bluuebunny/crossref_metadata_2025 huggingface dataset:
Laryngeal mask airway insertion using cricoid pressure and manual in‐line neck stabilisation
Authors: GABBOTT D. A. , SASADA M. P.
Published: February 2007

Forty patients were studied to assess the ease of insertion of the laryngeal mask in the simultaneous presence of cricoid pressure and manual in‐line stabilisation of the neck. This was compared with the normal technique of laryngeal mask insertion in the same patients. Fibreoptic views obtained through the laryngeal mask were documented on each occasion. The device was inserted successfully in all 40 patients when the head was kept in the normal position. This was achieved on the first attempt in 33 patients. When cricoid pressure and manual in‐line neck stabilisation were applied, successful laryngeal mask insertion was only possible in 29 patients, with correct placement at the first attempt in 14 patients. The differences were statistically significant (p < 0.001). When cricoid pressure and neck stabilisation were applied, vocal cord visualisation through the laryngeal mask with a fibreoptic bronchoscope was only possible in 15 patients. With the head in the normal position the vocal cords were seen in 33 patients. The implications of these results are discussed with respect to the role of the laryngeal mask in the multiply injured patient.
Resuscitation skills of trainee anaesthetists
Authors: BELL J. H. , HARRISON D. A. , CARR B.
Published: February 2007

We assessed the basic and advanced cardiopulmonary resuscitation skills of 30 trainee anaesthetists in a simulated exercise. Only one person performed basic cardiopulmonary resuscitation as outlined in the 1992 European Resuscitation Council guidelines. The management of ventricular fibrillation and asystole were correctly carried out by eight (27%) and nine (30%) anaesthetists, respectively. Neither the seniority of the anaesthetists nor their postgraduate qualifications correlated with their performance level. We conclude that all trainee anaesthetists need to undergo regular training and assessment of their resuscitation skills.
Tracheal occlusion in the prone position in an intubated patient with Duchenne muscular dystrophy
Authors: Rittoo D. B. , Morris P.
Published: February 2007

A 15‐year‐old boy with Duchenne muscular dystrophy developed complete airway obstruction under general anaesthesia when positioned prone for spinal surgery. Tracheobronchial compression against vertebral bodies facilitated by a shortened sternovertebral distance due to thoracic lordoscoliosis is suggested as the cause.
Percutaneous dilational tracheostomy Malposition leading to delayed weaning
Authors: Rigg C. D. , Edmondson L.
Published: February 2007

We report a patient in whom delayed weaning from ventilatory support was caused by the malposition of a percutaneous dilational tracheostomy tube. A fold of mucosa, identified at tracheoscopy, was found to be the limiting factor, and the situation was resolved by removal of the tracheostomy and reintubation. We believe that the case supports the routine use of a bronchoscope to check the position of the tracheostomy tube.
Comparison between two fibrescopes with different diameter insertion cords for fibreoptic intubation
Authors: Hakala P. , Randell T.
Published: February 2007

Two fibreoptic bronchoscopes with insertion cords of different diameters (3.7 and 5.0 mm) were compared during fibreoptic intubation in 84 adult patients (ASA 1‐2) undergoing orotracheal intubation under general anaesthesia. The fibrescope used was randomly selected. The incidence of resistance to passage of the tracheal tube through the vocal cords was higher using the thinner fibrescope, 14/40 (35%) as compared with the thicker fibrescope, 5/44 (11%) (p < 0.05). Intubation failed with the thinner fibrescope in 8/40 (20%) of patients, whereas all intubations with the thicker fibrescope were successful in six patients after manipulation of the tracheal tube (p < 0.01). With the thinner fibrescope manipulation of the tracheal tube after impingement led to intubation of the trachea in 6/14 (43%) patients. The duration of intubation was significantly shorter with the thicker fibrescope (p < 0.05). There were two instances of oesophageal intubation with the thinner fibrescope. A fibrescope with a thicker insertion cord is more suitable for orotracheal fibreoptic intubation in adult patients.
Cardiac function during orthotopic liver transplantation with venovenous bypass
Authors: CHEEMA S. P. S. , HUGHES A. , WEBSTER N. R. , BELLAMY M. C.
Published: February 2007

We have studied the effect of varying the flow of a venovenous bypass system during orthotopic liver transplantation. During these manipulations, central venous (n = 9) or pulmonary artery occlusion (n = 9) pressures were kept constant. There was no change in right ventricular systolic or diastolic function in either group, suggesting that any conformational change of the ventricle during bypass is not of functional significance. The extrapolated volume loading required to compensate for the absence of bypass is of the order of 3000 ml.
Cardiovascular effects of desflurane in experimental animals and volunteers
Authors: WEISKOPF R. B.
Published: February 2007

