bluuebunny/crossref_metadata_2025 huggingface dataset:
Exposure of nitrous oxide to X‐rays
Authors: YANAGIDA HISASHI , NAKAJIMA MICHIAKI
Published: February 2007

X‐radiation has been shown to produce nitric oxide (NO) and nitrogen dioxide (NO2) in the presence of nitrous oxide (N2O) The purpose of the present study was to confirm how much NO and NO2 was produced when constant amounts of nitrous oxide were exposed to constant X‐radiation. Twenty polyethylene bottles (capacity 10 litres) were filled with nitrous oxide alone. Another 20 bottles were filled with nitrous oxide and 30% oxygen. Each bottle was placed at a distance of 30 cm from the X‐ray tube and they were directly in the line of the X‐ray beam at a setting of 90 kV at 0·5 mA, a standard setting for chest fluoroscopy. The range of duration of X‐ray exposure was from 0 (control), to 2, 3, and 5 minutes in five bottles each, respectively. A colorimetric recording method (Saltzman) and a chemiluminescent monitor were used for measurement of NO and NO2. In the bottles filled with nitrous oxide alone, the production of NO was not affected by the duration of X‐ray exposure, but the longer duration of X‐ray exposure produced a larger amount of NO2. In the bottles filled with nitrous oxide and 30% oxygen, the longer duration of X‐ray exposure produced larger amounts of both NO and NO2. These finding confirmed a previous investigation in which nitrous oxide was not inert under X‐ray exposure. As the presence of oxygen plays an important role in the oxidation of nitrous oxide under X‐ray, this study suggests another potentially hazardous interaction that may occur secondary to the administration of an anaesthetic in the presence of X‐irradiation such as pulmonary angiography, cardiac catheterisation, and fluoroscopic bronchoscopy or biopsy.
Alfentanyl (R39209): initial clinical experience with a new narcotic analgesic
Authors: KAY B. , STEPHENSON D.K.
Published: February 2007

R39209 (Alfentanyl), a new narcotic analgesic with a uniquely short duration of effect, was used to supplement nitrous oxide and oxygen for the maintenance of anaesthesia. Twenty‐two patients undergoing minor surgery were studied.

Clinical anaesthesia was excellent or good in most (16) of the patients, and recovery was excellent or good in 18 patients, waking time being less than one minute in 15 patients. However the incidence of complications and side‐effects, mainly movement, apnoea, difficulty in assisting ventilation, nausea and vomiting was high.

Intravenous administration of R39209 during anaesthesia induced significant depression of respiratory rate and minute volume during the second, third and fourth minutes after injection. There was an unexplained significant rise in respiratory rate and minute volume in the first 30 seconds after the first injection.

The first administration ofR39209 also caused an unexplained, significant reduction in cardiac rate. An insignificant rise in mean systolic blood pressure followed injection of the drug.

The transient effect of R39209 was confirmed in clinical practice, and the drug exhibited the features of a typical narcotic analgesic. It is concluded that R39209 will have a useful place in anaesthetic practice, and that better clinical results will be obtained with more experience of the drug, and better selection of indications for its use.
Delayed adverse responses to both methohexitone and Althesin
Authors: BEAMISH DAVID , BROWN DAVID T.
Published: February 2007

A patient who reacted to both methohexitone and Althesin on separate occasions is described. On each occasion the reaction was delayed following anaesthesia. Underlying chronic infection had sensitised the patient's complement pathway, allowing it to be activated by two unrelated intravenous anaesthetic agents.
Interruption of pain pathways in the treatment of the cervical syndrome
Authors: Sluijter Menno E. , Koetsveld‐Baart Cobie C.
Published: February 2007

In the cervical syndrome a distinction should be made between an upper and a lower type. The upper type is usually emanating from the intervertebral or facetal joints, since pathology causing nerve‐root irritation is confined to the more caudal segments. In the lower type nerve‐root irritation is usually the cause of pain but secondary irritation of the facetal joints can be an important contributing factor.

Treatment should primarily be conservative. If this fails and if surgical intervention is not indicated an attempt should be made to interrupt pain pathways. This can be done by division of the posterior primary rami or by making a radio‐frequency lesion in the dorsal root ganglion. The results indicate these procedures can be of considerable help in a group of patients who do not respond to any other treatment.
Plasma phosphate and red cell 2,3‐diphosphoglycerate following abdominal surgery
Authors: MACDONALD ROSEMARY , GUILLOU P. J. , KESTER R. C.
Published: February 2007

Changes in plasma phosphate have been serially examined in 20 patients undergoing uncomplicated abdominal surgery. These studies confirm previous reports that a fall in plasma phosphate occurs in the postoperative period, but this does not appear to be metabolically deleterious to the patient since it is not accompanied by a significant concomitant fall in red cell 2,3‐DPG. These investigations form a basis for studies in complicated patients and serve to refute the suggestion that phosphate supplements should be added to all routine postoperative infusions.
Epidural pethidine in labour
Authors: Perriss B.W.
Published: February 2007

The degree of pain relief and duration of action were assessed after various doses of epidural pethidine had been given to 12 primigravid mothers in labour. Evidence of sympathetic and motor blockade was sought. Twenty‐eight doses were administered and of these 50% gave good pain relief and a further 43% of doses produced some relief. The duration of action was related to dose and varied between 55 min after 25 mg pethidine and 150 min after 100 mg. The blood pressure remained constant and there was no motor blockade. In the postpartum period five mothers expressed full satisfaction and seven were helped by the injection.
Audiovisual reviews
Authors: Jennett Sheila
Published: February 2007

