bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyponatraemia and mental symptoms following vesical ultrasonic lithotripsy
Authors: BATRA Y. K. , KAPOOR R. , HEMAL A. K. , VAIDYANATHAN S.
Published: February 2007

A patient became confused and restless after vesical ultrasonic lithotripsy performed with distilled water as the irrigant. Serum sodium decreased to 120 mmol/litre from the pre‐operative value of 138 mmol/litre. A cystogram revealed intraperitoneal extravasation of contrast. She recovered promptly after intravenous infusion of normal saline and emergency surgery for repair of the damaged bladder wall. This case illustrates that hyponatraemia and mental symptoms similar to those following transurethral resection syndrome also occur with ultrasonic lithotripsy when distilled water is used as the irrigant.
Tracheal tubes in cold stress
Authors: DAHLGREN B.‐E. , NILSSON H. G. , VIKLUND B.
Published: February 2007

During rescues in cold climates, plastic tracheal tubes have fractured because of cold stress or mishandling. Susceptibility of rubber and plastic tracheal tubes to cold stress was tested in a climate chamber. Plastic tubes became stiffer when chilled, had greater resistance to reshaping and were more sensitive to shock and manipulation. They also need protection against cold and shock during transport. Rubber tubes were more tolerant of cold stress. Very cold rubber and plastic tubes may induce tissue damage. Rewarming to a nondangerous temperature was shown to be a quick procedure. It is suggested that the rescuer's own body heat be used.
Evaluation of a new tracheal tube with a movable bronchus blocker
Authors: MacGILLIVRAY R. G.
Published: February 2007

A new tracheal tube which incorporates: a movable bronchus blocker (the Univent tube), was evaluated in eight patients who underwent thoracic surgery. Difficulties encountered with accurate placement suggest that routine use should be made of a fibreoptic bronchoscope to confirm the position of the blocker.
Plasma concentrations of bupivacaine during extradural anaesthesia for Caesarean section
Authors: WILSON C. M. , MOORE J. , GHALY R. G. , FLYNN R. , McCLEAN E. , DUNDEE J. W.
Published: February 2007

The clinical effects and plasma levels associated with the use of 0.5% bupivacaine with and without the addition of 1:200 000 adrenaline (5 μg/ml) were studied in 30 patients who underwent extradural anaesthesia for elective Caesarean section. The addition of adrenaline to bupivacaine prolongs analgesia, reduces the degree of hypotension and delays its onset. Plasma bupivacaine levels were consistently lower when adrenaline was added, but this difference was significant only at 10 minutes after the initial dose. Prolonging the interval between increments seems to be a more reliable way to reduce plasma concentration than the addition of the catecholamine.
Respiratory disturbance during recovery from etomidate anaesthesia
Authors: PARKER C. J. R.
Published: February 2007

A case is described in which recovery from the administration of a single dose of etomidate was complicated by periodic episodes of unconsciousness, tremor and apnoea. Subsequent investigations did not reveal any evidence of neurological disease.
Survey of the practice of epidural analgesia in a regional sample of obstetric units
Authors: Frank M. , Heywood A. , MacLeod D. M.
Published: February 2007

An investigation into practices of the epidural services in a regional sample of obstetric units was undertaken following recent reported disasters associated with epidural analgesia for labour pain. A questionnaire was completed by all 22 obstetric units in the region, which included six teaching, 14 district and two independent centres. In three units the epidural service was shared with the obstetricians. A continuous anaesthetic presence was provided in 16 of 22 units. There was considerable variation in the attendance upon epidural patients by the anaesthetists. Instructions to midwives for top‐ups and subsequent care of patients followed no uniform pattern. Midwife in‐service training in the initial management of serious epidural complications and in cardiopulmonary resuscitation was inconsistent. In some units, the avoidance of aortocaval compression was not emphasised in the management of serious complications such as severe maternal hypotension, total spinal blockade or cardiac arrest of the parturient. The results obtained in this survey suggest that there is a need to review the requirements in the provision of obstetric epidural services and consideration should be given to the establishment of a generally accepted standard of practice.
Anaesthesia and angiotensin‐converting enzyme inhibitors
Authors: YATES A. P. , HUNTER D. N.
Published: February 2007

The effect of enalapril pretreatment on the haemodynamic response to tracheal intubation and surgical stimulation has been studied in 22 patients. Enalapril 5 mg given 4 hours before operation was associated with a significant reduction in the pressor response associated with intubation (p < 0.05) and surgical stimulation (p < 0.005) compared with control. Heart rate changes were similar in the two groups. The role of the renin‐angiotensin system in relation to the pressor response to sympathetic stimulation is discussed and it is concluded that angiotensin‐converting enzyme inhibitors may help improve peri‐operative cardiovascular stabiity.
Pulmonary oedema following carbamazepine overdose
Authors: KITSON G. E. , WAUCHOB T. D.
Published: February 2007

The successful management of a case of pulmonary oedema is described after the late recognition of an overdose of carbamazepine which complicated recognised benzodiazepine overdosage. The presentation and management are described and the possible mechanism of this rare complication discussed.
The control of post‐thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo‐analgesia
Authors: Gough J. D. , Williams A. B. , Vaughan R. S. , Khalil J. F. , Butchart E. G.
Published: February 2007

