bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of cerebral hypoperfusion during cardiopulmonary bypass
Authors: ANDREWS P. J. D. , COLQUHOUN A. D.
Published: February 2007

We measured continuously cerebral venous oxyhaemoglobin saturation (Sjvo2) using a 4F fibreoptic catheter in 11 patients scheduled for elective myocardial revascularisation. The aims of this study were to assess the Oximetrix 3 computer and Opticath 40 cm catheter during moderate hypothermic cardiopulmonary bypass, and identify epochs of cerebral hypoperfusion (Sjvo2 < 54%). Radial artery pressure, brain electrical activity, arterial and cerebral venous oximetry (dual oximetry), end‐tidal CO2 and nasopharyngeal temperature were recorded continuously in each patient. Following in vivo calibration of 11 continuous Sjvo2 catheters and monitor, 57 simultaneous, paired recordings were additionally taken. The mean difference between the catheter Sjvo2 and the in vitro laboratory derived value was 0.34%, with a 95% confidence interval –3.2% to 2.4%. In 10 patients Sjvo2 decreased below normal at rewarming and myocardial reperfusion: mean lowest value 37%, range 19%–55%. Reduced Sjvo2 were associated with a decrease in perfusion pressure (r = 0.292, 80 DF, p = 7.7* 10‐3), and with an increase in nasopharyngeal temperature (r =–0.46, 115 DF, p = 2.7* 10‐7) after moderate hypothermia. The Oximetrix 3 computer and Opticath 40cm catheter provided reliable and accurate continuous monitoring of Sjvo2 during nonpulsatile cardiopulmonary bypass involving hypothermia with haemodilution and identified rewarming as the period of greatest risk of global cerebral hypoperfusion.
Haemothorax after attempted intercostal catheterisation
Authors: DANGOISSE M. , COLLINS S. , GLYNN C. J.
Published: February 2007

A 30‐year‐old man with chronic abdominal pain was referred to the Pain Relief Unit after a course of unsuccessful diagnostic blocks and treatments. On admission, history, examination and clinical investigations were consistent with a large pleural effusion due to a recent attempt to catheterise the intercostal space. Pleural drainage confirmed the diagnosis of haemothorax. Percutaneous intercostal nerve blocks are usually considered as safe and simple and no‐one to our knowledge has reported such a complication.
A comparison of arterial lines and insertion techniques in critically ill patients
Authors: BEARDS S. C. , DOEDENS L. , JACKSON A. , LIPMAN J.
Published: February 2007

We compared three arterial line insertion techniques and two types of arterial catheters in 69 critically ill patients. Use of the direct‐puncture technique (method A) was associated with a significantly higher failure rate (23%) than use of a catheter with a separate guide wire (method B,‘classical’Seldinger technique, p < 0.001) or a catheter with an integral guide wire (method C,‘modified’Seldinger technique, p < 0.02). Operators randomly allocated to using method A took significantly longer to perform the procedure than those using method C (p < 0.01), used significantly more catheters (p < 0.0001) and made significantly more punctures in achieving a successful insertion than those using either methods B (p < 0.001) or C (p < 0.001). Both catheter types B and C (polyurethane) were significantly less likely to block, thus requiring re‐insertion, than catheter type A (Teflon) (p < 0.02, p < 00 01 respectively). We recommend the use of a‘classical’Seldinger technique (method B) for arterial line insertion in critically ill patients and the use of a polyurethane catheter, in preference to Teflon, to maximise catheter life after insertion.
A comparison of thiopentone and propofol with respect to the incidence of postoperative shivering
Authors: Singh P. , Harwood R. , Cartwright D. P. , Crossley A. W. A.
Published: February 2007

One hundred patients (69 female) undergoing surgical excision of three or more wisdom teeth were randomly allocated to receive either thiopentone or propofol for induction of anaesthesia. Other than the induction agent, the anaesthetic regimen was standardised for all cases. All patients were observed for 15 min after entry into the recovery area to assess the presence and intensity of shivering. Twenty‐five patients in the thiopentone group (n = 50) and 11 patients in the propofol group shivered postoperatively (p < 0.005). There was no statistically significant difference in axillary temperature between shivering and non‐shivering patients. The use of propofol as an induction agent is associated with a lower incidence of postoperative shivering than thiopentone.
Effect of topical anaesthesia on the motor performance of vocal cords as assessed by tussometry
Authors: MAHAJAN R. P. , MURTY G. E. , SINGH P. , AITKENHEAD A. R.
Published: February 2007

Tussometry involves a continuous measurement of airflow produced by a cough manoeuvre displayed as an airflow‐time wave. There is a rapid rise to its peak (cough peak flow rate) and the time taken to reach the peak (peak velocity time) is determined by the laryngeal opening at the onset of cough. Cough peak flow and peak velocity time were measured in 10 healthy volunteers before and after topical anaesthesia of the larynx with lignocaine 100 mg sprayed under indirect laryngoscopy. Adequacy of anaesthesia was established by touching the cords deliberately with a fibreoptic laryngoscope. All subjects had excellent anaesthesia of the larynx. However, cough peak flow rate and peak velocity time remained unchanged following topical anaesthesia. We conclude that topical anaesthesia of the larynx does not impair the motor performance of the vocal cords during a voluntary cough.
Accuracy, alarm limits and rise times of 12 oxygen analysers
Authors: LAUBER R. , STEINER A. , ZBINDEN A. M.
Published: February 2007

