bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of oral cisapride and metoclopramide in diabetic autonomic neuropathy: an eight‐week double‐blind crossover study
Authors: DE CAESTECKER J. S. , EWING D. J. , TOTHILL P. , CLARKE B. F. , HEADING R. C.
Published: July 2010

Nineteen diabetic patients with autonomic neuropathy were enrolled in a double‐blind crossover study of cisapride, metoclopramide and placebo. Symptoms were evaluated from diary cards and from assessments undertaken at the end of each eight week treatment period. Measurements of oesophageal transit, gastric emptying and whole gut transit were made before treatment began and at the end of each treatment period. Three patients dropped out early in the study, and the results from 16 patients were analysed.

The severity of autonomic neuropathy, judged from cardiovascular reflex tests, correlated with delayed oesophageal transit and prolonged gastric emptying, but abnormal oesophageal transit and gastric emptying were often unrelated to the presence of upper gastrointestinal symptoms. Neither cisapride nor metoclopramide had a statistically significant effect on oesophageal transit, gastric emptying or whole‐gut transit, nor was any significant effect on symptoms identified, although a trend towards reduced nausea and vomiting with metoclopramide and reduced epigastric fullness and diarrhoea with cisapride was suggested.
Quinidine single dose pharmacokinetics and pharmacodynamics are unaltered by omeprazole
Authors: CHING M. S. , ELLIOTT S. L. , STEAD C. K. , MURDOCH R. T. , DEVENISH‐MEARES S. , MORGAN D. J. , SMALLWOOD R. A.
Published: July 2010

Omeprazole has been shown in previous studies to inhibit the hepatic metabolism of selected drugs. Quinidine is an antiarrhythmic and antimalarial agent with a low therapeutic index. We therefore examined the effect of 40 mg omeprazole daily for one week or placebo on the pharmacokinetics and pharmacodynamics of a single 400 mg dose of quinidine in 8 healthy volunteers in a double‐blind crossover study.

During placebo and omeprazole treatment, there was no significant difference in area under the time–plasma quinidine concentration curve, (17.0 ± 4.83 μg.h/ml, 18.6 ± 4.43 μg.h/ml, respectively;P> 0.2) or renal clearance of quinidine (56.2 ± 26.0 ml/min, 55.6 ± 12.7 ml/min, respectively;P> 0.5). Quinidine unbound fraction in plasma (0.170 ± 0.041vs.0.166 ± 0.041 in the presence of omeprazole;P> 0.5) was not altered by omeprazole. Peak plasma quinidine concentration and the time this occurred did not differ. Omeprazole also had no effect on these parameters for the metabolite 3‐hydroxyquinidine. There was no significant difference in the change in the corrected Q—T interval on the electrocardiogram due to quinidine (mean area under the time versus ±Q–Tccurve = 351 ± 192 ms. h, placebo; 414 ± 303 ms. h, omeprazole) showing that quinidine pharmacodynamics were unaltered by omeprazole. We conclude that omeprazole does not affect the pharmacokinetics of quinidine.
Drug‐induced hepatotoxicity
Authors: LEE W. M.
Published: July 2010

The liver is central to the metabolic disposition of virtually all drugs and xenobiotics (foreign substances).1–3For the most part, this process is accomplished without injury to the liver itself or to other organs. A few compounds such as acetaminophen, CCl4and the toxin responsible for mushroom poisoning are toxic themselves or produce metabolites which cause liver injury in a uniform, dose‐dependent fashion.4–7However, most agents form a sufficiently toxic byproduct and cause liver injury only quite rarely, under special circumstances. Generation of a toxic metabolite within the hepatocyte may produce direct cell injury with disruption of intracellular function, or may cause indirect injury by immune‐mediated membrane damage. Factors promoting the accumulation of toxins include genetic enzyme variants which allow greater formation of the harmful metabolite, induction of an isozyme species which produces more than the usual quantity of the toxin, interference with regular (non‐toxic) metabolic pathways by substrate competition for enzyme, or depletion of required detoxifying substrates.

The following review will provide clinical examples of some of these well‐known metabolic reactions, discuss some new issues in drug‐induced hepatotoxicity, such as use of combination agents and complex multiple drug regimens, alternative health strategies (vitamins and herbal remedies) as well as the widespread use of cocaine. The overall message is that, as new compounds are issued, new opportunities for drug‐induced hepatotoxicity arise. Until extensive experience with any new compound has evolved, it is best to maintain a healthy paranoia concerning the newer drugs—there are very few totally safe agents.
Twenty‐four‐hour intragastric acidity: 300 mg ranitidine b.d., 20 mg omeprazole o.m., 40 mg omeprazole o.m. vs. placebo
Authors: HOUBEN G. M. P. , HOOI J. , HAMEETEMAN W. , STOCKBRÜGGER R. W.
Published: July 2010

Background: There is considerable controversy about the degree of acid suppression that is optimal for the treatment of peptic disorders.