Desflurane (difluoromethyl‐1‐fluoro‐2,2,2‐trifluoroethyl ether [1‐653]) was introduced into clinical practice in 1992. The present review summarises the current state of knowledge of the cardiovascular effects of desflurane, with emphasis on investigations published in the past 2 years, and compares desflurane's effects with those of isoflurane, and where available, sevoflurane. Desflurane produces two distinct cardiovascular actions. First, desflurane decreases left ventricular systolic and diastolic function to an extent similar to that of isoflurane. It decreases systemic vascular resistance and mean arterial blood pressure in a dose‐dependent fashion. Heart rate is unchanged at lower steady‐state concentrations, but increases with higher concentrations. Addition of nitrous oxide maintains heart rate unchanged, increases systemic vascular resistance and mean arterial blood pressure, but decreases cardiac output. Secondly, when the end‐tidal concentration of desflurane is very rapidly increased to concentrations exceeding 1 MAC, in the absence of premedication, desflurane increases sympathetic activity, heart rate and mean arterial blood pressure. Prior administration of fentanyl, esmolol or clonidine blunts this response. The response and the ability of fentanyl to blunt it probably account for the disparate results in published studies on the use of desflurane in patients undergoing coronary artery bypass graft surgery.
Inhalational anaesthesia at the extremes of age: paediatric anaesthesia
Authors: OLSSON G. L.
Published: February 2007

The relevant physiological and pharmacokinetic differences between adults and infants and children are considered, and the advantages and disadvantages of the available inhalation anaesthetics are discussed. Desflurane shows promise as a new paediatric anaesthetic as it allows rapid changes in the depth of anaesthesia. However, irritant effects on the airways make desflurane unsuitable for induction. Desflurane anaesthesia, following halo thane induction, seems to be well tolerated.
Low‐flow anaesthesia
Authors: BAUM J. A. , AITKENHEAD A. R.
Published: February 2007

Although many anaesthesia machines are equipped with circle rebreathing systems, inhalational anaesthesia remains frequently performed using relatively high fresh‐gas flows. The major advantages of rebreathing techniques can be achieved only if the fresh‐gas flow is reduced to 1 l.min‐1 or less. Although there are potential risks associated with low‐flow anaesthesia, modern anaesthesia machines meet all the technical requirements for the safe use of low‐flow techniques if they are used in conjunction with equipment for monitoring inhaled and exhaled gas concentrations; these monitors are already increasingly available and, in the near future, are likely to become an obligatory safety standard in many countries. For both economic and ecological reasons, the use of new inhalational anaesthetics, with low tissue solubility and low anaesthetic potency, can be justified only if the efficiency of administration is optimised by using low‐flow anaesthetic techniques.
Economic analysis and pharmaceutical policy: a consideration of the economics of the use of desflurane
Authors: EGER E. I.
Published: February 2007

Several factors have to be considered in determining the cost of applying a new inhalational anaesthetic such as desflurane into clinical practice. Factors beyond the immediate control of the anaesthetic practitioner include the price set by the manufacturer (although this may be influenced by economic and political pressures), and the physical‐pharmacological properties of the anaesthetic (e.g. vaporization, potency, solubility). The anaesthetic practitioner can minimise cost by applying lower inflow rates. Lower solubility (and hence lower uptake) provides a greater economy at lower inflow rates than does higher solubility. Furthermore, lower solubility permits the use of lower inflow rates with greater precision to the control of anaesthesia, and greater ease of application. At present unit prices, the cost of desflurane approximately equals that of isoflurane when a 1 l.min‐1 inflow rate is used. The use of lower inflow rates presupposes that such rates do not allow the production of toxic compounds in recirculating gases. Modern equipment makes low‐flow anaesthesia reliable and easy to control, and as desflurane is not degraded by the standard carbon dioxide absorbents, its use in low‐flow systems is effective and economical. These cost considerations do not take into account the savings that may result from a more rapid recovery from anaesthesia, nor do they take into account the increased expense of capital equipment needed to apply a new anaesthetic.
Economic analysis and pharmaceutical policy
Authors: ROVIRA J.
Published: February 2007

Economic evaluation, a comparative analysis of alternative actions in terms of costs and consequences, allows rational decisions to be made concerning the deployment of resources (people, time, equipment, facilities and knowledge). Pharmaceutical policy reflects the various objectives of the many social groups, some of which are conflicting. While new methodologies for evaluation of health care programmes still need to gain wider acceptance, resource limitations for both care providers and decision makers make economic analysis an increasingly important tool.
The use of the McCoy laryngoscope in patients with simulated cervical spine injuries
Authors: Laurent S. C. , de Melo A. E. , Alexander‐Williams J. M.
Published: February 2007

We studied the laryngoscopic view in 167 patients with their head and necks held in the neutral position with manual in‐line stabilisation and cricoid pressure to simulate the patient with a suspected cervical spine injury. Each patient underwent laryngoscopy using both a McCoy and a Macintosh laryngoscope. The best view obtained by each laryngoscope was graded according to standard guidelines. The results showed that the McCoy was never worse than the Macintosh. It improved the Macintosh grade by 1 grade in 41% and by 2 grades in 8% (p < 0.001). Difficult laryngoscopy, defined as the inability to see the glottis (grade 3 or 4), was found in 56 (33%) with the Macintosh laryngoscope and only eight (5%) (p < 0.001) with the McCoy laryngoscope. We suggest that patients with a suspected cervical spine injury and a full stomach should be intubated using a McCoy in preference to a Macintosh laryngoscope.
Effect of intravenous fluid preload on vasoactive peptide secretion during Caesarean section under spinal anaesthesia
Authors: POUTA A. M. , KARINEN J. , VUOLTEENAHO O. J. , LAATIKAINEN T. J.
Published: February 2007

