bluuebunny/crossref_metadata_2025 huggingface dataset:
Respiratory depression in children at different end tidal halothane concentrations
Authors: LINDAHL S. G. E. , YATES A. P. , HATCH D. J.
Published: February 2007

Respiratory motor function and timing were investigated at end tidal halothane concentrations of 1.5%, 1.0% and 0.5% before and during 4% carbon dioxide stimulation in 10 spontaneously breathing children who weighed between 10.2 and 25.2 kg, during hypospadias repair under halothane anaesthesia. Their tracheas were intubated and all received a caudal block to eliminate surgical stimulation. Pneumotachography and capnography were used and in three cases movements of ribcage and abdomen were also studied by magnetometers. Respiratory drive was evaluated by occlusion tests. Ventilation was depressed at an end tidal halothane concentration of 1.5%, with smaller tidal volumes, higher respiratory rates, higher end tidal carbon dioxide tensions and a weaker respiratory drive compared with 1.0% and 0.5% halothane. Paradoxical breathing was noted at 1.5% as well as at 1.0% but not at 0.5% halothane anaesthesia; the ribcage moved inwards during inspiration. Respiratory compensation during periods of 4% carbon dioxide stimulation was inadequate at 1.5% halothane, as indicated by higher end tidal carbon dioxide tensions, less negative occlusion pressures and movements of ribcage and abdomen that were unresponsive to 4% carbon dioxide, when compared with 1.0% and 0.5% halothane. Respiratory rates were higher and duration of inspiration longer at 1.5% than at 1.0% and 0.5% halothane. Respiratory timing was unaltered by carbon dioxide stimulation. It is concluded that the ventilatory motor response to carbon dioxide is dose dependent and improves at more superficial anaesthetic levels, while respiratory timing is unresponsive to carbon dioxide stimulation irrespective of the halothane concentration used. Paradoxical breathing existed at end tidal halothane concentrations higher than 1%.
Comparison of the haemodynamic effects of intermittent positive pressure ventilation with high frequency jet ventilation
Authors: SHERRY K. M. , WINDSOR J. P. W. , FENECK R. O.
Published: February 2007

The cardiorespiratory effects of intermittent positive pressure ventilation and high frequency jet ventilation with and without positive end expiratory pressure were compared in patients following valvular heart surgery (mitral and/or aortic). Twenty patients received intermittent positive pressure ventilation and high frequency jet ventilation with 0. 0.5 and 1.0 kPa positive end expiratory pressure. High frequency jet ventilation was well tolerated. The addition of 1.0 kPa positive end expiratory pressure was associated with preservation of the arterial oxygen tension without any increase in shunt or significant adverse haemodynamic effect. The results are discussed and compared with a previous study of high frequency jet ventilation following aortocoronary bypass graft surgery.
Prolonged bradycardia and hypotension after neostigmine administration in a patient receiving atenolol
Authors: ELDOR J. , HOFFMAN B. , DAVIDSON J. T.
Published: February 2007

A 78‐year‐old woman admitted for an elective hip operation was maintained on atenolol for control of her hypertension. She received neostigmine and atropine for reversal of muscle relaxation at the end of general anaesthesia. She then developed prolonged bradycardia and hypotension which necessitated the use of adrenaline and isoprenaline. Such an adverse reaction with atenolol has not been described previously.
Protocols in obstetric units: their use in Wales in 1983 *
Authors: Owen B.
Published: February 2007

The Welsh Perinatal Mortality Initiative carried out an extensive enquiry into perinatal deaths in Wales between 1984 and 1986 and their report was published by the Secretary of State for Wales in December 1986. One aspect examined was the obstetric anaesthetic service and a comprehensive questionnaire was sent to all obstetric units where Caesarean sections are carried out. One of the questions was on the use of protocols in obstetrics and the results presented are disappointing.
Minimum fresh gas flow requirements of anaesthetic breathing systems during spontaneous ventilation: a graphical approach
Authors: DORRINGTON K. L. , LEHANE J. R.
Published: February 2007

A general solution is presented to the problem of finding the minimum fresh gas flow requirements, during spontaneous ventilation, of anaesthetic breathing systems in the Mapleson classification. The solution is applicable to any pattern of breathing, dead space volume and tidal volume. The method is graphical and its use and understanding require no mathematical skills. However, if an analytical form of the respiratory waveform is known, the method is easily extended by use of calculus to obtain a precise analytical solution.
A laryngoscope adaptor for difficult intubation
Authors: YENTIS S. M.
Published: February 2007

Tracheal intubation may be hindered by difficulty in insertion of the laryngoscope blade into the patient's mouth because the handle impinges on the patient's chest or on the hand of an assistant applying cricoid pressure. An adaptor is described which modifies the standard Penlon laryngoscope to enable lateral swivelling of the handle, thus avoiding the obstruction.
Removal of a giant ovarian cyst
Authors: MORRISON P. , MORGAN G.
Published: February 2007

Excision of a giant ovarian cyst may be associated with considerable mortality. Problems stem from the size of the cyst and the emaciated state of the patient. We describe a case in which the patient's preoperative nutritional and psychological state required attention. Gradual pre‐operative drainage of a cyst weighing 113 kg was carried out successfully. The main problems intra‐operatively stemmed from copious blood loss and the duration of surgery. Postoperatively, ventilatory inadequacy occurred and was probably caused by altered mechanies of ventilation, postoperative pain and pulmonary oedema. We suggest ways in which the management of such cases might be improved.
The morphine sparing effects of diclofenac sodium following abdominal surgery
Authors: Hodsman N. B. A. , Burns J. , Blyth A. , Kenny G. N. C. , McArdle C. S. , Rotman H.
Published: February 2007