Control of the Cardiovascular System By P. Sleight
Adverse reactions to ketamine Anaesthesia
Authors: SKLAR GARRY S. , ZUKIN STEPHEN R. , REILLY THOMAS A.
Published: February 2007

Ketamine, a phencyclidine derivative, has been used as a general anaesthetic since 1965. Numerous reports of adverse psychological reactions have caused diminished use of this drug. Many investigators have tried by pharmacological means to modify these reactions with limited success. In this study, a psychological strategy has resulted in the absence of any adverse psychological reactions and acceptance of ketamine Anaesthesia by all patients. Additionally, all surgeons were satisfied with operating conditions.
Veno‐venous extra‐corporeal membrane oxygenation
Authors: HOPKINSON R. , CARNIE J.
Published: February 2007

A case of post‐traumatic respiratory insufficiency is presented in whom a prolonged period of veno‐venous membrane oxygenation was utilised in an effort to provide life support and allow resolution of pulmonary damage. Stabilisation of respiratory function was achieved. Withdrawal of support was required because of surgical haemorrhage while the patient was fully heparinised. Respiratory function deteriorated and the patient died 4 days after discontinuing membrane oxygenation. The procedure was undertaken in the Intensive Care Unit of a District General Hospital where cardiopulmonary bypass facilities are not normally available.
An unusual cause of neonatal respiratory distress.
Authors: CAHILL J.F.
Published: February 2007

A 2·5 kg male infant developed respiratory distress in the neonatal period. A diagnosis of idiopathic hyaline membrane disease was made and he was treated accordingly. At 24 hours of age he required intubation, and the immediate and dramatic improvement in his condition suggested that the original diagnosis was incorrect. Closer examination of the chest X‐ray revealed an intrathoracic cyst and abnormal vertebrae. The cyst was removed surgically, and histological examination showed it to be a neuro‐endodermal cyst.
Inhalation of a foreign body. A hazard of protective rubber sleeves on the jaws of mouth gags
Authors: MULLIGAN I.P. , MARSHALL R.D.
Published: February 2007

A case is reported in which a young man who required tracheal intubation and intermittent positive pressure ventilation for head and chest injuries, inhaled a foreign body after extubating himself. The unusual nature of the foreign body and the manner of its entering the tracheobronchial tree is reported. The case suggests that the practice of using protective rubber sleeves on the jaws of mouth gags be reviewed and highlights the need to inspect all instruments after use, particularly those that have been employed in the mouth and upper airways.
Intermittent assisted ventilation for neonates
Authors: PETERS C.G. , BENNETT N.R.
Published: February 2007

A simple modification to the Siemens Servo 900B ventilator is described to enable the intermittent assisted ventilation (IAV) function to be used successfully with neonates.
Modification of tracheal tube for paediatric bronchography
Authors: VATASHSKY ELIK
Published: February 2007

A technique is described for performing bronchography in children using a combined tracheal tube and suction catheter. The catheter is cemented to the shorter (concave) exterior curvature along the length of the tracheal tube and the cross section of the combined tube then conforms to the shape of the open glottis. Ventilation through the tracheal tube is maintained throughout the injection of dye via the suction catheter and its subsequent aspiration after completion of bronchography. The technique has been used successfully in over 30 children.
Evaluation of midazolam as an intravenous induction agent
Authors: GAMBLE J.A.S. , KAWAR P. , DUNDEE J.W. , MOORE J. , BRIGGS L.P.
Published: February 2007

Midazolam, a new water‐soluble benzodiazepine, was investigated as an intravenous anaesthetic agent in 260 adult patients in doses ranging from 0.15 to 0.5 mg/kg using a variety of premedications. Its onset of action was generally slow, taking up to 3 minutes to exert its maximum effect. A wide variability in response was found in that some unpremedicated patients were satisfactorily anaesthetised with 0.15 mg/kg while others were only moderately sedated following doses of 0.5 mg/kg. Less variability was found in the elderly who also required smaller doses. Narcotic premedication potentiated the sedative effect of midazolam. Few respiratory or cardiovascular effects were noted apart from hiccough following the larger doses. The incidence of venous sequelae was much lower than that found following diazepam.
Anaesthesia for an unusual carcinoid metastasis
Authors: WARD D.S. , IWAMOTO K.
Published: February 2007

The intra‐operative course of a patient found to have a metastatic serotonin‐secreting carcinoid tumour in the orbit is reported. No prophylactic or intra‐operative therapy was necessary during the administration of enflurane anesthesia. This case demonstrates again the wide spectrum of clinical responses observed among patients with this disease.
Nineteenth century resuscitation apparatus
Authors: McLELLAN I.
Published: February 2007

This paper describes three pieces of 19th century resuscitation apparatus. These pieces, and the widespread literature on the subject, illustrate the interest in artificial respiration in this period.
Halothane and enflurane in dental anaesthesia
Authors: RYDER W. , WRIGHT P.A.
Published: February 2007