The endogenous release of the vasoactive peptides atrial natriuretic peptide and endothelin‐1 may modify maternal haemodynamic responses to a rapid intravenous volume load used to prevent hypotension at elective Caesarean delivery under spinal anaesthesia. Twenty‐two healthy pregnant women were examined during elective Caesarean section at term pregnancy. They were randomly assigned to receive either 2000ml of Ringer lactate solution (crystalloid group) or 500ml of 6% hydroxyethyl starch + 1000 ml of Ringer lactate solution (colloid group). The mean (SEM) concentration of atrial natriuretic peptide in plasma increased from 10.9 (1.5) to 24.7 (5.1)pmol.l‐1during crystalloid infusion and from 10.3 (1.4) to 28.2 (5.6)pmol.l‐1during colloid infusion. A slight decrease in endothelin‐1 levels was found during colloid infusion. A significant increase in the release of atrial natriuretic peptide in response to volume load may decrease vascular tone and initiate diuresis, thereby attenuating the effect of volume load on blood pressure during elective Caesarean delivery.
A valuable monitor of splanchnic perfusion?
Authors: Trinder T. J. , Lavery G. G.
Published: February 2007

Minimally invasive assessment of the adequacy of perfusion of the gastrointestinal tract has become clinically feasible with the availability of the gastric tonometer. This modified nasogastric tube permits calculation of the pH of the gut mucosal cells; a low tissue pH may indicate tissue hypoxia due to regional hypoperfusion. Such regional hypoperfusion is often undetected by other monitors and, if it occurs intra‐operatvely, may result in a poor outcome following major surgery. In critical illness, the splanchnic area seems to be particularly vulnerable to hypoperfusion and such a regional oxygen deficit is implicated in the causation of organ dysfunction/failure. Recent studies have begun to define the circumstances in which splanchnic tissue acidosis develops and several therapies have been proposed to reverse the regional oxygen deficit. This review seeks to clarify whether or not the tonometer is a valuable addition to our current monitoring aids.
Recurrent laryngeal nerve palsy after laryngeal mask airway insertion
Authors: Lloyd Jones F. R. , Hegab A.
Published: February 2007

A 39‐year‐old man developed a unilateral recurrent laryngeal nerve palsy following laryngeal mask airway insertion for a day case procedure.
Transient radicular irritation after single subarachnoid injection of isobaric 2% lignocaine for spinal anaesthesia
Authors: Hampl K. F. , Schneider M. C. , Bont A. , Pargger H.
Published: February 2007

Several cases have been reported recently in which symptoms suggestive of transient radicular irritation occurred following the use of hyperbaric 5% lignocaine for spinal anaesthesia. We report on three patients in whom we observed similar symptoms attributable to this kind of radicular irritation following uneventful spinal anaesthesia using isobaric 2% lignocaine. All three patients underwent minor gynaecological procedures and developed burning pains in the buttocks within 24 h of surgery. The long‐term outcome was not clear for all the patients, but in at least one the pain disappeared.
The effect of tunnelling on epidural catheter migration
Authors: Bougher R. J. , Corbett A. R. , Ramage D. T. O.
Published: February 2007

A prospective, randomised study of 82 patients having postoperative epidural analgesia was performed to determine whether the tunnelling of an epidural catheter influences its migration. Tunnelling of the catheter subc utaneously for a distance of 5 cm reduced the incidence of inward migration of I cm or more (p < 0.01) compared to a standard method affixation with a transparent adhesive dressing. This effect was more marked if the epidural catheter was sited in the thoracic rather than the lumbar area. Sixty two percent (n = 26) of tunnelled catheters remained within 0.5cm of their original position compared to 38% (n = 16) of non‐tunnelled catheters, although this difference was not statistically significant. Outward catheter migration was not reduced by subcutaneous tunnelling.
Skin sensitivity of the arm
Authors: van den Berg A. A.
Published: February 2007

One hundred and sixty seven operating theatre personnel familiar with the practice of venous cannulation were asked to rank (in increasing order from one to five, corresponding to least to most painful) their opinion of the pain which they considered might accompany venous cannulation of each of five vein sites on the upper limb (dorsum of arm, dorsum of hand, cephalic, ventrum of arm and cubital fossa) which may be selected for this purpose. The skin sensitivity of each of the test sites of each volunteer was then assessed with a test device comprising a Tuohy needle and clamp, which together weighed 75.02g. Following random application of the device to each of the test sites, the volunteer was asked to rank (in increasing order from one to five, corresponding to least to most painful) the actual pain felt. Analysis of pain expectations showed that there was no significant consensus view as to which site would be most tender. Following application of the test device the tenderness of the five sites was ranked (i) according to frequencies: dorsum of arm <dorsum of hand < cephalic <ventrum of arm < cubital fossa and, (ii) following statistical analysis: dorsum of arm = dorsum of hand = cephalic <ventrum of arm < cubital fossa. There was no correlation between expected and actual skin sensitivities. Knowledge of the different skin sensitivities of the upper limb may be useful when selecting a vein for venepuncture or the insertion of an indwelling venous catheter.
An economic evaluation of propofol/fentanyl compared with midazolam/fentanyl on recovery in the ICU following cardiac surgery
Authors: SHERRY K. M. , McNAMARA J. , BROWN J. S. , DRUMMOND M.
Published: February 2007

