bluuebunny/crossref_metadata_2025 huggingface dataset:
A new technique for sleeve resection and major bronchial resection using twin catheters and high frequency jet ventilation
Authors: McKINNEY M. , COPPEL D. L. , GIBBONS J. R. , COSGROVE J.
Published: February 2007

A new anaesthetic technique that uses two catheters combined with high frequency jet ventilation for sleeve resection of the major bronchus and carina is described. The advantages and disadvantages are discussed and compared with other techniques.
An evaluation of the Stihler 1FT 200 blood warmer
Authors: WALTERS S. E. , WOOD C. , MORGAN M.
Published: February 2007

The performance of the Stihler IFT 200 blood warmer was evaluated at flow rates from 25 to 150 mil minute and compared with that of the Hetotherm and Fenwal warmers. The Fenwal proved to be an efficient apparatus at all flow rates but the performance of the Hetotherm fell off slightly at higher flow rates. The Stihler IFT 200 did not meet requirements for use in the operating room.
The influence of anaesthetic technique on metabolism of oral morphine
Authors: SHELLY M. P. , TAYLOR B. L. , QUINN K. G. , PARK G. R.
Published: February 2007

The pharmacokinetics of oral controlled release morphine were studied in 10 patients to investigate the effect of two different anaesthetic techniques on its absorption and metabolism. Five patients received general anaesthesia with neuromuscular blockade; the remainder received lumbar epidural analgesia with general anaesthesia but without neuromuscular blocking agents. Blood samples were collected throughout the peri‐operative period for estimation of plasma morphine concentration using two radio immunoassay techniques, one specific for morphine, the other less specific and crossreacting with morphine glucuronides. Plasma morphine concentrations with the specific method were similar for the two groups of patients but there was a statistically significant difference between the two groups with the less specific method at 30 and 45 minutes after induction of anaesthesia. This difference was because of the varying concentrations of morphine metabolites and may reflect the change in splanchnic blood flow produced by lumbar epidural analgesia.
Recovery and morbidity after daycase anaesthesia
Authors: MILLAR J. M. , JEWKES C. F.
Published: February 2007

The anaesthetic conditions, recovery and side effects for 48 hours postoperatively were compared after anaesthesia for day surgery using propofol or thiopentone‐enflurane with and without alfentanil. Propofol provided good conditions for surgery with faster immediate recovery (p < 0.001): patients who received it were fit for discharge significantly sooner (p < 0.001). Visual analogue scores of postoperative wellbeing showed an improvement in both propofol groups (p < 0.01]; after thiopentone and enflurane the scores were reduced and took 2 days to return to the pre‐operative values. There was a significant (p < 0.001) reduction in postoperative morbidity in both the groups that received propofol up to 24 hours after discharge. The addition of alfentanil improved anaesthetic conditions and reduced postoperative morbidity with both propofol and thiopentone–enflurane.
A comparison of the response of hand and facial muscles to non‐depolarising relaxants
Authors: PATHAK D. , SOKOLL M. D. , BARCELLOS W. , KUMAR V.
Published: February 2007

This study compares the response of the muscles of the hand to those of the face during non‐depolarising neuromuscular blockade. It was found that observation of the facial muscles was misleading both in terms of degree of neuromuscular blockade and adequacy of reversal.
Argyria or cyanosis
Authors: TIMMINSand A. C. , MORGAN G. A. R.
Published: February 2007

A case of argyria secondary to the prolonged use of nasal drops that contained mild silver protein is presented. The patient was thought to be cyanosed immediately after a total knee replacement. Argyria, its differentiation from cyanosis and its prevention are discussed. The need for a careful drug history is noted.
Phenytoin‐induced resistance to pancuronium
Authors: HICKEY D. R. , SANGWAN S. , BEVAN J. C.
Published: February 2007

A case report is presented of a patient receiving chronic phenytoin therapy who demonstrated resistance to pancuronium by increased hourly requirements. Stable neuromuscular blockade was achieved by atracurium infusion at normal rates. Possible explanations for the differences in response to the two non‐depolarizing muscle relaxants are discussed.
Minitracheotomy in children
Authors: ALLEN P. W. , HART S. M.
Published: February 2007

The successful management of sputum retention by minitracheotomy in two 12‐vear‐old patients is reported. Some advantages and potential problems are discussed. This is the first time that minitracheotomy has been reported in this age group.
The Downs' adjustable flow generator
Authors: FISHER G. C.
Published: February 2007

A venturi powered device for the generation of continuous positive airways pressure has been assessed. Some of its functional characteristics appear to be ideal, but the oxygen concentration and adequacy of flows require checking after each adjustment. A positive pressure relief valve and an inlet valve are necessary for the safe use of the system and an airway pressure monitor is recommended.
An evaluation of the incentive spirometer to improve lung function after cholecystectomy
Authors: O'Connor M. , Tattersall M. P. , Carter J. A.
Published: February 2007

Forty patients who underwent elective cholecystectomy were allocated randomly to one of two groups. Patients in one group used an incentive spirometer as part of their postoperative chest physiotherapy; those in the other received routine postoperative physiotherapy as dictated by their needs. Each group contained equal numbers of smokers and nonsmokers, and the data from each group were analysed separately. The use of the incentive spirometer did not confer any benefits as judged by clinical evidence of pulmonary complications, pulmonary function tests or length of hospital stay.
Recovery of neuromuscular function and postoperative morbidity following blockade by atracurium, alcuronium and vecuronium
Authors: KONG K. L. , COOPER G. M.
Published: February 2007

