bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of epidurally administered sufentanil versus bupivacaine during thoracic surgery
Authors: DER LELY F. HAAK‐VAN , VAN KLEEF J. W. , DER VEER B. J. GESINK‐VAN , BURM A. G. L. , BOVILL J. G.
Published: February 2007

The efficacy of thoracic epidural sufentanil 50 μg was compared with bupivacaine 0.5% with adrenaline 5 μg.ml‐1 (dose 40 mg) or saline, in 30 patients (n = 10 in each group) undergoing lateral thoracotomy. Sufentanil, bupivacaine or saline was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg‐1 and thiopentone 2–5 mg.kg‐1. Anaesthesia was maintained with nitrous oxide 66% and halothane 0.3%. Supplementary sufentanil 25 μg was given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre‐operative value, whenever heart rate exceeded 90 beat. Min‐1 in the absence of hypovolaemia, or when other autonomic or somatic signs occurred. Fewer patients in the epidural sufentanil (n = 4, p < 0.005) and bupivacaine (n = 1, p < 0.001) groups required supplementary sufentanil compared to the placebo group, in which all patients needed supplementary sufentanil, but there was no statistical difference between the sufentanil and bupivacaine groups. One or more hypotensive episodes occurred in five patients in the sufentanil group, in all patients in the bupivacaine group and in no patient in the placebo group, and the differences were significant (p < 0.02).
An intra‐operative comparison of lumbar with thoracic epidural sufentanil for thoracotomy
Authors: DER LELY F. HAAK‐VAN , VAN KLEEF J. W. , BURM A. G. L. , BOVILL J. G.
Published: February 2007

The efficacy of thoracic epidural sufentanil 50 μg was compared with lumbar epidural sufentanil 50 μg in 30 patients (n = 15 in each group) undergoing lateral thoracotomy. Sufentanil was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg‐1 and thiopentone 2–5 mg.kg‐1 intravenously. Anaesthesia, nitrous oxide 66%, halothane 0.3% and sufentanil 25 μg intravenously were given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre‐operative value and heart rate exceeded 90 beat.min‐1 in the absence of hypovolaemia, or when other autonomic or somatic signs were seen. Four patients in the thoracic epidural group and five in the lumbar epidural group needed supplementary sufentanil. Six patients in the thoracic epidural group and three in the lumbar epidural group each had a single hypotensive episode. Lumbar and thoracic epidural sufentanil are equally effective in contributing to intra‐operative analgesia for lateral thoracotomy.
Intra‐operative blood glucose measurements
Authors: SMITH E. A. , KILPATRICK E. S.
Published: February 2007

Variations in haematocrit are known to affect the accuracy of reagent strip tests for glucose. We have investigated 10 patients during cardiopulmonary bypass, where intra‐operative decreases in haematocrit occur. Whole blood glucose concentrations were measured on five occasions at 30 min intervals during the procedure using the Glucometer II, One Touch II and Reflolux II meters as well as a reference instrument (YSI Model 23AM). Haematocrits were recorded simultaneously. Overall, for every 10% fall in haematocrit, Glucometer II measurements rose by 22% (r = 0.74, p < 0.00001), One Touch II measurements fell by 3% (r = 0.44, p < 0.002) and the Reflolux II measurements showed no significant variation. The One Touch II showed closer agreement to the reference (mean bias 0.3 mmol.l‐1 (95% between +0.86 and –0.26)) than the Reflolux II (bias 1.58 (+3.40 to –0.24)) or the Glucometer II (bias 3.25 (+6.18 to 0.32)). Thus, depending on the meter used, spuriously large intraoperative changes in blood glucose may seem to arise where patient haematocrit varies.
Response to suxamethonium during propofol‐fentanyl‐N2O/O2 anaesthesia in a patient with active myasthenia gravis receiving long‐term anticholinesterase therapy
Authors: VANLINTHOUT L. E. H. , ROBERTSON E. N. , BOOIJ L.H.D.J.
Published: February 2007

We describe the effect of repeated suxamethonium doses during propofol‐fentanyl‐N2O/O2 anaesthesia in a 29‐year‐old woman with active myasthenia gravis receiving chronic pyridostigmine therapy. Despite adequate pre‐operative pseudocholinesterase activity, suxamethonium resistance occurred. Neither bradycardia nor residual neuromuscular block were seen after repeated doses of suxamethonium.
Recovery from pre‐operative sedation with clonidine—brain stem auditory evoked response
Authors: Kumar A. , Tandon O. P. , Bhattacharya A. , Bose S. , Kundra P.
Published: February 2007

In a randomised double‐blind study, 34 elderly patients (ASA grades 1–2) underwent elective intra‐ocular surgery. Patients were allocated randomly to two groups to receive oral clonidine 300 μg or oral diazepam 10 mg 2h before surgery. Facial block and retrobulbar block were given at 2 h after premedication. Anaesthetic recovery was assessed using a clinical recovery score (at 0, 30, 60 and 120 min after arrival in the recovery room) and brain stem auditory evoked potential responses (BAER) (immediately after operation and at 120 min after operation). In both the groups the clinical recovery scores decreased significantly at 30 and 60 min following recovery (p < 0.01). At 120 min this score returned to the pre‐operative value in the clonidine group, but in the diazepam group there was a significant difference between the 2 h value and pre‐operative value (p < 0.05). In the clonidine group there was no significant rise in the interpeak latencies and absolute peak latencies of brain stem auditory evoked responses recorded immediately after operation and 120 min after operation. In the diazepam group, there was a significant rise in the interpeak latencies immediately after operation and 120 min after operation and a rise in absolute peak latencies (p < 0.05) immediately after operation. In the clonidine group there was a reduction (p < 0.05) in amplitude of wave V at immediately after operation. We conclude that clonidine 300 μg orally before surgery does not delay recovery.
Single dose intravenous ondansetron in the prevention of postoperative nausea and vomiting
Authors: PEARMAN M. H.
Published: February 2007

