bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravenous metoprolol and cardiac dysrhythmias
Authors: ROLLASON W.N. , RUSSELL J.G.
Published: February 2007

The use of intravenous metoprolol in a dose of 0·06–0·17 mg/kg body weight proved effective in the treatment of sinus tachycardia in excess of 150 beats/min and/or ventricular dysrhythmias associated with light halothane anaesthesia for outpatient dental surgery. There were no side‐effects related to this cardioselective beta‐blocker in the dosage used.

The prophylactic use of oral metoprolol should be considered for patients who find the prospect of dental treatment a fearsome experience.
Transcutaneous electrical nerve stimulation for chronic pain
Authors: Bates J.A.V. , Nathan P.W.
Published: February 2007

The results of 7 years experience in treating pain with transcutaneous electrical stimulation are reported. It was used on a group of 74 patients with postherpetic neuralgia and on a mixed group of 161 patients with chronic pain due to other conditions for which other forms of treatment had been unsatisfactory.

The patients were lent stimulators and electrodes of various kinds. A half of the patients returned their stimulators after one month, but a quarter of the patients were still using transcutaneous stimulation after 2 years.

No particular disease responded better or less well than any other; no particular kind of pain responded particularly well or badly.

One third of the patients with postherpetic neuralgia started improving from the commencement of stimulation.
Clinical pharmacokinetics of fazadinium
Authors: BEVAN D.R. , D'SOUZA J. , ROUSE JANE M. , CALDWELL J. , SMITH R.L.
Published: February 2007

Fazadinium was administered as an intravenous bolus of 0·5 or 1 mg/kg to nine patients during neuroleptanaesthesia. Continuous recording of neuromuscular activity and serial collection of blood samples for drug assay allowed the relationship between neuromuscular blockade and plasma fazadinium concentration to be studied. Pharmacokinetic analysis demonstrated high plasma clearances (221 and 185 ml/min), and short terminal half‐lives, (30 and 50 min), for the two doses of the drug. Mean plasma concentrations at 10 and 50% recovery were 1·42 and 0·88 μg/ml respectively, demonstrating that the potency of fazadinium is approximately half that of tubocurarine and one eighth that of pancuronium. In addition, the relationship between plasma concentration and depression of neuromuscular activity during spontaneous recovery from the relaxant is described.
Applications of respiratory mass spectrometry to intensive care
Authors: GOTHARD J.W.W. , BUSST C.M. , BRANTHWAITE M.A. , DAVIES N.J.H. , DENISON D.M.
Published: February 2007

A monitoring and research system based on a respiratory mass spectrometer controlled by a microprocessor has been installed in a paediatric intensive care unit. It provides an opportunity to study up to twelve patients simultaneously at distances up to 30 m from the instrument, can operate for prolonged periods without intervention, and includes a routine for regular calibration checks. There is an automatic sensitivity control which compensates for minor variations in probe patency or in water vapour pressure.

Information derived from the system can be displayed centrally or at the bedside and data can be conserved for up to 24 hours; past events can be recalled and displayed for either the previous hour or previous 24 hours. The system can be used to measure respired gas tensions, metabolic gas exchange, lung volume, pulmonary blood flow and pulmonary tissue volume. The clinical value and limitations of the system are discussed.
Administration of drugs during cardiopulmonary bypass
Authors: Kamath B.S.K. , Thomson D.M. , Johnston B.
Published: February 2007

This study was conducted to determine the efficiency of delivery of drugs injected as boluses by the common routes available during cardiopulmonary bypass.

Radioactive technetium (99m Tc) was injected in a 50 μci bolus into the central venous line or into the arterial or venous lines of the oxygenator and its passage monitored downstream by suitable radiation detectors. When injected into the central venous line, delivery was unpredictable and at times 50‰ or more of the dose may not appear for 5 min. When injected into the venous line of the oxygenator an average 5‰ of the total dose had not reached the detector during first passage, and had completely cleared at 2 min.

No significant difference was found between the different oxygenators and it is concluded that the venous line of the oxygenator is the most efficient site for the achievement of rapid action of drugs.
Haemodynamic changes following buprenorphine and morphine
Authors: SCOTT DAVID H. T. , ARTHUR G. RICHARD , SCOTT D. BRUCE
Published: February 2007

Twenty‐five women were investigated on the day after lower abdominal surgery in a single‐blind non‐crossover trial to assess and compare the haemodynamic effects of intravenous injections of buprenorphine 0·3 mg and morphine 7·5 mg. Arterial blood pressure was measured by sphygmomanometry and cardiac output by thoracic impedance cardiograph. Arterial blood pressure was significantly reduced following both drugs (p < 0·05), although the mean decrease in systolic arterial pressure was less than 8 mmHg. However, in one patient in each group the decrease was more than 20 mmHg. Cardiac output decreased but the mean reduction was less than 5%. The greatest individual decreases were 21% after buprenorphine and30% after morphine. Myocardial contractility, assessed by systolic time indices, did not appear to change. There were no consistent differences in the haemodynamic effects of the two drugs.
Computer‐assisted self‐assessment in anaesthesia: a preliminary study
Authors: Campbell Donald , Kenny Gavin N.C. , Schmulian Carol , Davis Paul D.
Published: February 2007