The Comité Européen de Normalisation recently proposed a new standard for‘the particular requirements of oxygen monitors for medical use’. The feasibility of this proposed standard was tested in respect of (1) accuracy of alarm activation (2) accuracy of oxygen display value during both continuous and cyclical gas flows (3) rise time during rapid changes in oxygen concentration in the following 12 analysers: Datex Capnomac II and Servomex 570A (paramagnetic); Brüel & Kjaer 1304 (magnetoacoustic); Criticare Poet II, Multinex, Dräger Oxydig, Dräger PM 8030, Megamed 046A (part of the Megamed 700 ventilator), Ohmeda 5120, Spacelabs Multigas, Teledyne TED 200 (galvanic); Kontron OM 810 (polarographic). All the analysers tested displayed an oxygen reading which was within ±3 vol% of the actual oxygen concentrations of the test gases (15, 21, 40, 60 and 100 vol%). A cyclical pressure of between ‐1.5 to +8kPa did not affect the measured oxygen concentration as displayed by the Brüel & Kjaer 1304, Datex Capnomac II and Servomex 570A analysers. The remainder, however, showed, depending on their measuring principle, a display error of between ‐1 and +6vol%. After exposure to high pressure all the oximeters functioned normally. Some of the tested devices showed more than 2% of deviation between their alarm activation and the preset alarm limits. Only the Kontron OM 810, the Megamed 046A and the Spacelabs Multigas monitors satisfied the requirements at all the tested oxygen concentrations. The time required by the oxygen analyser to display the rise from 29 to 92vol% after a sudden change of concentration from 21 to 100 vol% O2 is defined as‘rise time’and must not, according to the Comité EuropéUen de Normalisation standard proposal, exceed the manufacturers’specification by more than a factor of 1.15. The Brüel & Kjaer and Poet II monitors did not comply with this requirement, although their rise times were among the shortest. We conclude that the recommended standards concerning accuracy are generally met during continuous gas flow. Some of the monitors tested failed to meet the required standard during cyclical flows and in the accuracy of their alarm response. These small deviations are, however, not likely to be clinically relevant.
Depth of epidural space in children
Authors: Hasan M. A. , Howard R. F. , Lloyd‐Thomas A. R.
Published: February 2007

We have studied the depth of epidural space in 586 children who had lumbar epidural block as part of their anaesthetic management. The mean depth of epidural space in neonates was I cm (SD 0.2, range 0.4–1.5 cm). The depth of epidural space in older infants and children correlated significantly with age and weight with regression equations of depth (cm) = 1 + 0.15 × age (years) and depth (cm) = 0.8 + 0.05 × weight (kg) respectively.
Waiting in pain
Authors: DAVIES H. T. O. , CROMBIE I. K. , MACRAE W. A.
Published: February 2007

Patients with chronic pain may benefit from referral to a pain specialist. This study describes the delay between referral and first appointment of 3386 new referrals seen in ten outpatient pain clinics between 1990 and 1992. We then assess the follow‐up patterns of the pain clinics and how these relate to waiting times. Patients wait in pain for long periods before being seen in a pain clinic. In 1992 about half of patients waited more than 3 months for an appointment at a teaching hospital pain clinic; and half waited 9 weeks or longer to be seen at a district general hospital pain clinic. In many clinics the situation is worsening. Pain clinics differ widely in their patient follow‐up, with patients averaging more than twice as many visits in some clinics than others. Clinic practice on reappointing patients largely determines the number of new referrals who can be accepted for management, and hence affects waiting lists. Thus our data suggest that pain clinics themselves can help reduce waiting times, by changing the extent and nature of patient follow‐up. Ultimately, however, additional consultant sessions may be needed to enable pain clinics to meet the increasing demands placed on them.
Curare modification of suxamethonium blockade
Authors: HOOD J. R. , CAMPKIN N. T. A. , FELDMAN S. A.
Published: February 2007

Tubocurare (0.125 mg.kg‐1 or 0.25 mg.kg‐1) was injected 10 s before 1 mg.kg‐1 suxamethonium in patients anaesthetised with enflurane 1–1.5%. Measurement of electromyographic response was recorded using a 0.2 Hz train‐of‐four every 20 s. The modified blocks were slower in onset, of lesser intensity, and of shorter duration than that of suxamethonium alone, but were much closer to those of suxamethonium than of tubocurare. However, the train‐of‐four fade observed during onset of the modified blocks were similar to that of their tubocurare controls and significantly different from the suxamethonium group. We conclude that effective amounts of tubocurare are present in the neuromuscular junction within the 30 s following intravenous injection of the drugs, and this affects the onset of action of the suxamethonium block. The presence of train‐of‐four fade during a predominantly agonist block is difficult to explain on the basis of diminished acetylcholine release and a postsynaptic site of action of suxamethonium.
Use of a guide wire and a ureteral dilator as an aid to awake fibreoptic intubation
Authors: TELFORD R. J. , SEARLE J. F. , BOADEN R. W. , BAIER F.
Published: February 2007

We describe the successful use of a guide wire and ureteral dilator to pass a tracheal tube into the trachea through the mouth in an awake, sedated patient when attempts to pass a larger tube over an Olympus LFI fibreoptic bronchoscope were unsuccessful. Since the ureteral and renal dilators are available in a variety of sizes, if too large a tube is inadvertently mounted on the instrument this technique allows an appropriate sized tube to be inserted without the need to re‐endoscope the patient.
Severe pain in both legs after spinal anaesthesia with hyperbaric 5% lignocaine solution
Authors: SJÖSTRÖMand S. , BLÄSS J.
Published: February 2007