Postoperative nausea and vomiting continues to pose problems for surgical patients. Three studies were undertaken to evaluate the efficacy and safety of prophylactic intravenous ondansetron in male and female patients undergoing outpatient surgery. Studies 1 and 2 included a total of 1169 female patients scheduled to undergo surgery on a day case basis. In study 3, 468 male patients scheduled for outpatient surgery were enrolled. Patients received ondansetron or placebo prior to induction of anaesthesia. Efficacy and safety data were collected for 24 h postoperatively. Studies 1 and 2, individually, revealed that ondansetron 4 mg and 8 mg were significantly (p ≤ 0.05) better than placebo at preventing emesis. A combined analysis showed that the 4 mg and 8 mg doses were significantly (p ≤ 0.05) better than ondansetron 1 mg at preventing emesis, while 8 mg was not statistically different from 4 mg. Therefore, 4 mg was chosen as the optimal dose. In study 3, ondansetron 4 mg was significantly (p ≤ 0.001) more effective than placebo in preventing emesis in males. There were no differences between treatment groups with respect to vital signs, laboratory values, or adverse events. Intravenous ondansetron is safe and effective at preventing postoperative nausea and vomiting in male and female patients undergoing day case surgery.
Impact of postoperative nausea and vomiting in the surgical setting
Authors: HIRSCH J.
Published: February 2007

Postoperative nausea and vomiting is one of the most common complications of inpatient and day case surgical procedures. In a climate where total cost of an illness is becoming increasingly important, postoperative nausea and vomiting is a major contributor to direct and indirect costs for both the hospital and patient. In patient terms, the impact of increased recovery room stays and extra nursing time required by PONV patients has been estimated to range from 96–576 more surgical procedures which may be performed in an‘average’day case surgery centre. Postoperative nausea and vomiting is perceived by patients to account for equal or more debilitation than surgery itself and may cause them to lose wages due to absence from work. Reducing the incidence of nausea and vomiting and its associated problems may therefore provide opportunities to improve patient care, decrease the size of waiting lists and improve utilisation of scarce healthcare resources.
An impaled neck
Authors: BULLINGHAM A. , HAMPSON‐EVANS D. , PALAZZO M.
Published: February 2007

We describe the management of a patient impaled through the lower submandibular area by the top spike of some iron railings which immobilised his jaw and blocked access to the trachea. The Fire Brigade used specialised equipment to cut out a section of the railings so that the patient could be transported to hospital. Awake fibreoptic intubation was used to gain access to the patient's airway before induction of anaesthesia.
Peri‐operative effect of major gastrointestinal surgery on serum magnesium
Authors: Sanchez‐Capuchino A. , McConachie I.
Published: February 2007

This study investigates the changes in serum magnesium levels after major gastrointestinal surgery and evaluates if Plasma‐Lyte 148 used as maintenance fluid influences these changes in the peri‐operative period. Thirty patients presenting for procedures ranging from anterior rectal resection to thoraco ‐abdominal cardio‐oesophagectomy were randomly allocated into two groups, one of which received compound sodium lactate solution as the maintenance crystalloid during the intra‐ and postoperative period, and the other Plasma‐Lyte 148, a magnesium‐containing crystalloid solution. Serum magnesium levels were measured pre‐operatively, in the immediate recovery period and 24 h postoperatively. The results showed a statistically significant (p < 0.05) reduction in the magnesium levels in both groups. The reduction was less marked in the Plasma‐Lyte group but this did not achieve statistical significance (p > 0.05) compared with the compound sodium lactate group.
Survival after intensive care
Authors: RIDLEY S. , PLENDERLEITH L.
Published: February 2007

The life expectancy for survivors of critical illness has not been reported in the United Kingdom. The aim of this study was to compare the long‐term survival of intensive care patients with that of an age and sex‐matched population. All patients admitted to a general intensive therapy unit over 4 years (n = 1168) were included in the study. Details of the survivors were forwarded to the Registrar General for Scotland, who then issued copies of death certificates as the survivors died. The survival curve of patients discharged from the intensive therapy unit was significantly different from that of the normal population. The risk of dying in the first year after discharge was 3.4 times higher (95% confidence intervals 2.7–4.2) than that in the normal population. It is not until the start of the fourth year after discharge that the probability of death matched that of the normal population.
The polyurethane nasotracheal tube
Authors: WRIGHT C. J. , FRERK C. M. , PADFIELD A. , RYAN M. M. , SMITH G. B.
Published: February 2007

An uncuffed nasotracheal tube for use in minor maxillofacial surgery has been developed using polyurethane. The suitability of this tube as an alternative to the existing soft red rubber and harder polyvinyl chloride materials has been assessed at four centres during anaesthesia for routine oral surgery. The tube was found to be satisfactory.
Munchausen's syndrome
Authors: BAKER C. E. , MAJOR E.
Published: February 2007