Fifty‐six anaesthetists participated in a trial of the use of microcomputers for self‐assessment. Ninety‐three per cent of the anaesthetists found the concept of computer‐assisted self‐assessment acceptable. The only significant difference in the scores achieved by different groups was found with a specialised intensive care program in which senior registrars had a higher average score than older consultants.
Pulmonary blood flow and tissue volume
Authors: SALT J.C. , GOTHARD J.W.W. , BRANTHWAITE M.A.
Published: February 2007

Pulmonary blood flow and tissue volume have been measured by a rebreathing technique in which the disappearance of soluble and insoluble gases from an inhaled mixture is followed continuously using a respiratory mass spectrometer. Although measurements made with diethyl ether are more reproducible than those made with freon‐22, they are inaccurate because ether (the more soluble gas) is taken up by the tissues surrounding the respiratory dead space. Experiments carried out on four normal subjects demonstrate that measurements of both pulmonary blood flow and tissue volume are influenced by the volume of gas in the lungs during the manoeuvre. Possible reasons for this are discussed and an exponential relationship between the two variables and lung volume is suggested.
Anaesthetic staffing in England and Wales
Authors: REES L.T.
Published: February 2007

The numbers of anaesthetists and of surgeons in the English Health Regions and in Wales as at September 1978, are given in whole‐time equivalents per 100,000 of population.

All Regional figures are presented as percentages of the national average so that comparisons between Regions can be made. Marked inter‐Regional differences are shown, both in the nunbers of anaesthetists per unit of population and in the ratios of surgeons to anaesthetists.

The pattern argues for a modification in central policy and for a greater involvement of anaesthetists in future manpower planning than appears to have been the case in the past.
Low frequency ventilation
Authors: SPOEREL WOLFGANG E.
Published: February 2007

Two miniature ventilators, the ‘Automatic‐Vent’ and the ‘Minivent’, were used for controlled ventilation by intermittent occlusion of the outflow from the Bain breathing system. They were attached in a reverse position to that of their original use, so that the fresh gas inflow inflated the lungs up to the critical pressure of the magnetic valve. This resulted in low frequency ventilation with a long gradual inflation, a much shorter deflation, and no rebreathing.

The combination of the Bain system and the miniature ventilators was examined in a simple lung model. The minute ventilation had an upper limit of about 5·5 litres/minute which could no longer be increased with fresh gas flows above 8·0 litres/minute due to the design of the ventilators. Changes in compliance or inflation pressure altered the frequency or the I:E ratio, but not the minute ventilation.

Twenty‐eight patients were ventilated from 30 to 90 minutes with this system during routine anaesthesia, using fresh gas volumes usually recommended for the Bain system and inflation pressures between 15 and 20 cmH2O. A mean (± SD) fresh gas volume of 74 ± 4 ml/kg/minute resulted in a frequency of 6 ± litres/minute at an I:E ratio between 3:1 and 4:1. The mean PaCO2 was 4·92·0·67 kPa. The PaO2 ranged between 14·7 and 17·9 kPa with an inspired O2 of about 28%. No adverse cardiovascular effects were observed. Low frequency ventilation with an I: E ratio of up to 4:1 can provide adequate CO2 elimination and oxygenation. The combination of Bain circuit and magnetic vents could be used with caution as an economical ventilating system during anaesthesia.
Errors in oxygen concentration analysis: sensitivity of the IMI analyser to nitrous oxide
Authors: ORCHARD C.H. , SYKES M.K.
Published: February 2007

The sensitivity to nitrous oxide of the IMI oxygen analyser (Model 3300) has been tested. Even if the manufacturer's checks are performed and the analyser appears to be functioning correctly, the reading given by the IMI oxygen analyser may be seriously affected by the presence of nitrous oxide.

There is a wide variation in the sensitivity to N2O between different instruments, and this variation is partly a function of the electrode.

The influence of nitrous oxide on a particular meter may be assessed by placing the probe in 100% nitrous oxide and noting the shift of the meter from zero.
ICI 35868 (Diprivan): a new intravenous anaesthetic
Authors: KAY B. , STEPHENSON D.K.
Published: February 2007

ICI 35868 (Diprivan), 1–2 mg/kg was used to induce anaesthesia in 20 patients, and the results compared with induction of anaesthesia by Althesin 0·5 ml/kg given to a similar group of 20 patients. ICI 35868 was effective in inducing anaesthesia, but produced more respiratory depression, and cardiovascular effects which were significantly different from those produced by Althesin. ICI 35868 gave a smoother induction. It is concluded that ICI 35868 is a promising new induction agent which may also find application for the maintenance of anaesthesia.
Recovery from pancuronium
Authors: MARSH R.H.K. , CHMIELEWSKI A.T. , GOAT VALERIE A.
Published: February 2007

The rate at which paralysis from pancuronium could be reversed by neostigmine was monitored in two groups of patients, one elderly and the other young adults.

