
Authors: JAYASURIYA J. P. , ANANDACIVA S.
Published: February 2007

Voluntary, anonymous reporting of incidents which occur during anaesthesia is a mechanism for obtaining information about such problems. Our objective was to estimate the compliance with reporting such incidents. For 3 months, alongside the incident report form, another form, which had to be completed for every patient, was used. This form listed a series of defined events which could occur intra‐operatively. Compliance with the incident reports was estimated by comparing the data obtained from the two sets of forms. Overall compliance was only about 30%. There were differences in compliance for different events. Compliance was high with more serious events and poor in the case of common events, or when successful recovery had occurred. In order to improve compliance, incident report forms should be available on each anaesthetic machine and staff should be made more aware of the fact that reportable incidents are not limited to events which harmed the patient, but also include those which could have affected patient safety.
A comparison of the stress response to laryngoscopy
Authors: McCOY E. P. , MIRAKHUR R. K. , McCLOSKEY B. V.
Published: February 2007

The cardiovascular changes and catecholamine concentrations were compared in 20 patients before and after laryngoscopy with either the Macintosh or the McCoy laryngoscope blades. Following induction with fentanyl and thiopentone and muscle relaxation with vecuronium the vocal cords were visualised for 10 s with either the Macintosh or McCoy blade, chosen at random. Heart rate, arterial blood pressure and plasma noradrenaline and adrenaline concentrations were measured before, and at, laryngoscopy, and 1, 3 and 5 min later. There was a significant increase in both heart rate (33%) and arterial blood pressure (27%) after laryngoscopy using the Macintosh blade (p < 0.01). Use of the McCoy blade did not result in any significant change in either heart rate or arterial blood pressure. There was a slight increase (p > 0.05) in plasma noradrenaline concentrations using the Macintosh blade which persisted for 5 min after laryngoscopy. This was not observed with the McCoy blade. There was no change in plasma adrenaline concentrations with either blade during the 5 min after laryngoscopy when compared to the values before laryngoscopy. It is concluded that the stress response to laryngoscopy is less marked with the use of the McCoy blade and is probably due to a reduction in the force necessary to obtain a clear view of the larynx.
Early proponents of cardiac massage
Authors: And H. Böhrer , GOERIG M.
Published: February 2007

Open‐chest cardiac massage in humans to treat chloroform syncope was first performed by Niehans in Berne and Langenbuch in Berlin in the late 1880s. Closed‐chest cardiac massage in humans was advocated by Koenig and Maass in Göttingen in the last two decades of the 19th century. The closed technique was used in Central Europe for several decades to treat chloroform syncope.
Patients’attitudes to rectal drug administration
Authors: Vyvyan H.A.L. , Hanafiah Z.
Published: February 2007

One hundred adult patients attending for day case surgery were surveyed by anonymous questionnaire in order to determine their attitudes to rectal drug administration. Fifty four patients did not want an analgesic drug (diclofenac sodium) administered rectally whilst under anaesthesia, all preferring to take it orally if available. Ninety eight patients thought that drugs administered per rectum should always be discussed with them beforehand and a few had very strong feelings about this route of administration. We suggest that prescribers of rectal diclofenac should always discuss it with patients pre‐operatively. Whilst many are happy to have suppositories, some young patients are sensitive about this and prefer to take such medication by mouth.
Relationship of admission thyroid function tests to outcome in critical illness
Authors: RAY D. C. , DRUMMOND G. B. , WILKINSON E. , BECKETT G. J.
Published: February 2007

One hundred and eighty patients had serum thyrotropin, total triiodothyronine and free thyroxine concentrations measured within 3h of admission to the Intensive Therapy Unit to assess whether thyroid function tests could predict outcome in critical illness. Overall mortality was 30.6%. Nonsurvivors were older (p = 0.001), and had higher AP ACHE II scores (p < 0.001) and predicted mortalities (p < 0.001). There was no difference in the median values of thyrotropin, total triiodothyronine and free thyroxine concentrations between survivors and nonsurvivors. Thyrotropin concentration was subnormal in 15 patients, normal in 152 and elevated in 13 patients. In contrast, 80 patients had subnormal triiodothyronine concentration. Free thyroxine was subnormal in five patients. Thyrotropin, total triiodothyronine and free thyroxine concentrations were not related to outcome (p = 0.360, p = 0.622, p = 0.726, respectively). No variable independently predicted death. Total triiodothyronine concentrations were lower in patients who received dopamine before admission to the intensive therapy unit than in those who did not (p = 0.008); thyrotropin and free thyroxine concentrations were not influenced by dopamine administration. Serum concentrations of thyrotropin, total triiodothyronine and free thyroxine measured within 3 h of admission to the intensive therapy unit are not predictive of outcome.
Time course of action and intubating conditions following vecuronium, rocuronium and mivacurium
Authors: WIERDA J. M. K. H. , HOMMES F. D. M. , NAP H. J. A. , van den BROEK L.
Published: February 2007

The purpose of this study was to compare the time course of action and tracheal intubating conditions of vecuronium, rocuronium and mivacurium in anaesthetised patients. Anaesthesia consisted of thiopentone, fentanyl, N2O/O2 and isoflurane. After a 2 × ED90 dose the first attempt at tracheal intubation was made at 90s. If required, maintenance doses of 0.5 × ED90 were administered. The intubating conditions after rocuronium were significantly better than those after vecuronium and mivacurium. The average onset times of rocuronium (172 s) and vecuronium (192 s) were significantly shorter than that of mivacurium (229 s). The clinical duration and recovery time were significantly shorter after mivacurium (13 and 6min, respectively) than with vecuronium (33 and 14min, respectivelys) and rocuronium (28 and 11 min, respectively). We conclude that rocuronium might be of advantage whenever the interval between the administration of the muscle relaxant and tracheal intubation must be short, whereas mivacurium may be of benefit if fast spontaneous recovery is required.
Comparison of central venous pressure measurements in the intrathoracic and the intra‐abdominal vena cava in critically ill children
Authors: LITMANOVITCH M. , HON H. , LUYT D. K. , DANCE M. , MATHIVHA L. R.
Published: February 2007

A prospective study was conducted to compare simultaneous intrathoracic and intra‐abdominal central venous pressures in 10 critically ill, ventilated paediatric intensive care patients. Central venous pressures were measured using the water column technique over a 6h study period. There was excellent correlation between intrathoracic and intra‐abdominal vena caval pressure measurements (r = 0.974, p < 0.001). The difference between paired measurements did not exceed the limits of agreement (± 2SD, – 2.36 to 4.42cm H2O). The mean (SD) difference between readings was small (1.03 ± 1.69 cmH2O) and was within clinically tolerable limits. These data suggest a clinically useful, close relationship between intra‐abdominal and conventional intrathoracic central venous pressure measurement in this group of patients.
Physostigmine in recovery from anaesthesia
Authors: Hamilton‐Davies C. , Bailie R. , Restall J.
Published: February 2007

Intravenous ketamine anaesthesia has been used by the British army in the field for many years. A recognised problem has been the unpredictable recovery profile this produces. We anaesthetised 28 ASA 1 patients using a standard British military technique. At termination of the anaesthetic, half of the patients were given a physostigmine/glycopyrronium mixture and half were given the equivalent volume of saline 0.9%. There was a significant difference between the two groups with regard to recovery times (p < 0.001). There was no significant difference with regard to other variables. In trauma anaesthesia the improved recovery profile from the use of physostigmine following ketamine anaesthesia may lead to earlier evacuation ofthe patient.