We present a variant of Munchausen's syndrome not previously described in which acute severe asthma is the presenting complaint. The clinical presentation is so extreme that the patient has received artificial ventilation on several occasions despite having had normal arterial blood gas values. The patient appears to be able to mimic the signs of severe respiratory distress by means of a protracted Valsalva manoeuvre, and all signs of acute asthma instantaneously disappear with sedation. Because of the chronic‘asthma’, and the frequent dramatic acute episodes, the patient successfully claims invalidity benefit, and has done so for many years.
Forces acting on the maxillary incisor teeth during laryngoscopy using the Macintosh laryngoscope
Authors: BUCX M. J. L. , SNIJDERS C. J. , VAN GEEL R. T. M. , ROBERS C. , VAN DE GIESSEN H. , ERDMANN W. , STIJNEN T.
Published: February 2007

We determined the forces on the maxillary incisors during routine laryngoscopy in 65 adult patients. The forces were measured by a strain gauge based sensor positioned between the handle and the blade of the laryngoscope. The mean maximal force acting on the maxillary incisors was 49 N. In patients without maxillary incisors, the force acting on the gums was significantly lower at 21N (p < 0.001). These results suggest that, despite traditional advice to the contrary, a levering movement of the laryngoscope, using the maxillary incisors (or gums) as a fulcrum, is common practice. Biomechanical analysis revealed that, although levering is not the preferred movement, it is an efficient way of bringing the glottis into view. These results may have implications for future laryngoscope design.
A comparison of the effect on gastric emptying of either enflurane or propofol given during maintenance of anaesthesia for minor surgery
Authors: BENNETT M. W. R. , BEMBRIDGE J. L. , SHAH M. V.
Published: February 2007

Twenty patients scheduled for minor gynaecological surgery were studied. Anaesthesia was induced with propofol and maintained either with enflurane/oxygen/nitrous oxide or propofol/oxygen/nitrous oxide. The rate of gastric emptying was measured indirectly by the paracetamol absorption model. The results showed that there was no significant difference in gastric emptying rate between the two groups. Recovery in the propofol group was more rapid in that paracetamol ingestion occurred earlier in the recovery period compared with the enflurane group.
Intensive care management of multiple‐organ dysfunction due to falciparum malaria in a married couple
Authors: GRACE D. , LA VERY G. G. , JACKSON P. , CANAVAN D. A. , FEE J. P. H.
Published: February 2007

A married couple presented simultaneously with malignant tertian malaria and rapidly developed septicaemia and severe multiple‐system organ failure. Despite schizonticidal treatment and multisystem support in intensive care the husband died. The selection of chemoprophylactic agents for this couple was not ideal and the duration of therapy before exposure to risk was inadequate. Severe infection with plasmodium falciparum is life‐threatening and requires early diagnosis. It is best managed in an intensive care unit where continuous assessment may enable rapid detection of clinical deterioration and allow appropriate treatment to be instituted. The diagnosis should be considered in symptomatic patients who have travelled through areas where malaria is endemic. Recognised guidelines for the prescription of malarial chemoprophylaxis should be followed to ensure adequate protection.
Difficult intubation following thoracic trauma
Authors: GROVES J. , EDWARDS N. , HOOD G.
Published: February 2007

A previously fit 20‐year‐old man presented with a large haemothorax following a stab wound to the left chest. Pre‐operative airway assessment indicated that tracheal intubation would be routine. On induction of anaesthesia, visualisation of the larynx proved impossible because of soft tissue swelling. Successful intubation was eventually achieved with the aid of a gum elastic bougie. At operation, the patient's common carotid artery was found to have been perforated close to its origin on the aorta. The patient made an uneventful recovery.
A new keyed vaporizer filler
Authors: WITTMANN P. H. , WITTMANN F. W. , CONNOR J. , CONNOR T.
Published: February 2007

A new design of keyed filler with a dead space of 1.1 ml was used with 50 bottles of isoflurane to fill vaporizers. The volume of isoflurane remaining in the‘empty’bottle, the residual volume, was measured. The trial was repeated using the old style filler which has a dead space of 3.3 ml. The new filler reduced the mean residual volume by 73% but still did not completely empty the bottle.
Haemodynamic effects of R 80122 immediately after cardiopulmonary bypass; preliminary results
Authors: Herregods L. , Roily G. , Van Belleghem Y. , Van Nooten G.
Published: February 2007

R 80122 is a new short‐acting phosphodiesterase type III inhibitor. In a preliminary investigation, three patients, scheduled for coronary artery bypass surgery, were given R 80122 after weaning from cardiopulmonary bypass. Two patients received 10μig.kg‐1.min‐1 for 10 min as a loading infusion followed by a 5 μg.kg‐1.min‐l maintenance dose. One patient received a 20 μg.kg‐1.min‐1 for 10 min loading infusion followed by a 10 μg.kg‐1min‐1 maintenance infusion. After weaning from cardiopulmonary bypass and during the administration period, no arrhythmias or cardiac ischaemia were detected. The administration of R 80122 improved the haemodynamic profile with an increase in cardiac output, a decrease in systemic vascular resistance and a stable heart rate and mean arterial blood pressure. These preliminary results indicate that R 80122 possesses positive inotropic activity in combination with vasodilating properties.
Calculation of inspired oxygen fraction during anaesthesia based on awake oxygen saturation
Authors: Mandal P. , Chaudhary S.
Published: February 2007