Recovery of neuromuscular function and postoperative morbidity were studied in 51 fit female patients who had nonemergency gynaecological laparoscopy as inpatients. They were allocated randomly to one of three groups to receive either atracurium 0.31 mg/kg, alcuronium 0.25 mg/kg, or vecuronium 0.06 mg/kg as part of an otherwise standard anaesthetic technique. There were neither differences in intubation conditions nor in the occurrence of postoperative diplopia whichever muscle relaxant was used. Deficits in grip strength and expiratory force were seen at one hour after reversal with atropine 1.2 mg and neostigmine 2.5 mg in all patients, deficits which persisted for 3 hours in those who received alcuronium. The recovery of inspiratory force, was slower and less complete at up to 3 hours in those who received alcuronium and there was a high incidence of minor postoperative morbidity at up to 24 hours in each of the three groups. The only statistical difference in symptomatic morbidity was an increase in muscle weakness in those who received alcuronium compared with atracurium at 3 hours after laparoscopy. Only 25Va, 20% and 31% of the patients who received atracurium, alcuronium and vecuronium respectively said that they would have liked to be day stay patients.
Comparison of propofol and methohexitone as anaesthetic agents for electroconvulsive therapy
Authors: DWYER R. , McCAUGHEY W. , LAVERY J. , McCARTHY G. , DUNDEE J. W.
Published: February 2007

Propofol was compared to methohexitone for induction of anaesthesia for electroconvulsive therapy. Seizures were significantly shorter after the use of propofol, in respect of both visible seizures and duration of cerebral electrical seizure activity. This suggests the possibility that additional treatments may be needed for the same clinical effect in psychiatric illness when propofol is used as the induction agent. Propofol was more effective than methohexitone at obtunding the hypertensive response to electroconvulsive therapy without causing significant hypotension.
Plasma catecholamine concentrations—changes after infiltration with local anaesthetic solutions and adrenaline during bat‐ear surgery
Authors: Lew J. K. L. , Mobley K. A. , Achola K. J. , Smith G.
Published: February 2007

Plasma catecholamine concentrations were measured in 12 patients who had bilateral bat‐ear surgery following infiltration of each ear with 2 ml 2% lignocaine with adrenaline 1: 100 000. Venous blood samples were withdrawn before and at set intervals after infiltration. Plasma adrenaline concentration increased from 0.8 pmol/ml to a peak of 2.2 pmol/ml at 2 minutes after infiltration: this is cm increase of 175%. There was no significant change in plasma noradrenaline concentration.
Propofol for induction of anaesthesia in children
Authors: MORTON N. S. , WEE M. , CHRISTIE G. , GRAY I. G. , GRANT I. S.
Published: February 2007

The induction characteristics, dosage requirements, cardiovascular and respiratory effects of propofol with added lignocaine were compared with those of thiopentone and halothane inhalational induction in two groups of children aged 1–5 years and 5–10 years. Propofol induction produced significantly greater decreases in blood pressure, particularly in the 1–5‐year age group. Heart rate was maintained well with all three induction techniques. Pain on injection into a vein on the dorsum of the hand was significantly more common with propofol despite the addition of lignocaine. However, this was mild in the majority of children and did not interfere with the induction of anaesthesia. The incidence of respiratory depression and other adverse effects was low with all three induction methods. The mean induction doses of both intravenous agents were greater in the 1–5‐year age group. The ratio of thiopentone to propofol dose was approximately 2.5:1 in both age groups. The high incidence of pain on injection with propofol may prove to be a significant drawback to its otherwise satisfactory use in children.
Anaesthesia for valvuloplasty
Authors: CHAFFE A. , FAIRBRASS M. J. , CHATRATH R. R.
Published: February 2007

Two years' experience of anaesthesia for percutaneous balloon valvuloplasty in children is presented and the problems associated with this procedure are discussed.
Reversal of sedation by prolonged infusion of flumazenil (Anexate, Ro 15–1788)
Authors: BODENHAM A. , BROWNLIE G. , DIXON J. S. , PARK G. R.
Published: February 2007

A 22‐year‐old male was involved in a road traffic accident and sustained multiple injuries. He received an infusion of midazolam to sedate him during a period of artificial ventilation. His conscious level remained depressed 36 hours after the infusion was discontinued but the sedation was completely reversed with flumazenil. An infusion was started because of the short duration of action of flumazenil, and continued for 8 days. The infusion was slopped seven times during this period and on each occasion except the last, his conscious level deteriorated but returned to normal when flumazenil was administered again. Plasma concentrations of midazolam and α‐hydroxymidazolam were measured and found to be low during this period. Possible explanations for this finding are discussed.
Overtransfusion as a possible cause of split skin graft loss
Authors: FRENCH G. W. G. , TOMLINSON P.
Published: February 2007

A child who underwent burns surgery received excessive transfusion of red blood cells during operation and subsequently suffered severe skin graft and donor site loss. The possible causes are discussed and hyperviscosity is suggested to be the most probable.
Anaesthesia for carbon dioxide laser laryngeal surgery in infants
Authors: HUNTON J. , OSWAL V. H.
Published: February 2007

Problems associated with the presence of a tracheal tube during anaesthesia for infant laryngeal surgery using the carbon dioxide laser are described. This paper discusses alternatives and describes an effective anaesthetic technique and a new tracheal tube.
Cuff failure in polyvinyl chloride tracheal tubes sprayed with lignocaine
Authors: WALMSLEY A. J. , BURVILLE L. M. , DAVIS T. P.
Published: February 2007