A clinical trial was designed to compare the use of halothane and enflurane in outpatient dental anaesthesia. A wholly inhalational technique was chosen. Basal nitrous oxide and oxygen was delivered from a Walton V demand‐flow machine and was supplemented alternately with halothane or enflurane delivered from paired Goldman vaporisers in series. Under these circumstances, enflurane produced significantly fewer dysrhythmias than halothane, but was a more difficult, more expensive and less versatile agent to use. Overall, it was considered inferior to halothane in this context except, perhaps, where repeat anaesthetics might be required at short intervals of time.
The fibrinolytic effects of anaesthesia
Authors: SIMPSON P. J. , RADFORD SHEILA G. , FORSTER S. J. , COOPER GRISELDA M. , HUGHES A. O.
Published: February 2007

The fibrinolytic effects of six different anaesthetic agents were studied in 36 patients undergoing abdominal hysterectomy. Fibrinolytic activity was measured by dilute whole blood and euglobulin clotlysis times. Concentrations of plasminogen, fibrinogen and fibrin degradation products were also determined. Significant enhancement of fibrinolytic activity, measured as a decrease in clotlysis time, was seen during anaesthesia and surgery with all agents studied. Halothane produced the least effect and the greatest increase in fibrinolytic activity was seen during trichloroethylene anaesthesia. Lumbar extradural anaesthesia also consistently produced enhancement of fibrinolysis. The reasons for these results and their clinical implications are discussed.
Cimetidine as an oral antacid before elective Caesarean section
Authors: JOHNSTON J. R. , McCAUGHEY W. , MOORK J. , DUNDEE J. W.
Published: February 2007

The H2‐receptor antagonist cimetidine was used as a pre‐operative antacid in 64 women scheduled for elective Caesarean section. All were given cimetidine 400 mg 90–215 minutes before induction, with 20 of them having an extra 400 mg dose the previous night. The intragastric pH at induction of anaesthesia was reliably above 2.5 if the treatment was given 90 150 minutes beforehand. The volume of gastric contents was reduced when compared with a control series of women receiving either no pre‐operative antacid or 30 ml magnesium trisilicate mixture BPC. No adverse effects on mothers or infants were detected.
Diet induced ketosis in epilepsy and anaesthesia
Authors: HINTON W. , SCHWARTZ RUBY H. , LOACH A. B.
Published: February 2007

Ketogenic diets have a high fat and low carbohydrate and low protein content to induce ketosis which is monitored by daily urine testing. Lapses in diet are frequently associated with loss of anticonvulsant control. There has, as yet, been no report of children maintained on a ketogenic diet subject to anaesthesia and surgery; this paper records the changes in metabolic variables observed in three patients undergoing simple inhalation anaesthetics for minor surgery.
Anaesthesia and cognitive functioning
Authors: COHEN R. L. , MacKENZIE A. I.
Published: February 2007

Day care patients at Law Hospital, who had received either a general or a local anaesthetic in conjunction with minor surgery, were assessed by five tests of mental junction before surgery and before discharge from hospital some hours after surgery. These patients did not perform differently from control patients, who were subjected to the same two testing sessions, without intervening surgery or anaesthesia. It was concluded that the day cases were quite capable of normal cognitive functioning at the time of their discharge and that the procedures followed by the hospital for the discharge of day cases are generally adequate.
Retropharyngeal abscess following tracheal intubation
Authors: MAJUMDAR B. , STEVENS R. W. , OBARA L. G.
Published: February 2007

A case of retropharyngeal abscess following tracheal intubation is presented with a review of the English medical literature. It is a rare complication of tracheal intubation.
Ethylene glycol poisoning
Authors: GORDON H. L. , HUNTER JENNIFER M.
Published: February 2007

A case of self‐poisoning with ethylene glycol is presented. The metabolic upset induced by ingestion of this substance is discussed and the principles underlying treatment with ethyl alcohol, sodium bicarbonate and renal dialysis are outlined. The practical problems experienced with this therapy are detailed. The need for immediate instigation of treatment and for intensive care are emphasised.
Ineffective transcutaneous nerve stimulation following epidural anaesthesia
Authors: Davies J. R.
Published: February 2007

Thirty‐five patients were delivered by elective Caesarean section under general or epidural anaesthesia. For postoperative analgesia they received narcotic analgesics as required and either transcutaneous nerve stimulation or an inactive stimulator. The patients receiving an active stimulator following general anaesthesia had significantly less pain and required significantly less postoperative analgesia than their control group. The epidural patients did not receive any additional benefit from active stimulation, but had the same amount of pain and the same analgesic requirement as patients receiving active stimulation following general anaesthesia. The possible causes for the failure of transcutaneous nerve stimulation after epidural anaesthesia and their implications are discussed.
Effects of nitrous oxide on liver haemodynamics and oxygen consumption in the greyhound
Authors: THOMSON I. A. , HUGHES R. L. , FITCH W. , CAMPBELL D.
Published: February 2007

The effects of increasing concentrations of nitrous oxide 30, 50 and 70% on the hepatic circulation and hepatic oxygen consumption were investigated in seven normocapnic greyhounds. Hepatic arterial and portal venous blood flows were measured continuously using electromagnetic flow probes, and mean arterial pressure and cardiac output monitored. The administration of nitrous oxide caused linear decreases in hepatic arterial, portal venous and total liver blood flows. Increases in mean arterial pressure, hepatic arterial resistance and mesenteric vascular resistance were noted. There were no significant changes in hepatic oxygen consumption. It is suggested that the decrease in liver blood flow may result from alpha‐adrenoceptor stimulation.
Maternal mortality
Authors: BREHENY FRANCIS , McCARTHY J.
Published: February 2007