One hundred ASA grade 1 or 2 patients were studied to assess the use of awake oxygen saturation to determine the necessary inspired oxygen fraction during anaesthesia. The inspired oxygen fraction was adjusted gradually to the lowest possible value to maintain the pre‐operative oxygen saturation at a constant level. Normocapneic ventilation was maintained and analgesia was provided with 0.5mg.kg‐1 of pethidine given intravenously. In addition to routine monitoring and measurement (electrocardiograph, oxygen saturation, expired carbon dioxide concentration and noninvasive blood pressure), arterial samples for blood gas analysis and venous samples for lactate and pyruvate levels were taken when awake and 30 min after achieving a steady state with a minimum inspired oxygen fraction. The mean inspired oxygen fraction required in these patients was 20.91 (SD 1.92%) ranging from 18–25%. The arterial pH were 7.34 (SD 4.04) (awake) and 7.35 (SD 3.15) (after 30 min), the partial pressure of oxygen 13.17 (SD 1.97) (awake) and 13.83 (SD 1.6 kPa) (after 30 min) and the partial pressure of carbon dioxide and base excess were normal. Serum lactate levels were 1.04 (SD 0.25) (awake) and 1.15 (SD 0.48) (after 30 min) mmol.l‐1, whilst pyruvate levels were 0.1 (SD 0.02) (awake) and 0.12 (SD 0.21) (after 30 min) mmol.l‐1. Patients’recovery and postoperative course were uneventful.
Chair dental anaesthesia: a survey of current and intended practice in Mersey Region
Authors: Barrett P. J. , Skinner A. C. , Whelan E.
Published: February 2007

We performed a questionnaire survey to establish the current and intended practice of chair dental anaesthesia amongst recently appointed consultants, and senior registrars within the Mersey Region. Only 26% of the consultants surveyed practised chair dental anaesthesia, however, more consultants would have had their anaesthetic sessions allowed. Consultants performed 4.62 ± 3.5 sessions per month and anaesthetised 8.0 ± 2.27 patients per session. Cases were mostly performed in community dental centres. The most common reason for discontinuing the practice of chair dental anaesthesia was the Poswillo report and its implications. Sixty‐eight per cent of senior registrars declared an interest in chair dental anaesthesia. This group had received significantly more training (p < 0.005) in dental anaesthesia than those with no interest. Most anaesthetists (52/71) felt that chair dental anaesthesia was acceptable in centres approved to Poswillo standards; 16 anaesthetists felt that it should be confined to a hospital environment and three felt that it should not be performed at all.
A comparison of different modes of noninvasive ventilatory support: effects on ventilation and inspiratory muscle effort
Authors: ELLIOTT M. W. , AQUILINA R. , GREEN M. , MOXHAM J. , SIMONDS A. K.
Published: February 2007

The aims of noninvasive ventilation include the correction of hypoventilation and unloading of inspiratory muscles. Volume cycled flow generators, bi‐level positive airway pressure and continuous positive airway pressure techniques have all been used with face and nasal masks. We have compared these modes of ventilatory support, administered by a nasal mask in stable, awake outpatients with chronic obstructive pulmonary disease or neuromusculo‐skeletal disease in respect of their effects on ventilation, inspiratory muscle effort and oxygen saturation. There were no clinically significant differences between the volume cycledflow generator and bi‐level positive airway pressure methods; compared to spontaneous ventilation, oxygen saturation increased and inspiratory muscle effort decreased. Tidal volume increased and respiratory rate reduced, the largest changes occurring with bi‐level positive airway pressure. Only the volume cycledflow generator increased minute ventilation significantly. Ventilation and inspiratory muscle effort were unaffected by continuous positive airway pressure but oxygen saturation was lower than during spontaneous ventilation. In awake, stable outpatients acclimatised to nasal ventilation there were no clinically significant differences between volume cycledflow generator and bi‐level positive airway pressure techniques, but continuous positive airway pressure was less effective.
A simple method for monitoring the concentration of inhaled nitric oxide
Authors: PETROS A. J. , COX P. , BOHN D.
Published: February 2007

Nitric oxide is a potent endogenous vasodilator involved in the homeostatic control of systemic blood pressure. It has also recently been demonstrated that when inhaled in low concentrations it acts as a specific pulmonary vasodilator. The concept of inhaled nitric oxide as a form of therapy is almost an anathema to anaesthetists. However, nitric oxide is being used increasingly for the treatment of persistent pulmonary hypertension of the neonate and in the adult respiratory distress syndrome. One major limitation to its frequent and widespread use is the problem of measuring the concentration of nitric oxide delivered. Currently, the gold standard technique used is chemiluminesence. However, the equipment required is costly and can be difficult to use. If the use of inhaled nitric oxide increases and it develops a therapeutic role then its applications may be limited only to centres which can afford such equipment. Others may be prevented from using a potentially valuable therapy due to lack of a controlled delivery system for nitric oxide. An inexpensive, simple alternative technique to chemiluminesence is described, which will allow most intensive care units the freedom to use inhaled nitric oxide if necessary.
Severe tracheal stenosis and operative delivery
Authors: SUTCLIFFE N. , REMINGTON S. A. M. , RAMSAY T. M. , MASON C.
Published: February 2007

We report the management of anaesthesia for Caesarean section in a woman with severe extensive tracheal stenosis. Management was initially with spinal anaesthesia, but general anaesthesia became necessary as a result of profuse intra‐operating bleeding. We describe the use of the Hayek oscillator cuirass ventilator to allow instrumentation of the larynx whilst maintaining respiratory support, and for weaning from mechanical ventilation.
Determination of the reliability of three scoring systems to evaluate children after general anaesthesia
Authors: KEEGAN N. J. , YUDKOWITZ F. S. , BODIAN C. A.
Published: February 2007