A randomised, double‐blind placebo controlled study was undertaken to assess the analgesic efficacy of diclofenac. Following major abdominal surgery and 12 hours later, patients received either placebo or diclofenac 75 mg intramuscularly and their cumulative morphine requirements administered by a patient‐controlled system over 24 hours were compared. Pain scores were also measured. Arterial blood gases and coagulation studies were assessed pre‐ and postoperatively. Morphine consumption was significantly greater in the placebo group (59.5 compared to 38.5 mg, p < 0.01). Pain scores were significantly lower in the diclofenac group at 4 hours, but not thereafter. Arterial carbon dioxide was significantly increased in the control groups. There was no significant change in platelet count within each group, but a significant difference between the groups (p < 0.05).
Anatomical re‐evaluation of lumbar dura mater with regard to postspinal headache
Authors: DITTMANN M. , SCHÄFER H.‐G. , ULRICH J. , BOND‐TAYLOR W.
Published: February 2007

The effects of puncture of fresh cadaver dura with 20‐, 22‐, 26‐ and 29‐gauge needles were observed. A ‘tin‐lid’ phenomenon, manifested with all needle sizes, was capable of sealing the resultant hole. The larger the needle, the larger the hole, while rotation of the needle bevel 90° to the fibres altered the shape of the hole. Holes made in thicker parts of the dura tended to retract more rapidly than those in thinner areas.
Spread of radiopaque dye in the thoracic epidural space
Authors: SLAPPENDEL R. , GIELEN M.J.M. , HASENBOS M.A.W.M. , HEYSTRATEN F.M.J.
Published: February 2007

A radiological study was performed in 23 patients to look for the position of thoracic epidural catheters and the spread of the contrast medium iohexol 300 mg/ml and 180 mg/ml when used in volumes of 3 and 8 ml. The dye was injected through the epidural catheter just after thoracic surgery. The spread of the dye showed no relation to the injected volume or the sensory spread after 2% lignocaine 3 ml. In three cases no contrast could be seen on the X ray, and in two the radiopaque dye was found just outside the epidural space. No relationship between the spread of the dye and the sensory blockade was found, but the position of the epidural catheter should be checked radiographically when the epidural route is to be used for long‐term pain relief.
Where there is no laryngoscope
Authors: O'DONOHOE B. P. , PAGE R. J. E. , AWINI C.
Published: February 2007

In hospitals of the developing world where financial constraints limit the procurement of even the most basic medical equipment, improvisation has become important and necessary. We describe a reliable, low‐cost, locally produced laryngoscope constructed out of wood.
The Alcock chloroform vaporizer
Authors: ZUCK D.
Published: February 2007

A long‐forgotten chloroform inhaler, probably the first accurately calibrated, temperature compensatable, plenum vaporizer, is described. Its place in the dosimetric movement at the beginning of the 20th century is considered, together with a brief account of the life of its designer.
Hypoxaemia during induction of anaesthesia—an audit of children who underwent general anaesthesia for routine elective surgery
Authors: Laycock G.J.A. , McNicol L.R.
Published: February 2007

Arterial oxygen saturation was measured using pulse oximetry during induction of anaesthesia in 108 children aged 10 days‐14 years. No restriction was placed on the method of induction. Oxygen saturation decreased to less than 90% in 29 children (26.8%) and less than 80% in seven children (6.4%). There was a significantly increased incidence of desaturation (to less than 90%) in children under one year of age, in those who had no premedication, in those who received only atropine as a premidicant and in children who were anxious or crying before intravenous induction. Oxygen saturation did not decrease below 90% in any child who received inhalational induction.
Hapten inhibition and dextran anaphylaxis
Authors: LJUNGSTRÖM K.‐G. , RENCK H. , HEDIN H. , RICHTER W. , WIHOLM B.‐E.
Published: February 2007

Hapten inhibition with dextran 1 has been used in Sweden since 1982 to prevent severe anaphylactic reactions to dextran. This has led to a reduction in the reports of severe reactions to dextran from 22 per 100 000 units of dextran used between 1975 and 1979, to 1.2 per 100 000 units between 1983 and 1985. The number of fatal reactions decreased from 23 to one. More than 600 000 units of dextran were used during each period.
Sufentanil to supplement nitrous oxide in oxygen during balanced anaesthesia
Authors: O'CONNOR M. , SEAR J. W.
Published: February 2007

Sufentanil in doses of 0.4 and 1.0 μg/kg was used as an analgesic supplement to nitrous oxide‐oxygen anaesthesia in 28 patients whose lungs were ventilated during body surface or lower abdominal surgery. Significant decreases in arterial blood pressure followed drug administration (mean 35.6%). Decreases in arterial pressure of greater than 30% occurred in 5 out of 14 patients in the low dose group, and 12 out of 14 in the high dose sufentanil group. There was a blunting of the pressor response to laryngoscopy and intubation after sufentanil. Increases in blood pressure were seen in both treatment groups at the onset of surgery. The peak responses were 27% increase in mean arterial pressure in the low dose group, and 51% increase in the 1.0 μg/kg group. There was however no significant change in heart rate. Fourteen patients (8 in the low dose group) required volatile supplementation during surgery for clinical signs of inadequate anaesthesia. This occurred between 21 and 70 minutes after sufentanil administration, and plasma drug concentrations 0.06 and 0.54 ng/ml. Tracheal extubation was successfully achieved at the end of surgery in 26 out of 28 patients at plasma sufentanil concentrations which ranged from 0.03 to 0.37 ng/ml. The two remaining patients, neither of whom had received additional volatile supplementation, required naloxone to overcome postoperative ventilatory depression. No cases of intra‐operative awareness were noted.
Insulin treatment of the insulin‐dependent diabetic patient undergoing minor surgery
Authors: CHRISTIANSEN C. L. , SCHURIZEK B. A. , MALLING B. , KNUDSEN L. , ALBERTI K. G. M. M. , HERMANSEN K.
Published: February 2007