A retrospective study of the causes of maternal mortality over the past 20 years in the National Maternity Hospital, Dublin, was undertaken. Anaesthesia contributed to 4.4% of all maternal deaths and to 5.7% of ‘true’ maternal deaths. In the last 10 years studied it did not contribute to maternal mortality. It was concluded that anaesthesia was not a major cause of maternal mortality in this hospital.
On assisting the anaesthetist
Authors: VENN CHRISTINE
Published: February 2007

The author was born in Leipzig Germany in 1936. She first trained as a children's nurse in West Berlin and, after bringing up three children, qualified as a State Enrolled Nurse at Addenbrooke's Hospital Cambridge in 1976. She has held her present post as an anaesthetic room nurse in the Ear Nose and Throat operating theatre of Addenbrooke's Hospital Cambridge for 3 years. The paper analyses the task of the anaesthetic room nurse in supporting the anaesthetist both physically and psychologically.
Editorial
Authors: Donald K.W. , Boulton T. B.
Published: February 2007

I would be a liar if I did not straightway admit that the pain defies description. Scottish Medical Journal, 1976
Spinal anaesthesia for Caesarean section
Authors: CORKE B. C. , DATTA S. , OSTHEIMER G. W. , WEISS J. B. , ALPER M. H.
Published: February 2007

The effect upon the neonate of a short period of maternal hypotension sustained during the initiation of spinal analgesia for Caesarean section was studied. Babies born to mothers with hypotension were significantly more acidotic than controls although acid‐base levels were still within normal limits. Neuro‐behavioural studies were found to be normal in both groups at 4 and 24 hours. It was concluded that a short period (<2 minutes) of hypotension was not harmful to the neonate.
Diazepam and suxamethonium muscle pain (a dose‐response study)
Authors: Verma R.S.
Published: February 2007

Postoperative muscle pain occurred in 17.2% of patients given diazepam intravenously 5 minutes prior to suxamethonium. The incidence of muscle pain was 48% in those patients who were not given diazepam before suxamethonium. The difference is statistically significant (p < 0.01). Five mg diazepam reduced the incidence of pain but not significantly (p = 0.30); 10 mg diazepam significantly reduced the incidence (p < 0.05); while 15 and 20 mg diazepam showed belter effects (p < 0.01). Diazepam pretreatment also reduced the severity, frequency and duration of muscle pain. The incidence of fasciculations was significantly reduced hut there was no correlation between the incidence of fasciculations and the occurrence of muscle pains.
Status asthmaticus
Authors: MATHER S. J. , EDBROOKE D. L. , NEWBY D. M.
Published: February 2007

The management of a case of status asthmaticus complicated by surgical emphysema is described. In view of voice changes, intubation was necessary but intermittent positive pressure ventilation was considered unwise, because of the surgical emphysema. A means of maintaining adequate sedation in an intubated patient whilst allowing spontaneous respiration is outlined.
An inflatable obstetric anaesthetic ‘wedge’
Authors: CARRIE L. E. S.
Published: February 2007

An inflatable ‘wedge’ for use in obstetric or other operations is described. As well as being inexpensive, the apparatus is remarkably robust and has the advantage that the degree of inflation or deflation can be easily adjusted from the head of the operating table.
Carbon dioxide response after epidural morphine
Authors: Holland R. B. , Levitt M. W. D. , Whitton L. A. , Shadbolt N.
Published: February 2007

The change in minute volume in response to a rising inspired carbon dioxide concentration was compared in 20 patients who received epidural morphine for postoperative analgesia (the test group), and 18 patients who did not (the control group). The minute volume increase in the test group was depressed at 6 hours but not at 12 hours postoperatively, but the degree of depression was not statistically significant. Control patients had no significant respiratory depression at any time. When the test and control groups were compared with each other, no statistically significant difference between groups was found. Two patients in the test group demonstrated a markedly depressed response to carbon dioxide challenge postoperatively. The incidence of nausea and vomiting was similar in both groups, while the presence and severity of pain was reduced in the test group.
Undergraduate teaching: a developing country experience
Authors: Ene E.E. , Akpan Sylvia G.
Published: February 2007

The objectives and programme of instruction for medical students in the University of Lagos are described.

The reactions of 144 students to the course were assessed by a detailed questionnaire. AH the students expressed a preference for instructional simulation to teaching in an operating theatre. Twenty per cent indicated that they would consider anaesthesia as a career.
Inhalation of formaldehyde vapour
Authors: LAWLER P. G.
Published: February 2007

A hazard of formaldehyde sterilisation of Williams bacterial filters is described. A short period of inhalation of formaldehyde vapour produced no sequelae. The mode of sterilisation of filters required review.
Naloxone reversal of meptazinol‐induced respiratory depression
Authors: SLATTERY P. J. , HARMER M. , ROSEN M. , VICKERS M. D.
Published: February 2007

The effects of intravenous meptazinol on respiratory rate and end‐tidal CO2 concentrations were investigated in a group of 20 anaesthetised subjects. In clinically effective doses, meptazinol produced a dose‐related fall in respiratory rate and elevation in end‐tidal CO2 concentration. Naloxone reversed these effects.
Anaesthesia in first degree atrioventricular block
Authors: HAYWARD R. , DOMANIC N. , ENDERBY G. E. H. , McDONALD L.
Published: February 2007

A patient with an intracardiac conduction defect characterised by first degree atrioventricular block due to slowed transmission through the atrioventricular node with increased refractoriness of the node, is described. Asymptomatic first degree block, rarely progressing to transient Wenckebach (type 1 second degree) block had been present for a period of 32 years until general anaesthesia was required, when profound bradycardia attributable to complete atrioventricular block developed abruptly. Subsequent investigations located delayed intracardiac conduction through the atrioventricular node, and indicated excess vagal activity rather than structural disease as the cause.