A patient is presented who developed severe pain in both legs, that began 5 h after a spinal anaesthetic with lignocaine 5% in dextrose 7.5%, but lasted for less than 24 h.
A modification of the Bain system for ambient air‐oxygen inhalation
Authors: SHRESTHA B. M. , TWEED W. A. , BASNYAT N. B. , LEKHAK B. D.
Published: February 2007

In developing countries like Nepal, anaesthetic compressed gases, especially nitrous oxide, are expensive and in short supply and anaesthetic techniques must equally use oxygen and volatile anaesthetics sparingly. We have designed a non‐rebreathing anaesthetic system which meets these requirements. An Ambu‐E anaesthetic valve and self‐inflating Ambu bag connected to a Bain system form a non‐rebreathing system which uses ambient air to supplement a mixture of low flow oxygen and halothane. Over 100 patients have been anaesthetised with this system using a balanced anaesthetic technique. The oxygen flow was 2 l.min‐1 and the average halothane consumption was 8 ml.h‐1. The average inspired oxygen concentration was 34%, and the air: oxygen dilution ratio was 5:1. A graphical analysis of gas flow predicts that the system is almost 100% efficient, in that almost all of the oxygen and halothane will enter the alveoli. Our experience confirms that this is a safe, simple and economical method for inhalation anaesthesia. We recommend it for locations where anaesthetic machines and mechanical ventilators are lacking, and where medical oxygen is in short supply.
Late presentation of tracheo‐oesophageal fistula
Authors: TEASDALE A. R. , NIELSEN M. S.
Published: February 2007

We report a 6‐year‐old boy with an H‐type tracheo‐oesophageal fistula, previously undiagnosed, which presented initially as asthma and became apparent only after tracheal intubation.
The effect of insufflation leaks in long‐term ventilation. Waking and sleeping transcutaneous gas tensions in ventilator‐dependent patients with an uncuffed tracheostomy tube
Authors: Watt J.W.H. , Fraser M.H.
Published: February 2007

Transcutaneous blood gases were recorded for 60 min when awake and asleep in 10 ventilator‐dependent patients with high tetraplegia who used a pressure‐limited ventilator and uncuffed tracheostomy tube. The mean arterial oxygen tension awake was 16.0 kPa compared with 15.2 kPa when asleep; the mean arterial carbon dioxide tension awake was 3.2 kPa, compared with 3.9 kPa when asleep. The oxygen tensions in each patient during the awake and sleep states were not significantly different between the two states, but during sleep the carbon dioxide tension was significantly greater.
Improving the induction characteristics of methohexitone
Authors: Raphael J. H. , Bexton M. D. R.
Published: February 2007

A double‐blind, randomised, controlled study was undertaken to investigate the effects on injection pain and excitatory phenomena of adding thiopentone to methohexitone. One hundred and twenty unpremedicated, day‐case patients received one of four induction regimens: unmodified 1% methohexitone, or a mixture of 2.5% thiopentone and 1% methohexitone in ratios of 1:1, 1:3 or 1:9 by volume. The addition of one part of thiopentone to three parts of methohexitone produced a mixture which significantly reduced the occurrence of pain and discomfort compared with methohexitone alone from 67% to 13% (p < 0.01) and reduced the occurrence of excitatory effects from 50% to 13% (p < 0.01).
A new laryngeal mask prototype
Authors: BRAIN A. I. J. , VERGHESE C. , STRUBE P. , BRIMACOMBE J.
Published: February 2007

A new prototype laryngeal mask airway is described which incorporates a second mask to isolate the upper oesophagus and a second dorsal cuff to increase the seal against the glottis. We have made a within‐patient comparison of seal pressures between the prototype and standard laryngeal mask airway in 20 patients, and determined if the prototype facilitates functional isolation of the glottis and upper oesophagus. Leak pressure was found to be significantly higher for the prototype and equalled or exceeded 5.0kPa in all patients (p < 0.001). The prototype laryngeal mask airway provided functional isolation in all patients as judged by leak and placement of a gastric tube via the oesophageal mask. Ease of insertion and incidence of pharyngeal morbidity appeared similar to the standard laryngeal mask, but were not formally tested. The prototype laryngeal mask airway exhibits potentially useful new features which justify further evaluation and development.
The effect of pre‐operative oral fluids on morbidity following anaesthesia for minor surgery
Authors: Gilbert S. S. , Easy W. R. , Fitch W. W.
Published: February 2007

Postoperative morbidity and serum osmolality were studied in 46 patients who were encouraged to drink water until 3h pre‐operatively and 49 receiving the normal fasting regimen prior to minor surgery. There was significantly less thirst in the postoperative period in those patients allowed to drink and subjectively better recovery than after previous anaesthesia. There was no morbidity from ingestion of up to 11 of water 2.5h pre‐operatively. Although there was only a moderate improvement in postoperative recovery we feel that allowing patients to drink water pre‐operatively improves patient comfort, especially since patients may have to fast for much longer than guidelines recommend, simply because of the traditional organisation of operating lists.
An assessment of the consistency of ASA physical status classification allocation
Authors: HAYNES S. R. , LAWLER P. G. P.
Published: February 2007