Some patients were found to have prolonged recovery times, and this slow reversal occurred more frequently in the older group of patients. Possible reasons for this are discussed.
Barbiturate therapy in cerebral ischaemia
Authors: BELOPAVLOVIC M. , BUCHTHAL A.
Published: February 2007

Experimental and clinical studies of the protective effect of barbiturates in cerebral ischaemia are reviewed. Their action in protecting the brain from the effects of ischaemia is related to their action as anaesthetic agents and probably to the depression of neuronal function and metabolism but is incompletely understood. Their effect is dose related. Early administration is likely to be crucial to the success of barbiturate therapy as secondary events following an episode of cerebral ischaemia can lead to irreversible brain damage within 2–3 h. A potential collateral circulation appears to be essential for the protective effect of barbiturates. There may be a possibility of partly overcoming time delays in administration by giving larger doses of barbiturates.
Barbiturate therapy in the management of cerebral ischaemia
Authors: BELOPAVLOVIC M. , BUCHTHAL A.
Published: February 2007

Two patients who underwent surgery for cerebral aneurysms are presented. In the first case 31 g thiopentone were given postoperatively over 20 h after the patient had already been comatose for many hours. Such high doses raise considerable problems in patient management. In the second case a loading dose of 50 mg/kg thiopentone was given prophylactically to a patient undergoing cerebral aneurysm surgery beginning at the induction of anaesthesia and before surface cooling was begun. Cerebral activity was monitored continuously with a cerebral function monitor (CFM). There was no significant cardiovascular depression, little delay in postoperative recovery and no permanent neurological sequelae.

In cerebral aneurysm surgery, cerebral oedema following cerebral ischaemia, either associated with vasospasm or resulting from surgical occlusion of vessels, remains a major problem postoperatively and may be an indication for preventive treatment with barbiturates. The authors contend that this technique merits further evaluation in cerebro‐vascular surgery, especially in high risk cases.
Intra‐operative awakening during scoliosis surgery
Authors: Abott T.R. , Bentley G.
Published: February 2007

A method of intra‐operative awakening which allows assessment of spinal cord function during Harrington rod spinal fusion for scoliosis is described. The anaesthetic technique is based on a standard muscle relaxant, N2O anaesthetic sequence supplemented with intravenous morphine 0·1 mg/kg at the commencement of surgery and 0·2 mg/kg intramuscular premedication. This relatively large total dose of morphine may reduce intra‐operative awareness, and may also provide substantial pain relief during the initial 24 h postoperative period. It has been used successfully in 20 patients aged between 6 and 16 yr. Five patients remembered being woken, but did not regard it as unpleasant. In one patient, this technique allowed intra‐operative detection and correction of impaired motor function of the legs
Occupational exposure to anaesthetics in 20 hospitals
Authors: DAVENPORT H.T. , HALSEY M.J. , WARDLEY‐SMITH BRIDGET , BATEMAN P.E.
Published: February 2007

The nitrous oxide and halothane contamination in the inspired air of anaesthetists and in the atmospheres of operating theatres, anaesthetic induction and recovery rooms, were measured during normal unmodified working sessions in 20 hospitals using integrated personal samplers. The nitrous oxide (and halothane) levels ranged from < 10 to 3000 ppm (<0·1 to 60 ppm) in the different areas with an average of 388·5 ppm (2·8 ppm) for the inspired air of the anaesthetists during 2 hour sampling periods. There was no correlation between the levels of the anaesthetists' exposures and those in the static air samples and this appeared to be due primarily to a wide variation in work practices and techniques. Thus it is potentially misleading to assess anaesthetists' occupational exposure by collecting ambient air samples in the operating rooms. Comparisons with more prolonged measurements in one hospital indicated that the installation of relatively simple active scavenging devices will be effective in most hospitals.
Laryngeal oedema and pre‐eclampsia
Authors: SEAGER S. JEANNE , MACDONALD ROSEMARY
Published: February 2007

A case of laryngeal obstruction secondary to laryngeal oedema and a superimposed upper respiratory tract infection in a pre‐eclamptic patient is reported. The management of the case is described and the possible effects of drug therapy on the uterus are discussed. Other reports of asymptomatic laryngeal oedema in pregnancy are reviewed.
Paraplegia after epidural analgesia associated with an extradural spinal tumour
Authors: HIRLEKAR GIRISH
Published: February 2007

A patient is described who developed paraplegia after epidural analgesia. Myelography showed obstruction at the level of T7. Laminectomy revealed an extradural metastasis involving the vertebral column and causing compression of the spinal cord. The primary was an adenocarcinoma of the prostate.
Obstetric pain relief using epidural morphine
Authors: Booker P.D. , Wilkes R.G. , Bryson T.H.L. , Beddard J.
Published: February 2007

Epidural injections of morphine (2·5 or 4 mg) were given to 25 patients in labour. Forty‐eight per cent had good relief of pain lasting from 3¼ to 11 hours (average 5¼ hours). Sixteen per cent of patients had transient or partial relief, and in 36% there was no discernible effect at all. No serious side effects were observed in either mother or baby. It is felt that this technique merits further investigation in view of its potential advantages over more traditional methods of pain relief in labour.
Buprenorphine in postoperative pain: results in 7500 patients
Authors: Harcus A.H. , Ward A.E. , Smith D.W.
Published: February 2007

Buprenorphine, a partial opiate‐receptor agonist with potent analgesic properties, was given to 7548 patients in the immediate postoperative period. Ninety per cent of patients had good or adequate pain relief for at least 4 hours; there were few adverse effects and the incidence of drug‐associated respiratory depression was estimated at less than 1%. There were no other side‐effects of clinical note.
Paraplegia following epidural analgesia
Authors: BALLIN NEVILLE C.
Published: February 2007

A case is presented of a patient who developed temporary paraplegia following epidural analgesia. An X‐ray of the lumbar spine showed a very narrow spinal canal and the cause of the paraplegia was thought to be nerve root compression resulting from a haematoma.
Digital regional analgesia
Authors: Ryding F.N.
Published: February 2007

The application of regional intravenous analgesia to a single digit is described and assessed.
Nitrous oxide elimination by the newborn
Authors: MANKOWITZ E. , BROCK‐UTNE J.G. , DOWNING J.W.
Published: February 2007