The inter‐observer reliabilities of three scoring systems (Excitement Score, Face Mask Acceptance Score, Steward Score) were assessed by pairs of independent evaluators who observed 21 children during emergence from general anaesthesia. Each scoring system was analysed using the intraclass correlation coefficient giving values of 0.997 and 0.988 for the Excitement and Face Mask Acceptance Scores, respectively. Those for the Steward Score were 0.956, 0.924 and 0.295for the‘consciousness’,‘airway’, and‘movement’subdivisions, respectively. Ambiguous wording and inexplicit instructions may explain the lower correlations for the Steward Score. Reliability of scoring systems cannot be assumed and systems of undocumented reliability bring into question the results of the studies in which they are employed.
Lignocaine test dose to detect intravenous injection
Authors: MICHELS A. M. J. , LYONS G. , HOPKINS P. M.
Published: February 2007

The accidental intravascular injection of bupivacaine or etidocaine epidurally has resulted in several maternal deaths. To be effective, a test dose must allow detection of intravenous catheter placement and prevent accidental intravenous injection. This study was designed to determine the dose of lignocaine required for this purpose. Sixty healthy gynaecological patients were allocated randomly to receive an intravenous dose of normal saline (group 1), lignocaine 0.5 mg.kg‐1 (group 2) or 1 mg.kg‐1 (group 3) 3 min prior to induction of anaesthesia. At 1 min intervals the patients were asked about subjective symptoms produced by this‘test dose’In group 2 only 50% of patients reported a positive test dose, whereas in the patients of group 3, a significantly greater percentage (95%) had a positive test dose (p < 0.01). This suggests that the use of 1 mg.kg‐1 lignocaine as a test dose would result in a significantly higher sensitivity for detecting intravascular injection than the use of 0.5 mg.kg‐1
The effects of pethidine, fentanyl and lignocaine on postanaesthetic shivering
Authors: ALFONSI P. , HONGNAT J.‐M. , LEBRAULT C. , CHAUVIN M.
Published: February 2007

Pethidine is reported to be more effective than equi‐analgesic doses of other opioids as an inhibitor of postanaesthetic shivering. The aim of this study was to verify whether this action resulted from a local anaesthetic effect of pethidine or from inadequate fentanyl dosage in previous studies. We studied 52 ASA 1 or 2 patients. They were randomly allocated, in a double ‐blind fashion, to one of four groups to receive either pethidine (0.85 mg.kg‐1) or fentanyl (1.7 μg.kg‐1) or lignocaine (1 mg.kg‐1) or 0.9% saline. All the patients were shivering and had a core temperature below 36°C during recovery from non‐septic abdominal or orthopaedic surgery. After 15 min, all the patients given saline were still shivering, as were 92% in the lignocaine group. In contrast, only 23% of the patients who were given fentanyl still shivered (p < 0.01 versus saline) and 8% in the pethidine group (p < 0.001 versus saline). The mean (SD) core temperature in the pethidine group was slightly lower than that in the fentanyl group (35.1 (0.6) and 35.9 (0.5)) when the patients stopped shivering. Furthermore, shivering restarted in 6/10 patients in the fentanyl group after 15 min compared with 1/12 in the pethidine group. Our results show that fentanyl (1.7μg.kg‐1) can inhibit postanaesthetic shivering but this effect is less pronounced and of shorter duration than with pethidine (0.85 mg.kg‐1).
The influence of ketanserin or urapidil on haemodynamics, stress response and kidney function during operations for myocardial revascularisation
Authors: PETRY A. , WULF H. , BAUMGÄRTEL M.
Published: February 2007

The study was performed to investigate the different effects of ketanserin and urapidil on haemodynamics, kidney function and plasma catecholamine and aldosterone levels. Forty male patients scheduled for myocardial revascularisation were assigned at random to two groups: group K received ketanserin, group U received urapidil. Anaesthesia consisted of fentanyl, flunitrazepam and pancuronium. Haemodynamic variables were evaluated at eight predefined time points of the operation. Creatinine and free‐water clearance as well as plasma levels of adrenaline, noradrenaline and aldosterone were measured in three different periods of the operation. While the groups showed no clinically relevant differences in the haemodynamic variables and the hormone plasma concentrations, the creatinine clearance in group K was slightly increased in the period after cardiopulmonary bypass. Both ketanserin and urapidil prevented hypertension even in the presence of elevated catecholamine plasma levels during and after cardiopulmonary bypass.
Effects of propofol and Intralipid on immune response and prostaglandin E2 production
Authors: PIRTTIKANGAS C.‐O. , SALO M. , RIUTTA A. , PERTTILÄ J. , PELTOLA O. , KIRVELÄ O.
Published: February 2007

The present study evaluated the effects of propofol and its solvent Intralipid on the immune response and in vivo prostaglandin E2 production in patients during induction of anaesthesia and in healthy volunteers after Intralipid injection. Fifteen female patients (median age 48 years, ASA 1‐2) scheduled for uterine dilatation and curettage were randomly assigned to two groups. In group 1 propofol (median dose 3.1 mg.kg‐1) and in group 2 thiopentone (median dose 6.0 mg.kg‐1) were injected intravenously over 60s. Surgery was started after collection of the last blood sample. In the second part of this study, Intralipid 10% 0.3 ml. kg‐1 was injected intravenously in eight healthy volunteers (four women and four men, median age 32 years) over 60s. Plasma bicyclo‐PGE2 concentrations increased during anaesthesia induction in both anaesthetic groups (p<0.01). By contrast, no changes were seen in plasma bicyclo‐PGE2 concentrations after Intralipid injection in volunteers. Lymphocyte proliferative responses to mitogens did not change during anaesthesia induction in patients. In volunteers, Intralipid injection caused a slight increase in T‐cell percentages (p<0.01) and unstimulated lymphocyte proliferative responses (p<0.05), but it did not affect other lymphocyte subsets and immunoglobulin production. Intralipid and propofol were not found to be immunosuppressive at clinical doses used during anaesthesia induction.
Air embolism during awake craniotomy
Authors: Scuplak S.M. , Smith M. , Harkness W.F.J.
Published: February 2007