The American Society of Anesthesiologists’(ASA) Physical Status Classification was tested for consistency of use by anaesthetists. A postal questionnaire was sent to 113 anaesthetists of varying experience working in the Northern Region of England. They were asked to allot ASA grades to 10 hypothetical patients. Ninety‐seven (85.8%) responded to two mailings. In no case was there complete agreement on ASA grade, and in only one case were responses restricted to two of the five possible grades. In one case there was a significant difference in answers between anaesthetists with the FRCA (or equivalent) qualification, and those without. So much variation was observed between individual anaesthetist's assessments when describing common clinical problems that the ASA grade alone cannot be considered to satisfactorily describe the physical status of a patient.
Lower limb nerve blocks in children using unsheathed needles and a nerve stimulator
Authors: BÖSENBERG A. T.
Published: February 2007

The use of unsheathed non‐insulated needles and a nerve stimulator as an aid to peripheral nerve blockade in children has received little attention in the literature. In order to assess the value of such a technique, a study was performed in children presenting for lower limb surgery with no contraindication to femoral and/or sciatic nerve block. Four hundred and eleven children, mean age 4.25 (SD 3.8) years and mean weight 16.8 (SD 9.4) kg, received a total of 883 peripheral nerve blocks: 419 femoral nerve blocks and 464 sciatic nerve blocks. One hundred and twenty six children were below one year of age. The current required to stimulate the more superficial femoral nerve ranged from 0.5‐1.0 mA whilst for the deeper sciatic nerve ranged from 1.2–2.0 mA. Staff in training, with little or no experience of the technique, successfully performed 223 nerve blocks in 114 patients under the author's guidance. The overall success rate was 98%, the failures occurring early in the series.
Difficult tracheal extubation in a patient with an unsuspected congenital subglottic stenosis
Authors: Asai T.
Published: February 2007

A case is described of difficulty in advancing a tracheal tube and subsequent difficult extubation in an asymptomatic patient. The origin of this complication was an unsuspected subglottic stenosis, and a subsequent experiment showed how the relatively large folds of the cuff of an armoured tracheal tube could become caught on a narrow section of airway.
Raynaud's syndrome following intravenous induction of anaesthesia
Authors: Bedforth N.M. , Lockey D.J.
Published: February 2007

Following intravenous induction of anaesthesia, a previously healthy 14‐year‐old male patient developed episodes of vasospasm with reactive hyperaemia, suggestive of Raynaud's syndrome.
Intra‐operative tracheal obstruction by tumour fragments
Authors: Tzabar Y.
Published: February 2007

A patient underwent oesophageal dilatation for invasive secondary carcinoma. During the course of the procedure, ventilation of the patient's lungs became impossible due to total tracheal obstruction. A rigid bronchoscopy was performed and the cause was found to be fragments of tumour that had broken off and were behaving like a ball‐valve in the trachea and right main bronchus.
Continuous monitoring of irrigating fluid absorption during transurethral surgery
Authors: HAHN R. G. , LARSSON H. , RIBBE T.
Published: February 2007

We have designed an automatic detector system for noninvasive monitoring of irrigating fluid absorption during transurethral resection of the prostate. Ethanol, which is used as a tracer for the fluid, is measured in the expired breath of the patient. The breath ethanol monitor can be used both in the awake patient and during general anaesthesia. A lap‐top computer controls the monitor and calculates the fluid absorption 1–3 times per min and uses the pattern of ethanol changes to indicate whether the fluid is being taken by the intra‐ and/or extravascular route. The monitor has been used in routine operations for one year. The interpretation of absorption routes was checked by control methods or by evaluation of the postoperative breath‐ethanol curve. We found the indicated absorption to be correct in all resections with absorption large enough for the monitor to present an interpretation.
Premedication with midazolam in children. Effect of intranasal, rectal and oral routes on plasma midazolam concentrations
Authors: Malinovsky J‐M. , Populaire C. , Cozian A. , Lepage J‐Y. , Lejus C. , Pinaud M.
Published: February 2007

We report a study performed to compare the time and plasma drug concentrations necessary to achieve a similar state of sedation after midazolam premedication given by various routes in children of 2–5 years old. Children were randomly allocated to one of three groups to receive midazolam 0.2mg.kg‐1 given intranasally, 0.5mg.kg‐1 given orally or 0.3mg.kg‐1 given rectally. Sedation was measured regularly until venepuncture was possible in a cooperative child. At this time, a first blood sample was taken to measure plasma concentration, followed by another 10 min later. Anaesthesia consisted of intravenous propofol supplemented with regional analgesia. At recovery from anaesthesia, a third blood sample was taken. Adequate sedation occurred sooner (7.7, SD 2.4 min) with intranasal than oral (12.5, SD 4.9 min) or rectal (16.3, SD 4.2 min) midazolam. The initial blood levels were lower when the drug was given by the alimentary routes despite higher doses (146, SD 51 ng.ml‐1 in 11.5, SD 3.9 min; 104, SD 34ng.ml‐1 in 21.6min; and 93, SD 63 ng.ml‐1 in 23.1, SD 3.5 min for the intra nasal, rectal and oral routes respectively). Duration of surgical procedures, and of propofol infusion, and recovery from anaesthesia was similar for the three groups. The only problem arose in a 30‐month‐old boy in the intranasal group who developed respiratory depression with a plasma midazolam concentration of 169 ng.ml‐1. Intranasal midazolam is an excellent alternative for rapid premedication provided that respiratory monitoring is used.
Molecular sieves: an alternative method of carbon dioxide removal which does not generate compound A during simulated low‐flow sevoflurane anaesthesia
Authors: FEE J. P. H. , MURRAY J. M. , LUNEY S. R.
Published: February 2007