A comparison was made of the drug costs and nursing dependency of patients undergoing elective cardiac surgery and routine postoperative recovery for two anaesthetic techniques using either propofol with low dose fentanyl or midazolam with high dose fentanyl. Estimates of resource use were based on a randomised clinical trial undertaken at the Northern General Hospital, Sheffield. Times from entry to the intensive care unit until extubation and discharge were recorded for 70 patients and were transformed to nursing shifts. Nursing dependency was calculated on the basis of one nurse per ventilated patient and 0.5 nurse from the start of the shift after extubation. Nursing costs were allocated on the basis of the patient's status at the beginning of each shift in line with the hospital's staffing policy. All drugs used from the morning of the operation until discharge were recorded. Costs of nursing and drugs were calculated. The total cost of patients in the propofol group was 13.3% less than midazolam patients (p = 0.043, for geometric means Cl 0.4% to 27.8%). The clinical study was not designed for economic endpoints; however, it demonstrated achievable savings in propofol‐treated patients.
Assessment of neuromuscular block at the thumb and great toe using accelography in infants
Authors: KITAJIMA T. , ISHII K. , OGATA H.
Published: February 2007

We assessed neuromuscular block at the thumb and great toe using accelography after the administration of vecuronium in infants. Train‐of‐four stimuli were simultaneously applied to the ulnar and tibial nerves using cutaneous electrodes. Anaesthesia was maintained with nitrous oxide (66%) in oxygen and sevoflurane (1%). Vecuronium 0.1mg.kg‐1 was used for paralysis and reversed with intravenous neostigmine 0.04mg.kg‐1 with atropine 0.02mg.kg‐1 when the train‐of‐four ratio on the right great toe returned to 25%. The mean (SD) times from initial administration of vecuronium to completion of maximal block on the thumb and great toe were 78 (21.1) s and 75 (14.3) s, respectively (p>0.05). The times from maximal block to 25% recovery of twitch height at the thumb and great toe were 46 (9.1) min and 45 (9.0) min, respectively. The reversal time from 25% to 75% of the train‐of‐four ratio after the administration of neostigmine was 136 (49.1)s. We conclude that neuromuscular monitoring of the great toe in infants may be a suitable alternative when the thumb is inaccessible.
The effect of prophylactic clonidine on postoperative shivering
Authors: VANDERSTAPPEN I. , VANDERMEERSCH E. , VANACKER B. , MATTHEUSSEN M. , HERIJGERS P. , VAN AKEN H.
Published: February 2007

Summay

The primary goal of this study was to assess the influence of clonidine administered after induction on postoperative shivering after elective peripheral surgery. The effect of clonidine on intra‐operative haemodynamics (blood pressure and heart rate) during the first 30 min after induction and on the postoperative sedation of the patient was also investigated. Two hundred and eighty male ASA 1 and 2 patients, undergoing elective peripheral surgery were randomly administered either placebo or clonidine 2 μg.kg‐1 intravenously over 10 min after induction of anaesthesia. Clonidine was found to reduce the total incidence (p = 0.024), the severity (p = 0.005) and the duration (p= 0.01) of postoperative shivering. Clonidine did not increase postoperative sedation or diminish overall consciousness. We conclude that administration of clonidine 2 μg.kg‐1 intravenously after induction of anaesthesia is safe and reduces postoperative shivering in this group of patients.
A study of the incorrect use of ventilator disconnection alarms
Authors: CAMPBELL R. M. , SHEIKH A. , CROSSE M. M.
Published: February 2007

Pressure‐sensitive ventilator disconnection alarms may fail to function correctly when used with discharging compliance ventilators such as the Manley Blease. The increase in gas flow on disconnection generates raised pressure owing to the resistance provided by components of the breathing system. Thirty‐four anaesthetists, who were unaware of the nature of the survey, were observed to see if previous recommendations for the correct adjustment of the ventilator alarm were being followed. It was found that 77% of alarms were incorrectly adjusted and would not have alarmed in the event of a true disconnection occurring.
Misplacement of multihole epidural catheters‐a report of two cases
Authors: Sala‐Blanch X. , Martinez‐Palli G. , Agusti‐Lasus M. , Nalda‐Felipe M. A.
Published: February 2007

The misplacement of a multilwie (three lateral holes) epidural catheter such that it lies partly in the subdural space is demonstrated in two patients by means of epidurographic studies.
Postoperative morbidity following cataract surgery
Authors: BARKER J. P. , VAFIDIS G. C. , HALL G. M.
Published: February 2007

Two hundred and thirty‐one patients were questioned the day following their cataract surgery to ascertain the incidence of postoperative morbidity. One hundred and nineteen patients received local anaesthesia (LA) and 112 received general anaesthesia (GA). There was a significant difference in the incidence of nausea (21% in G A group, 3% in LA group, p < 0.01), sore throat (41% G A group, 3% LA group, p < 0.01), and bruising of the eye (15% G A group, 39% LA group, p < 0.01). There was no significant difference in the incidence of vomiting, headache, double vision, the severity of postoperative pain, or the need for analgesia. The time before the patients drank and ate postoperatively was significantly shorter in the local anaesthetic group (1.3 h and 1.8 h LA group, 4.1 h and 6.7 h GA group respectively, p < 0.01).
Immunomodulation: an important concept in modern anaesthesia
Authors: McBRIDE W. T. , ARMSTRONG M. A. , McBRIDE S. J.
Published: February 2007