A case of venous air embolism during awake craniotomy is described. Chest pain and electrocardiographic changes were the major presenting features. Capnography detected a decrease in end‐tidal carbon dioxide and demonstrates its use as an aid in the diagnosis of air embolism in the awake patient. Following this episode persistent hypoxaemia developed secondary to acute pulmonary oedema and a pleural effusion.
Eighty‐seven days of orotracheal intubation
Authors: Iqbal S. , Zuleika M.
Published: February 2007

A patient with 80% burns, who required orotracheal intubation for 87 days because the tracheostomy site was not accessible, survived without significant laryngotracheal complications.
An adaptation of the objective structured clinical examination to a final year medical student course in anaesthesia and intensive care
Authors: Critchley L. A. H. , Short T. G. , Buckley T. , Gin T. , O'Meara M. E. , Oh T. E.
Published: February 2007

The Department of Anaesthesia and Intensive Care at the Chinese University of Hong Kong provides a 4 week course in our specialty for final year medical students. Our curriculum covers basic concepts in anaesthesia and intensive care, management of common medical emergencies and the safe performance of basic practical skills. For the last 4 years we have used an adaptation of the Objective Structured Clinical Examination to assess learning. Question stations included the use of manikins to assess practical skills, such as cardiopulmonary resuscitation and airway management, identification and description of the use of equipment and interpretation of clinical scenarios and investigations. We believe that our adaptation of the Objective Structural Clinical Examination is better than traditional methods of examination and it has allowed us to identify deficiencies in our teaching methods. The Objective Structured Clinical Examination has been well received by our students and is perceived by them to be a fair reflection of their level of knowledge and skill attainment during the course.
A cadaver study appraising accuracy of blind placement of percutaneous tracheostomy
Authors: DEXTER T. J.
Published: February 2007

An attempt was made to place a percutaneous catheter between the first and second cartilaginous rings of the trachea in 20 cadavers presenting for postmortem examination. Only nine of the catheters entered the trachea in the intended space. All catheters which were noted to be difficult to place entered the trachea higher than intended. One third of all catheters punctured the thyroid isthmus.
The Ohmeda Universal PAC drawover apparatus
Authors: LUNN D. V. , YOUNG P. C.
Published: February 2007

The Ohmeda Universal PAC drawover apparatus, a modification of an earlier series of vapour‐specific vaporizers, was assessed with regard to its output under varying gas flows and temperatures and its clinical usage with isoflurane and enflurane. The device tended to over‐deliver vapour, particularly at low flows and at high temperatures. Its clinical performance during spontaneous and positive pressure ventilation was satisfactory, although adequate concentrations were not achieved using enflurane in the spontaneous ventilation mode. The device was not assessed with ether or halothane. The robust construction, relatively large capacity and thermocompensation make it suitable for field or military anaesthesia.
Case reports Cardiopulmonary complications during anaesthesia and surgery for severe thoracic lordoscoliosis
Authors: Bagshaw O. N. T. , Jardine A.
Published: February 2007

A 15‐year‐old girl underwent a posterior spinal fusion procedure for severe lordoscoliosis. On turning to the prone position acute posture‐related upper airway obstruction occurred. During surgery, manipulation of the spine caused several episodes of loss of cardiac output. Retrospective assessment of the pre‐operative chest X rays demonstrated approximation of the sternum and thoracic vertebrae, with evidence of tracheal narrowing at the level of the thoracic inlet. We feel that both complications were directly related to the severity of the lordoscoliosis and that careful pre‐operative clinical, spirometric and X ray assessment should be undertaken in such patients.
Post cholecystectomy admission to the intensive care unit
Authors: Messahel F. M.
Published: February 2007

Admissions to the intensive care unit following three different techniques for cholecystectomy, the open, mini‐lap and laparoscopic methods, were studied over an 18‐month period. Of 1078 cases of operative cholecystectomy performed during that period, 28 cases (2.6%) from all groups were admitted to the intensive care unit. Cases in the open and mini‐lap cholecystectomy groups were admitted for postoperative monitoring because of pre‐existing medical diseases and were discharged after an average period of stay of 2.4 and 4.7 days respectively. In contrast, the average stay of patients in the laparoscopic group was 14.8 days and the majority were admitted as a result of complications related to the procedure. In this group, one patient died on the first day of admission to the unit (mortality of 8.3%). This study has shown that laparoscopic surgery, from the intensive care point of view, is a very costly surgical procedure.
The effect of cerebrospinal fluid dilution of isobaric 0.5% bupivacaine used for spinal anaesthesia
Authors: Cherng Y‐G. , Huang H‐H. , Chen T‐G. , Huang C‐L.
Published: February 2007