The elimination of nitrous oxide by ten infants whose mothers had received 50% nitrous oxide in oxygen and enflurane 0·6–1% during general anaesthesia for Caesarean section was studied. The concentration of nitrous oxide detected in end‐expired gas ranged from 1 to 4 vol% (mean 1·9 vol%). These levels are too low to produce significant diffusion hypoxia in vigorous neonates. However, a minority of infants may be adversely affected and it is recommended that oxygen‐enriched air be administered to infants whose mothers have received nitrous oxide.
Forum
Authors: Welch D.B. , Hrynaszkiewicz A.
Published: February 2007

The effectiveness of methadone given postoperatively by the lumbar epidural route to patients following upper abdominal or thoracic surgery was assessed. Intermittent injections of methadone diluted in large volumes of normal saline were given during the first 48 hours after surgery. Pain relief was assessed by both the patient and an observer using a visual linear analogue scoring system. Methadone 4–5 mg in 18–20 ml normal saline provided good postoperative pain relief for 6–8 hours.
An American approach to anaesthesia research and a British perspective
Authors: Nahrwold Michael L. , Jones Ronald M.
Published: February 2007

The organisation of research in the Department of Anesthesiology at the University of Michigan is described and the comments of a British Senior Registrar working within the system are recorded.
The Triservice anaesthetic apparatus
Authors: HOUGHTON I.T.
Published: February 2007

The Triservice anaesthetic apparatus is a draw‐over system using ambient air as the primary carrier gas. Its modules are a self‐inflating bag, a vaporiser, a supplementary oxygen regulator and a ventilator; each is described. The outputs of halothane and trichloroethylene were measured with changes of temperature, continuous and intermittent gas flows and with alteration in barometric pressure. The output of oxygen from the Houtonox regulator was measured and the effect of the oxygen supplementation on the inspired oxygen concentration determined. The resistance to airflow of the apparatus was also measured and the effect of extreme cold observed.

The merits, limitations and the way in which the equipment may be used are discussed. A carrying case with equipment for 10 anaesthetics is illustrated.
Cimetidine in elective Caesarean section
Authors: Mccaughey W. , HOWE J.P. , MOORE J. , DUNDEE J.W.
Published: February 2007

Aspiration pneumonitis, Mendelson's syndrome, continues to be an important cause of maternal morbidity and mortality in obstetric Anaesthesia, despite widespread adoption of the practice of routine administration of alkalis. Histamine H2 receptor blocking drugs have been shown to reduce gastric secretion in non‐obstetric patients. Cimetidine was given intravenously to fasting patients before elective Caesarean section. In all 10 patients who received cimetidine 200 mg intravenously at 60–80 minutes before Anaesthesia, the pH of gastric contents at the time of induction was above 2·5. When the interval between administration of the drug and induction of Anaesthesia was only 30–40 minutes (six patients) or was over 90 minutes (20 patients) then the pH was raised to above this value in only two‐thirds of patients. By contrast eight of 10 untreated patients were found to have a gastric pH of less than 2·5. No adverse effects of cimetidine were seen in mothers or infants.
An Addisonian crisis complicating anaesthesia
Authors: SMITH M.G. , BYRNE A.J.
Published: February 2007

A patient with Addison's disease required surgery having attempted suicide, by cutting his throat and wrist. He was also in an acute adrenal crisis, as a result of deliberately omitting his replacement steroid therapy. Urgent surgery was indicated and therefore anaesthesia was undertaken before the patient's adrenal crisis was fully controlled. The anaesthetic management is described.
A case of status epilepticus.
Authors: FENECK R.O.
Published: February 2007

A case of status epilepticus which was refractory to conventional anticonvulsants is described. The total dosage of thiopentone necessary to control the convulsions is greater than that previously recorded. The use of regular plasma estimation of thiopentone levels, and of cortical monitoring with the Cerebral Function Monitor (Ormed Engineering) is described, and is recommended where anticonvulsants are used for prolonged control of status epilepticus and in dosages greater than is common practice.
Endotracheal compared with intravenous injection of 3 mg/kg of lignocaine
Authors: PATEL R.I. , PETERSON R.G. , ALDRETE J.A.
Published: February 2007

The arterial and venous concentrations differ quantitatively and temporally after the administration of lignocaine via any route. Hence, arterial and venous levels were studied simultaneously following intravenous and tracheal injection in dogs, at 5, 15, 30, 60 seconds and at 5, 15, 30, 60, 120 minutes. Following intravenous injection, concentrations in the carotid artery were consistently higher for 60 seconds, the jugular vein levels were higher at 5 minutes and they were parallel thereafter.