The incidence of tracheal tube cuff rupture was noted in 30 polyvinyl chloride tracheal tubes lubricated with three different solutions. All cuffs moistened with water were intact after 2 hours of cuff inflation whereas two of 10 lubricated with 4% lignocaine solution had burst. Both of these had leaked at the site of cuff attachment to the tube. Fifty percent of tubes lubricated with Astra lignocaine spray burst during the study. Four of the five had developed pinholes in the cuffs themselves. The remaining 50% of this group showed marked distortion and thinning of their intact cuff walls. The implications of these findings are discussed in view of the widespread use of PVC tracheal tubes.
Intra‐ocular pressure changes during induction of anaesthesia and tracheal intubation
Authors: MIRAKHUR R. K. , ELLIOTT P. , SHEPHERD W. F. I. , ARCHER D. B.
Published: February 2007

Intra‐ocular pressure was measured during induction of anaesthesia with propofol (n = 40) or thiopentone (n = 40) followed by vecuronium to facilitate tracheal intubation which was carried out 3 minutes after the administration of relaxant. The average induction doses were 2.15 and 4.83 mg/kg for propofol and thiopentone, respectively. Half the patients in each group received a supplementary dose of the same induction agent (propofol 1.0 mg/kg or thiopentone 20 mg/kg) prior to intubation. Both propofol and thiopentone produced a significant reduction in intra‐ocular pressure which decreased further after administration of vecuronium as well as the second smaller dose of the induction agents. Intra‐ocular pressure prior to intubation was lower in the two propofol groups in comparison to the corresponding thiopentone groups. Intubation was associated with an increase in intra‐ocular pressure but it still remained significantly below the baseline values except in the group given one dose of thiopentone. Supplementary doses of inducation agents before intubation attenuated the increase in intra‐ocular pressure. Propofol was significantly more effective this respect and this group showed the lowest intra‐ocular pressure throughout the study period. However administration of propofol resulted in a 30% incidence of pain on injection and a decrease in systolic arterial pressure of more than 30% in about half the patients.
Mood evaluation and outpatient anaesthesia
Authors: McDONALD N. J. , MANNION D. , LEE P. , O'TOOLE D. P. , O'BOYLE C. , KEANE P. K.
Published: February 2007

Mood state was evaluated in 40 unpremeditated patients who underwent minor gynaecological surgery, before and up to 4 hours after, anaesthesia induced with either propofol 2.5 mg/kg or thiopentone 5 mg/kg. Assessments were made by a self‐report technique, the profile of mood states method. The results indicate that mood state was less affected postoperatively in patients induced with propofol than with thiopentone. The overall impression of the investigators was that propofol patients had a definite sense of well‐being after anaesthesia.
Propofol for inpatient dental anaesthesia. A comparison of propofol as sole anaesthetic agent with thiopentone and halothane for inpatient dental anaesthesia
Authors: Hunter S. J. , McLaren C. A. B.
Published: February 2007

The induction, maintenance and recovery characteristics of propofol anaesthesia were compared with thiopentone induction and halothane maintenance in 51 spontaneously breathing, intubated patients who underwent dental surgery. Induction with thiopentone produced fewer side effects than propofol, notably pain on injection. Control of the depth of anaesthesia was better in patients who breathed halothane than in those who received intermittent bolus doses of propofol. Recovery characteristics of the two groups were similar.
A comparison of propofol and midazolam by infusion to provide sedation in patients who receive spinal anaesthesia
Authors: Wilson E. , Mackenzie N. , Grant I. S.
Published: February 2007

Twenty patients scheduled for orthopaedic surgery under spinal anaesthesia received by intravenous infusion either 1% propofol or 0.1% midazolam at a rate adjusted to maintain adequate sedation as judged on a five‐point scale. No other anaesthetic or analgesic drugs were given. The mean time to reach the required level of sedation was similar in both groups and the quality and ease of control of sedation were good in all patients. Mean infusion rates were 3.73 mg/kg/hour for propofol and 0.27 mg/hg/hour for midazolam. Airway maintenance was excellent and there were no side effects other than restlessness of the arms in one patient in each group. Recovery, judged by ability to open the eyes and recall date of birth, was significantly more rapid after propofol than after midazolam (2 and 10 minutes respectively after the end of infusion) and two patients in the latter group were unduly drowsy in the initial postoperative period. Pre‐ and postoperative amnesia were greater in the midazolam group but no patient had recall of peri‐operative events. Psychometric tests showed significantly better recovery of higher mental function after propofol for up to 2 hours after surgery.
‘Cured’ myasthenia gravis and neuromuscular blockade
Authors: LUMB A. B. , CALDER I.
Published: February 2007

A symptomless myasthenic patient who played representative squash received 0.1 mg/kg of vecuronium and enflurane as part of a general anaesthetic for elective gynaecological surgery. Neuromuscular block was prolonged. The effect of neuromuscular blocking agents and volatile anaesthetics in symptomless myasthenics is discussed. We conclude that these patients should be assumed to be sensitive to such agents.
Pupillary signs during cardiac surgery
Authors: WOODALL N. M. , MARYNIAK J. K. , GILSTON A.
Published: February 2007