This review summarises evidence for immunomodulatory effect of drugs administered peri‐operatively. The clinical significance of the balance of pro‐ and anti‐inflammatory cytokines may be seen in certain disease states, for example, meningococcal meningitis and Lyme arthritis. This balance may be altered peri‐operatively. Traditionally, these changes are considered to be due to the stress response of surgery, the response to cardiopulmonary bypass, or endotoxaemia. This review presents in vitro evidence suggesting that drugs modulating this cytokine balance include non‐steroidal anti‐inflammatory agents, phosphodiesterase inhibitors and opioids, acting through effects on intracellular cyclic nucleotide messenger systems. An important consequence of the pro‐inflammatory cytokine activity is increased adhesion of neutrophils. Aspects of this process may be inhibited by avoiding low blood flow states, by reducing adhesion molecule expression (for example by use of pentoxifylline), or by use of negatively charged anions such as heparin. Neutrophil activity is generally depressed by intravenous anaesthetic induction agents, but is enhanced by opioids. Natural killer cell activity, which is involved in immunity against tumour cells and virally infected cells is transiently depressed by volatile anaesthetic agents and opioids. In contrast catecholamines enhance natural killer cell activity. Whereas decrease in immunoglobulin levels occur peri‐operatively, this is not thought to be as a result of drugs at clinically used concentrations but rather due to haemodilution.
Esmolol aids extubation in intensive care patient with ischaemic pulmonary oedema
Authors: Duane D. T. , Redwood S. R. , Grounds R. M.
Published: February 2007

A 49‐year‐old man with a history of ischaemic heart disease failed successful tracheal extubation on four consecutive occasions following emergency surgery because of the development of acute pulmonary oedema. Attenuation of the cardiovascular responses to tracheal tube removal by pretreatment with an intravenous infusion of esmolol hydrochloride allowed successful extubation of the patient to be achieved.
Flumazenil: an unreliable antagonist in baclofen overdose
Authors: Byrnes S. M. A. , Watson G. W. , Hardy P. A. J.
Published: February 2007

We report a case of inadvertent overdose of baclofen given intrathecally resulting in coma. This was unresponsive to flumazenil and required supportive intensive therapy. With the increasing use of baclofen intrathecally for spasticity and its wide interpatient dose variability, there is a need to find a safe antagonist to baclofen for routine medical use.
Epidural morphine for postherpetic neuralgia
Authors: WATT J. W. G. , WILES J. R. , BOWSHER D. R.
Published: February 2007

Eleven patients with established postherpetic neuralgia, unresponsive to antidepressant therapy, entered this single‐blind, placebo‐controlled study to assess the effectiveness of epidural morphine in the control of the pain of postherpetic neuralgia. Two patients obtained a reduction in pain of greater than 50% following morphine 0.5 mg. The duration of this pain relief was 36 h in one patient and 72 h in the other. Repeated doses, however, were ineffective in one patient and resulted in intolerable side effects in the other. The other six patients who received morphine developed oploid‐related side effects without pain relief. Three patients did not receive morphine as they gained significant, long‐lasting pain relief from placebo. Two retained that benefit for more than 6 months. Epidural morphine is more likely to produce side effects than pain relief when administered to patients with postherpetic neuralgia.
Spontaneous movement after injection of propofol
Authors: CHAN A. , NICKOLL E. , THORNTON C. , DORÉ C. , NEWTON D. E. F.
Published: February 2007

Spontaneous movement following injection of propofol at induction was studied in 303 patients. Two hundred patients were Caucasians and 103 were Asians. In a pilot study carried out prior to the main study, 26% of the Asians moved at induction as compared with 6% of the Caucasians. The patients were studied in relation to a number of variables; age, sex, weight, height, race, smoker/non smoker, vegetarian/non vegetarian, alcohol consumption, premedication, use of fentanyl at induction and dose of propofol. When race was included as the sole variable there was a marginal but not significant difference between the two groups in terms of movement (p = 0.06). However, when the other recorded variables were taken into account, race was not included as a predictor of whether or not the patient moved. The best model for predicting whether the patients moved or not combines the variables weight and dose of propofol. Patients were more likely to move if they were lighter and the dose of propofol used at induction was higher.
Lung aeration
Authors: REBER A. , ENGBERG G. , WEGENIUS G. , HEDENSTIERNA G.
Published: February 2007

We have investigated the effect of pre‐oxygenation and hyperoxygenation (an increase in inspired oxygen fraction from 0.4 to 1.0 after induction of general anaesthesia) on aeration and atelectasis formation in the lungs during total intravenous anaesthesia. Twenty‐seven consecutive patients were randomly allocated to group I (with pre‐oxygenation), group 2 (without pre‐oxygenation), or group 3 (hyperoxygenation). Lung aeration was investigated by means of spiral computed tomography. The aeration of lung regions identified by computed tomography scans was divided into five categories: over‐aeration, normal aeration, reduced aeration, poor aeration, and atelectasis formation. In group I larger areas of atelectasis were found in the basal parts of the lungs compared to group 2. In group 3 a significant increase in atelectatic areas with a corresponding reduction in areas with reduced aeration occurred at the bases of the lungs. The considerable increase in atelectasis associated with pre‐oxygenation and its rapid appearance during hyperoxygenation suggest that these procedures should be used with caution.
Emergency transtracheal ventilation: assessment of breathing systems chosen by anaesthetists
Authors: RYDER I. G. , PAOLONI C. C. E. , HARLE C. C.
Published: February 2007