Following tracheal administration the highest arterial concentration was reached in 15 minutes and the highest venous levels at 5 minutes.
Cardiovascular and hormonal responses to electroconvulsive therapy.
Authors: JONES RONALD M. , KNIGHT PAUL R.
Published: February 2007

A patient suffering from severe psychiatric depression underwent a course of electroconvulsive therapy. A marked rise in systemic arterial pressure, heart rate and plasma catecholamines in response to electroconvulsive therapy was attenuated by β‐receptor blockade using propranolol. The significance and mechanism of this attenuation are discussed.
Beta‐receptor blockade and tracheal intubation
Authors: FARNON D. , CURRAN J.
Published: February 2007

Adrenergic beta‐receptor blockade was induced to attenuate the pressor response to laryngoscopy and tracheal intubation; the patient subsequently suffered cardiovascular collapse culminating in cardiac arrest. The rationale of the technique is discussed.
Dose‐response relationship for disoprofol (ICI 35868; Diprivan)
Authors: KAY B. , STEPHENSON D.K.
Published: February 2007

The duration of sleep following intravenous administration of three doses of disoprofol (1, 2 and 3 mg/kg) was compared with that following methohexitone 1 or 2 mg/kg. Disoprofol and methohexitone were shown to be approximately equipotent. Side‐effects were dose‐related for both drugs, but the incidence was significantly less following disoprofol than methohexitone 2 mg/kg. The most frequent side‐effects were pain on injection, myoclonia and hiccup. Studies of blood concentrations of disoprofol show that the profile is dose‐independent and conforms to a two‐compartment model with a very short distribution phase (about 2 minutes) and short elimination phase (about 70 minutes). Waking blood levels gave no indication of acute tolerance. Disoprofol would appear to be particularly useful for induction of a short period of sleep using a small dose given quickly, or for maintenance of sleep by continuous infusion.
High dose buprenorphine for postoperative analgesia
Authors: Budd Keith
Published: February 2007

Buprenorphine was given intravenously to produce analgesia in the immediate postoperative period, the dose being titrated against the response of each patient in order to obtain complete freedom from pain. In 50 patients following lower segment Caesarean section under general anaesthesia, buprenorphine in the dose range 0.4–7.0 mg was found to be a potent, long lasting and safe analgesic. Serial blood gas estimations performed on ten of the patients confkmed the clinically observed lack of respiratory depression.
Inadvertent intra‐arterial injection of flucloxacillin
Authors: ZIDEMAN D.A. , MORGAN M.
Published: February 2007

Flucloxacillin 500 mg in 5 ml water was accidentally injected into a radial artery. This resulted in gangrene of parts of the thumb, index and middle fingers, necessitating amputation. Gangrenous areas requiring skin grafting also occurred on the forearm.
Epidural block during labour in a patient with spina bifida cystica
Authors: VAAGENES P. , FJÆRESTAD I.
Published: February 2007

A case report is presented of a patient in whom a lumbosacral meningocele had been successfully removed in the neonatal period and who later received a lumbar epidural block for pain relief during labour. Although a high level was chosen for the puncture, deficiency of the dorsal interspinous layer of ligaments complicated the localisation of the epidural space when the ‘loss of resistance’ technique was applied. Analgesia was achieved more rapidly and with a lower dose of analgesic drug than is normally necessary for satisfactory relief of pain in labour.
Induced hypotension with a mixture of sodium nitroprusside and trimetaphan camsylate
Authors: MacRae W.R. , Wildsmith J.A.W. , Dale B.A.B.
Published: February 2007

Thirty patients undergoing induced hypotension were given a 10:1 mixture of trimetaphan camsylate and sodium nitroprusside by intravenous infusion. A readily controllable hypotension was produced with considerable reduction in the dosage of these drugs compared to their use individually. There were no cases of prolonged hypotension.
The placental transfer of cimetidine
Authors: HOWE J.P. , MCGOWAN W.A.W. , MOORE J. , MCCAUGHEY W. , DUNDEE J.W.
Published: February 2007

The placental transfer of cimetidine 200 mg intravenously was investigated in 16 patients in normal labour and 40 patients undergoing elective Caesarean section. Cimetidine crosses the placental barrier, blood levels at delivery in mothers and infants being lower with increasing time from injection. Umbilical cord blood cimetidine levels are markedly lower than those of the mother during the first hour following administration but thereafter levels are similar. The mean fetal–maternal ratio at delivery was highest (0.84) at 1 1/2–2 hours following administration. Postdelivery infant and maternal blood samples showed that cimetidine could not be detected, in most cases, 19 hours following administration. The relevance of these findings is discussed.
A hazard of Swan‐Ganz catheterisation
Authors: SMITH GARY B. , WILLATTS SHEILA M.
Published: February 2007

A case of pneumoperitoneum which complicated the insertion of a Swan‐Ganz catheter is reported. The importance of constant awareness of potential complications of invasive intensive care monitoring is emphasised.
Internal jugular catheterisation
Authors: MORGAN R.N.W. , MORRELL D.F.
Published: February 2007

A case is presented of near fatal haemorrhage into the pleural space following laceration of a vertebral artery during attempted cannulation of the internal jugular vein before cardiopulmonary bypass. The literature on similar cases is reviewed and recommendations made.
Severe cardiovascular collapse following phenoperidine
Authors: GREEN D.W.
Published: February 2007

A case of severe cardiovascular collapse following phenoperidine in a patient receiving controlled ventilation for status asthmaticus is described and the treatment discussed.
Protection against pulmonary acid aspiration with ranitidine
Authors: ANDREWS A. D. , BROCK‐UTNE J. G. , DOWNING J. W.
Published: February 2007