In a prospective randomised study in 20 insulin‐dependent diabetics who had minor surgery under general anaesthesia we compared the metabolic responses to intravenous glucose‐insulin‐potassium infusion with those who had conventional subcutaneous insulin administration. The former treatment resulted in lower blood glucose levels both during the infusion period (p < 0.05) as well as the entire observation period (operative, first and second postoperative days; p < 0.01). More blood glucose values were within the intended range of 5 to 10 mmol/litre in the glucose‐insulin‐potassium as compared to the conventional group (48% versus 24%; p < 0.01). The levels of lactate, 3‐hydroxybutyrate, glycerol, alanine, glucagon, insulin and growth hormone did not differ between the two groups. The infusion regimen resulted in better glycaemic control both peri‐and postoperatively than the conventional subcutaneous insulin regimen in insulin‐dependent diabetic patients who have minor surgery.
Diabetes mellitus and anaesthesia
Authors: DUNNET J. M. , HOLMAN R. R. , TURNER R. C. , SEAR J. W.
Published: February 2007

A variety of methods are currently available for the management of the diabetic patient in the peri‐operative period. A questionnaire about current clinical practice was sent to all anaesthetists in the Oxford region. The majority reported that minor surgery in both insulin treated and noninsulin treated diabetic patients warranted no intervention other than avoidance of meals and medication before surgery, and that, for major surgery, a glucose‐insulin‐potassium infusion should be used. Fifty one out of 71 respondents in the junior staff grades preferred this latter approach for intermediate surgical procedures in insulin treated patients compared with 27 out of 69 of the consultant staff. Most anaesthetists aimed for blood glucose levels of 7–13 mmolilitre in the peri‐operative period. The literature is also reviewed.
Respiratory criteria of fitness for surgery and anaesthesia
Authors: NUNN J. F. , MILLEDGE J. S. , CHEN D. , DORE C.
Published: February 2007

A retrospective analysis has been undertaken of 53 operations in 42 patients with severe chronic obstructive airway disease. All patients had a forced expiratory volume in 1 second between 0.3 and 1 litre, but the outcome of surgery was successful after their first operations, all of which were elective; 38 of the 42 had uneventful anaesthesia and surgery together with a normal postoperative period, while four had artificial ventilation of the lungs. The best predictors of the use of postoperative ventilation were the arterial Po2 and whether the patient was dyspnoeic at rest.
Complete heart block during anaesthesia in a patient with sarcoidosis
Authors: THOMAS D. W. , MASON R. A.
Published: February 2007

An apparently fit voting man with sarcoidosis developed complete heart block during an emergency mastoidectomy. A temporary transvenous pacemaker was inserted, but permanent pacing was required in the postoperative period. The clinical and pathological features of cardiac sarcoidosis are described; complete heart block is the commonest presentation of cardiac involvement. The role of anaesthesia as the precipitating factor in this case is discussed.
Postoperative sore throat related to the use of a Guedel airway
Authors: Browne B. , Adams C. N.
Published: February 2007

Eighty‐eight patients in ASA classes 1 or 2 and aged between 18 65 years, who were to undergo anaesthesia, were allocated randomly to a group with or without an airway. Methohexitone, nitrous oxide, alfentanil and enflurane were used, with the patients breathing spontaneously. This study showed that there was no significant difference between the two groups in the incidence of sore throat, or any other related symptom, and concludes that the use of an oropharyngeal airway does not increase morbidity among nonintubated patients.
Macroglossia and posterior fossa disease
Authors: MOORE J. K. , CHAUDHRI S. , MOORE A. P. , EASTON J.
Published: February 2007

We describe five eases of macroglossia in patients with posterior fossa disease and suggest that the primary mechanism is neurogenically determined rather than one of vascular obstruction or local trauma.
Effect of propofol on cerebrospinal fluid pressure and cerebral perfusion pressure in patients undergoing craniotomy
Authors: RAVUSSIN P. , GUINARD J. P. , RALLEY F. , THORIN D.
Published: February 2007

The effects of propofol on cerebrospinal fluid pressure, mean arterial pressure, cerebral perfusion pressure and heart rate were studied during induction, tracheal intubation and skin incision in 23 patients scheduled for elective craniotomy. Premeditation consisted of midazolam 0.1 mg/kg intramuscularly and metoprolol 1 mg/kg orally. Measurements were made or derived at time zero and 0.5, 1, 1.5, 2 and 3 minutes after an induction dose of propofol 1.5 mg/kg. A continuous infusion of propofol was started at time zero at a rate of 100 mg/kg/minute. Fentanyl 2 μg/kg was added before tracheal intubation, application of the pin head holder and skin incision. Cerebrospinal fluid pressure and mean arterial pressure decreased significantly 2 minutes after propofol alone, by 32% and 10% respective/y, while a cerebral perfusion pressure above 70 mmHg was maintained. Heart rate did not change. Propofol combined with moderate dose of fentanyl, obtunded the usual cerebrospinal fluid and arterial pressure responses to intubation and other noxious stimuli. Thus propofol seems to be a suitable intravenous anaesthetic agent for induction and maintenance in neuroanaesthesia.
Propofol anaesthesia alters somatosensory evoked cortical potentials
Authors: MAURETTE P. , SIMEON F. , CASTAGNERA L. , ESPOSITO J. , MACOUILLARD G. , HERAUT L. A.
Published: February 2007