Pupil sizes and reactions to light were studied in 100 patients who had cardiopulmonary bypass. Behaviour of the pupils was observed at six stages during the operation. Most patients (71) had pupils of equal size and similar reaction to light at all times. Twenty‐three patients developed unequal pupils at some stage, while six had equal pupils throughout but exhibited differing reaction to light. Major cerebral deficit was significantly more common after operation in patients who developed inequality in pupil size than those who did not (p < 0.05). No relationship was seen between dissimilar pupil reaction to light and the development of neurological complications. The clinical estimation of pupil size may help to identify those patients who may exhibit postoperative major neurological dysfunction.
Hyperosmolality due to antacid treatment
Authors: FARAJ J. H.
Published: February 2007

Magnesium trisilicate mixture is an antacid used commonly in our Intensive Care Unit in the prevention and treatment of stress ulcers. In this case the administration of large doses over a period of time led to the development of massive hyperosmolality, cerebral dehydration and coma. Management with hypotonic fluid resulted in complete recovery.
A plea for noradrenaline
Authors: STUART‐TAYLOR M. E. , CROSSE M. M.
Published: February 2007

Hypotension induced by nifedipine and chlorpromazine is discussed, together with the role of noradrenaline in the correction of this problem, which was resistant to other forms of therapy.
Effect of limb tourniquet on cerebral perfusion pressure in a head‐injured patient
Authors: ELDRIDGE P. R. , WILLIAMS S.
Published: February 2007

Thirty percent of patients with severe head injury also have significant extracranial injuries. Treatment for these injuries should not be allowed to jeopardise the brain which is more susceptible to damage in these circumstances. A case is presented in which significant decrease in cerebral perfusion pressure occurred consequent upon use of a lower limb tourniquet.
Pain relief after tonsillectomy Effect of benzydamine hydrochloride spray on postoperative pain relief after tonsillectomy
Authors: Valijan A.
Published: February 2007

The efficacy of benzydamine hydrochloride (Difflam) spray to relieve pain from postoperative tonsillectomy was assessed, but it was found that it did not relieve the symptoms after operation when compared to matching placebo.
Peripartum cardiomyopathy
Authors: LAVIES N. G. , TURNER D. A. B.
Published: February 2007

A case of peripartum cardiomyopathy that occurred together with pre‐eclampsia is described. This gave rise to pulmonary oedema at 36 weeks’ gestation. Intensive care management and the need for invasive monitoring, especially pulmonary artery wedge pressure, of patients who develop pulmonary oedema in the peripartum period is discussed.
Isoflurane and cerebrospinal fluid pressure—a study in neurosurgical patients undergoing intracranial shunt procedures
Authors: Campkin T. V. , Flinn R. M.
Published: February 2007

The effect of isoflurane 1.0% and 1.5% with nitrous oxide on ventricular cerebrospinal fluid pressure was studied in 17 patients who underwent intracranial shunt procedures. Isoflurane at both concentrations caused significant increases in cerebrospinal fluid pressure during normocapnic ventilation, but these could be prevented by simultaneous hyperventilation or by the prior induction of hypocapnia. Decreases in mean arterial pressure occurred also, and resulted in a significant reduction in cerebral perfusion pressure in normocapnic patients.
Intra‐operative collapse or death related to the use of acrylic cement in hip surgery
Authors: Duncan J. A. T.
Published: February 2007

Six intra‐operative deaths and two episodes of near‐fatal hypotension occurred in 52 consecutive Hastings procedures (insertion of metal prosthesis grouted in acrylic cement) for subcapital fracture of the femoral neck. This high complication rate was identified by a system of clinical audit undertaken by members of the anaesthetic department.
Propofol—fentanyl anaesthesia for coronary artery surgery and cardiopulmonary bypass
Authors: RUSSELL G. N. , WRIGHT E. L. , FOX M. A. , DOUGLAS E. J. , COCKSHOTT I. D.
Published: February 2007

A two‐stage propofol infusion combined with fentanyl was wed to maintain anaesthesia during coronary artery surgery in patients with good ventricular function. Whole blood propofol concentrations were measured at frequent intervals; plasma protein binding was measured before, during and after cardiopulmonary bypass. An initial infusion rate of 10 mg/kg/hour provided good protection from the pressor response to sternotomy. A predictable steady state concentration was achieved in the prebypass period with a maintenance infusion rate of 3 mg/kg/hour. The onset of bypass resulted in a small decrease in propofol concentration as a result of haemodilution. Induced hypothermia resulted in an increase in propofol concentration which returned rapidly to the prebypass steady state value during rewarming. The free propofol fraction increased during cardiopulmonary bypass. No patient had any recall of operative events or required inotropic support during weaning from bypass.
Respiratory arrest after a caudal injection of bupivacaine
Authors: LUMB A. B. , CARLI F.
Published: February 2007

A 3.5‐year‐old child with Cornelia de Lange syndrome presenting for orchidopexy and herniotomy received general anaesthesia which was supplemented by a caudal injection of bupivacaine. Shortly after this he had a respiratory arrest with fixed dilated pupils. No cardiovascular system instability was observed. Approximately one hour later the child made a rapid and complete recovery. The possible causes of these events are discussed with particular reference to the potential effects of caudal injections on intracranial pressure.
The Cyclops 33 radiation thermometer
Authors: RAMACHANDRA V. , ALLAN L. G. , CARLI F.
Published: February 2007

The Cyclops 33 is a portable infrared radiation thermometer. It has many potential advantages over existing thermometers in anaesthetic practice. The technical details are described and the benejits over other instruments discussed. This apparatus offers considerable scope for advance in the field of thermometry in anaesthesia.
Epidural fentanyl and perineal pain in labour
Authors: Reynolds F. , O'Sullivan G.
Published: February 2007