A prospective study was conducted to see the effect on spinal anaesthesia of the dilution of isobaric 0.5% bupivacaine with cerebrospinal fluid. Sixty patients were randomly allocated to three groups. In group 1, patients received 3 ml isobaric 0.5% bupivacaine intrathecally without aspirating cerebrospinal fluid. In groups 2 and 3, cerebrospinal fluid 1 ml and 2 ml was aspirated respectively and mixed with 3 ml isobaric 0.5% bupivacaine. A total volume of 4 ml in group 2 and 5 ml in group 3 was administered. Thus, the volume of cerebrospinal fluid remained unchanged. Pinprick analgesia and motor block was evaluated from induction until recovery. No differences in onset time, duration and‘two segments regression’ were noticed. The only statistical difference was the time to reach complete motor block, which was shorter in group I as compared to groups 2 and 3 (6.9 SD 1.4 min versus 11.3 SD 3.0 and 13.5 SD 3.9 min respectively). The mean value of maximum decrease in systolic blood pressure was small, being less than 15% of the pre‐operative value for each group. In conclusion, the effect of diluting isobaric 0.5% bupivacaine with cerebrospinal fluid, 1 ml and 2 ml, is minimal and it is an unnecessary procedure with limited clinical effect.
Interobserver variation in the chest radiograph component of the lung injury score
Authors: BEARDS S. C. , JACKSON A. , HUNT L. , WOOD A. , FRERK C. M. , BREAR G. , EDWARDS J. D. , NIGHTINGALE P.
Published: February 2007

The lung injury score is a semi‐quantitative system used in the definition and grading of the acute respiratory distress syndrome. It is composed of two, three or four equally weighted components. One component is derived from the chest radiograph, which may contribute up to 50% of the total score. A score of 1 is awarded for each quadrant on the chest radiograph which contains alveolar consolidation. We examined the interobserver variation between two anaesthetists, two radiologists and two critical care physicians who scored blindly 100 chest radiographs from patients with adult respiratory distress syndrome. There was very good agreement between the two radiologists in the total scores (kappa 0.97) and in individual scores in each of the 4 quadrants (kappa 0.97–1.0). The agreement between anaesthetists and radiologists was only fair for the total score (kappa 0.37–0.42), but moderate to good for individual quadrant scores (kappa 0.43–0.73). The agreement between the two anaesthetists was moderate for individual quadrant scores (kappa 0.44–0.60), but only fair for total score (kappa 0.34). There was poor agreement between the two critical care physicians for total score (kappa 0.05) and for individual quadrant scores (kappa 0.04–0.20). Agreement between the physicians and other observers was poor to fair for the total score (kappa 0.12–0.32) and poor to moderate for the individual quadrant scores (kappa 0.15–0.63). Both anaesthetists and physician 2 underestimated the overall chest scores (median scores 2, 3 and 1 respectively) in comparison to the radiologists (median scores 3.5). Physician 1 significantly overscored (median score 4). The chest radiograph component of the lung injury score can be consistently assessed by radiologists, but significant variations may be introduced when assessed by other clinicians. This has significant implications for the use of the lung injury score in studies of adult respiratory distress syndrome and other studies which incorporate radiographic appearances in the definition.
The influence of isoflurane on a continuous infusion of mivacurium
Authors: DE MEY J. C. , FONCK K. , MAREELS K. , ROLLY G.
Published: February 2007

Sixty surgical patients were studied to evaluate the neuromuscular effects of mivacurium 0.l5 mg.kg‐1 (2 × ED95)for tracheal intubation. After intubation the patients were randomly allocated to receive alfentanil with either propofol (starting with 9mg.kg‐1 h‐1, reducing to 6mg.kg‐1 h‐1 after 20min) or isoflurane (0.5% end‐tidal). In addition, all the patients were given a continuous infusion of mivacurium 10 μg.kg‐1 min‐1 after tracheal intubation which was adjusted to maintain 90% depression of T1. Following mivacurium 0.15 mg.kg‐1 T1 decreased below 25% in all but four patients. Mean (SD) percentage maximum block attainedwas 92.9% (12.5) after 309 (89)s. Tracheal intubation was completed 232 (155) s after administration of the relaxant and intubating conditions were graded as‘excellent’ or‘good’ in 56 patients. Although the mean (SD) mivacurium infusion rate for maintaining T1 at 10% was higher in the propofol group, 4.8 (2.1) compared with 4.4 (2.0) μg.kg‐1 min‐1 in the isoflurane group, this was not significantly different (p > 0.05). The mean (SD) recovery index was prolonged in the isoflurane patients, 757 (508)s, compared to those receiving propofol, 466 (219)s (p < 0.05).
Anaesthesia in a child with Patau's syndrome
Authors: Martlew R. A. , Sharpies A.
Published: February 2007

A 5‐year‐old girl who had Patau's syndrome associated with double outlet right ventricle and pulmonary stenosis required general anaesthesia for the formation of a modified Blalock‐Taussig shunt.
Anaesthesia and adverse effects after intrathecal pethidine hydrochloride for urological surgery
Authors: GRACE D. , FEE J. P. H.
Published: February 2007