This study evaluated the effects of propofol on somatosensory evoked cortical potentials in 20 ASA grade 1 or 2 patients who underwent spinal surgery. Anaesthesia consisted of propofol, dextromoramide, 50% nitrous oxide and oxygen mixture. The induction dose of propofol was 2 mg/kg and was followed by an infusion of 6 mg/kg for the first hour and 3 mg/kg subsequently. Somatosensory evoked cortical potentials were recorded on the scalp and compared to pre‐operative values using Student's paired t‐test. We observed a significant depression of evoked potential 10 minutes after induction, which continued until the early phase of recovery. Because of its short and quickly reversible action, propofol is an acceptable agent when clinical monitoring of the spinal cord is indicated but is not satisfactory when monitoring has to he based on somatosensory cortical evoked potentials.
Multicentre study of propofol in day case surgery
Authors: Sanderson J. H. , Blades J. F.
Published: February 2007

An open multicentre study that involved 879 patients was set up after the launch of propofol to examine its use outside of the clinical trial programme and within the context of a routine clinical setting. Propofol was assessed as the main anaesthetic agent for a range of day case surgery that included gynaecological, urogenital, body surface, orthopaedic and dental procedures. For the purposes of the study, supplementary agents were restricted to fentanyl, alfentanil or nitrous oxide; no volatile anaesthetics were allowed. Induction of anaesthesia was smooth; 91.6% of patients experienced no excitatory or other adverse effect. The mean duration of anaesthesia was 12 minutes 12 seconds and the mean dosage of propofol was 10.6 mg/kg/hour. Maintenance was uneventful in the large majority of patients. Pain on injection affected approximately 25% of patients and the incidence was reduced when large veins were used for injection. Recovery was rapid with a short interval of approximately 1 minute between awakening and orientation (time to giving correct date of birth). There was a low incidence of postoperative nausea and vomiting.
Intubation under induction doses of propofol
Authors: Keaveny J. P. , Knell P. J.
Published: February 2007

Twenty patients, ASA grades 1 and 2, aged 18–65 years were admitted to an open study to investigate the ease of tracheal intubation after induction of anaesthesia with propofol without the use of muscle relaxants after the chance observation that propofol 2.5 mg/kg allowed easy laryngoscopy and tracheal intubation. Satisfactory intubation conditions were achieved in 19 patients.
Recovery times and side effects after propofol infusion and after isoflurane during ear surgery with additional infiltration anaesthesia
Authors: Ledderose H. , Rester P. , Carlsson P. , Peter K.
Published: February 2007

Two anaesthetic procedures that did not include nitrous oxide were compared in a randomised study of 50 patients for tympanoplasty and tympanoscopy: propofol given for induction and maintenance, and thiopentone‐isoflurane given for induction and maintenance, respectively. Induction in the first group was with a bolus injection of propofol and the same agent was given for the duration of anaesthesia by continuous intravenous administration. Thiopentone was given until loss of the eyelash reflex and anaesthesia maintained with isoflurane 0.4–2.0%. Analgesia was achieved in both groups by fentanyl given intravenously and by local injection of mepivacaine with ornipressin. The two patient groups were analysed for age, sex and weight as well as for side effects during the induction, maintenance and recovery periods, such as coughing, vomiting, venous pain, spontaneous movements, singultus, headaches, dysrhythmias and psychic disorders possibly due to anaesthesia. Side effects were moderate in both groups. Recovery time was statistically significantly shorter in the propofol group and the patients in this group appeared to be much more aware after recovery than those in the thiopentone‐isoflurane group.
Gastro‐oesophageal reflux in pregnancy at term and after delivery
Authors: VANNER R. G. , GOODMAN N. W.
Published: February 2007

Gastro‐oesophageal reflux during a 40‐minute reflux provocation test was assessed by lower oesophageal pH monitoring in 25 pregnant women at term, and again on about the second day after delivery. At term 17 women refluxed a total of 29 times; after delivery five women refluxed once each. There was a significant decrease in gastro‐oesophageal reflux by the second day after delivery (p< 0.05). Gastro‐oesophageal reflux is, however, only one of the factors that predisposes to acid aspiration pneumonitis.
Multidimensionality of psychological recovery from anaesthesia
Authors: ZUURMOND W. W. A. , BALK V. A. , van DTS H. , van LEEUWEN L. , PAUL E. A. A.
Published: February 2007