Perineal pain during the course of routine epidural analgesia with bupivacaine was treated with a 10‐ml top‐up of either bupivacaine 25 mg, fentanyl 100 μg or fentanyl 100 μg plus bupivacaine 10 mg, in 46 women in the first stage of labour. Only fentanyl plus bupivacaine produced consistently reliable analgesia which was quicker in onset and longer in duration (140, SD 26 minutes) than either fentanyl (114, SD 26 minutes) or bupivacaine (99, SD 44 minutes) alone. Side effects, itching and drowsiness, which were not troublesome, were more frequent in the groups given fentanyl.
Spinal anaesthesia in infants born prematurely
Authors: Gallagher T. M. , Crean P. M.
Published: February 2007

Spinal anaesthesia was used for 25 infants who were born prematurely and who subsequently required inguinal herniotomy. Hyperbaric bupivacaine 0.5% was administered in a dose of 0.3 mg/kg. Satisfactory surgical anaesthesia was achieved in 22 patients and there were no episodes of haemodynamic instability. The technique was not associated with postoperative apnoea. Spinal anaesthesia is a safe and effective alternative to general anaesthesia in these high‐risk infants. However, postoperative apnoea monitoring is still essential for all infants born prematurely.
‘Locked‐in’ syndrome
Authors: KENNY D. J. , LUKE D. A.
Published: February 2007

The ‘locked‐in’ syndrome has not previously been described in the immediate period after open‐heart surgery. We describe the case of a patient who remained tetraplegic and mute, but alert, after graft surgery. A brief review of the aetiological factors in the development of this type of stroke after coronary artery bypass is presented.
Atracurium overdose in a small infant
Authors: CHARLTON A. J. , HARPER N. J. N. , EDWARDS D. , WILSON A. C.
Published: February 2007

An error in setting a syringe driver caused a 2.75 kg infant to receive 37 mg atracurium over 75 minutes. Clinically full recovery of muscle power had returned spontaneously 135 minutes after the infusion was stopped. The child suffered no ill effects. Assay of blood and urine for atracurium and laudanosine conjirmed rapid clearance of the drug.
Hypoxaemia during outpatient dental anaesthesia
Authors: Allen N. A. , Rowbotham D. J. , Nimmo W. S.
Published: February 2007

Eighty children, ASA grade I, who had outpatient general anaesthesia for tooth extraction were studied. An inhalational induction was performed, with patients receiving halothane, niirous oxide and either 33% or 50% oxygen. Oxygen saturation was measured throughout the procedure using the Ohmeda Biox 3700 pulse oximeter. No Significant difference in the incidence of hypoxaemia was found between the two groups. There was no association between the grade of surgeon or anaesthetist and the incidence of hypoxaemia.
Anaphylaxis to latex during surgery
Authors: LEYNADIER F. , PECQUET C. , DRY J.
Published: February 2007

Five young women, all of whom had anaphylactic responses in operating units, are described. Three of them worked in a hospital, three showed immediate hyper sensitivity to fruit and all had known urticaria to latex. Anaphylaxis appeared progressively 15 to 30 minutes after injection of anaesthetic drugs. Skin tests with these drugs were negative. Skin prick tests through gloves and with four different allergen preparations (saline which had been incubated with gloves and three kinds of latex) were positive. Human basophil degranulation tests with all four allergens were positive and radio allergo sorbent tests to latex were also positive. IgE‐dependent allergy to latex may be investigated by questionnaire and if necessary by prick tests before each operation to prevent anaphylaxis due to surgical gloves.
Volatile agent use: perception and practice A survey of agent use over a 3‐year period
Authors: Tarpey J. , Lawler P. G.
Published: February 2007

We calculated the quantity, as MAC hours and MAC hours anaesthetic, of halothane, enflurane and isoflurane, used in this Health District over a 3‐year period. Halothane accounted for 77% of anaesthesia in the first year and for 57% in the final year. Overall usage of volatile agents decreased. Fifteen consultants and 19 senior registrars perceived, in a survey of practice, only a change in relative use of volatile anaesthetic agents with a large swing from halothane to both enflurane and isoflurane. Half the anaesthetists stated that the medicolegal consideration was the prime reason for their change. The perceived total demise of halothane does not appear to have been realised, despite individual anaesthetist's perceptions.
Opioid supplementation during propofol anaesthesia
Authors: MOFFAT A. C. , MURRAY A. W. , FITCH W.
Published: February 2007

Sixty patients of ASA grade 1 or 2 who presented for minor daycase gynaecological or urological procedures were randomly allocated to three groups. Group A received fentanyl 1 μg/kg and Group B alfentanil 5 μg/kg prior to induction. Group C received no pre‐induction opioid. Anaesthesia was induced intravenously with propofol and maintained using nitrous oxide 67% in oxygen supplemented with 20‐mg bolus doses of propofol as required. The pre‐induction administration of fentanyl or alfentanil was not found significantly to affect either the doses of propofol required for induction or maintenance or the quality of anaesthesia compared with propofol alone. These results suggest that for minor outpatient procedures under general anaesthesia, the concomitant use of a short‐acting opioid confers no benefits over propofol with nitrous oxide and oxygen alone.
A clinical study into the possible intrinsic bradycardic activity of vecuronium
Authors: COZANITIS D. A. , ERKOLA O.
Published: February 2007