Aim: To compare the effects of three different regimens that are reported to strongly inhibit acid secretion.

Methods: Intragastric 24‐hour pH monitoring was performed in 11 healthy subjects in a randomized, multiple, cross‐over, double‐blind study. Each subject received four dose regimens, each for 2 weeks, in a random order. The regimens were: 300 mg ranitidine b.d., 20 mg omeprazole o.m., 40 mg omeprazole o.m., and placebo.

Results: The decrease in gastric acidity during the daytime and during the total 24‐hour period by all three treatments was significantly greater than after placebo: a significant difference in acid inhibition was found between ranitidine and 40 mg omeprazole, but not between ranitidine and 20 mg omeprazole, nor between the two doses of omeprazole. During the night‐time the decrease in gastric acidity by all three treatments was significantly greater than after placebo: no difference was seen between the two doses of omeprazole and ranitidine. For the time of pH greater than 3 we found no statistical difference between the various acid decreasing regimens. The pH remained significantly longer above 4 after ranitidine and the two doses of omeprazole compared with placebo, and also longer above 4 after 40 mg omeprazole compared with ranitidine, but not after 20 mg omeprazole compared with ranitidine, nor after the two different doses of omeprazole.

Conclusions: Dosing with 300 mg ranitidine b.d., 20 mg omeprazole or 40 mg omeprazole is superior in gastric acid inhibition compared with placebo, when measured using 24‐hour pH monitoring.
Syuptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy
Authors: HOUGHTON L. A. , HEYMAN D. J. , WHORWELL P. J.
Published: July 2010

Aims: The purposes of this study were to quantify the effects of severe irritable bowel syndrome on quality of life and economic functioning, and to assess the impact of hypnotherapy on these features.

Methods: A validated quality of life questionnaire including questions on symptoms, employment and health seeking behaviour was administered to 25 patients treated with hypnotherapy (aged 25–55 years; four male) and to 25 control irritable bowel syndrome patients of comparable severity (aged 21–58 years; two male). Visual analogue scales were used and scores derived to assess the patients' symptoms and satisfaction with each aspect of life.

Results: Patients treated with hypnotherapy reported less severe abdominal pain (P < 0.0001), bloating (P < 0.02). bowel habit (P < 0.0001), nausea (P < 0.05). flatulence (P < 0.05). urinary symptoms (P < 0.01), lethargy (P < 0.01), backache (P= 0.05) and dyspareunia (P= 0.05) compared with control patients. Quality of life, such as psychic well being (P < 0.0001), mood (P < 0.001), locus of control (P < 0.05), physical well being (P < 0.001) and work attitude (P < 0.001) were also favourably influenced by hypnotherapy. For those patients in employment, more of the controls were likely to take time off work (79% vs. 32%; p = 0.02) and visit their general practitioner (58% vs. 21%: P = 0.056) than those treated with hypnotherapy. Three of four hypnotherapy patients out of work prior to treatment resumed employment compared with none of the six in the control group.

Conclusion: This study has shown that in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients’quality of life and reduces absenteeism from work. It therefore appears that, despite being relatively expensive to provide, it could well be a good long‐term investment.
High prevalence of Helicobacter pylori infection in Japanese patients with membranous nephropathy
Authors: MORIYAMA T. , KANEKO T. , FUJII M. , TSUBAKIHARA Y. , KAWANO S. , IMAI E.
Published: July 2010

Background

Membranous nephropathy is the most common cause of nephrotic syndrome in Japanese adults, and is often precipitated by systemic diseases such as infection, neoplasm, and autoimmune conditions. Recently, the Helicobacter pylori antigen was detected histochemically in the glomeruli of membranous nephropathy patients, raising the possibility that H. pylori may be the pathogen that causes.

Aim

To reveal the p1revalence of H. pylori infection in the Japanese membranous nephropathy population and to test the therapeutic efficacy of H. pylori eradication on the course of disease in membranous nephropathy patients.

Methods

The prevalence of H. pylori infection was investigated by the HM‐CAP method in 32 membranous nephropathy patients and an age‐matched control group (C: n = 243).

Results

A significantly higher H. pylori infection rate was found in membranous nephropathy patients than in the control group (positive/total: membranous nephropathy 21/32 vs. C 108/243, P < 0.05 by chi‐squared test). Eradication of H. pylori was achieved in four membranous nephropathy patients with proteinuria who were receiving glucocorticoid therapy, three of whom experienced a reduction of proteinuria after eradication.

Conclusions

We found a higher prevalence of H. pylori infection in Japanese membranous nephropathy patients than in age‐matched control subjects, which suggests the possible involvement of H. pylori infection in the pathogenesis of membranous nephropathy.
Coinfection of Helicobacter pylori and Neisseria subflava is closely associated with lymph follicle formation in human stomach
Authors: NAKAMURA M. , MATSUI H. , SERIZAWA H. , MURAYAMA S. Y. , YAMAGUCHI T. , TAKAHASHI T. , MATSUMOTO T. , YAMADA H. , HIBI T. , TSUCHIMOTO K.
Published: July 2010

Background

Many reports have described coinfection of Helicobacter pylori and other bacteria in the gastric mucosa in humans. However, relatively few have reported the relation of coinfection with pathological characteristics.