Molecular sieves are used in industry to 'scrub’ industrial gases. We examined, during simulated low‐flow closed system anaesthesia, (1) the carbon dioxide adsorbing potential of molecular sieves and (2) the reactivity of the sieves compared to soda lime using sevoflurane as an indicator. A low‐flow anaesthetic system containing 13X molecular sieves was connected to a model lung. End‐tidal concentrations of CO2 were measured continuously at an O‐2 flow of 800 ml.min‐1 and a CO2 flow of 200 ml.min‐1. In the second study, sevoflurane (FE'sevo 1.7%) was added to the system after which samples were taken from the inspiratory limb of the anaesthetic system. This experiment was performed both during carbon dioxide removal with soda lime and with the molecular sieves. The samples were stored in gas‐tight syringes and analysed by gas chromatography. The temperature of both absorbents was measured throughout the study. The molecular sieves adsorbed carbon dioxide (20 %) efficiently for a period of 5h. There was a gradual increase from the baseline of 4.4% to 4.5, 5.4, and 6.0% at 90, 180, and 300 min, respectively. When sevoflurane was added to the system, compound A was detected at the start of both experiments. However, when soda lime was used the concentrations of compound A increased 10‐fold after 2.5 h compared with baseline values. No increase in compound A was observed when molecular sieves were used for carbon dioxide removal. The highest mean (SD) temperature of the molecular sieves was 41.5 (3.2)° C. Molecular sieves are effective adsorbents of carbon dioxide when used in a simulated low‐flow, closed anaesthetic system. Compound A is not formed when sevoflurane is added to the system.
Lignocaine metabolite formation: an indicator for liver dysfunction and predictor of survival in surgical intensive care patients
Authors: SCHRÖTER J. , WANDEL C. , BÖHRER H. , SCHMIDT H. , BÖTTIGER B. W. , MARTIN E.
Published: February 2007

Formation of the lignocaine metabolite monoethyl‐glycine‐xylidide (MEGX) by hepatic cytochrome P450 enzymes is a new method for evaluating liver function. The purpose of this study was to compare MEGX formation with other liver function parameters in surgical intensive care unit patients. The study included 29 critically ill patients who had been admitted to the unit for more than 3 days with a median APACHE III score‐predicted mortality > 30%. On day 4, lignocaine was given intravenously at a dose of 1 mg.kg‐1 over 2 min and MEGX formation was measured 15 min later. Eighty‐nine percent of the patients had MEGX values below 90μg.l‐1 indicating impaired liver function. Eleven patients died, 18 patients survived. The group of patients with fatal outcome had significantly lower MEGX values (median: 23μg.l‐1) than the group of survivors (median: 53μg.l‐1, p < 0.01). Bilirubin values were elevated in the non‐survivor group (median: 2.8mg.dl‐1) compared to the survivors (median: 0.9mg.dl‐1, p < 0.05). There was no significant difference between the two groups in the other liver function tests. We conclude from our results that the MEGX test can be considered an indicator for hepatic dysfunction and predictor of survival in critically ill patients.
A microprocessor based photoplethysmograph for use in clinical practice
Authors: WRIGHT I. P. , GRIFFITHS M. , CHILDS C.
Published: February 2007

A microprocessor‐based system of photoplethysmography and its use in measuring skin blood flow is described. The system was designed specifically for use over long periods and for the analysis of the output to be handled by a personal computer. The photoplethysmograph described in this paper is shown to be a qualitative method for assessment of changes in peripheral skin blood flow. There is potential for use of this instrument in a variety of clinical conditions.
Effects of magnesium sulphate on suxamethonium‐induced complications during rapid‐sequence induction of anaesthesia
Authors: STACEY M. R. W. , BARCLAY K. , ASAI T. , VAUGHAN R. S.
Published: February 2007

Twenty patients were studied in a double‐blind manner to investigate whether magnesium sulphate, when given during a rapid‐sequence induction of anaesthesia, lessens the side effects caused by suxamethonium. Patients were randomly allocated to two groups; equal volumes of either magnesium sulphate (40 mg.kg‐1) or saline were given during rapid‐sequence induction of anaesthesia, after thiopentone but before the administration of suxamethonium (1.5 mg.kg‐1). The changes in the serum potassium concentration, the degree of muscle fasciculations and the presence of postoperative myalgia were recorded. The mean serum potassium concentration increased by 0.08 mmol.l‐1 in the magnesium group and by 0.1 mmol.l‐1 in the control group at 2 min after injection of suxamethonium; in neither group was there a significant increase from baseline values. The systolic blood pressure and heart rate increased in both groups after tracheal intubation. The incidence of fasciculations was significantly lower in the magnesium group. Magnesium did not clinically prolong muscle relaxation. There was no difference between the groups in the incidence of myalgia after surgery (one patient in each group). Since no significant increase in the serum potassium concentration was demonstrated, no assessment could be made of the effect of magnesium sulphate on the serum potassium concentration after administration of suxamethonium.
Assessment of recovery following day‐case arthroscopy
Authors: GUPTA A. , KULLANDER M. , EKBERG K. , LENNMARKEN C.
Published: February 2007