Forty female patients received a standardised anaesthetic technique with thiopentone sodium and enflurane. Half of the patients received, under double‐blind conditions, either physiological saline or glycopyrronium before induction of anaesthesia; 10 minutes after induction of anaesthesia, all patients received vecuronium 0.1 mg/kg. A further 10 patients received neither glycopyrronium nor vecuronium. The results show that vecuronium per se does not produce a decrease in heart rate.
Comparison of anxiety before induction of anaesthesia in the anaesthetic room or operating theatre
Authors: SONI J. C. , THOMAS D. A.
Published: February 2007

Anxiety before induction of anaesthesia was studied in 100 patients who were allocated randomly to one of two groups. Patients in one group were anaesthetised in an anaesthetic room and those in the other group were anaesthetised inside the operating theatre. Both subjective and objective indices of anxiety were used in the comparison. Other factors that contributed to anxiety were assessed by a simple questionnaire. There was no significant difference in the level of anxiety between the two groups. The site of induction did not emerge as a major contributory factor to anxiety. The advantages and disadvantages of anaesthetic rooms are discussed.
Laryngeal mask anaesthesia for repair of cleft palate
Authors: BEVERIDGE M. E.
Published: February 2007

A method of anaesthesia for repair of cleft palate is described. The baby had Pierre Robin syndrome and tracheal intubation had proved to be impossible.
Delayed detection of hypoxic events by pulse oximeters: computer simulations
Authors: VERHOEFF F. , SYKES M. K.
Published: February 2007

There is a variable delay between a reduction in alveolar Po2 and the decrease in arterial oxygen saturation recorded on a pulse oximeter. The decrease in arterial oxygen saturation in response to disconnexion of a paralysed patient from the breathing system, oxygen supply failure with continued mechanical ventilation and disconnexion of the fresh gas supply to Mapleson D and circle absorption breathing systems were studied by simulations on the MacPuf computer model of the cardiorespiratory system. The simulations revealed that there were marked differences between the rate of arterial desaturation which resulted from each of the three types of oxygen supply failure and that arterial oxygen saturation may reach dangerous levels before a pulse oximeter alarm is activated.
The Bain, ADE, and Enclosed Magill breathing systems A comparative study during controlled ventilation
Authors: CRISWELL J. , McKENZIE S. , DAY S. , DISLEY J. , BRUCE W. E. , SONI N.
Published: February 2007

The Enclosed Magill, Humphrey ADE and the Bain breathing systems are all used for controlled ventilation of the lungs. This study compares the three systems in vitro with a lung model and in clinical practice. No difference was observed, with ventilatory variables commonly used in clinical practice, between the Bain and the ADE, while significantly lower end‐tidal carbon dioxide values were observed with the Enclosed Magill (about 7%). Lower fresh gas flows can be used under these circumstances to maintain normocapnia with the Enclosed Magill than either the Bain or the Humphrey ADE.
The chronotropic effect of acetylcholine in the presence of vecuronium and atracurium A study in the isolated perfused rabbit heart
Authors: BELLIS D. J. , DAY S. , BARNES P. K.
Published: February 2007

The bradycardia produced by 1 μg acetylcholine in the isolated perfused rabbit heart, in the presence of vecuronium and atracurium, was studied and compared with control. Vecuronium at a concentration of 2.5 μg/litre and atracurium 6 μg/litre did not enhance the negative chronotropic effect of acetylcholine. Atracurium produced a statistically significant inhibition of the negative chronotropic effect of acetylcholine.
Continuous brachial plexus blockade A technique that uses an axillary catheter to allow successful skin grafting
Authors: RANDALLS B.
Published: February 2007

An 82‐year‐old woman sustained a full thickness burn of her hand. A technique for producing anaesthesia of the brachial plexus via an indwelling catheter is described. Confirmation of the catheter position was obtained by X ray. Bupivacaine was infused via the catheter after operation to produce immobilisation of the hand to ensure multiple skin grafts would take. Consequent with this goal was excellent postoperative analgesia.
Unexpectedly extensive conduction blocks in obstetric epidural analgesia
Authors: MORGAN B.
Published: February 2007

Life‐threatening extensions of conduction block during obstetric epidural analgesia can be classified according to the risk to the mother. High blocks that occur in the presence of the anaesthetist should present a readily treatable problem. Reports of total spinal anaesthesia that occur with no anaesthetist in attendance call for a reappraisal of present practice. Changes in current anaesthetic practice, which might increase safety with epidural analgesia, are top‐ups by midwives, but only when the anaesthetist is on the delivery suite: repeated assessment of the nature of the conduction block by an anaesthetist: and continuous infusions with anaesthetist‐only top‐ups.
Paediatric postoperative analgesia A comparison of rectal diclofenac with caudal bupivacaine after inguinal herniotomy
Authors: Moores M.A. , Wandless J.G. , Fell D.
Published: February 2007

Forty‐three children for day case inguinal herniotomy under general anaesthesia were assigned randomly to receive either 1 ml/kg caudal bupivacaine 0.25% or rectal diclofenac 0.25 mg/kg intra‐operatively to provide postoperative analgesia. Pain and demeanour were assessed by an observer in the early postoperative period after operation and by questionnaire for the parents over the first 24 hours. Caudal bupivacaine provided more pain‐free patients at first but later the incidence of pain was similar in the two treatment groups. Rectal diclofenac is a useful alternative to caudal blockade in this group of patients.
Variables of patient‐controlled analgesia 4: the relevance of bolus dose size to supplement a background infusion
Authors: OWEN H. , KLUGER M. T. , PLUMMER J. L.
Published: February 2007