The significance of first degree heart block is discussed in relation to other forms of atrioventricular conduction defect and the current recommendations for temporary pacing for elective general anaesthesia.
Anaesthesia for pharyngolaryngectomy with extrathoracic oesophagectomy and gastric transposition
Authors: Plant Mary
Published: February 2007

Pharyngolaryngectomy with extrathoracic oesophagectomy and gastric transposition has become a standard operation for laryngopharyngeal cancer. The anaesthetic management of patients undergoing this procedure is described, with reference to a personal series of 10 cases.
Respiratory obstruction of unusual origin
Authors: HINE I.
Published: February 2007

Inadvertent exposure at close range to a jet of propellant gas escaping from an aerosol container produced severe and rapidly‐developing oedema of the face, tongue and oropharynx of the victim. Emergency tracheostomy was necessary to maintain an airway.
Diagnosis of reflex sympathetic dysfunction. Use of the skin potential response
Authors: Cronin K.D. , Kirsner R.L.G.
Published: February 2007

An objective diagnostic technique for reflex sympathetic dysfunction has been developed utilising bilateral skin potential response measurement. The simple and non‐invasive technique is clinically reliable and can be used to avoid unnecessary sympathetic blocks.
The Association of Anaesthetists of Great Britain and Ireland 1932–82
Authors: HELLIWELL P. J.
Published: February 2007

The first 50 years (1932–82) of the existence of the Association of Anaesthetists of Great Britain and Ireland are described and its progress, organisation and future aspirations are explored.
The anaesthetic management of a patient with familial dysautonomia
Authors: STENQVIST O. , SIGURDSSON J.
Published: February 2007

Familial dysautonomia is a rare inherited disease of the nervous system, involving mainly peripheral sensory and sympathetic nerves. The autonomic instability is of greatest importance for the anaesthetist although the sensory defect is the most dramatic symptom of the disease. A case report of a 15‐year‐old girl undergoing two operations for severe scoliosis is presented with a discussion of the anaesthetic problems encountered in this disease.
Transcutaneous Pco2 in adults
Authors: GOLDMAN M. D. , GRIBBIN H. R. , MARTIN R. J. , LOH L.
Published: February 2007

Using a transcutaneous Pco2 (PtcCO2) electrode, arterial Pco2 (Paco2) was compared with PtcCO2in eight adults (seven patients, one normal subject) over a wide range of values of PaCO2(2.4 to 7.87 kPa). At an electrode temperature of 43°C, PtcCO2=1.25 Paco2kPa (95% confidence limits: 0.60 kPa). Change in PtcCO2accurately reflected change in Paco2.
Anaesthetic manpower in the future in the UK
Authors: VICKERS M. D.
Published: February 2007

The short‐term objective of the DHSS of a 1:1 consultant: junior ratio by 1988 is compatible with current trends in consultant expansion and implies no reduction in registrars before then.

The target of doubling the number of consultants in 15 years cannot be met in anaesthesia without a fairly sharp, and relatively short‐lived increase in senior registrar numbers. This has implications for planning in other specialties, particularly surgery. It seems prudent to assume the target will take longer than 15 years to achieve. Between 1988 and 2004 there would need to be a reduction of between one and two registrar posts per region per annum if the DHSS target of a consultant:junior ratio of 1.8: 1 is to be met. Lesser reductions would be necessary if there were to be expansion of Hospital Practitioners in anaesthesia. No change in the number of senior registrar posts need be envisaged. If entry were properly controlled, the current number of registrar posts would be compatible with a viable career structure for British graduates.
Doxapram and postoperative chest complications
Authors: DRUMMOND G. B. , PARK G. R.
Published: February 2007

In a double‐blind study, an infusion of doxapram, 1 mg/kg/hour, for 4 hours after upper abdominal surgery reduced the incidence of spontaneous cough but did not influence the incidence of other chest complications, such as increased expectoration of sputum or abnormal physical signs.
Extradural versus intramuscular diamorphine
Authors: JACOBSON L. , PHILLIPS P. D. , HULL C. J. , CONACHER I. D.
Published: February 2007

The effects of diamorphine hydrochloride 0.1 mg/kg, given either extradurally or intramuscularly for postoperative analgesia were compared in two randomised double‐blind studies involving 39 patients undergoing thoracotomy and major gynaecological surgery. Assessments were made at fixed intervals after the administration of diamorphine and consisted of the measurement of pain or analgesic effect. Segmental, sympathetic and any adverse effects were sought. There was no significant difference in the quality of analgesia between the two groups in either trial. Extradural diamorphine provided safe and effective analgesia of rapid onset, with no specific undesirable side‐effects. In both studies, analgesia was more prolonged following extradural administration. The relative proportion of spinal binding may be increased after extradural administration and this may be reflected in the prolonged analgesia observed.
On‐demand analgesia
Authors: WELCHEW E. A.
Published: February 2007