Six recovery tests, choice reaction time (CRT), CRT double task, jinger tapping test (FTT), critical flicker fusion frequency (CFF), Maddox wing, and p‐deletion test, which cover basic cognitive, motor and perceptive functions as well as concentration, were analysed and compared with each other. Correlation between these tests after recovery from standardised general anaesthesia was calculated in 22 patients. Moderate to high correlation was found between CRT and CRT doubletask (r = 0.62 to r = 0.73), when parameters of six different tests were compared. Finger tapping correlated moderately with the movement time of both the CRT and the CRT doubletask (r = 0.46 andr = 0.47 respectively). We concluded that the CRT test, which measures initiation and movement time, might replace the CRT doubletask and the FTT. The CFF correlated moderately with the initiation time of the CRT doubletask, but because a srightly different function seems to be involved, further research is needed. Maddox wing and the p‐deletion test correlated with no other test. Results indicated that recovery is differentiated in at least four distinct psychomotor functions, which should be tested by CRT (to measure initiation and movement time), Maddox wing and p‐deletion.
Continuous versus intermittent epidural analgesia
Authors: LAMONT R. F. , PINNEY D. , RODGERS P. , BRYANT T. N.
Published: February 2007

A randomised study of 381 women was carried out to compare the obstetric outcome after epidural analgesia maintained by an intermittent fop‐up regimen or with a continuous infusion. The two groups were well matched with respect to age, parity, mode of onset of labour and indication for epidural. Maintenance of epidural analgesia by continuous infusion resulted in a significantly decreased need for top‐up doses. A reduction in the incidence of hypotension, cardiotocographic evidence of intrapartum fetal hypoxia and Caesarean section was associated with this. It is concluded that the maintenance of epidural analgesia by continuous infusion is a safe and reliable method and may be more advantageous and less labour intensive than the traditional intermittent regimen.
Intravenous regional analgesia with prilocaine for foot surgery
Authors: DAVIES J. A. H.
Published: February 2007

Intravenous regional analgesia for foot surgery with an ankle tourniquet was used for 48 cases. Prilocaine 0.5% 3 mg/kg body weight was injected either quickly over about 2 minutes or slowly over about 5 minutes. The tourniquet was intiated either to occlusion pressure plus 100 mmHg or to occlusion pressure plus 200 mmHg. Plasma prilocaine levels were measured while the tourniquet remained inflated and after release of the tourniquet. All four techniques resulted in a low incidence and magnitude of prilocaine leak and low prilocaine plasma levels after tourniquet release. The data suggest that a slow injection with the high tourniquet infation pressure is better, although the diferences in leakage with an intact tourniquet were not statistically significant. Excellent analgesia was achieved in over 90% of patients and there were no complete failures. No dangerously high prilocaine plasma levels were produced and no serious side eflects observed.
A disposable device for patient‐controlled analgesia with fentanyl
Authors: ROWBOTHAM D. J. , WYLD R. , NIMMO W. S.
Published: February 2007

A disposable nonelectronic patient‐controlled analgesia device was used to deliver fentanyl after upper abdominal surgery. Pain relief was satisfactory and plasma fentanyl concentrations were similar to those obtained by other workers who used electronic patient‐controlled analgesia devices.
Dose‐response studies of atracurium, vecuronium and pancuronium in the elderly
Authors: Bell P. F. , Mirakhur R. K. , Clarke R. S. J.
Published: February 2007

Dose‐response curves were constructed for atracurium. vecuronium and pancuronium in elderly subjects in order to assess potency of these relaxants. The results were compared to data previously obtained for adult subjects using the same method. A single‐dose method of potency determination was used in both studies. The results indicate no significant difference in the potency of these relaxants between elderly and adult subjects; the ED95s were 249 and 226 μg/kg for atracurium, 43.1 and 39.6 μg/kg, for vecuronium and 65.9 and 60 μg/kg for pancuronium respectively in the elderly and the adults.
Ventilator disconnexion alarm failures
Authors: PRYN S. J. , CROSSE M. M.
Published: February 2007

Pressure‐sensitive ventilator disconnexion alarms do not always alarm during disconnexion of a discharging compliance ventilator such as Manley Blease, unless accurately adjusted. High flows during disconnexion result in significant pressure generation caused by outflow resistance of catheter mounts, heat and moisture exchangers, capnometer cuvettes, and angled connectors; this may lead to alarm failure because of incorrectly adjusted pressure alarm limits. The exact position of the disconnexion is critical and if the alarm's pressure sensor is placed in either the inspiratory or expiratory limb of the ventilator it makes no difference to its correct function. Nine different heat and moisture exchangers were compared in the same breathing system. Those with 15‐mm male connectors generate the highest pressures on disconnexion (1.1 kPa). It is suggested that the low pressure alarm limit is set only marginally below the peak inspiratory pressure, and that it is readjusted for every patient and after every change in ventilation. Most importantly, the alarm should be shown to be functional by a trial disconnexion at the tracheal tube.
Alfentanil used to supplement propofol infusions for oesophagoscopy and bronchoscopy
Authors: Kestin I. G. , Chapman J. M. , Coates M. B.
Published: February 2007

This randomised double‐blinded study compared the cardiovascular stability and rate of recovery when propofol infusions with or without alfentanil were used to provide anaesthesia for rigid oesophagoscopy and (or) bronchoscopy. Forty‐six patients were allocated randomly to receive either alfentanil 10 μg/kg or saline just before a rapid sequence induction with propofol. Suxamethonium I mg/kg was given and infusions of suxamethonium 10 mg/minute and propofol (10 mg/kg/hour for 10 minutes, 8 mg/kg/hour for 10 minutes and then 6 mg/kg/hour thereafter) were started. There were 23 patients in each group with no significant demographic differences between the groups. A significantly mean lower induction dose of propofol was needed in the alfentanil group (1.7 mg/kg compared to 2.2 mg/kg). Cardiovascular measurements were made on the ward pre‐operatively, just before induction, just after induction, just after intubation, and at 3‐minute intervals thereafter. Arterial pressure was significantly lower during the procedure in the patients who received alfentanil and there was a significant incidence of hypotension. There was no significant difference between the groups in respect of heart rate, with a significant increase in both groups just after intubation compared to the baseline values. Recovery from anaesthesia was assessed using the critical flicker fusion threshold. No differences were found between the groups and patients in both groups had returned to baseline values by 60 minutes. No patient had any recall of intra‐operative events, and there were no other adverse effects of any significance.
Gastric aspirates after trauma in children
Authors: BRICKER S. R. W. , McLUCKIE A. , NIGHTINGALE D. A.
Published: February 2007