This is a comparative study of two methods to relieve postoperative thoracotomy pain. Continuous thoracic epidural infusion of fentanyl produced superior analgesia when compared with cryo‐analgesia of the relevant thoracic nerves. Linear analogue pain scores were consistently lower in the epidural group reaching significance (p < 0.05) at 32 and 40 hours after operation. All 36 patients in the cryo‐analgesia group required additional analgesia, while 12 out of the 32 patients in the epidural group did not. This difference was significant at p < 0.001. Respiratory and cardiovascular measurements were similar in both groups and the only side effect attributable to the epidural fentanyl was itching but this was not a problem.
Epidural fentanyl for shaking in obstetrics
Authors: Matthews N. C. , Corser G.
Published: February 2007

This study assesses the efficacy of epidural fentanyl in the relief of shaking associated with epidural analgesia. Fifty mothers whose shaking was sufficient to cause distress were divided randomly to receive either fentanyl 25 μg in 5 ml sterile normal saline or 5 ml of saline through their in‐situ epidural. Shaking stopped within 15 minutes in 18 out of 25 (72%) of those given fentanyl but in only 4 out of 25 (16%) of the saline group and this is statistically significant (p < 0.01). Fentanyl can be recommended in this context.
Successful difficult intubation
Authors: KIDD J. F. , DYSON A. , LATTO I. P.
Published: February 2007

The reliability of two signs of tracheal placement of a gum elastic bougie was studied. These signs were clicks (produced as the tip of the bougie runs over the trachea! cartilages) and hold up of the bougie as it is advanced (when the tip reaches the small bronchi). Ninety‐eight simulated and two genuine Grade 3 difficult intubations were attempted with the aid of a gum elastic bougie. Seventy‐eight trachea/ and 22 oesophageal placements of the bougie resulted. No clicks or hold up occurred with the bougie in the oesophagus. Clicks were recorded in 89.7% of tracheal placements of the bougie. Hold up at between 24–40 cm occurred in all tracheal placements. We conclude that these signs are reliable and that they should be taught as part of any difficult intubation drill in which the gum elastic bougie is used.
Anaesthetic management in patients with epidermolysis bullosa dystrophica
Authors: HAGEN R. , LANGENBERG C.
Published: February 2007

Successful anaesthetic management of two patients with severe epidermolysis bullosa dystrophica was accomplished with the use of ketamine—diazepam dissociative anaesthesia in one and brachial plexus block in the other. The classification and pathology of epidermolysis bullosa is considered, and the problems associated with anaesthesia in patients with this disease are discussed.
Nifedipine prevents the pressor response to laryngoscopy and tracheal intubation in patients with coronary artery disease
Authors: Kale S.C. , Mahajan R.P. , Jayalakshami T.S. , Raghavan V. , Das B.
Published: February 2007

The efficacy of sublingual nifedipine, administered one minute before anaesthetic induction, in order to minimise the pressor response to laryngoscopy and tracheal intubation was studied in a group of 15 patients who underwent coronary artery bypass surgery. Another group of 15 similar patients served as control. Premedication consisted of oral diazepam 5–10 mg, intramuscular morphine 0.2 mg/kg and promethazine 0.4 mg/kg. Anaesthesia was induced with morphine. 0.1–0.15 mg/kg and thiopentone 3–5 mg/kg. Laryngoscopy and tracheal intubation were facilitated with suxamethonium 1.5 mg/kg. A significant increase in blood pressure occurred during and after laryngoscopy and tracheal intubation in the control group. This increase was absent in the patients pretreated with nifedipine. The nifedipine group also maintained a lower rate‐pressure‐product than the control group during the period of study. It is concluded that nifedipine 10 mg is a useful pretreatment to prevent the pressor response to laryngoscopy and tracheal intubation in patients with coronary artery disease.
Peri‐operative dreaming and awareness in children
Authors: HOBBS A. J. , BUSH G. H. , DOWNHAM D. Y.
Published: February 2007

Dreaming under anaesthesia was investigated in a prospective study of 120 day case paediatric patients, aged 5–17 years, who underwent a variety of surgical procedures. Patients were anaesthetised using the ‘Liverpool technique’ of paediatric anaesthesia (nitrous oxide‐oxygen‐relaxant). No patient reported awareness, but 23 of 120 patients (19%) reported dreams. Analysis of the data revealed that the choice of muscle relaxant, (nondepolarising or depolarising) had a statistically significant effect on the incidence of dreaming (p < 0.05). It is suggested that the technique of intermittent intravenous suxamethonium may result in increased muscle spindle discharge and cause cerebral arousal and an increased incidence of dreaming.
Relapsing polychondritis and the anaesthetist
Authors: HAYWARD A. W. , AL‐SHAIKH B. B.
Published: February 2007

The anaesthetic management of a patient with upper airway obstruction secondary to relapsing polychondritis is described. The relevance of this condition to the anaesthetist is discussed.
Clinical relevance of the B12/N2O interaction A report of a seminar
Authors: NUNN J. F.
Published: February 2007

The interaction of nitrous oxide and vitamin B12 and its implications are not the exclusive territory of any one discipline. The initial discovery was by a chemist but it is of obvious relevance to anaesthetists and intensivists; some complications are neurological others haematological. The interaction provides an extremely important research tool as the first easily available B12‐deficient animal model. Finally there are implications for exposure to contaminated atmospheres in hospitals and in industry.
Edrophonium–hyoscine butylbromide mixture for reversal of neuromuscular blockade: heart rate changes in infants and children
Authors: Yamashita M. , Tajima K.
Published: February 2007