Fifty healthy patients, aged 15–45 years, undergoing day‐case arthroscopy, participated in a study to assess aspects of recovery and mood. Psychomotor tests, including the p‐deletion test and the Trieger dot test, were performed pre‐operatively and mood was measured using the mood adjective checklist. Anaesthesia in all patients was induced with propofol and a laryngeal mask airway was inserted immediately. All patients received alfentanil as the intra‐operative analgesic. The patients were randomly allocated to receive one of two different regimens for maintenance of anaesthesia: propofol group—maintenance with an infusion of propofol 10 mg.kg‐1.h‐1for 15 min followed by 6 mg. kg‐1.h‐1 and nitrous oxide and oxygen (bolus doses of propofol were given if anaesthesia was deemed to be light); isoflurane group—maintenance with isoflurane (inspired concentration 0.5–2.0%) in nitrous oxide and oxygen. Postoperatively, psychomotor tests were repeated every 30 min and mood was measured after 2 h and 24 h. Psychomotor recovery was quicker in the isoflurane group than the propofol group and had returned to baseline values in the isoflurane group by 60 min. The time to discharge was similar in both groups as was the incidence of side effects. There was no difference in mood scores between the groups either at the time of discharge or at 24 h. We conclude that psychomotor recovery is somewhat quicker when isoflurane‐based anaesthesia is used for day‐case arthroscopy, but other factors, including time to awakening, mood and time to discharge are similar for both techniques.
Comparison of the reinforced laryngeal mask airway and tracheal intubation for nasal surgery
Authors: Williams P. J. , Thompsett C. , Bailey P. M.
Published: February 2007

Airway maintenance and protection during anaesthesia and recovery provided by the reinforced laryngeal mask airway was compared with the sequential use of a tracheal tube followed by the Guedel airway in 66 patients having anaesthesia for nasal surgery. One patient was withdrawn from the laryngeal mask group because the airway was difficult to position. All patients had an oropharyngeal pack inserted and Moffett's solution instilled into the nasal cavities. At the end of surgery the nasal cavities were packed. During operation airway maintenance was good and airway protection was equally effective in both groups. Contamination of the lower airway occurred in only five patients. During recovery from anaesthesia the laryngeal mask and Guedel airway were well tolerated by most patients, but only the mask laryngeal provided an unobstructed airway in all patients. The laryngeal mask protects the larynx from contamination during and after operation until the return of the patient's own protective reflexes.
Metoclopramide and prochlorperazine do not decrease propofol hypnotic requirements
Authors: Ali P. B. , Graham S. G.
Published: February 2007

One hundred patients scheduled for minor surgery were given either saline, metoclopramide 0.1 mg.kg‐1 or 0.2 mg.kg‐1, or prochlorperazine 0.1 mg.kg‐1 or 0.2 mg.kg‐1 before induction of anaesthesia with a fixed rate infusion of propofol. Neither metoclopramide nor prochlorperazine reduced the induction dose of propofol. The possibility that these agents increased the induction dose could not be excluded.
The neuromuscular blocking effects of vecuronium during sevoflurane, halothane and balanced anaesthesia in children
Authors: TAIVAINEN T. , MERETOJA O. A.
Published: February 2007

Forty‐five children aged 5–12 years were randomly allocated to receive 1.0 MAC of sevoflurane or halothane, or balanced anaesthesia with propofol and alfentanil. The ulnar nerve was stimulated every 20 s supramaximally with a train‐of‐four pattern and adductor pollicis electromyography was recorded. A cumulative log‐probit dose‐response curve of vecuronium was established. Thereafter, spontaneous recovery of neuromuscular function was monitored until complete. Effective doses of vecuronium were lowest in the sevoflurane group and greatest during balanced anaesthesia; for 50% neuromuscular blockade these were 13.3%μg.kg‐1, 21.8 μg.kg‐1and 36.6 μg.kg‐1during sevoflurane, halothane and balanced anaesthesia, respectively, p < 0.05. Recovery of neuromuscular function was slower during sevoflurane than during halothane or balanced anaesthesia. Sevoflurane potentiated vecuronium more than halothane; when compared to balanced anaesthesia the dose requirements of vecuronium were reduced by approximately 60% and 40%, respectively.
Relief of tension subcutaneous emphysema using a large bore subcutaneous drain
Authors: Kelly M. C. , McGuigan J. A. , Allen R. W.
Published: February 2007

We report a case of subcutaneous emphysema following multiple attempts to cannulate both subclavian veins for pacemaker insertion. Initial bilateral pneumothoraces were complicated by subcutaneous emphysema which became so severe that respiration and cardiac output became seriously impaired. The insertion of a single large bore subcutaneous drain produced a dramatic improvement. The aetiology, complications and management of tension subcutaneous emphysema are discussed.
Local anaesthesia for cannulation
Authors: DENNIS A. R. , LEESON‐PAYNE C. G. , LANGHAM B. T. , AITKENHEAD A. R.
Published: February 2007

A questionnaire study was undertaken to assess the influence of recently published, simple and conclusive research on the practice of anaesthetists in four centres. The research had clearly demonstrated the benefit of subcutaneous infiltration of local anaesthetic in reducing the pain of intravenous cannulation. Of the 81% who responded, 71% were aware of the research; 43% of these anaesthetists had altered their clinical practice as a result of the research and 73% used local anaesthesia for cannulae of 18 gauge or less, compared with only 46% of those who were unaware of the research. Practice comparisons were made between centres and grades of anaesthetist. Senior house officers were significantly less likely to be aware of the research than other grades. Anomalies were identified between the apparent awareness of the research and routine practice agreeing with the study findings. The value of research and the incorporation of clinical findings into everyday practice is discussed.
Epidural infusion of alfentanil or diamorphine with bupivacaine in labour—a dose finding study
Authors: HILL D. A. , McCARTHY G. , BALI I. M.
Published: February 2007