The volumes and pH of gastric aspirates obtained from 110 children (aged 1–14 years) who underwent surgery for trauma were related to the duration of pre‐operative starvation and to the interval between food and injury. Aspirates were larger in children fasted for 4–6 hours than in those fasted for up to 10 hours, and were larger in children injured within 2 hours of eating than in those in whom this interval was longer (p < 0.05). However, 19 of 39 children (49%) starved for over 8 hours had an aspirate of more than 0.4 ml/kg. as did five of 16 children (31%) injured 3 or more hours after eating. Thus, a ‘safe’ interval between oral intake and induction cannot be predicted. We conclude that securing the airway by prompt tracheal intubation is the safest way to manage any child who presents for emergency anaesthesia after trauma.
Regional anaesthesia for surgery of the forearm and hand
Authors: SMITH B. E. , CHALLANDS J. F. , SUCHAK M. , SIGGINS D.
Published: February 2007

Eighty patients who presented for surgery of the forearm or hand were allocated randomly to one of two groups. In Group A, surgery was performed under supraclavicular brachial plexus block only; a mixture of equal parts of prilocaine 1% and bupivacaine 0.5% without adrenaline was used. In Group B, supraclavicular brachial plexus block was performed using prilocaine 1% alone, but in addition discrete nerve blocks were performed at elbow level using 0.5% bupivacaine without adrenaline. Patients in Group B had a significantly shorter duration of unwanted postoperative motor blockade and a significantly longer duration of postoperative analgesia (p < 0.005).
A comparison between propofol and thiopentone as induction agents in obstetric anaesthesia
Authors: MOORE J. , BILL K. M. , FLYNN R. J. , McKEATING K. T. , HOWARD P. J.
Published: February 2007

Two comparable series of 21 patients who had elective Caesarean section had general anaesthesia induced by thiopentone sodium 4.53 (SD 0.65) mg/kg or propofol 2.15 (SD 0.26) mg/kg. Maintenance was similar for both groups. Blood pressure was lower in the propofol group during the induction‐delivery interval. Umbilicallmaternal vein ratios for thiopentone and propofol were 8.5 and 7.2 respectively. Infant wellbeing as judged by Apgar score and cord blood analysis showed little difference between the two induction agents. Factors associated with uterine relaxation and bleeding were similar in the two groups.
Isoflurane inhibits enflurane metabolism in man
Authors: OIKKONEN M. P.
Published: February 2007

Halogenated inhalation anaesthetics interfere with each other's hepatic microsomal metabolism. The increase in plasma inorganic fluoride concentration, caused by the metabolism of a standardised dose of enflurane, was attenuated by isoflurane given either before or after the enflurane exposure. It is conluded that isoflurane inhibits the metabolism of enflurane in man, a fact that might be advantageous in certain clinical situations.
Anaphylactoid reaction to chymopapain
Authors: SMITH M. B. , HOFMANN V. C.
Published: February 2007

Chymopapain is a proteolytic enzyme used in the chemonucleolysis of the herniated nucleus pulposus of lumbar intervertebral discs. It causes rapid hydrolysis of the noncollagenous polypeptides that maintain the tertiary structure of the chondromucoprotein of the nucleus pulposus. We report here an anaphylactoid reaction after the intervertebral injection of chymopapain.
Variables of patient‐controlled analgesia 2. concurrent infusion
Authors: OWEN H. , SZEKELY S. M. , PLUMMER J. L. , CUSHNIE J. M. , MATHER L. E.
Published: February 2007

The effectiveness of morphine after surgery by patient‐controlled analgesia alone or with a concurrent infusion was studied. The infusion did not reduce the dose of self‐administered analgesic and patients treated in this way received twice as much drug as those who used patient‐controlled analgesia alone. Pain control was similar in both groups. The practice of patient‐controlled analgesia plus infusion requires critical review.
Open‐heart surgery in a patient with a high oxygen affinity haemoglobin variant
Authors: FRANCINA A. , CHASSARD D. , BAKLOUTI F. , GEORGE M. , ESTANOVE S.
Published: February 2007

A man in heart failure with a high oxygen affinity haemoglobin variant (Hb Rainier) underwent a mitral comrnissurotomy with the aid of cardiopulmonary bypass. Pre‐operatively, a total blood exchange transfusion was carried out to prevent potential hypoxic and thrombo‐embolic complications. No complications occurred in the postoperative period.
Impairment of the antagonism of vecuronium‐induced paralysis and intra‐operative disopyramide administration
Authors: BAURAIN M. , BARVAIS L. , D'HOLLANDER A. , HENNART D.
Published: February 2007