The effectiveness of hyoscine butylbromide in the prevention of edrophonium‐induced bradycardia was assessed in 50 infants and children. A mixture of edrophonium (1.0 mg/kg) and either atropine (0.01 mg/kg) or hyoscine butylbromide (0.4 mg/kg) was administered to reverse the effects of tubocurarine. An initial bradycardia followed the injection of the edrophonium‐atropine mixture. In contrast there was no initial decrease in heart rate after the administration of the edrophonium‐hyoscine butylbromide mixture. Hyoscine butylbromide can be used with advantage as a substitute for atropine in edrophonium reversal in infants and children.
Resuscitation in late pregnancy
Authors: REES G. A. D. , WILLIS B. A.
Published: February 2007

This paper considers cardiopulmonary resuscitation in obstetric patients at term and the influence of aortocaval compression on the outcome. The maximum chest compression force produced by eight physicians was measured as a function of angle of inclination using an inclined plane. The compression force at an angle of 27° is 80% of that in the supine position and the Cardiff resuscitation wedge, designed to prevent aortocaval compression, is described with this inclination. Midwives' expertise in basic life support 6 months after instruction was assessed using a manikin simulator. The majority had acquired errors in external chest compression and mouth to mouth ventilation. These were corrected by additional tuition. Resuscitation of the manikin on the Cardiff wedge was found to be as efficient as in the supine position.
Which intravenous induction agent for day surgery?
Authors: HEATH P. J. , KENNEDY D. J. , OGG T. W. , DUNLING C. , GILKS W. R.
Published: February 2007

Eighty day patients for the vaginal termination of pregnancy were randomly allocated to receive thiopentone, propofol, methohexitone or etomidate as intravenous induction agents. The same anaesthetist administered the anaesthesia and all the observers were blind to the agents used. The results show that thiopentone and propofol produced the least sequelae at induction and in recovery. Furthermore, both agents produced a high quality of induction and recovery. All patients were discharged home 2 hours postoperatively and there was no obvious delay in recovery. This study has altered clinical practice in our Day Surgery Unit.
Malignant hyperthermia in the Wolf‐Hirschhorn syndrome
Authors: GINSBURG R. , PURCELL‐JONES G.
Published: February 2007

A case of malignant hyperthermia in a small child with a chromosomal abnormality is described. The management of malignant hyperthermia in very small children is discussed.
Myoclonic spasms following intrathecal morphine
Authors: GLAVINA M. J. , ROBERTSHAW R.
Published: February 2007

Myoclonic twitching in the lower limbs of a patient who received intrathecal narcotics is described. There was no loss of consciousness. Reports of this phenomenon in animals are reviewed.
A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah's Witness
Authors: LOCKWOOD D. N. J. , BULLEN C. , MACHIN S. J.
Published: February 2007

Blood volume was maintained by an infusion of hydroxyethyl starch 2000 ml (Hespan: HES) during and for the first 28 hours after a major orthopaedic operation in a 13‐year‐old girl who was a Jehovah's Witness. This was responsible for a generalised clinical haemorrhagic state, an acquired coagulopathy associated with a shortened thrombin, prolonged prothrombin and activated partial thromboplastin times, and an acquired von Willebrand syndrome. The coagulation, after cessation of the infusion of HES, did not become normal until approximately 72 hours later.
One lung high frequency ventilation for peroral sealing of bronchial stump fistulae
Authors: Mallios C. , van Stolk M. A. , Scheck P. A. , Overbeek S. E. , Sie T. H.
Published: February 2007

The use of high frequency ventilation for 28 repairs of bronchial stump fistulae with fibrin sealant is discussed. Intravenous anaesthesia with continuous infusions of methohexitone, alfentanil and suxamethonium was employed. This method of anaesthesia and ventilation proved to be satisfactory.
Teaching guided fibreoptic nasotracheal intubation
Authors: Coe P. A. , T. A. King, MB, ChB, FFARCS  , R. M. Towey, MB, ChB, FFARCS
Published: February 2007

An anaesthetic technique suitable for training infibreoptic intubation is described. It uses a capped oropharyngeal airway which leaves the nose free for fibreoptic intubation and allows the airway to be maintained and ventilation to be controlled if necessary. An assessment is made of the technique after 50 fibreoptic intubations with the Olympus LF‐1 fibrescope. There were no failed intubations and no serious complications.
Urea and electrolyte measurement in pre‐operative surgical patients
Authors: McCleane G.J.
Published: February 2007

In a prospective study of 1062 patients who presented for routine and emergency surgical procedures, the frequency of urea and electrolyte measurement was determined. In addition, the incidence of abnormal urea and electrolyte measurements were recorded. It was found that these abnormal values were most frequent in the paediatric population (though they they had the fewest urea and electrolyte measurements performed) and in the over 60s. The American Society of Anesthesiologists' grade was found to he a useful predictor as to whether the urea and electrolyte measurement could be expected to be abnormal. It is suggested that American Society of Anesthesiologists' Grade I patients do not require routine urea and electrolyte measurements whilst those in grades 3, 4 and 5 and those on diuretics do.
Effects of thiopentone, etomidate and propofol on the haemodynamic response to tracheal intubation
Authors: HARRIS C. E. , MURRAY A. M. , ANDERSON J. M. , GROUNDS R. M. , MORGAN M.
Published: February 2007