The choice of equipment for emergency transtracheal ventilation and the time taken to assemble it were surveyed in 39 anaesthetists. Thirty seven (95%) assembled a system in a median time of 104s (interquartile range 54s to 120s). Systems specially constructed from oxygen tubing and connectors took longest to put together (p < 0.05). Consultants and senior registrars performed no better than senior house officers and registrars (p > 0.05). In the second part of the study we tested four anaesthetic systems which the survey revealed might be chosen for emergency transtracheal ventilation. These were: a simple length of oxygen tubing; a T‐piece system; a Bain system; a jet injector. All had the appropriate connectors. The oxygen flow was measured through a 14 G venous‘transtracheal’cannula on depression of the oxygen flush device on a standard Boyle's M anaesthetic machine. The jet injector was connected to the high pressure outlet. This device delivered the highest flow, 43 l.min‐1 and was the only system capable of ventilating a trachea/lung model. The T‐piece system, and the one constructed from oxygen tubing, delivered flows of 12.7 and 12.0 l.min ‐1, respectively, whereas the Bain system delivered only 4.7 1.min ‐1. We conclude that, except for jet ventilation, none of the systems chosen, using equipment available in the anaesthetic room, would be likely to achieve effective CO2 elimination; at best they would provide oxygenation.
Postoperative analgesia in dental day case surgery
Authors: Wakeling H. G. , Barry P. Creagh , Butler P. J.
Published: February 2007

A randomised, double‐blind placebo‐controlled trial was conducted to compare the analgesic efficacy of piroxicam as Feldene‘Melt’with diclofenac suppositories following day case wisdom tooth extraction. Piroxicam was found to be equivalent to diclofenac in speed of onset and efficacy when given 1 h prior to surgery with no significant adverse effects. It is therefore possible to confer the benefits of postoperative analgesia from a non‐steroidal anti‐inflammatory drug whilst avoiding the inconvenience of the rectal route of administration.
Anaesthesia for cardioversion
Authors: STONEHAM M. D.
Published: February 2007

Cardioversion is a minor procedure requiring sedation and analgesia. However, it is often performed out‐of‐hours in remote sites by inexperienced anaesthetists. An understanding is required both of the pathophysiology underlying cardiac arrhythmias and of the technical side of defibrillation equipment, including electrical safety. Patients should have their coagulation status and electrolyte balance checked prior to the procedure to reduce the likelihood of complications. Almost all the available anaesthetic agents have been used for cardioversion in the past, with varying degrees of success. The anaesthetic agent chosen for patients undergoing cardioversion must provide analgesia and sedation, cause the least cardiovascular compromise possible and still enable rapid recovery. Propofol may be the closest anaesthetic agent to this ideal currently available, although careful titration of any agent chosen is also important. Cardioversion may be performed as an emergency, including in the pregnant patient, providing safe anaesthetic practice is followed.
Anaesthetic management in maple syrup urine disease
Authors: Kahraman S. , Ercan M. , Akkuş Ö. , Erçelen Ö. , Erdem K. , Coşkun T.
Published: February 2007

Two children with maple syrup urine disease undergoing emergency and elective surgery are reported. The administration of ketamine to a 12‐month‐old boy without neurological problems and propofol infusion to a 5‐year‐old girl with a history of convulsions, was uneventful. We believe that a, full knowledge of the pathophysiology of maple syrup urine disease and potential peri‐operative problems associated with the disease are essential, so that patients are not subjected to unnecessary risks.
Use of liposome‐associated bupivacaine in a cancer pain syndrome
Authors: Lafont N. D. , Legros F. J. , Boogaerts J. G.
Published: February 2007

Bupivacaine. 0.25% encapsulated by multilamellar liposomes was administered epidurally to a patient suffering pain associated with lung cancer and the effect compared with a plain bupivacaine solution of the same concentration. Complete analgesia was produced for 4 h with the plain solution and 11 h with the liposomal formulation. No motor blockade or haemodynamic instability was observed with the liposome‐associated bupivacaine.
Laryngoscopy using the McCoy laryngoscope after application of a cervical collar
Authors: GABBOTT D. A.
Published: February 2007

A rigid cervical collar was applied to 102 patients under general anaesthesia. Laryngoscopy was performed using a McCoy laryngoscope blade (size 3) initially in the standard Macintosh configuration followed by activation of the distal hinged tip. The two views obtained at laryngoscopy were graded according to standard guidelines. In 46/102 (45.1%) patients the laryngoscopic view was improved by one or more grades. In 10/102 (9.8%) the view was improved by two grades. Difficult laryngoscopy (grade 3 or 4) was encountered in 26/102 patients using the McCoy laryngoscope in the unactivated position (Macintosh configuration). Of these 26 patients, 24 (92.3%) had glottic structures identified (grade 1 or 2) when the distal tip of the laryngoscope blade was activated (p < 0.001). The McCoy laryngoscope significantly improves the view at laryngoscopy in the patient whose neck is immobilised in a rigid cervical collar.
Osteogenesis imperfecta and malignant hyperthermia
Authors: Porsborg P. , Astrup G. , Bendixen D. , Lund A. M. , Ørding H.
Published: February 2007