A range of self‐administered demand doses of morphine (0.4, 0.7 and 1.0 mg) were prescribed to supplement a fixed‐rate infusion (1.5 mg/hour) for pain control after gynaecological surgery. The number of demand doses administered during the first 25 hours after surgery was not significantly influenced by size of demand dose. There was a significant linear trend to increasing amount of demanded morphine with increasing bolus size. These results cast doubt on the usefulness of the concept of a minimum effective analgesic concentration of morphine.
Pharmacokinetics of glycopyrronium in parturients
Authors: ALI‐MELKKILÄ T. , KAILA T. , KANTO J. , IISALO E.
Published: February 2007

A sensitive radioreceptor assay was used to determine the pharmacokinetics of glycopyrronium 6 μg/kg after intramuscular (deltoid muscle) administration in eight Caesarean section patients. A fast absorption rate was found with a mean maximum plasma concentration (Cmax of 6.3 (SD 1.5) ng/ml, a mean time to Cmax (Tmax) of 10.0 (3.8) minutes and the elimination half‐life (Tl of 33.4 (1.92). The respective AUC0–8 h value was 5.61 (1.27) hours ng/ml. This dose produced a significant increase in the maternal heart rate after 10 minutes (p < 0.05) and an antisialogogue effect after 30 minutes (p < 0.05) of the drug injection. Almost half of drug (48.3%) was excreted into the urine within 3 hours. There were no measurable levels of glycopyrronium in the lumbar cerebrospinal fluid (CSF) after 60 minutes of drug injection. The concentrations of glycopyrronium in the umbilical venous (0.28 (0.25) ng/ml) and in the umbilical arterial (0.18 (0.11) ng/ml) plasma after 86 minutes of drug injection were low and clinically insignificant, as was the case in the amniotic fluid (0.15 (0.08) ng/ml).
Tracheal intubation under fluoroscopic control X ray‐guided orotracheal intubation in three cases of impossible direct laryngoscopy
Authors: Innocente F. , Ori C. , Giron G. P.
Published: February 2007

Three patients are described in whom it was impossible to visualise the larynx at direct laryngoscopy. Tracheal intubation was successfully and rapidly achieved with the aid of continuous fluoroscopy.
Epidurography in premature infants
Authors: NIEKERK J. VAN , BAX‐VERMEIRE B. M. J. , GEURTS J. W. M. , KRAMER P. P. G.
Published: February 2007

A caudal epidural catheter was inserted in 20 premature, high risk infants for abdominal or thoracic surgery under combined caudal epidural and general anaesthesia. Epidurography was used to confirm the position of the catheter which was found to be misplaced in three patients. The catheter penetrated the dura in one case, in another the tip was located in an epidural vessel and in the third the catheter was seen to be curled up within the epidural space. It was concluded that epidurographic control is essential with this method of anaesthesia in very small infants, in whom it was found to provide considerable advantages despite serious risks.
Withdrawal syndrome after propofol infusion
Authors: AU J. , WALKER W. S. , SCOTT D. H. T.
Published: February 2007

We report a case of classical general depressant withdrawal syndrome that culminated in grand mal convulsions, in a patient who received propofol infusion for sedation after cardiac surgery.
Prolonged neuromuscular blockade with vecuronium in a neonate with renal failure
Authors: HAYNES S. R. , MORTON N. S.
Published: February 2007

An 11‐day‐old neonate with renal failure caused by dysplastic kidneys was anaesthetised with thiopentone, vecuronium, nitrous oxide and oxygen, for insertion of a long‐term peritoneal dialysis catheter. Complete neuromuscular block of 210 minutes’duration ensued after the initial dose of vecuronium (97 μg/kg). Partial block persisted for a further 30 minutes. The prolonged neuromuscular block in this case may have been because of proportionately greater dependence on renal clearance of vecuronium in neonates.
Alkalinisation of prilocaine for intravenous regional anaesthesia
Authors: ARMSTRONG P. , BROCKWAY M. , WILDSMITH J. A. W.
Published: February 2007

Ten volunteers underwent intravenous regional anaesthesia on two separate occasions using 40 ml prilocaine 0.5% to which was added 5 ml of either saline 0.9% or sodium bicarbonate 8.4%. Addition of sodium bicarbonate decreased the time of onset of loss of sharp touch and temperature sensations and of motor power. Time to full recovery of the arm was slower with the alkalinised solution and nine of the subjects preferred this block. The addition of sodium bicarbonate to prilocaine for intravenous regional anaesthesia may be clinically useful.
‘Leopard’ syndrome
Authors: RODRIGO M. R. C. , CHENG C. H. , TAI Y. T. , O'DONNELL D.
Published: February 2007

‘Leopard’ syndrome is a rare inherited disorder associated with a high prevalence of cardiac abnormalities. General anaesthesia for dental treatment in a patient who had cardiomyopathy and bizarre electrocardiographs abnormalities associated with this syndrome is described. A thorough cardiac assessment is advised in a patient with multiple lentigines, although no clinical symptoms or signs may be found. Even if no cardiac abnormality is found before it is better to re‐assess the patient, since abnormalities may develop later. The assessment should be repeated if any abnormality was detected before but without clinical significance, since the disease is progressive and may progress more rapidly in some patients than in others.
Acute infective airway obstruction associated with subglottic stenosis
Authors: PHILLIPS J. J. , SANSOME A. J.
Published: February 2007