Ninety patients presenting for elective surgery were randomly divided into three groups A, B and C and studied on a double‐blind basis to assess the effects of ranitidine, a new histamine H2‐receptor antagonist and placebo on gastric secretion. Group A received 150 mg ranitidine orally at 2200 hours on the evening before surgery and a further 150 mg 1–2 hours before operation. Group B received 150 mg ranitidine with premeditation only, while Group C received a placebo at 2200 hours and again with premedication on the day of surgery. Gastric fluid was aspirated immediately after induction of anaesthesia and the volume and pH of the aspirate measured. Gastric volumes were significantly greater in the placebo group when compared to Group B. but not to Group A. The proportion of patients with pH > 2.5 at induction of anaesthesia was 100. 82.3 and 67.9% in Groups A, B and C, respectively. The percentage of patients who had measured gastric volume < 25 ml or pH > 2.5 were Group A—90%. Group B–75.9% and Group C—57%. Thus ranitidine 150 mg orally on the evening before surgery and on the morning prior to anaesthetic induction lowered the mean volume and raised the average pH of gastric content to safe levels in all cases.
Delayed respiratory arrest after bupivacaine
Authors: HOLMBOE J. , KONGSRUD F.
Published: February 2007

A case history is reported in which a 55‐year‐old man developed respiratory arrest nearly 3 hours after administration of an epidural anaesthetic with bupivacaine 135 mg. Some of the possible explanations are discussed, but none of them fully accounts for the complication.
Transoesophageal cardiac pacing
Authors: HARTLEY J. M. F.
Published: February 2007

An elderly patient, whilst undergoing anaesthesia for a total hip replacement, developed a marked bradydysrhythmia suggestive of sick sinus syndrome. The heart rate was unaffected by atropine 1.2 mg administered intravenously. Cardiac pacing was achieved by means of a non‐invasive transoesophageal pacemaking catheter. The simplicity of this technique although temporary, is ideal for emergencies.
Paralysis of the right hemidiaphragm
Authors: POLLARD B. J. , HAIN W. R. , SMALL P. G.
Published: February 2007

A case is described of a baby born with a combination of a paralysed hemidiaphragm and congenital hypothyroidism which led to the need for artificial ventilation. Difficulties were encountered in discontinuing the ventilatory support. The problems involved in timing extubation of infants are discussed together with consideration of the diagnosis and treatment of neonatal hypothyroidism.
A simple suction device
Authors: MACRAE W. A.
Published: February 2007

A simple suction device is described, suitable for portable resuscitation kits. It can be made cheaply, from parts already available in most hospitals and is reliable and effective.
Drug recognition by nurses and anaesthetists
Authors: Smellie Gavin D. , Lees Norman W. , Smith Elizabeth M.
Published: February 2007

A survey of nurses and anaesthetists in a 500‐bed teaching hospital set out to discover how they located a drug container in order to read its label and verify its contents. Members of each group assessed the value of seven factors thought to help in this location and answered questions on personal errors in drug administration. The nurses found the expected position of the drug container in the trolley or cupboard to be the most important factor, followed by the size of the container. The anaesthetists placed the colour of the container as most important, followed by the manufacturer's distinctive container as their second best guide to drug location. This preference for colour and a distinctive container can be used to reduce the chance of confusing drugs locally. A scheme for colour‐coding ampoules in broad groups to reduce gross mistakes in the future is presented.
Cardiac output changes during Caesarean section
Authors: NEWMAN B.
Published: February 2007

A non‐invasive technique of measuring cardiac output changes is described and studies of its accuracy and reproducibility are reviewed. Cardiac output changes in 11 patients undergoing Caesarean section under general anaesthesia were measured with this technique. Increases in cardiac output after induction and commencement of surgery (mean 19%, p < 0.05), and after delivery (mean 19%, p < 0.05) were found.
Outpatient sedation for oral surgery
Authors: WARD M. E. , ROSE N. M.
Published: February 2007

In an attempt to exploit the benefits and to reduce the incidence of side‐effects of etomidate during intravenous sedation for nervous patients undergoing oral surgery under local analgesia, a series of four clinical trials were undertaken: a pilot study in which etomidate was preceded by a combination of pentazocine and diazepam; a double‐blind study in which saline was randomly substituted for the etomidate, and two further studies in which the administration of etomidate was preceded by that of either pentazocine or diazepam alone. The combination of a small dose of diazepam (0.1 mg/kg) with an initial does of etomidate (0.1 mg/kg) followed by increments of the latter as necessary proved to be most successful in reducing the severity of unwanted reactions while retaining the unique advantages of etomidate.
Continuous intravenous infusion of disoprofol (ICI 35868, Diprivan)
Authors: O'CALLAGHAN A. C. , NORMANDALE J. P. , GRUNDY E. M. , LUMLEY JEAN , MORGAN M.
Published: February 2007

Disoprofol has been used to induce and, by continuous infusion, to maintain a light level of general anaesthesia in 100 patients undergoing surgery with the aid of a regional block. Its effects have been compared with 100 patients anaesthetised in a similar manner with Althesin. Disoprofol proved to be a very satisfactory agent for use by this method and apart from an appreciable incidence of pain on injection the number of complications‘was small and comparable to those found with Althesin, which caused more involuntary movements. Recovery was particularly rapid and clear‐headed following disoprofol, and occurred highly significantly more quickly than after Althesin. Disoprofol, however, will not be marketed in the present formulation which has Cremophor EL as the solubilising agent.
Open heart surgery in a patient with homozygous sickle cell disease
Authors: RIETHMULLER R. , GRUNDY E. M. , RADLEY‐SMITH R.
Published: February 2007

A child in heart failure with homozygous sickle cell disease underwent corrective surgery on cardiopulmonary bypass. The use of early intra‐operative exchange transfusion produced a rapid fall in the level of HbS. Postoperatively she developed falciparum malaria which responded to treatment. She was eventually discharged home to Nigeria 8 weeks after her operation.
Intra‐ocular pressure and premedication with oral diazepam
Authors: Trew C.T. , Manus N.J. , Jackson D.M.
Published: February 2007