A double‐blind study comparing a totally patient‐controlled on‐demand intravenous regime delivering fentanyl and a simple, regular, 4‐hourly intramuscular regime delivering morphine is described. It was demonstrated that mean pain scores in the two groups were almost identical whilst sedation scores were not significantly different. Nausea scores were significantly lower in the regular morphine group. Postoperative respiratory function tests were not significantly different in the two groups.
Experience with self‐administered pethidine with special reference to the general practitioner obstetric unit
Authors: Harper N.J.N. , Thomson J. , Brayshaw S.A.
Published: February 2007

We describe our experience with on‐demand self‐administered intravenous pethidine when used to provide analgesia on a general practitioner obstetric unit. The Cardiff Palliator was used by 42 patients at or near term. Analgesia was satisfactory in a high proportion of case i and this method of analgesia was generally preferred to intramuscular pethidine. Apgar scores were unsatisfactory in three instances but obstetric considerations were thought to have contributed. The problems of incorporating this form of analgesia into the practice of a general practitioner unit are discussed.
Anaesthesia for myringotomy
Authors: DRAKE‐LEE A. B. , CASEY W. F. , OGG T. W.
Published: February 2007

The effect of two methods of anaesthesia on the findings at myringotomy in children with secretory otitis media was studied. One group of patients spontaneously breathed a mixture of nitrous oxide. oxygen and halothane whereas a second group had assisted ventilation, tracheal intubation and breathed a mixture of halothane and oxygen. Nitrous oxide diffused significantly into middle ears which had gas under reduced pressure (with or without fluid present) when compared with normal ears (p <0.05). Assisted ventilation prior to tracheal intubation did not introduce gas into the middle ear. It is concluded that impedance audiometry is a reliable method of assessing the middle ear prior to surgery.
Effects of intermittent 0.5% nitrous oxide/air (v/v) on the fertility of male rats and the post‐natal growth of their offspring
Authors: VIEIRA ERICA , CLEATON‐JONES P. , MOYES D.
Published: February 2007

In a study of male rat fertility male Wistar albino rats were exposed to 0.5% nitrous oxide/air mixtures (v/v) for 30 days and control rats were exposed to oil‐free air for the same time period. Thereafter each male was mated with three nulliparous female rats and mated again with three more nulliparous rats after a 6‐month recovery period. The offspring were weighed and measured for 8 weeks postnatally. There was a significant reduction in mean litter size of the female rats mated with the male rats directly after the nitrous oxide exposure period. The offspring from the female rats mated with the males directly after the exposure period were significantly smaller in size than the control group. These results show a reversible reduction in male Wistar rat fertility, after exposure to 0.5% nitrous oxide in air (v/v), as well as a postnatal growth depression.
Failed intubation in congenital tracheal stenosis
Authors: GODDARD R. H. , HUGHES D. G.
Published: February 2007

A girl aged 16 years was found to have tracheal obstruction which prevented satisfactory intubation at induction of anaesthesia for surgical correction of an idiopathic scoliosis. Subsequent radiological investigations revealed a tracheal stenosis, and an anaesthetic assessment of her upper airway was carried out before major surgery.
Bicornuate uterus and aortocaval compression
Authors: MAGEE D. A.
Published: February 2007

A severe case of supine hypotensive syndrome associated with a bicornuate uterus is presented. It is suggested that failure of left lateral tilt to prevent the syndrome was associated with anatomical displacement of the uterus to the right. The importance of trying right lateral tilt, if response to left tilt is poor, is noted.
Internal jugular catheterisation in small children. The use of a posterior approach
Authors: Chatrath R.R. , Stock J.G.L. , Jones O.D.H.
Published: February 2007

Internal jugular catheterisation, using a posterior approach, was attempted in 50 infants and children aged from 1 day to 12 years, weighing 1.25 to 30 kg. Thirty‐five of the patients weighed less than 10 kg. Catheterisation was successful in 49 cases. Initial catheter position was satisfactory in 48 of the 49 cases and satisfactory pressure waveform and flow characteristics were achieved in all 49 cases. There were no complications attributable to the technique. The technique proved reliable and easily learnt and is recommended as a particularly suitable approach to central venous catheterisation in small children.
An evaluation of Org NC 45 (vecuronium) in paediatric anaesthesia
Authors: FERRES C. J. , CREAN P. M. , MIRAKHUR R. K.
Published: February 2007

Vecuronium (Org NC 45) was evaluated as a neuromuscular blocking agent in chidren and compared with pancuronium in a double‐blind study. Satisfactory intubating conditions were present 90 seconds after 0.1 mg/kg of either drug. The onset of complete block was quicker after vecuronium but the greatest difference was found in the duration to 25% recovery which was significantly shorter with vecuronium (20 min) compared with pancuronium (48 min). The use of vecuronium was associated with cardiovascular stability and no clinical evidence of histamine release. Antagonism of the block was readily achieved with neostigmine.
Second stage of labour with or without extradural analgesia
Authors: PHILLIPS K. C. , THOMAS T. A.
Published: February 2007

Two groups of parturients who had received selective extradural analgesia were studied. In Group A patients the regional block was allowed to wear off for the second stage of labour whereas in Group B patients' analgesia was maintained throughout labour.