Following induction of epidural analgesia with 0.375% bupivacaine, 120 healthy parturients were randomly assigned in a double blind fashion to one of eight infusion groups. All received 8ml.h‐1 of0.125% bupivacaine either alone (control group), or with alfentanil at 133, 266 or 400μg.h‐1 (groups A1‐A3) or with diamorphine at 133, 266, 400 or 533μg.h1 (groups D1‐D4). Significantly longer top‐up intervals were achieved with the two highest doses of both alfentanil and diamorphine when compared with bupivacaine alone (p<0.01), making the minimum effective doses 266 μg.h‐1 of alfentanil and 400 ng.h‐1 of diamorphine. Perineal analgesia was better in all the opioid groups compared with the control group (p < 0.05). The intensity of motor block was greater in the control group (p < 0.05). The incidence of pruritus did not differ between groups. The highest dose of diamorphine caused significantly more nausea. No significant neonatal side‐effects were demonstrated.
Evaluation of the influence of movement on saturation readings from pulse oximeters
Authors: PLUMMER J. L. , ZAKARIA A. Z. , ILSLEY A. H. , FRONSKO R. R. L. , OWEN H.
Published: February 2007

This study aimed to develop a protocol for assessing the influence of movement on oxyhaemoglobin saturation readings from pulse oximeters. Thirty‐six volunteers took part in the study. In each volunteer, each hand was monitored by both a Nellcor N200 oximeter using a disposable probe and by a Datex Satlite DS103 oximeter using a clip‐on finger probe. Volunteers made five standardised movements during which output was recorded from all four oximeters. All movements were associated with apparent decreases in oxyhaemoglobin saturation which were statistically significant for two movements with the Nellcor equipment and for four movements with the Datex equipment. Movement was associated with increases in the magnitude of pulse amplitude, but this was not quantitatively associated with magnitude of artefactual changes in saturation. Use of this standardised movement protocol allows quantification of movement artefact from pulse oximeters and should facilitate the development of equipment less affected by movement.
An asthmatic weaned from a ventilator using a laryngeal mask
Authors: Taylor J. C. , Bell G. T.
Published: February 2007

A case is described in which a patient was unable to be weaned from ventilatory support whilst the trachea remained intubated. She was successfully weaned using a laryngeal mask.
Facilitation of laryngeal mask insertion
Authors: Stoneham M. D. , Bree S. E. , Sneyd J. R.
Published: February 2007

The effects of pretreatment with lignocaine administered intravenously on the insertion of the laryngeal mask airway were investigated in 80 unpremedicated, ASA 1 or 2, adult day‐case patients in a randomised, double‐blind, placebo‐controlled trial. Patients received either intravenous lignocaine 1.5mg.kg‐1 or an equivalent volume of sodium chloride 0.9%. Induction of anaesthesia was achieved with propofol given via a syringe driver at a fixed rate of 600ml.h‐1 until the patient dropped a weighted syringe. No opioid or sedative drugs were given prior to induction. Pain on injection of propofol was recorded. Jaw opening, ease of insertion of the laryngeal mask, coughing, gagging and airway patency were all scored on three‐point scales immediately after mask insertion. If insertion failed, anaesthesia was deepened by gentle manual ventilation for 1 min with nitrous oxide/oxygen/2% enflurane and insertion re‐attempted. This cycle was continued until success was achieved and the number of such cycles recorded. There were no differences between the lignocaine and control groups with respect to induction dose of propofol, degree of jaw opening, or amount of gagging. Laryngeal mask insertion was facilitated by pretreatment with lignocaine administered intravenously, without an alteration in induction dose of propofol (p < 0.05). Coughing and airway obstruction were both significantly reduced by pretreatment with lignocaine, as was the incidence of failure of insertion requiring deepening of anaesthesia (p < 0.05).
Anaesthesia for a patient with tracheobronchomegaly (Mounier‐Kuhn syndrome)
Authors: Bourne T. M. , Raphael J. H. , Tordoff S. G.
Published: February 2007

Tracheobronchomegaly is a rare condition in which anaesthetic experience is limited. Patients with tracheobronchomegaly are at risk of large airway collapse and obstruction, aspiration pneumonitis and tracheal trauma following airway instrumentation. We describe our anaesthetic technique and problems encountered during nephrectomy in a patient with this condition.
Comparison of direct blood pressure measurement at the radial and dorsalis pedis arteries during surgery in the horizontal and reverse Trendelenburg positions
Authors: Parry T. , Hirsch N. , Fauvel N.
Published: February 2007

The differences in simultaneous arterial pressure measurements from the radial and dorsalis pedis arteries were studied in anaesthetised adult patients in either the horizontal or reverse Trendelenburg position. Significantly higher pressures were measured from the dorsalis pedis artery than from the radial artery in both positions, even allowing for the hydrostatic effect on the dorsalis pedis arterial pressure in the non‐horizontal group. If the dorsalis pedis artery is to be used to measure direct arterial blood pressure, we recommend that readings be compared with an arm sphygmomanometer to avoid potentially dangerous hypotension being missed.
A survey of obstetric patients who refuse regional anaesthesia
Authors: Gajraj N. M. , Sharma S. K. , Souter A. J. , Pole Y. , Sidawi J. E.
Published: February 2007

One hundred obstetric patients presenting for elective surgery who had refused regional anaesthesia were interviewed just prior to entering the operating room. In each case, the reason for refusing a regional technique was recorded. The most frequent reasons given were fear of backache (33%) and fear of the needle (28%). Anaesthetists should be aware of patients’ concerns and be able to discuss the relevant issues.
Delayed amniotic fluid embolism following Caesarean section under spinal anaesthesia
Authors: Margarson M. P.
Published: February 2007