Thirty patients scheduled for routine eye surgery were randomly allocated to receive either diazepam 0.2 mg/kg or ascorbic acid 100 mg orally 90 minutes pre‐operatively in a double‐blind fashion. Diazepam caused no significant change in intra‐ocular pressure.
Plasma levels of methylprednisolone following administration during cardiac surgery
Authors: THOMPSON M. A. , BROADBENT M. P. , ENGLISH JUDIE
Published: February 2007

Methylprednisolone was given to patients undergoing open‐heart surgery in a dose of 30 mg/kg administered following induction of anaesthesia and repeated with the start of cardiopulmonary bypass. The effects of this treatment on 2,3‐DPG, P50 and cardiac index were compared with a control group who did not receive steroids. In addition plasma levels of methylprednisolone were assayed throughout the operations and up to 24 hours postoperatively. There was no significant difference between the two groups despite apparently adequate plasma levels of methylprednisolone, and it is concluded that steriods do not affect the P50 or 2,3‐DPG in patients undergoing cardiopulmonary bypass.
Subclavian venous catheterisation in small children using the Seldinger technique
Authors: Pybus D.A. , Poole J.L. , Crawford M.C.
Published: February 2007

Subclavian venous catheterisation, using a Seldinger technique, was attempted in 25 children weighing less than 10 kg (mean 6.4 kg). Catheterisation was successful in 24 cases. Initial catheter position was satisfactory in 19 of the 24 cases (79%) and with repositioning it was possible to obtain satisfactory flow and pressure‐wave recordings in all 24 patients. The technique is simple and provides reliable access to the central circulation in small infants. There was no serious morbidity attributable to the technique.
The anaesthetist and industrial action by ancillary workers
Authors: LODER R. E.
Published: February 2007

Introduction and Summary

The author retired from active practice as a consultant anaesthetist in the British National Health Service during 1980 at the age of 60. He kept a detailed diary for the last full year as consultant. One of the Editors suggested that the diary could form the basis of a series of essays on various aspects of the life and practice of a consultant anaesthetist during the second half of the twentieth century, with his considered views culled from the experiences of a professional lifetime. The first essay deals with the effects of the industrial action by hospital ancillary‐workers in 1979 and considers the special role of the hospital anaesthetist during such disputes.
Laboratory data on ICU admission
Authors: BATCHELOR G. N. , ASBURY A. J. , GREENFIELD A. A.
Published: February 2007

One hundred and seventeen patients admitted to an intensive care unit were studied, to determine whether there is any relationship between laboratory data taken on admission to the unit and the final outcome (survival or non‐survival) of the stay within the intensive care unit.

Discriminant analysis of the data shows that patients could be allocated to one of two groups (survival or non‐survival) using the two parameters of age and serum phosphate, and that this allocation proves correct in 70% of cases, irrespective of the admitting disease and treatment.

The validity of this discriminant function was tested in a further 53 cases and the allocation of patients to survival or non‐survival groups was found to be correct in 70% of cases, supporting the first estimate of the discriminant function.
High frequency venturi jet ventilation
Authors: DAVEY A. J. , LEIGH J. M.
Published: February 2007

A Penlon Nuffield Series 200 Ventilator, adapted for use as a high frequency jet ventilator, was used to treat a patient with adult respiratory distress syndrome. Adequate alveolar ventilation with this method was achieved with lower mean intrapulmonary pressure (5.4 cmH2O) than with conventional intermittent positive pressure ventilation (IPPV) (6 cmH2O). An improved cardiac output was also apparent, as judged by a better systemic blood pressure [105/50 mmHg for high frequency jet ventilation (HFJV) compared to 90/40 mmHg for IPPV] and a lower central venous pressure 6 cmH2O for HFJV as compared to 9.5 cmH2O with conventional IPPV.

During HFJV, the patient's need for sedatives and narcotics was reduced. This allowed an assessment to be made of any potential neurological damage caused by the cervical fracture. An assessment had not been possible during conventional ventilation due to the heavy narcotic and sedative regime required to settle the patient.

This case report provides further evidence that HFJV is a useful adjunct in the management of patients requiring mechanical ventilation and also that the Penlon Nuffield Series 200 Ventilator is capable of high frequency jet ventilation.
High frequency venturi jet ventilation
Authors: DAVEY A. J. , LAY G. R. , LEIGH J. M.
Published: February 2007

The functional characteristics of the Penlon Nuffield Series 200 Ventilator used for high frequency venturi jet ventilation are investigated.

The results show that the ventilator is capable of ventilating lungs with low compliance with large minute volumes and should prove to be effective in clinical practice.
Book review
Authors: Blogg C.E.
Published: February 2007

Adverse Reactions to Anaesthetic Drugs. Volume 8. Monographs in Anaesthesiology Edited by J.A. Thornton.
Editorial
Authors: Hall John , Corall Ian
Published: February 2007

Great births are hard in the labour, and many glorious men have been cut out of the womb.
Prevention of air emboli in hip surgery
Authors: HARVEY P. B. , SMITH J. A.
Published: February 2007

A study is described in which clinically detectable air emboli which occurred during total hip replacement were eliminated by flushing the femoral shaft cavity with carbon dioxide. Transient falls in blood pressure were still observed immediately after insertion of bone cement, and alternative mechanisms are discussed.
Pneumocephalus as a complication of posterior fossa surgery in the sitting position
Authors: MacGillivray R. G.
Published: February 2007