The maintenance of selective analgesia was of positive benefit to the mothers. They experienced much less pain, labour was not prolonged, dosage of bupivacaine was not increased, the forceps delivery rate was lower and there were fewer persistent malrotations.
Cardiovascular response to intubation
Authors: BORALESSA H. , SENIOR D. F. , WHITWAM J. G.
Published: February 2007

The cardiovascular response evoked by tracheal intubation was observed in 20 patients undergoing elective abdominal surgery in whom anaesthesia was induced with either midazolam 0.3 mg/kg or thiopentone 4.5 mg/kg followed by pancuronium 0.1 mg/kg. In the thiopentone group, intubation caused a mean rise in systolic arterial pressure from 141 to 193 mmHg (p < 0.0005) and in the heart rate‐systolic pressure product from 11101 to 21763 (p < 0.05); 5 minutes later the mean values were still 173 mmHg and 19030 respectively. In the midazolam group systolic arterial pressure and the rate pressure product increased from 138 to 151 mmHg and 10960 to 14267 respectively in response to intubation. These values were significantly lower than the thiopentone group (p < 0.005 in each case) and were relatively transient and returned to control values within 5 minutes.
Home ventilatory assistance
Authors: DUNKIN L. J.
Published: February 2007

In the course of 6 years, eleven patients with neuromuscular disorders have been offered home ventilatory assistance. Six of these patients survive and are managed satisfactorily by their families with medical and nursing care provided by general practitioner, community, and hospital services.
Pethidine, atropine, metoclopramide and the lower oesophageal sphincter
Authors: HEY V. M. F. , PHILLIPS K. , WOODS I.
Published: February 2007

The effects of an intramuscular injection of pethidine (1.5 mg/kg) plus atropine 0.5 mg, or pethidine (1.5 mg/kg) plus atropine 0.5 mg plus metoclopramide 10 mg on the lower oesophageal sphincter pressure have been studied manometrically in human volunteers. The mean barrier pressure in the former group was significantly lower than the baseline for the 75 minutes studied. In the latter group the mean barrier pressure was significantly lower than the baseline value for the first 45 minutes only of the study. The addition of atropine 0.5 mg to pethidine 1.5 mg/kg further lowers the barrier pressure when compared with the depression seen with pethidine alone in a previous study. While the addition of intramuscular metoclopramide to the mixture of pethidine and atropine fails to return the mean barrier pressure to the baseline value, it does raise the mean barrier pressure to a level which is probably above the opening pressure of the lower oesophageal sphincter.
An unusual complication of lithotripsy
Authors: SUNDNES K. O. , VAAGENES P. , KVARSTEIN B.
Published: February 2007

The case described illustrates a most unusual course of events due to a perforation in the wall of the bladder during transurethral lithotripsy. Irrigation fluid forced its way retroperitoneally to the mediastinum. The differential diagnostic problems encountered are discussed.
The use of a whistle discriminator
Authors: FOOTERMAN D. S.
Published: February 2007

A whistle discriminator is recommended for routine checking of anaesthetic machines, and for the testing of pipelines. It is suggested that this procedure should replace the single hose test.
An apparatus for the delivery of 50% premixed nitrous oxide and oxygen on demand or by controlled ventilation
Authors: NANCEKIEVILL D. G.
Published: February 2007

A small, portable and robust apparatus for the administration of 50% premixed nitrous oxide and oxygen mixture for analgesia for hospital and emergency use is described. The equipment can deliver the mixture on demand or by intermittent positive pressure ventilation. It has important advantages over earlier devices particularly in the accident and emergency field in which it has already proved successful.
Anaesthesia during the Falklands campaign
Authors: JOWITT M. D. , KNIGHT R. J.
Published: February 2007

The work of the Parachute Field Surgical Team in the Falkland's campaign is described. Data are provided on the methods of resuscitation and anaesthesia used. Suggestions are made for improving drugs and equipment for use in civil disaster or war.
Phantom limb pain during spinal anaesthesia
Authors: MACKENZIE N.
Published: February 2007

Phantom limb pain following amputation is a well known hut comparatively rare phenomenon. Spinal anaesthesia in amputees may cause reappearance of phantom pain in previously pain‐free patients despite complete sensory analgesia. Two such cases are described.
Lorazepam as a premedicant for regional anaesthesia
Authors: RUSSELL W. J.
Published: February 2007

In a double‐blind controlled trial of male patients undergoing transurethral resection of the prostate, oral lorazepam was assessed against a placebo. The same anaesthetist performed all spinal blocks and made all assessments. The patients who received lorazepam had substantial amnesia for the operation and were drowsier, but remained cooperative during the procedure. Patient anxiety as assessed by the anaesthetist and as recalled by the patient was decreased, although anxiety assessment by linear analogue was the same for both groups. Lorazepam significantly increased the patient acceptability of spinal anaesthesia.
Hypersensitivity reactions to Althesin infusion: measurement of complement involvement
Authors: BENOIT Y. , CHADENSON O. , DUCLOUX B. , VEYSSEYRE C. M. , BRINGUIER J. P. , VEYSSEYRE C. , DESCOTES J.
Published: February 2007

Two cases of hypersensitivity reactions in the course of slow infusion of Althesin are reported. Serial examination of their complement system showed a marked activation of the alternate pathway which returned almost to normal within 24 hours.
Plasma concentrations of atropine after rectal administration
Authors: OLSSON G. L. , BEJERSTEN ANNETTE , FEYCHTING H. , PALMÉR LENA , PETTERSSON BRITT‐MARIE
Published: February 2007