We describe a patient with osteogenesis imperfecta who developed tachycardia, metabolic and respiratory acidosis (pH 7.14, Pco2 8.4 kPa, BE 8.5 mmol.l‐1) and hyperthermia up to 40°C during anaesthesia with barbiturates, fentanyl, pancuronium, and nitrous oxide. Malignant hyperthermia was suspected and the patient treated accordingly. Two years later the in‐vitro contracture test for malignant hyperthermia was completely normal. We conclude that hypermetabolism in patients with osteogenesis imperfecta is due to unknown mechanisms other than malignant hyperthermia.
Lingual nerve paralysis following the use of the laryngeal mask airway
Authors: Laxton C. H.
Published: February 2007

A 42‐year‐old woman, undergoing a diagnostic laparoscopy, developed a unilateral lingual nerve palsy following the use of a laryngeal mask airway
Antiemetic efficacy of ondansetron with patient‐controlled analgesia
Authors: Davies P. R. F. , Warwick P. , O'Connor M.
Published: February 2007

A double‐blind, randomised, placebo‐controlled study was performed to assess the antiemetic efficacy of ondansetron in women receiving morphine from a patient‐controlled analgesia system after total abdominal hysterectomy. Sixty‐six ASA grade 1 or 2 patients scheduled for total abdominal hysterectomy were randomly allocated into one of two groups. All patients received a standardised anaesthetic and postoperative patient‐controlled analgesia regimen. Group 1 received ondansetron 4 mg at induction of anaesthesia, repeated 8 h later. Group 2 received saline as a placebo at the same times. Pain scores, nausea scores, episodes of vomiting, use of rescue antiemetics and recollection of nausea and vomiting were not different between the groups. Only 15% of patients who received ondansetron and 30% of patients who received the placebo recorded no nausea or vomiting in the first 24 h. We conclude that ondansetron, in the dose studied, does not reduce nausea and vomiting in women receiving morphine from a patient‐controlled analgesia system after total abdominal hysterectomy.
Attitudes to pain and pain relief in adult surgical patients
Authors: Brydon C.W. , Asbury A.J.
Published: February 2007

Pain relief after surgery is. frequently inadequate. In the last few years much research has been devoted to improving the situation. Unfortunately, very little work has been undertaken to explore the patients' contribution to pain management. The beliefs and attitudes held by patients when they enter the hospital environment may be responsible in some instances for their not achieving optimal pain relief from the available techniques. We have studied some of these attitudes with a survey of 180 adult patients admitted for elective surgery. We found that most patients still expect pain. following surgery. However, they are not afraid to ask for analgesics when in pain and do not attribute pain to their own wrong doing. There are, however, some patients who appear to have deviant’ pain beliefs that could hinder their appropriate use of analgesics. Sadly, it is impossible to identify these patients according to age, gender, socio‐economic group or previous experience of pain or surgery.
PIF3 regulates anthocyanin biosynthesis in an HY5‐dependent manner with both factors directly binding anthocyanin biosynthetic gene promoters in Arabidopsis
Authors: Shin Jieun , Park Eunae , Choi Giltsu
Published: February 2007

Phytochromes are red/far‐red light receptors that regulate various light responses by initiating the transcriptional cascades responsible for changing the expression patterns of 10–30% of the entire plant transcriptome. Several transcription factors that are thought to participate in this process have been identified, but the functional relationships among them have not yet been fully elucidated. Here we investigated the functional relationship between two such transcription factors, PIF3 and HY5, and their effects on anthocyanin biosynthesis. Our results revealed that PIF3 and HY5 do not regulate each other at either the transcriptional or the protein levels in continuous light conditions, suggesting that they are not directly linked within phytochrome‐mediated signaling. We found that both PIF3 and HY5 positively regulate anthocyanin biosynthesis by activating the transcription of the same anthocyanin biosynthetic genes, but the positive effects of PIF3 required functional HY5. Chromatin immunoprecipitation analyses indicated that both PIF3 and HY5 regulate anthocyanin biosynthetic gene expression by directly binding to different regions of the gene promoters in vivo. Additional experiments revealed that PIF3 bound the promoters regardless of light and HY5. Collectively, these data show that PIF3 and HY5 regulate anthocyanin biosynthesis by simultaneously binding anthocyanin biosynthetic gene promoters at separate sequence elements.
A plastid‐localized glycogen synthase kinase 3 modulates stress tolerance and carbohydrate metabolism
Authors: Kempa Stefan , Rozhon Wilfried , Šamaj Jozef , Erban Alexander , Baluška František , Becker Thomas , Haselmayer Joachim , Schleiff Enrico , Kopka Joachim , Hirt Heribert , Jonak Claudia
Published: February 2007