The haemodynamic response to tracheal intubation was compared in 303 patients in whom anaesthesia was induced with either thiopentone 4 mg/kg, etomidate 0.3 mg/kg or propofol 2.5 mg/kg, with and without fentanyl 2 μg/kg. There was after propofol alone a significant decrease in arterial blood pressure, which did not increase above control values after intubation. Significant increases in arterial pressure followed intubation in patients induced with thiopentone or etomidate alone. Increases in heart rate occurred with all agents after laryngoscopy. The use of fentanyl resulted in arterial pressures lower than those after the induction agent alone, and in an attentuation, but not abolition of the responses to largyngoscopy and intubation.
Effect of propofol on cerebral blood flow and metabolism in man
Authors: VANDESTEENE A. , TREMPONT V. , ENGELMAN E. , DELOOF T. , FOCROUL M. , SCHOUTENS A. , de ROOD M.
Published: February 2007

Cerebral blood flow, cerebral oxygen consumption, lactate and glucose metabolism were measured in 13 patients during anaesthesia with nitrous oxide, oxygen and enflurane 0.5% and after 30 minutes infusion of propofol. The mean blood concentration of propofol was 4.06μg/ml. Cerebral blood flow decreased by 27.6% and cerebral vascular resistance by 51%. There were no changes in lactate and glucose metabolism. Cerebral oxygen consumption decreased by 18.25%. Changes in the electroencephalograph were related to the blood levels of propofol.
Changes in intra‐ocular pressure in the elderly during anaesthesia with propofol
Authors: GUEDES Y. , RAKOTOSEHENO J. C. , LEVEQUE M. , MIMOUNI F. , EGRETEAU J. P.
Published: February 2007

Variations in intra‐ocular pressure during anaesthesia were studied in two groups of 15 elderly patients selected randomly. The groups were not significantly different with regard to age, sex, weight or ASA classification. The first group received intravenous propofol as a bolus followed by a continuous infusion. The second group received a bolus of thiopentone followed by maintenance with enflurane. Intra‐ocular pressure, heart rate and arterial pressure were measured before and after induction, after intubation and at the end of the operation. Overall, compared with baseline values, the results showed a decrease in intra‐ocular pressure of 31% in group I and 17% in group 2, and a decrease in systolic arterial pressure of 14% in both groups.
Propofol for electroconvulsive therapy
Authors: ROUSE E. C.
Published: February 2007

Twenty patients who received electroconvulsive therapy were anaesthetised with either propofol or methohexitone in a randomised crossover study. Recovery times were similar but patients who received propofol tended to be arientated sooner. The decrease in arterial blood pressure after induction was greater with propofol than with methohexitone. There was an increase in blood pressure immediately after therapy in patients who received methohexitone but not in those given propofol. There was a slight difference in pain on injection. The mean duration of convulsion (measured in 10 patients) during anaesthesia was shorter with propofol than with methohexitone.
A comparison between propofol and ketamine for anaesthesia in the elderly. Haemodynamic effects during induction and maintenance
Authors: Maneglia R. , Cousin M. T.
Published: February 2007

The haemodynamic effects of propofol and ketamine were studied in two groups of eight randomly allocated elderly patients (mean age 85.8 years) anaesthetised for hip replacement. Group 1 patients received propofol 1 mg/kg by intravenous bolus for induction and 0.1 mg/kg/minute by continuous infusion for maintenance. Group 2 patients received ketamine 1.5 mg/kg by intravenous bolus as induction dose and 50 μg/kg/minute by continuous infusion for maintenance. All patients breathed spontaneously via a facemask at FIO2 1.0. Haemodynamic status was established before induction and at 1, 3, 5, 10 and 15 minutes after induction. Arterial pressure and cardiac output decreased slightly in group 1 but heart rate, right atrial pressure and pulmonary arterial pressure remained unchanged. Myocardial oxygen consumption showed a significant decrease of 27%. There was a significant increase in blood pressure and pulmonary capillary wedge pressure (by 97%) in group 2. Cardiac output and systemic vascular resistance remained unchanged whereas myocardial oxygen consumption showed a very significant increase of 100%.
Atracurium recovery: prediction of safe reversal times with edrophonium
Authors: CASHMAN J. N. , JONES R. M. , ADAMS A. P.
Published: February 2007

The time to safe return of neuromuscular function after atracurium 0.3 mg/kg intravenously was assessed in 24 patients in whom anaesthesia was maintained with halothane 0.5%. Safe reversal (recovery to a T4 ratio > 05), after this dose of atracurium, could only be reliably and rapidly (< 2 minutes) achieved with edrophonium if a period greater than 30 minutes elapsed since administration of the relaxant. This coincides with the appearance of four recognisable twitches if a train‐of‐four pattern of nerve stimulation is used. Thus, if no monitoring equipment is available, at least half‐an‐hour should elapse after administration of atracurium in a moderate dose (e.g. 0.3 mg/kg) before rapid and reliable reversal can be anticipated. Four twitches in a train‐of‐four should be recognisable, if a nerve stimulator is available.
Intravenous enalaprilat and autonomic reflexes
Authors: MURPHY J. D. , VAUGHAN R. S. , ROSEN M.
Published: February 2007