A case of amniotic fluid embolus is described with an acute onset occurring 90 min after surgical delivery in a mildly pre‐eclamptic primigravida undergoing Caesarean section for a breech presentation. Severe disseminated intravascular coagulation and massive postpartum haemorrhage were corrected and she went on to make a full recovery. The pathophysiology of amniotic fluid embolism is discussed and new diagnostic tests are reviewed. It is suggested that in this patient an amniotic fluid collection in dilated uterine veins was mobilised as venous tone returned following the offset of spinal anaesthesia and sympathetic blockade.
Peri‐operative assessment of glomerular permeability
Authors: De Gaudio A. R. , Piazza E. , Barneschi M. G. , Ginanni R. , Martinelli P. , Novelli G. P.
Published: February 2007

Surgical trauma may provoke an increase in glomerular permeability. Microalbuminuria is a subclinical increase in urinary albumin ranging from 20 to 300 mg.l‐1. This cannot be measured with routine laboratory tests and is estimated by radioimmunoassay. It has been proposed that microalbuminuria, an expression of increased glomerular permeability, serves to reflect a generalised increase in systemic vascular permeability. In this study the degree of microalbuminuria (expressed as microalbuminuria/creatinine ratio to correct for dilutional changes) has been measured in two groups of patients undergoing either videolaparoscopic surgery (group A) or conventional, open, abdominal surgery (group B). The anaesthetic technique was standardised and the duration of surgery similar in the two groups. A significant increase (p < 0.01) in the microalbuminuria I urinary creatinine ratio occurred in patients undergoing open abdominal surgery (group B). This alteration appeared 2 h after surgery but had disappeared 24 h after the end of the operation. During surgery, there was a direct relationship between glomerular permeability and the severity of the surgical insult.
Correct positioning of the epiglottis for application of the Brain laryngeal mask airway
Authors: Fukutome T.
Published: February 2007

Positioning of the epiglottis when the Brain laryngeal mask airway is in place was studied in 20 adult patients, using a new technique of insertion. The laryngeal mask was inserted when the anterior displacement of the mandible extended the epiglottis, thereby the providing an excellent airway in all patients. In 10 out of these 20 patients, the conventional technique of insertion revealed an incomplete extension of the epiglottis, and inadequate opening of the laryngeal inlet. It was concluded that the anterior displacement of the mandible during insertion of the laryngeal mask enhances the opening of the larynx, the result being an excellent airway.
Inhalation anaesthesia at the extremes of age: geriatric anaesthesia
Authors: CONZEN P. , PETER K.
Published: February 2007

No single anaesthetic technique is superior for all elderly patients, although the prognosis is improved if minor surgical procedures are performed with local anaesthesia rather than with general or major regional anaesthesia. If general anaesthesia is required, which specific inhalation anaesthetic can improve the prognosis of the geriatric patient? The low solubility of desflurane and its resistance to biodegradation would seem to recommend its use in the geriatric patient. However, these theoretical advantages remain to be adequately documented.
The use of bromothymol blue and sodium thiopentone to confirm tracheal intubation
Authors: DEAN V. S. , DINGLEY J. , VAUGHAN R. S.
Published: February 2007

The possibility of using chemical changes to confirm correct tracheal tube placement was investigated with a view to their use in developing countries where more sophisticated methods are unavailable. The effect of bubbling expired gases through a 10% solution of bromothymol blue and a 0.25% solution of thiopentone led to chemical changes producing, in the case of bromothymol blue, a colour change and in that of thiopentone, precipitation, probably due to a change in pH caused by carbon dioxide. We also discovered that the time to precipitation of the thiopentone could be greatly reduced if it was mixed with a precise quantity of lignocaine. These simple end points can reliably confirm the correct placement of a tracheal tube at least as rapidly as the correct use of capnography.
An evaluation of the levering laryngoscope
Authors: Tuckey J. P. , Cook T. M. , Render C. A.
Published: February 2007

This study was undertaken to evaluate the effect of the levering laryngoscope on the view obtained at laryngoscopv. Two hundred and ten consecutive patients who required tracheal intubation were studied. The view at laryngoscopy with the levering laryngoscope blade in the neutral and elevated positions was recorded. In patients in whom there was a Cormack and Lehane grade 3 view of the larynx with the blade in the neutral position, elevation of the levered tip of the blade significantly improved the visualisation of the larynx. In patients where the view of the larynx was grade 1 or 2 with the blade in the neutral position, elevation of the levered tip often (23%) resulted in the view being impaired. This was not a clinical problem as the blade could simply be returned to the neutral position. The levering laryngoscope is a useful additional aid to laryngeal visualisation.
Peri‐operative hypoxaemia in children undergoing application of a plaster jacket for scoliosis
Authors: LOVELL A. T. , RAY S. , FOX R. S. R. , TAYLOR V. M.
Published: February 2007

Twenty children (six female), median age 24 months (range 12–156) who presented for application of a plaster jacket for scoliosis were studied pre‐operatively with pulse oximetry overnight and on the first postoperative night. Pre‐operatively the median (range) arterial oxygen saturation was 97 (95–98)%, although eight children had short episodes of desaturation to <90%. Postoperatively the median saturation was unchanged, and nine children had short episodes of desaturation. Neither the presence of episodes of desaturation pre‐operatively, nor the median or lowest saturation recorded were predictors of postoperative median saturation or the presence of episodes of desaturation. Despite the presumed reduction in chest wall compliance, the application of a plaster jacket for scoliosis in these young children was not associated with a significant change in their oxygenation.