Anaesthesia, postoperative analgesia and the incidence of adverse effects after intrathecal pethidine hydrochloride 0.50mg.kg‐1 and 0.75mg.kg‐1 were assessed and compared with a conventional technique using isobaric bupivacaine 13.75mg in patients undergoing transurethral resection of the prostate gland. Sensory and motor block were significantly shorter with both pethidine regimens than with bupivacaine (p < 0.001). Although sensory and motor block were shorter after pethidine 0.50mg.kg‐1 than after pethidine 0.75mg.kg‐1 the difference in duration was clinically insignificant. The incidence of incomplete motor block was significantly greater with pethidine 0.50mg.kg‐1 than with bupivacaine 13.75mg.kg‐1 (p < 0.01). Visual analogue pain scores recorded after the operation were low and were similar in the pethidine groups to those obtained with bupivacaine alone. Mean arterial blood pressure was significantly lower in both pethidine groups compared with the bupivacaine group between 30 and 240 min after intrathecal injection (p < 0.001). However, the within‐group reductions in blood pressure were within clinically acceptable limits. The incidences of nausea and emesis were low and emesis occurred in patients in the bupivacaine group only (p < 0.03). Pruritus was seen only in patients receiving pethidine. Intra‐operative sedation occurred more often in patients receiving both pethidine 0.50mg.kg‐1 and 0.75mg.kg‐1 compared with patients receiving bupivacaine (p < 0.04). Both pethidine regimens provided acceptable anaesthesia and there were no significant differences between the two regimens in quality of intra‐operative anaesthesia, incidence of adverse events or postoperative analgesia.
The accuracy of references in Anaesthesia
Authors: Asano M. , Mikawa K. , Nishina K. , Maekawa N. , Obara H.
Published: February 2007

We reviewed all the references quoted in Volume 45(1990) (n = 3967) and half the references quoted in Volume 49 (1994) (n = 2183) of Anaesthesia. The references were numbered sequentially and 100 references from each year were randomly selected. Citations of non‐journal articles were omitted leaving 197 citations for careful scrutiny. The authors’ names, article title, journal title, volume number, page numbers, and year were examined in each selected reference. A reference was deemed correct if each element of the citation was identical to its source. Of the references examined, 32% and 41% contained one or more errors in 1990 and 1994, respectively. The elements most likely to be inaccurate were, in descending order of frequency, article title, author, and page number. There was no significant difference in the error rate between the 2 years. It is the responsibility of contributors to ensure that all references are carefully checked.
Clinical characteristics of commonly used spinal needles
Authors: CARSON D. F. , SERPELL M. G.
Published: February 2007

The important features which determine the ease of use of spinal needles include rapid detection of cerebrospinal fluid, minimal delay before injection and low resistance to injection of local anaesthetic. We investigated these three parameters among the following 11 spinal needles: Becton‐Dickinson 22 G, 25 G and 27 G Whitacre, 25 G and 27 G Quincke; B. Braun Spinocan 22 G, 25 G and 26 G Quincke; Vygon 25 G Whitacre, Portex 26 G Pencil Point and the 24 G Sprotte. Three needles of each type were tested using an artificial cerebrospinal fluid model maintained at body temperature and at two hydrostatic pressures of 12 and 50 cm of water. The Becton Dickinson 27 G Whitacre has an immediate detection time at both pressure heights, a reasonably short‘ready to inject’ time and relatively low resistance to injection, which, together with a reported low rate of postdural puncture headache, would indicate that it is the most appropriate for spinal anaesthesia. The 25 G Whitacre types would be the next most suitable to use.
Safelon—a new device to reduce needle‐stick injuries during intravenous cannulation
Authors: WATTERS J. , MacCALLUM R. , MAURICE S. , ROBERTSON C.
Published: February 2007

A prospective evaluation was performed to assess the efficacy and ease of use of a novel self‐sheathing intravenous cannula with needle protection device (Safelon). Use of the device did not require significant change to the normal cannulation technique. Blood splashes during insertion and the risk of needle‐stick injury were reduced.
The estimation of inspired isoflurane concentration in a low‐flow system
Authors: GOWRIE‐MOHAN S. , CHAKRABARTI M. K. , LOCKWOOD G. G.
Published: February 2007

We have examined the predictability of inspired isoflurane concentration during low‐flow anaesthesia using a to‐and‐fro breathing system. Twenty one adult patients requiring mechanical ventilation of the lungs during surgery took part in this study. Using a fresh gas flow of 2 l.min‐1, the ratio of inspired isoflurane concentration to isoflurane vaporizer setting was found to be approximately 4/5th after 5 min of anaesthesia. The ratio was maintained throughout the procedure, except for a few minutes following each change in vaporizer setting.
Severe airway management problems during insertion of a cuffed oesophageal stent
Authors: Langham B. T. , McLaren I. M.
Published: February 2007

A 68‐year‐old man underwent a general anaesthetic for insertion of an oesophageal stent for a tracheo‐oesophageal fistula. The authors report the management of severe airway problems caused by the insertion of the stent and discuss the use of a double lumen tube in this situation.
The use of protective gloves, the incidence of ampoule injury and the prevalence of hand laceration amongst anaesthetic personnel
Authors: Parker M. R. J.
Published: February 2007

In a study of 97 anaesthetic sessions, the incidence of hand laceration secondary to opening glass ampoules was 6% and the prevalence of visible old hand laceration 26%. The wearing of gloves for procedures likely to cause contamination by human secretions ranged from 35–86%, Overall there was no statistically significant difference in glove wearing habits of trainees and consultants. In the presence of a visible laceration, glove wearing by trainees increased and was significantly higher than that practiced by consultants. There were at least 90 procedures performed in 97 sessions during which an anaesthetist risked contaminating a visible laceration. It appears that the occupational risk of contracting a blood‐borne viral infection is still unnecessarily increased by anaesthetists not wearing protective gloves for all procedures in which contamination may occur.