Thirty healthy patients, who were to undergo surgery which required tracheal intubation, were given an intravenous injection of enalaprilat (either 0.5 mg, 1 mg, 2 mg or 4 mg; six patients, for each dose) or normal saline 17 minutes before induction of anaesthesia with thiopentone 3–5 mg/kg, and suxamethonium 1.5 mg/kg. Postural manoeuvres were performed 5 minutes before and 6, 11 and 16 minutes after enalaprilat or saline. Complete inhibition of angiotensin converting enzyme occurred with all doses of enalaprilat, which allowed the four different treatment groups to be considered as one large treated group. The mean arterial pressure was almost unchanged during the postural manoeuvres; the heart rate increased, mostly similarly (by approximately 10%) in both groups. Mean arterial pressure in the recumbent position decreased over the 17 minutes before induction in the enalaprilat group, and increased slightly in the control group (treated mean, −5.0%; controls mean, 1.8%; difference, −6.8%; 95% confidence intervals of difference, −2.3 to −11.3%, p < 0.01). This difference was again seen after induction (treated, − 8.0%; controls, 7.7%; confidence intervals of difference, −0.6 to −31%) and for a 5‐minute period shortly after tracheal intubation. The increases in mean arterial pressure produced by intubation itself were similar in both groups (treated, + 36%; controls, +35%; 95% confidence intervals of difference, −16% to +18%). Changes in heart rate after induction were also similar in both groups. It is concluded that intravenous enalaprilat acted as a hypotensive agent with a sparing effect on autonomic reflexes, both before and after induction of anaesthesia.
The effects of secondary transport on critically ill patients
Authors: RIDLEY S. , CARTER R.
Published: February 2007

This study examined the effect of secondary transport on critically ill patients and the effectiveness of a regionally based intensive care service. Four hundred and ninety‐jive patients were studied retrospectively over a 2‐year period. Eighty‐two were transferred from peripheral hospitals in a mobile intensive care unit while the remaining 413 were admitted directly to the intensive therapy unit at the Western Infirmary, Glasgow. The severity of illness in both groups was assessed using the APA CHE II scoring system. The transferred group were scored before and after the journey, while the directly admitted group were scored only on admission. The results show that the transferred patients exhibited a consistent cardiorespiratory response to transport irrespective of their severity of illness, and that the mortality in both groups of patients in the intensive therapy unit was not significantly different. The results also suggest that in the transferred group, the outcome is not only dependent on the severity of illness but also on other factors, such as the hospital from which the patient was referred and the duration of the pretransfer admission.
Paul Sudeck—his contribution to anaesthesia
Authors: HOWAT D. D. C.
Published: February 2007

Paul Sudeck is not generally recognised as a pioneer in anaesthesia, although he is well known for the atrophy of bone named after him. However, he not only championed the use of ether as a safe anaesthetic agent, described a method of ether analgesia for outpatient surgery and devised an inhaler for its administration, but also reintroduced nitrous oxide into Germany and invented possibly the first circle carbon dioxide absorption system with an optional attachment for continuous positive pressure respiration.
Controlled‐release morphine in cancer pain
Authors: HOSKIN P. J. , POULAIN P. , HANKS G. W.
Published: February 2007

Nineteen patients with pain from advanced cancer stabilised on oral 4‐hourly aqueous morphine who were to be converted to twice daily controlled‐release morphine tablets (MST Continus) completed this study. Patients were randomised to receive either their usual 4‐hourly morphine dose or placebo with the first dose of MST tablets. There were no significant differences between the treatment groups in ratings of pain intensity, pain relief or side effects, or in any of the measured pharmacokinetic parameters. No patients in the placebo group experienced any breakthrough pain, and nursing staff were unable to identify which patients had received the active dose of morphine elixir. We conclude that there is no need for a loading dose when aqueous morphine is changed to MST tablets.
Chlormethiazole sedation for critically ill patients in renal failure
Authors: GRAY P. A. , PARK G. R.
Published: February 2007

Chlormethiazole infusions were used successfully to provide night sedation for 10–19 nights in three patients with renal failure managed by continuous veno‐venous haemofiltration with dialysis. Fluid overload has accompanied the use of this drug previously because of its low concentration. The ability to remove large amounts of fluid during haemofiltration dialysis proved to be effective in preventing this. All three patients had impaired liver function and showed evidence of chlormethiazole accumulation after 4–6 days. The combination of progressive reduction in dose and daily withdrawal of infusions prevented a major problem. Acceptance of this technique by the patients was high. Chlormethiazole may be a useful addition to the drugs available to provide sedation in well defined clinical circumstances.
Admissions to the intensive care unit after complications of anaesthetic techniques over 10 years
Authors: COOPER A. L. , LEIGH J. M. , TRING I. C.
Published: February 2007

Fifty‐three patients were admitted in a 5‐year period to the intensive care unit as a result of a complication of an anaesthetic technique. These patients represented 1 in 1543 anaesthetics carried out in the District in the period and 2.0% of all admissions to the intensive care unit. The mortality rate was 17%. The complication was considered to be wholly or partially avoidable in 14 instances (26%). Five of these subjects died and two had a residual neurological deficit.
An unusual case of symptomatic hypoglycaemia in a child
Authors: LONG T. M. W.
Published: February 2007

An unusual case of pre‐operative, symptomatic hypoglycaemia in an otherwise fit, well developed 6‐year‐old boy is reported, and highlights the unpredictable effect of pre‐operative starvation on children admitted on the day of surgery. The presentation and incidence of hypoglycaemia before operation in children is also reviewed.
Obliteration of the axillary artery after axillary block
Authors: OTT B. , NEUBERGER L. , FREY H. P.
Published: February 2007

A case of total obliteration of the axillary artery after axillary block is presented. This resulted from an accidental intramural injection of local anaesthetic (mepivacaine 1%, 40ml, with adrenaline 1:200 000). Axillary block was performed using the loss of resistance technique with a blunt needle (45° bevel). The diagnosis was made by paplation of the peripheral pluse and by comparison between the skin temperatures of each arm. The thrombosed part of the artery was successfully reconstructed with an autologous saphenous vein graft.
Epidural anaesthesia and thrombocytopenia
Authors: HEW‐WING P. , ROLBIN S. H. , HEW E. , AMATO D.
Published: February 2007