A 63‐year‐old male was admitted to hospital for a cholecystectomy, vagotomy and gastro‐enterostomy. Muscle paralysis was induced with 70 μg/kg vecuronium, followed by increments of 20 μg/kg when the initial twitch height returned to 2.5% of control. The patient received 3 doses of 10 mg disopyramide intravenously, on account of supraventricular ectopic beats, followed by an infusion of 2.5 mg/hour. Paralysis was reversed using 0.75 mg atropine and 2.5 mg neostigmine once the twitch height had returned spontaneously to 2.5% of its initial value. Fifteen minutes later, twitch height had returned to control value and the train‐of‐four was above 85%, but the responses to tetanic stimulation at 100 Hz and 50 Hz remained severely depressed (10% and 45%, respectively). The patient's trachea was extubated after 20 minutes, but residual fade was still observed. This impairment of neuromuscular transmission, detected only with high frequency stimulation, was present with a measured concomitant plasma level of disopyramide of 5.1 μg/ml.
Anaesthetic management of the patient with a permanent pacemaker
Authors: BLOOMFIELD P. , BOWLER G. M. R.
Published: February 2007

Over 25 000 people in Britain now have pacemakers, and the number is increasing steadily. Anaesthetists encounter patients with pacemakers regularly. Knowledge about the increasingly wide range of pacemakers available is necessary to ensure safe management of these patients, many of whom are frail and elderly. This review outlines the indications for permanent pacing, the types of pacemaker used and the assessment and management of pacemaker patients for anaesthesia.
A new method of analgesia for relief of circumcision pain
Authors: ANDERSEN K.H.
Published: February 2007

A prospective, randomised, double‐blind study was designed to determine whether topical application of 2% lignocaine is effective in decreasing analgesic drug requirements during and after circumcision surgery. General anaesthesia with halo thane and nitrous oxide 60‐70% in oxygen was administered via a facemask and a Bain system. Administration of halothane was stopped after removal of the foreskin; lignocaine (2%) or placebo was applied topically as drops to the surface of the penis to two groups of patients. Halothane was restarted if the anaesthesia was ineffective. The intra‐operative consumption of halothane was significantly less (p < 0.05) in the treated group as compared with the placebo group (0 and 17, SEM 3,%× minute). The treated group required significantly less (p < 0.002) pethidine after operation (5 and 10 patients), and the pain‐free period was significantly longer (p < 0.01) (41, SEM 6 and 6, SEM 2 minutes) as compared with the placebo group.
The use of flumazenil (Anexate, Ro 15‐1788) in the management of drug overdose
Authors: POLLARD B. J. , MASTERS A. P. , Bunting P.
Published: February 2007

This is a report of a large selfadministered overdose of temazepam and meprobamate. The administration of Jumazenil (Ro 15‐1788) led to the partial antagonism of the depressant action of the drugs which was sufficient to avoid the need for invasive respiratory and cardiovascular support.
Second report from an anaesthetic reactions advisory service
Authors: Watkins J.
Published: February 2007

The continued work of the advisory service is reported; this now amounts to at least 300 enquiries about clinically severe adverse reactions each year. Thiopentone is still the most commonly associated intravenous induction agent with adverse reactions (76%), particularly when it is used with suxamethonium. Local anaesthetics account for between 5 and 10% reports.
Laryngeal anaesthesia with aspiration following intubation
Authors: AUCOTT W. , PRINSLEY P. , MADDEN G.
Published: February 2007

Two patients who had undergone emergency tracheal intubation developed signs of aspiration of ingested food. Nasendoscopy demonstrated supraglottic anaesthesia which recovered from the laryngeal margins in towards the vocal cords. It is assumed that this was caused by a neuropraxia of the internal branch of the superior laryngeal nerve, presumably as a result of trauma related to intubation.
Rebreathing during spontaneous and controlled ventilation with T‐piece breathing systems: a general solution
Authors: DORRINGTON K. L. , LEHANE J.R.
Published: February 2007

A general solution is presented to the problem of finding the degree of rebreathing generated by T‐piece breathing systems. The solution is applicable to any ventilatory waveform, dead space volume and tidal volume and is identical for spontaneous and controlled ventilation for any given ventilatory waveform. The method is graphical and its use and understanding require no mathematical skills. However, if an analytical form of the ventilatory waveform is known, the method is easily extended by use of calculus to obtain a precise analytical solution.
Pulse oximetry in methaemoglobinaemia
Authors: RIEDER H.U. , FREI F.J. , ZBINDEN A. M. , THOMSON D. A.
Published: February 2007

The results of pulse oximetry saturation in a patient with a high level of methaemoglobinaemia, who subsequently underwent intravenous methylene blue treatment, are presented. The reasons for the erroneously low values after treatment are explained. Pulse oximeters currently available are not helpful in patients treated with methylene blue and should be used with caution in patients who present with cyonosis of unknown origin.
Epidural diamorphine and bupivacaine in labour
Authors: McGRADY E.M. , BROWNHILL D.K. , DAVIS A.G.
Published: February 2007

A double‐blind randomised study was performed to assess the analgesic effect of epidural diamorphine, administered with bupivacaine, on primigravid women in labour. Fifty patients received 0.25% bupivacaine 10 ml via the epidural catheter as their initial dose; patients in Group I received diamorphine 5 mg with the bupivacaine. A 0.1% bupivacaine infusion was started at 10 minutes and bolus doses of bupivacaine were given if required. There was a significant reduction in rate of bupivacaine administration, pain scores at 20 and 30 minutes, number of supplements required, and degree of motor blockade in the diamorphine group.
The pneuPAC ventilator with new patient valve and air compressors
Authors: PARK G. R. , MANARA A. R. , BODENHAM A.R. , MOSS C. J.
Published: February 2007