Glycogen synthase kinase 3 (GSK‐3) was originally identified as a regulator of glycogen synthesis in mammals. Like starch in plants, glycogen is a polymer of glucose, and serves as an energy and carbon store. Starch is the main carbohydrate store in plants. Regulation of starch metabolism, in particular in response to environmental cues, is of primary importance for carbon and energy flow in plants but is still obscure. Here, we provide evidence that MsK4, a novel Medicago sativa GSK‐3‐like kinase, connects stress signalling with carbon metabolism. MsK4 was found to be a plastid‐localized protein kinase that is associated with starch granules. High‐salt stress rapidly induced the in vivo kinase activity of MsK4. Metabolic profiling of MsK4 over‐expressor lines revealed changes in sugar metabolism, including increased amounts of maltose, the main degradation product of starch in leaves. Plants over‐expressing MsK4 showed improved tolerance to salt stress. Moreover, under high‐salinity conditions, MsK4‐over‐expressing plants accumulated significantly more starch and showed modified carbohydrate content compared with wild‐type plants. Overall, these data indicate that MsK4 is an important regulator that adjusts carbohydrate metabolism to environmental stress.
THE DEVELOPMENT OF THE USE OF ENGLISH IN INTERNATIONAL AERONAUTICAL COMMUNICATIONS
Authors: FIELD ARNOLD
Published: February 2007

In the early days of the development of aviation, no requirement existed for communication between the aircraft and a ground station. Flying was carried out within sight of the ground or water, and the information required by a pilot was mainly visual. For example, navigation was carried out by the observation of well‐known landmarks and the direction of landing at an aerodrome was judged either from observation of a windsock or of a white letter T displayed in a Signals square. The approach to land was also by visual communication. A green lamp signal was an All Clear, and a red lamp signal advised the pilot to make another visual circuit before attempting to land. In extremis, when a red lamp signal had not been observed, the firing of a red Verey light usually achieved the objective.
ENGLISH AS AN INTERNATIONAL LANGUAGE VIA DRAMA TECHNIQUES
Authors: SMITH LARRY E. , VIA RICHARD A.
Published: February 2007

Today English is the principal means of communication among people of different nations. It is estimated (Bowen, 1976) that between 500 and 600 million people living on all continents use English as their primary or secondary language. More and more countries are making English their lingua franca to communicate with the rest of the world—not just the native English‐speaking world. English is being used not only as a second or foreign language but also as an international language (Richards, 1978).
COLLABORATIONS: LEARNER‐CENTERED TASKS FOR THE ESL CLASSROOM
Authors: OLSEN JUDY E. WINN‐BELL
Published: February 2007

In recent years we have come to hear the phrase ‘focus on the learner’ more and more. Teachers are exhorted to promote student‐centered learning, where the teacher assumes a role that is not so much the giver of knowledge as the facilitator in students' discovering that knowledge themselves. The details of just how the teacher is to do this effectively are often much more sketchy than the details of why she/he should. And for some of us as teachers, there is that little inner fear that the class will founder if we are not obviously at the helm every minute during the class. How can we ‘let go’ of our students, while providing meaningful and structured activities for them?
THE OBJECTIVE ASSESSMENT OF ASPECTS OF SPOKEN ENGLISH
Authors: YULE GEORGE
Published: February 2007

Assessment of the spoken English abilities of both native and non‐native speakers typically concentrates on features such as fluency, range of vocabulary, and grammatical accuracy. It is not difficult to find fault with such an approach. While the ability to produce vocabulary items and grammatical structures can be assessed objectively, it does not necessarily lead to effective spoken communication outside the classroom or the test situation. The problem with measuring fluency is essentially a matter of controlling the variation in subjective judgements which may be made on different occasions regarding what is ‘fluent speech’. Despite these drawbacks, there will no doubt continue to be a requirement that fluency and grammatical accuracy in using the spoken language be assessed.
INTEGRATING READING AND WRITING SKILLS
Authors: BLAKEY T. N.
Published: February 2007

Writers of textbooks published since the beginning of 1978 are invited to submit 1000 word articles discussing the principles underlying their work and accompanied by two pages from the book in question. The articles should be problem‐based, not advertisements, and the extracts should be in a form for reproduction without redrawing. Writers will be responsible for obtaining all necessary permissions.
My language, your culture: whose communicative competence?
Authors: NELSON CECIL L.
Published: February 2007

ABSTRACT: The paper examines the notion of ‘communicative competence’ specifically with reference to transplanted varieties of English (e.g. Indian English) used in various non‐Western sociocultural contexts in the world. It is claimed that the notion of communicative competence that relies on the traditional notion of ‘competence’ of a native speaker is misleading for understanding and interpreting English texts written in these contexts by, for example, Indians and Africans. The examples presented here show that the judgements of native speakers with regard to deviations (or innovations) in such varieties of English are as much based on attitudinal factors, as on genuine expectations in the context of verbal interaction. The concepts intelligibility and interpretability are viewed from the perspective of the conventions (literary, cultural and so on) developed in the institutionalized non‐native varieties of English. The examples are taken from written texts, and several theoretical and methodological questions are raised.
Input and foreign/second‐language accuracy order: a reappraisal
Authors: KRAKOWIAN BOGDAN
Published: February 2007

Abstract: This is a report on a morpheme study conducted with learners of English as a foreign language in Poland. The accuracy order of 11 morphemes obtained from the study was correlated with three other accuracy orders reported for English as a second language. Although the correlations showed some degree of similarity between foreign‐ and second‐language accuracy orders, no definitive conclusions could be drawn from them because of the shortcomings of morpheme research methodology. Some of these shortcomings are discussed and some suggestions for future research are offered.