A case is presented of a mother with unanticipated profound thrombocytopenia who received a continuous epidural anaesthetic for labour. No neurological sequelae or excessive bleeding occurred. It is clear, after a review of the literature, that more information is needed to define the lower limits of platelet count at which it is safe to proceed with epidural anaesthesia.
Epidural versus general anaesthesia for elective Caesarean section Effect on Apgar score and acid‐base status of the newborn
Authors: Evans C. M. , Murphy J. F. , Gray O. P. , Rosen M.
Published: February 2007

Elective Caesarean section deliveries over a 5‐year period were studied to compare the effect of epidural block with general anaesthesia on the condition of the infant at birth. The Apgar score and umbilical arterial acid‐base status were used as determinants of the latter. Epidural block was used in 139 (22.8%) mothers while 471 (77.2%) were performed under general anaesthesia. No babies in the epidural group were severely depressed (Apgar < 4), compared with 6.2% in the general anaesthesia group. Only 4.3% of the epidural sections were moderately depressed (Apgar 4–6), compared with 15.4% of the others. These differences remained highly significant when infants of less than 2500 g were excluded, and when matched groups were compared. Mean umbilical arterial pH was similar within the two groups (pH 7.28), and was not consistent with asphyxia in almost 90% of the depressed infants. The findings suggest that general anaesthesia, rather than asphyxia or aortocaval compression, is responsible for most of the depressed infants born by elective Caesarean section. This may involve over 20% of babies delivered in this manner, so greater use of epidural block for elective Caesarean section is recommended. Further investigations are required to improve results with general anaesthesia.
The influence of patient characteristics on the requirements for postoperative analgesia
Authors: BURNS J. W. , HODSMAN N. B. A. , McLINTOCK T. T. C. , GILLIES G. W. A. , KENNY G. N. C. , McARDLE C. S.
Published: February 2007

The requirements for analgesia after upper abdominal surgery were evaluated in 100 patients who received morphine by way of a patient‐controlled analgesia system. Hourly and cumulative 24‐hour requirements were analysed for possible correlations with patient characteristics and for the patterns of consumption throughout the 24‐hour study period. The level of pain relief was assessed by linear analogue pain scores at 4–6 hours and 24 hours. Male patients (n = 46) required significantly more morphine than female patients (n = 54) to achieve similar levels of pain relief (p < 0.05). There was an inverse correlation between age and morphine consumption in both males and females (r = ‐ 0.684, p < 0.00005 and r = ‐ 0.502, p < 0.00005 respectively). No correlation was found between morphine consumption and patient weight. The pattern of hourly morphine consumption appeared to follow a diurnal rhythm, with peak times of demand at 0900 and 2000 hours. The variations in requirements for analgesia among patients and with time of day should be taken into account when a regimen for postoperative analgesia is prescribed.
Variables of patient‐controlled analgesia 1. bolus size
Authors: OWEN H. , PLUMMER J. L. , ARMSTRONG I. , MATHER L. E. , COUSINS M. J.
Published: February 2007

The efficacy of a range of demand doses of morphine for patient‐controlled analgesia was studied. Patients who self–administered the smallest dose (0.5 mg) were frequently unable to achieve good pain control; patients who received the largest dose (2 mg) had a high incidence of ventilatory depression. A dose of 1 mg was the best increment under the conditions of this study but the relationship between increment and lockout interval requires consideration.
Efficacy of lignocaine in the suppression of the intra‐ocular pressure response to suxamethonium and tracheal intubation
Authors: GROVER V. K. , LATA K. , SHARMA S. , KAUSHIK S. , GUPTA A.
Published: February 2007

The effect of lignocaine pretreatment on the intra‐ocular pressure response to suxamethonium and tracheal intubation was studied in 80 adult patients, divided randomly into four groups of 20 each. These groups received respectively normal saline (10 ml), lignocaine 1 mg/kg, 1.5 mg/kg and 2 mg/kg as pretreatment, in a double blind manner, one minute before anaesthetic induction with thiopentone and suxamethonium 1.5 mg/kg. Lignocaine pretreatment caused a signijicant decrease in intra‐ocular pressure. Suxamethonium caused a significant increase, but lignocaine pretreatment in doses of 1.5 mg/kg and 2 mg/kg effectively kept the postsuxamethonium pressure below control values. Tracheal intubation further aggravated the postsuxamethonium increase in intra‐ocular pressure. Lignocaine, in doses of 1.5 mg/g and 2 mg/kg also effectively kept the postintubation pressure values below control levels. Lignocaine, in dose of 1 mg/kg, only partially attenuated the postsuxamethonium and postintubation increase in intra‐ocular pressure. In conclusion, lignocaine pretreatment, in a dose of 1.5 mg/kg, offers protection against suxamethonium‐ and tracheal‐intubation initiated increases in intra‐ocular pressure, without causing any signijicant decrease in arterial pressure.
Acute thyroid crisis on induction of anaesthesia
Authors: BENNETT M. H. , WAINWRIGHT A. P.
Published: February 2007