The pneuPAC Model 2‐R pneumatic logic ventilator with a new air entrainment valve that offers the option of an Fio2 of l.0 or 0.45 is described. Its robustness, portability, variable Fio2, choice of positive end expiratory pressure and pressure relief valves make it versatile and suitable for transporting critically ill patients, as well as for resuscitation use when adverse conditions may be encountered. Two new medical air compressors, one mains driven and the other battery powered, designed for use with the ventilator, are also described. The function of the ventilator with the new valve was assessed using a piped gas supply and then reassessed when powered by the compressors.
Paraplegia after coeliac plexus block
Authors: WOODHAM M. J. , HANNA M. H.
Published: February 2007

A case is described in which paraplegia followed a coeliac plexus block performed using 90% alcohol under X ray screening. The likely cause was an ischaemic injury to the cord secondary to damage to the artery of rldamkiewicz. This rare complication seems difficult to avoid.
The pressor response and laryngeal mask insertion
Authors: BRAUDE N. , CLEMENTS E. A. F. , HODGES U. M. , ANDREWS B. P.
Published: February 2007

The pressor response associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway avoids the need for laryngoscopy and allows positive pressure ventilation of the lungs in appropriate patients. This study compared the pressor response of tracheal intubation with that of mask insertion in two groups of 24 and 23 healthy patients respectively. All patients were anaesthetised with thiopentone, nitrous oxide, enflurane and paralysed with atracurium. We have shown a similar, but attenuated patlern of response associated with mask insertion in comparison with laryngoscopy and intubation; signijicant differences between the groups were evident in arterial diastolic blood pressure immediately after insertion and again 2 minutes later. Use of the laryngeal mask may therefore offer some limited advantages over tracheal intubation in the anaesthetic management of patients where the avoidance of the pressor response is of particular concern.
The requirement for intensive care support for the pregnant population
Authors: GRAHAM S. G. , LUXTON M. C.
Published: February 2007

Pregnancy‐associated admissions to the Intensive Care Unit during the first 5 years of a newly established teaching hospital obstetric unit are reviewed. There were 23 such admissions; in the same period, 21 983 deliveries occurred. The most frequent cause for Intensive Care admission was hypertensive disease of pregnancy. Most patients required admission for less than 48 hours. Two patients died during the period of study.
Cardiovascular response during cerebral angiography under general and local anaesthesia
Authors: Clayton D. G. , O'Donoghue B. M. , Stevens J. E. , Savage P. E.
Published: February 2007

Nineteen patients with subarachnoid haemorrhage who had cerebral angiography with the new contrast medium iohexol, were randomly allocated to receive either local anaesthesia plus sedation, or general anaesthesia. Arterial blood pressure, Pao2, Paco2 and patient acceptability were examined. Significant fiuctuations in arterial blood pressure occurred in the patients who received general anaesthesia. Local anaesthesia was associated with a stable blood pressure, adequate spontaneous ventilation and good patient acceptability. The quality of films obtained was examined and found to be of good or very good diagnostic quality in all cases in both groups of patients. Greater use of local anaesthesia with sedation for angiography is recommended.
Anaesthesia and brain damage in the newborn
Authors: CHARLTON A. J. , DAVIES J. M. , RIMMER S.
Published: February 2007

Eighty newborn babies were studied by ultrasound brain scan before and after their first general anaesthetic. Periventricular haemorrhage or ischaemia occurred in 23 patients (29%) and affected both term and premature babies. Four new lesions developed but only three of 19 existing lesions deteriorated. The very premature (< 33 weeks gestation) were most at risk (four of eight deteriorated). Deterioration or development of lesions occurred only in very ill babies with known risk factors. Anaesthesia did not appear to be implicated in any case.
Epidural anaesthesia for day care surgery.
Authors: Sarma V. J. , Lundström J.
Published: February 2007

The records of 682 patients who received epidural anaesthesia for day care surgery were reviewed. The advantages and disadvantages of this form of anaesthesia is discussed. No major complications were recorded.
Pain on injection of methohexitone The use of lignocaine to modify pain on injection of methohexitone during anaesthesia for electroconvulsive therapy
Authors: Simpson K. H. , Halsall P. J. , Sides C. A. , Keeler J. F.
Published: February 2007

The present study was designed to assess the incidence of pain when methohexitone was administered to 35 depressed patients who had electroconvulsive therapy, and to determine whether the use of lignocaine could modify this, without affecting seizure duration. The same patients were studied during three separate treatment sessions; they received either methohexitone alone or mixed with, or preceded by, lignocaine 10 mg. Six (17%) patients spontaneously complained of pain during injection of methohexitone alone; the use of lignocaine prior to methohexitone reduced this to zero (p < 0.05). A total of 49% patients reported pain during injection of methohexitone; the use of lignocaine either mixed with, or given prior to, methohexitone significantly reduced this to 23% and 20% respectively (p < 0.05). Seizure duration was not significantly different during the three treatments.
Anaesthesia in a gravid achondroplastic dwarf
Authors: BRIMACOMBE J. R. , CAUNT J. A.
Published: February 2007

A patient with achondroplasia presented for elective Caesarean section under epidural anaesthesia. A block from C5 to S4 developed over 20 minutes after 12 ml plain bupivacaine 0.5%. This case serves to highlight the difficulties of regional anaesthesia in the gravid achondroplastic dwarf.