Pre‐existing subglottic stenosis in a 22‐month‐old child with laryngotracheobronchitis resulted in failure to intubate the trachea on the intensivé therapy unit. Tracheostomy was necessary in the operating theatre to secure the airway. The implications for safe management are discussed.
Behaviour of small children before induction. The effect of parental presence and EMLA and premedication with triclofos or a placebo
Authors: PAGE B. , MORGAN‐HUGHES J. O.
Published: February 2007

The effect of the prescription of triclofos 70 mg/kg orally 90 minutes before operation on the behaviour of 263 children aged 1 to 5 years was studied in a blind, randomised, placebo‐controlled trial. EMLA was applied to the dorsum of one hand when the premedication was administered, and all the children were accompanied by a parent during induction of anaesthesia. The frequency of satisfactory behaviour was significantly higher in the triclofos group (p < 0.02), but the time spent in the recovery ward was increased.
Blood contamination of anaesthetic and related staff
Authors: HARRISON C. A. , ROGERS D. W. , ROSEN M.
Published: February 2007

The incidence of skin contamination of anaesthetic and related staff by patient's blood and saliva was studied during 270 anaesthetics in Cardiff hospitals over seven continuous days in October 1989. A survey was also made of current Hepatitis B immunisation status and glove‐wearing habits of 75 anaesthetists. Blood from 35 (14%) patients caused skin contamination of 65 staff during 46 incidents. Twenty‐eight (61%) of the contamination incidents occurred during vessel cannulation. Five (8%) of the 65 staff contaminated by blood already had cuts on their hands. There were nine incidents (4%) of skin contamination by saliva. Fifty‐three (71%) anaesthetists were immunised against Hepatitis B. Only seven (9%) anaesthetists wear gloves for oral or nasal intubation, six (8%) for insertion of peripheral venous cannulae, 47 (63%) for insertion of arterial lines and 67 (89%) for insertion of central lines. All anaesthetic and associated staff should wear gloves on a routine basis.
Treatment of atelectasis of upper lung lobes. Selective bronchial suctioning with J‐shaped catheter tip and guide mark
Authors: KUBOTA Y. , TOYODA Y. , KUBOTA H. , ASADA A. , UEDA Y. , HIROTA Y.
Published: February 2007

We developed a technique for blind bronchial suction using a curved‐tip catheter with a guide mark, for the treatment of atelectasis of the lower and middle lobes of the lung. Suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design. We treated successfully two cases of atelectasis of the right upper lobes using a Rusch Metras bronchography catheter with a guide mark which is not readily available. Therefore we devised a J‐shape tipped catheter with a guide mark. We have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter.
Mechanical ventilation during low‐flow anaesthesia. Experience with an alternative to the bag‐in‐bottle
Authors: BERNTMAN L. , LUTTROPP H. H. , WERNER O.
Published: February 2007

Clinical experience with low‐flow anaesthesia during controlled ventilation of the lungs is described. The anaesthesia circle is separated by a corrugated hose that serves as a large deadspace. This open connexion has no bellows or overflow valve and therefore the risk of mechanical dysfunction is small. No mixing of circle and ventilator gas occurs during normal operation. Major decreases in the oxygen concentration in the system are unlikely even if the fresh gas flow is interrupted or significant leaks from the circle occur because 100% oxygen is delivered by the ventilator. A hose volume larger than 1650 ml prevented gas mixing at tidal volumes of 380–1170 ml. There was no system‐related mishap in over 600 patients, who comprised about 40% of the neurosurgical patients anaesthetised during that period. The cost of isoflurane was reduced to about 33% of that incurred during previous periods.
Anaesthesia for cardioversion. A comparison between propofol, thiopentone and midazolam
Authors: Gupta A. , Lennmarken C. , Vegfors M. , Tydén H.
Published: February 2007

This study compares the induction and recovery characteristics, haemodynamic changes and side effects of propofol, thiopentone and midazolam when used as the anaesthetic agents for cardioversion. Recovery after midazolam was significantly longer (p < 0.05) than with either thiopentone or propofol. There was no difference in the recovery times between thiopentone and propofol. There was a significant decrease in mean arterial pressure 2 minutes after induction with propofol and midazolam. Three patients each in the thiopentone and propofol groups needed assisted ventilation because of apnvea, and four patients each in the propofol and midazolam groups had low Spo2 values (<95%). Flumazenil was used to reverse the effects of midazolam in eight patients and five of these were still drowsy 4 hours after the procedure. This study indicates that thiopentone is the most satisfactory agent for anaesthesia for cardioversion.
Posture and epidural catheter insertion. The relationship between skill, experience and maternal posture on the outcome of epidural catheter insertion
Authors: STONE P. A. , KILPATRICK A. W. A. , THORBURN J.
Published: February 2007

This study was undertaken to investigate the outcome of epidural catheter insertion in the sitting or lateral position in mothers during labour. An initial prospective randomised study period (144 patients) suggested that the sitting position offered some superiority over the lateral in terms of technical ease of insertion. It was concluded, by minimising the subjective aspects in a follow‐up, prospective nonrandomised study period (152 patients), that the determining factor lies in the skill and experience of the anaesthetist. There was no significant difference in complication rates or maternal discomfort between the two positions in either study period.
Long‐term patient‐controlled analgesia in children
Authors: MOWBRAY M. J. , GAUKROGER P. B.
Published: February 2007

Three children who received patient‐controlled analgesia for periods of up to 41 days are described. In each case patient‐controlled analgesia allowed pain control to be achieved in difficult situations. No patient developed tolerance or clinical signs of dependence. This use of long‐term patient‐controlled analgesia warrants further evaluation.