Thyroid crisis on induction of anaesthesia was treated with dantrolene, because of a mistaken diagnosis of malignant hyperthermia. There was immediate improvement after dantrolene with reduction in muscle rigidity, mental confusion and pyrexia. High circulating T4 has an effect on calcium flux across the sarcoplasmic reticulum and dantrolene may inhibit this pathological mechanism. We suggest the same dosage regimen as is used in the treatment of malignant hyperthermia.
Automatic control of arterial pressure after cardiac surgery Evaluation of a microcomputer‐based control system using glyceryl trinitrate and sodium nitroprusside
Authors: COLVIN J. R. , KENNY G. N. C.
Published: February 2007

Arterial hypertension after cardiac surgery is common and is associated with increased morbidity. Glyceryl trinitrate may be a more suitable agent for control of hypertension than sodium nitroprusside. We have developed a closed–loop system for the Atari 1040 ST microcomputer to control arterial pressure by the simultaneous infusion of two vasodilators under computer control. Use of this system with glyceryl trinitrate and sodium nitroprusside in 24 patients who required vasodilators after cardiopulmonary bypass, revealed that hypertension was controlled by glyceryl trinitrate alone in 14 of the patients and 10 required supplementary sodium nitroprusside. The results suggest that glyceryl trinitrate is a suitable agent for control of hypertension after cardiac surgery in the majority of patients. They also show that a sizeable minority required additional sodium nitroprusside, and that an automated‘dual pump’ system is a satisfactory method of administering two vasodilators in this way.
Postoperative absorption of controlled‐release morphine sulphate
Authors: LEW J.K.L. , MOBLEY K. A. , ACHOLA K. J. , HORNE M. , SMITH G.
Published: February 2007

The absorption of morphine sulphate in a controlled‐release formulation was studied in 12 patients who had undergone unilateral inguinal hernia repair under a light general anaesthetic and ilio‐inguinal block. Serum morphine concentrations were measured serially and gastric emptying was assessed by measurement of paracetamol absorption. Three patients had delayed gastric emptying and impaired morphine absorption in the immediate postoperative period. Four hours later, there was a significant reduction in gastric emptying in eight patients who had normal paracetamol and morphine absorption in the immediate postoperative period.
Cardiovascular responses to flumazenil‐induced arousal after arterial surgery
Authors: FISHER G. C. , HUTTON P.
Published: February 2007

Patients who underwent peripheral arterial surgery had anaesthesia maintained with an infusion of midazolam. They were allowed either to recover spontaneously or to have the effects of midazolam reversed by flumazenil at the end of surgery. This study demonstrated that the cardiovascular responses to arousal using flumazenil are no dqferent from those seen when the patient is allowed to recover in the normal way. This result has obvious advantages for clinical practice but the dangers of resedation must not be forgotten.
Instability of the tracheal tube in neonates
Authors: ROOPCHAND R. , ROOPNARINESINGH S. , RAMSEWAK S.
Published: February 2007

A postmortem study of the degree of displacement of the tracheal tube was performed on 13 neonates of varying birthweights. There was significant movement of the tube on flexion and extension of the neck, and on opening the infant's mouth. Our findings lend support to certain techniques of tracheal tube placement; the ultimate aim is to position it accurately.
Major thoracic surgery during active tetanus
Authors: FARLING P. A. , SHARPE T. D. E. , GRAY R. C.
Published: February 2007

This report describes the anaesthetic and intensive care management of a patient who had a thoracotomy during active tetanus. The dilemmas which faced the clinicians involved with the case are discussed.
Angiotensin II in the management of excision of phaeochromocytoma
Authors: SOMMERVILLE K. J. , MCKELLAR J. B. M.
Published: February 2007

The management of a patient with an unusual combination of anaesthetic problems, namely phaeochromocytoma and difficult intubation is described. Angiotensin II is discussed in the management of hypotension after excision of the tumour.
Postdural puncture headache A comparison between 26‐ and 29‐gauge needles in young patients
Authors: Flaatten H. , Rodt S.Å. , Vamnes J. , Rosland J. , Wisborg T. , Koller M.E.
Published: February 2007

The incidence of postdural puncture headache after spinal anaesthesia with two types of 26‐ and 29‐gauge needles was investigated in 149 patients less than 30 years old. Ten patients, (6.7%), six men and four women, developed typical symptoms of postdural puncture headache, while six (4.0%) developed headache of other origin. There were no headaches in the 29‐gauge group. Spinal anaesthesia in four patients (8%) was impossible to perform with the 29‐gauge needle. By using the latter, spinal anaesthesia can be given to young adults with little risk of postdural puncture headache.
Comparison of the effects of famotidine and ranitidine on gastric secretion in patients undergoing elective surgery
Authors: ESCOLANO F. , CASTAÑO J. , PARES N. , BISBE E. , MONTERDE J.
Published: February 2007

A randomised double‐blind comparison of oral famotidine and ranitidine given 2 hours before induction, on gastric secretion (volume and pH) was carried out on 93 patients undergoing elective surgery. Gastric contents were aspirated immediately after tracheal intubation. Famotidine significantly reduced the gastric volume, compared with the other groups, including ranitidine. Both famotidine and ranitidine significantly elevated gastric pH towards neutral, compared with the other groups. There was no significant difference between ranitidine and famotidine in respect of the pH. The patients premedicated with famotidine and ranitidine were well protected against Mendelson's syndrome, whereas 38% of patients from the other groups remained at risk.
Penetrating craniocerebral airgun injury
Authors: WRIGHT P. J. , MURRAY R. J.
Published: February 2007