A case of pneumocephalus complicating posterior fossa surgery in the sitting position is presented. Rapid diagnosis was obtained by computerised tomography. This condition should be suspected whenever a patient demonstrates delayed recovery or neurological deficit after craniotomy and nitrous oxide anaesthesia. The literature on the subject is reviewed.
Pneumocephalus after posterior fossa exploration in the sitting position
Authors: PANDIT UMA A. , MUDGE BARBARA J. , KELLER T. S. , SAMRA S. K. , KILARU P. , PANDIT S. K. , COHEN P. J.
Published: February 2007

Entrainment of air following exploration of posterior cranial fossa in the sitting position was studied in five patients. Intracranial pressure was monitored through a ventriculostomy catheter after closure of the dura. In three patients nitrous oxide was added to the breathing mixture only after the baseline intracranial pressure had stabilised following closure of the dura. A marked rise in intracranial pressure was observed immediately. A rapid decrease in intracranial pressure occurred when nitrous oxide administration was stopped. Two patients were given nitrous oxide from the beginning. No change in intracranial pressure was noted.

Computerised tomogram on the first postoperative day revealed a significant amount of air in eight cases.
Recalled apprehension after premedication with lorazepam
Authors: Burton A. J.
Published: February 2007

Seventy patients undergoing minor gynaecological surgery were allocated to four groups. Patients received intramuscular diazepam or papaveretum in combination with hyoscine, oral lorazepam in combination with hyoscine, or no premedication at all. Visual analogue scales were used to assess apprehension and postoperative recall of apprehension. From this study only patients given lorazepam and hyoscine can be said to recall less pre‐operative apprehension than patients not premedicated.
Caudal block for postoperative analgesia in children
Authors: Bramwell R.G.B. , Bullen Catherine , Radford P.
Published: February 2007

A clinical trial was performed to compare the effects of intramuscular dihydrocodeine with caudal bupivacaine on postoperative pain and recovery in 181 children who had undergone either circumcision, inguinal herniotomy or orchidopexy performed under general anaesthesia. Linear analogues were used to assess level of consciousness and apparent pain. Recovery of consciousness was slower after caudal analgesia. For 90 minutes following circumcision there was significantly less pain with caudal analgesia, but better pain relief could not be demonstrated following inguinal herniotomy and orchidopexy.
Unusual dissemination of pseudomonads by ventilators
Authors: IM S. W. K. , FUNG J. P. H. , SO S. Y. , YU D. Y. C.
Published: February 2007

Three patients acquired Pseudomonas pneumonia while they received mechanical ventilation. Detailed microbiological studies on these cases showed direct surface spread of pseudomonads from ventilator tubing into the airways. The ventilator tubing was not sterilised properly by liquid disinfectant due to air‐trapping and inadequate drying. Proper cold sterilisation not only of nebulisers and humidifiers, but also of ventilator tubings, is emphasised.
Acebutolol and coronary artery surgery
Authors: THOMS G. M. M. , REECE I. J. , ODOM N. J. , KAYE C. M. , SANKEY M. G.
Published: February 2007

Plasma levels of acebutolol and its major human metabolite, diacetolol, were determined before, during and after aortocoronary bypass grafting in 10 patients who had received a chronic oral regimen of acebutolol 200 mg t.d.s. for at least 6 days before surgery, a 200 mg dose with the premedication and 5–10 mg intravenously immediately before intubation. It was found that this regimen produced beta‐adrenoceplor antagonist levels which were within the range in which attenuation of hypertension and tachydysrhythmiu occurs. These effective plasma levels were sustained throughout surgery and persisted into the early recovery period.
A cumulative anaesthesia record system
Authors: Middleton Harry , Hales Susan
Published: February 2007

The use of a cumulative anaesthesia record draws attention to possible hazards, avoids dangers of repeat administrations, recalls patients' preferences and successful techniques and shows the complete course of an anaesthetic in the event of medicolegal problems.
Early documentation of disaster victims
Authors: FINCH P. M. , HAMILTON T.
Published: February 2007

Early documentation is important in the process of sorting disaster victims. To provide a basis for this documentation, a four category card has been designed that can be rapidly used with little previous training. Once folded, the card displays the category of urgency on one side and basic medical details on the reverse. Later changes of category can easily be effected by refolding the card.
The alcoholic patient and surgical stress
Authors: HAXHOLDT OLGA ST. , JOHANSSON G.
Published: February 2007

In order to find out how the response to operative trauma is influenced by chronic alcohol consumption, 53 patients (28 alcoholics and 25 non‐alcoholics) were investigated. The chronic alcoholic was defined as a person having a regular, daily alcohol consumption of over 70 g pure alcohol for at least 3 years. The mean annual consumption in the patients studied was 52 litres pure alcohol (143 ml/day). The investigation was also designed to determine whether the pre‐operative infusion of alcohol could prevent the withdrawal syndrome and in that way alter the stress response.

The results clearly showed a diminished adrenocortical response to surgical stress in alcoholic patients. While it was possible to suppress some catecholamine‐mediated withdrawal symptoms by pre‐operative alcohol infusion this did not influence the stress response, in any way. It is concluded that complications under anaesthesia and in convalescence in alcoholic patients are not only the consequence of the withdrawal but rather of the general toxic effects of alcohol especially on the endocrine and metabolic functions.