The rectal administration of the premedication for children is often preferred in order to minimise discomfort. The appropriate dose of atropine when rectally administered is poorly documented. In this study six children weighing between 7.5 and 41 kg were given 0.02 mg atropine sulphate/kg rectally and four children were given the same doses intramuscularly. Plasma concentrations of atropine were analysed at several intervals after administration by a modified mass fragmentographic method accurate to 0.1 ng/ml. Peak plasma concentration of atropine, reached after 15 minutes, was 0.7 ng/ml, compared with 2.40 ng/ml reached after 5 minutes for the intramuscular route. The relation between intramuscular and rectal peak concentration was 3.2:1.
Cardiac complications during use of etomidate
Authors: VAN DEN HURK A. W. , TEIJEN H. J.
Published: February 2007

Two patients are described who exhibited cardiac complications during administration of etomidate. One patient showed myocardial ischaemia and the other developed cardiac asystole.
Antidiuretic hormone concentrations following midazolam premedication
Authors: Sjövall Sari , Kanto Jussi , Grönroos Matti , Himberg Jaakko‐Juhani , Kangas Lauri , Viinamäki Osmo
Published: February 2007

Midazolam given orally the night before and on the morning of operation had a distinct subjective pre‐operative sedative effect as compared with placebo. Patients receiving midazolam also experienced less apprehension and excitement before surgery, but in relation to quality of sleep, the difference between the two groups was not statistically significant. Antidiuretic hormone (ADH) concentrations were determined just before induction of anaesthesia and were significantly lower in the midazolam group (2.14 pg/ml, SD 0.96) than in the placebo group (3.07 pgjml, SD 1.73). Our results show that midazolam is a useful sedative anxiolytic oral premedicanl, which appears to prevent initiation of a stress reaction before induction of anaesthesia.
Pre‐oxygenation–how long?
Authors: BERTHOUD MIRIELLE , READ D. H. , NORMAN J.
Published: February 2007

Pre‐oxygenation was studied in 12 fit volunteers and 20 patients using an oxygen flow of 8 litres/minute delivered from a standard anaesthetic machine via a Magill or Bain breathing attachment. End‐tidal nitrogen concentrations of 4% or less were achieved within 3 minutes; the fastest times were achieved using the Magill breathing System when the reservoir bag was filled with oxygen prior to application to the face. Gas‐tight fits of face masks on patients were found to be essential.
Failure of diazepam to prevent the suxamethonium‐induced rise in intra‐ocular pressure
Authors: FENECKL R. O. , COOK J. H.
Published: February 2007

The effects of intravenous suxamethonium chloride (1 mg/kg) on intra‐ocular pressure (IOP) were studied following pretreatment with diazepam 0.05 mg/kg, tubocurarine 0.05 mg/kg, and in a control group, at induction of anaesthesia. In all three groups, a significant increase in IOP was seen during the induction sequence.

In a further study, the effects of intravenous suxamethonium chloride (1 mg/kg) on IOP were studied following a period of stable general anaesthesia and pretreatment with diazepam 0.05 mg/kg. A significant rise in IOP was again seen following the administration of suxamethonium. The authors conclude that neither of the techniques described herein will reliably and predictably prevent the rise in IOP seen following the use of suxamethonium.
Protamine titration after cardiopulmonary bypass
Authors: DUTTON D. A. , HOTHERSALL A. P. , McLAREN A. D. , TAYLOR K. M. , TURNER M. A.
Published: February 2007

A method of protamine titration, with the use of the ‘Haemochron 400’ system for reversal of heparinisation after cardiopulmonary bypass is described. Twenty‐three patients, average age 47 years, undergoing this procedure for either valve replacement or coronary artery bypass grafting were studied. Accurate reversal of heparinisation was achieved using comparatively small doses of protamine. A linear relationship between the dose ratio of protamine and heparin and the time interval between their respective administrations was defined where only a single dose of heparin had been administered.
Aminophylline may act as a morphine antagonist
Authors: STIRT J. A.
Published: February 2007

A case is presented in which low dose intravenous aminophylline was successfully used to antagonize morphine‐induced central nervous system and respiratory depression. The rationale for the use of aminophylline as a morphine antagonist, as well as possible mechanisms of action, are discussed.
The radiological characteristics of bronchopleural fistula following pneumonectomy
Authors: LAUCKNER MORAG E. , BEGGS I. , ARMSTRONG R. F.
Published: February 2007

The radiological appearances of bronchopleural fistula are poorly recorded in the anaesthetic literature. Anaesthetists carry increasing responsibility for postoperative respiratory management. We have, therefore, reviewed the X‐rays of five cases of proven bronchopleural fistula following pneumonectomy and summarised the findings.
Restricted spread of analgesia following epidural blood patch
Authors: RAINBIRD A. , PFITZNER J.
Published: February 2007

A complete restriction of upward spread of local analgesic solution in the epidural space is reported in a patient who three years earlier had received an epidural blood patch for post‐spinal headache. Organisation of the blood clot with fibrous tethering of the dura to the wall of the spinal canal is suggested as the most likely cause of this apparent obstruction to spread. Other potential complications of epidural blood patch are presented. It is concluded from the literature on the subject that there is a need for a multi‐centre analysis of the factors which might influence the incidence of inadvertent dural tap with an epidural needle.
Recessive dystrophic epidermolysis bullosa
Authors: TOMLINSON A. A.
Published: February 2007

A case report is presented of a patient with recessive dystrophic epidermolysis bullosa requiring anaesthesia for thoraco‐abdominal surgery. The classification and pathology of epidermolysis bullosa is considered together with the clinical features and treatment. The problems associated with anaesthesia and this disease are discussed with special reference to the airway.