Low velocity cerebral missile injuries inflicted by air guns frequently cause little primary neurological damage, but the patient often suffers severe later deterioration which has been classified as a type of ‘talk and die’ head injury. The anaesthetic management of a penetrating air rifle missile injury using an infusion of propofol is described.
Characteristics of the Pharmaseal continuous flushing device
Authors: McKINNEY M. S. , ORR I. A.
Published: February 2007

Pharmaseal continuous flushing devices were tested with regard to flow characteristics into simulated arterial and venous pressure systems. Two driving pressures were used and it was found that variation in driving pressure made a significant difference to the flow, while arterial or venous pressure made no significant difference. The flow devices had a wide variation although they were all of the same type. The fluid volume delivered was in the region of 100 ml in a 24‐hour period.
Death on the table
Authors: BACON A.K.
Published: February 2007

This describes one way to handle the aftermath of anaesthetic catastrophe. The techniques of how to share bad news, interview relatives, complete official forms, deal with the legal process and debrief colleagues are outlined. It is hoped that this article will promote discussion on this topic and improve communication with all those affected by mishaps in the operating suite.
Neostigmine after spontaneous recovery from neuromuscular blockade
Authors: GOLDHILL D. R. , WAINWRIGHT A. P. , STUART C. S. , FLYNN P. J.
Published: February 2007

The effect of neostigmine on neuromuscular function was examined after spontaneous recovery from an atracurium‐induced neuromuscular blockade, which reached a train‐of‐four ratio of either 0.5 or 0.9. Two doses of neostigmine 2.5 mg were given 5 minutes apart. Neuromuscular recovery was assessed with train‐of‐four and tetanic stimuli. The first dose of neostigmine antagonised the neuromuscular blockade. The second dose diminished tetanic height and increased tetanic fade. The train‐of‐four measured mechanically was adversely affected to a small degree, but when measured with the electromyograph no significant change occurred. Neostigmine may adversely affect neuromuscular function after spontaneous recovery from a non‐depolarising block. This is unlikely with a single modest dose and any effects are probably short‐lived.
Cerebral effects of anaesthesia and hypothermia
Authors: STEPHAN H. , SONNTAG H. , LANGE H. , RIEKE H.
Published: February 2007

Cerebral blood flow, cerebral oxygen and glucose consumption, and cerebral lactate and pyruvate release were measured; spectral analysis of the EEG was recorded in 10 male patients who had coronary artery bypass surgery. The measurements were taken to evaluate the effects of fentanyl–midazolam anaesthesia during normothermia and during hypothermic nonpulsatile cardiopulmonary bypass at 26°C venous blood temperature, when a temperature‐corrected Paco2‐value of 5.3 kPa was maintained. Anaesthesia with fentanyl 7 μg/kg and midazolam 200 μg/kg as induction doses, followed by infusions of fentanyl 0.15 μg/kg/minute and midazolam 3 μg/kg/minute, was characterised by a decrease in fast‐wave activity and an increase in high‐amplitude, slow‐wave activity in the EEG. There was also a decrease in cerebral blood flow (38%), oxygen consumption (22%) and glucose consumption (25%), while lactate and pyruvate production remained unchanged. Hypothermia of 26°C venous blood temperature suppressed EEG almost completely and decreased oxygen and glucose consumption by a further 61% and 54%, respectively, with no changes in lactate and pyruvate production while cerebral blood flow increased by 145%. These results show that the effects of fentanyl–midazolam anaesthesia on cerebral metabolism are enhanced during hypothermic cardiopulmonary bypass while the influence of anaesthesia on cerebral blood flow is overshadowed by the practice of a temperature‐corrected acid‐base management.
A Kynar piezoelectric film respirometer
Authors: MOYLE J. T. B.
Published: February 2007

This paper describes a new technique for measuring respiratory gas flows and volumes using polyvinylidene fluoride film.
Measurement of the flow‐resistive properties of double‐lumen bronchial tubes in vitro
Authors: CHIARANDA M. , ROSSI A. , MANANI G. , PINAMONTI O. , BRASCHI A.
Published: February 2007

This study measures the resistance to gas flow of different double‐lumen bronchial tubes used for separate ventilation of each lung in critically ill patients. Different‐sized Robertshaw and Carlens' tubes were studied, as well as a new device that consisted of a cuffed bronchial catheter introduced through a standard tracheal tube. The pressure‐flow relationship was curvilinear in all cases. Robertshaw and Carlens' tubes were generally found to have bronchial and tracheal channels with almost similar resistance and offered total resistances similar to those of 7.0–8.0 mm internal diameter tracheal tubes. The new device had a higher resistance than others of equal external diameter. This must be taken into account when its use is recommended for prolonged respiratory support.
Bed rest and postlumbar puncture headache
Authors: COOK P. T. , DAVIES M. J. , BEAVIS R. E.
Published: February 2007

A prospective, blind, randomised trial was undertaken to determine if the incidence of postlumbar puncture headache is significantly altered by 24 hours’ recumbency. One hundred and two patients were allocated randomly to rest supine in bed for either 4 or 24 hours after spinal anaesthesia for urological or gynaecological surgery. A standardised spinal anaesthetic technique was applied that incorporated the use of a 22‐gauge needle. All patients were followed‐up prospectively to determine if there was a difference in the incidence of postlumbar puncture headache between the two groups. Five patients (11.6%) who were recumbent for 4 hours developed postlumbar puncture headache, a result which was not statistically significantly different from the seven patients (11.9%) in the other group who complained of postlumbar puncture headache.