Aim

To culture and identify bacteria other than H. pylori from the gastric mucosa of 64 patients undergoing scheduled gastric biopsy for various gastric conditions. The relation of coinfection with the pathological changes was also investigated.

Methods

From colonies showing characteristics different to those of H. pylori, bacteria were identified by the 16S rRNA gene sequence using FASTA. Cluster analysis was performed using GENETYX‐MAC and a phylogenetic tree was constructed using the UPGMA method. The correlation of pathological observation and the existence of identified bacteria and H. pylori were also analysed.

Results

Forty‐eight per cent of patients were positive to H. pylori, and 27% were positive to Neisseria species. Coinfection of the two bacterial existences was significantly linked. DNA sequencing studies revealed these Neisseria strains to coincide mostly with Neisseria subflava. With regard to the interaction of pathological characteristics, Neisseria and H. pylori coinfection was closely related to lymph follicle formation.

Conclusions

Coinfection of H. pylori and N. subflava was found to be closely related to lymph follicle formation.
Chronic biochemical cholestasis in patients receiving home parenteral nutrition: prevalence and predisposing factors
Authors: LLOYD D. A. J. , ZABRON A. A. , GABE S. M.
Published: July 2010

Background  Chronic biochemical cholestasis has been shown to be associated with a fivefold increase in histologically advanced liver disease in patients receiving home parenteral nutrition.

Aims  To investigate prevalence of chronic biochemical cholestasis in home parenteral nutrition patients and examine factors influencing its occurrence.

Methods  Records of all patients receiving home parenteral nutrition for >6 months treated at a single centre were reviewed and plasma biochemistry recorded. Logistic regression analysis was employed to identify factors associated with prevalence of chronic biochemical cholestasis.

Results  Records of 113 patients were reviewed. The point prevalence of chronic biochemical cholestasis was 24%, increasing to 28% if patients receiving parenteral fluid and electrolytes only were excluded. In multivariate analysis, presence of colon in continuity was associated with a significantly lower prevalence of chronic biochemical cholestasis, while total parenteral calorie intake was associated with a higher prevalence of chronic biochemical cholestasis. No association was seen between small intestinal lengths or between parenteral lipid intake and chronic biochemical cholestasis in multivariate analysis.

Conclusions  Chronic biochemical cholestasis is common in patients receiving home parenteral nutrition. High parenteral calorie intake and lack of a colon in continuity with small intestine are independently associated with an increased risk of chronic biochemical cholestasis.
The neuromuscular transmission monitor
Authors: WINDSOR J. P. W. , SEBEL P. S. , FLYNN P. J.
Published: July 2010

The neuromuscular transmission monitor (NTM) is a new device for measuring neurornuscular transmission during anaesthesia, We have assessed its use in comparison with a force transducer and found for single twitch and train‐of‐four modes that there was a strong positive correlation between the two methods. This device appears reliable in use and provides a satisfactory alternative to conventional neuromuscular monitoring.
Influence of meptazinol on metabolic and hormonal responses following major surgery
Authors: KAY N. H. , ALLEN M. C. , BULLINGHAM R. E. S. , BALDWIN D. , McQUAY R. J. , MOORE H. A. , PRICE R. K. , SEAR J. W.
Published: July 2010

Opioid drugs in high doses can obtund the stress response to major surgery but only at the expense of marked cardiorespiratory depression. The postoperative hormonal response to surgical stress was measured in 20 patients undergoing hysterectomy who were given either meptazinol 100 mg or morphine 15 mg intramuscularly at the end of the surgery. Both drugs at the doses used failed to diminish the stress response. Those patients who received meptazinol showed elevated prolactin levels: this may be an indicator of agonist activity at the μ1, opioid receptor.
Organophosphate insecticide poisoning
Authors: KIPLING R. M. , CRUICKSHANK A. N.
Published: July 2010

Organophosphate insecticides are widely used agents which are quickly absorbed through the skin and mucous membranes. The effects of acute exposure to these agents can be severe and intensive therapy may be required. Specific drugs are available to reverse the muscarinic, nicotinic and central effects of these poisons. When given early they are very effective and early diagnosis and treatment may therefore be life‐saving. A case of acute poisoning with an organophosphate anticholinesterase insecticide is reported. The signs and symptoms of acute poisoning are described and a rational approach to specific treatment is discussed.
Fulminating epiglottitis in adults
Authors: WARNER JENNIFER A. , FINLAY W. E. I.
Published: July 2010

Three cases of epiglottitis in previously healthy young adults are reported. Two of these were fatal and occurred within nine months of each other. Both patients died within 24 hours of the development of definitive symptoms. The seriousness of this condition is stressed: a management protocol is suggested, based on our experience and the literature is reviewed.
Self‐administered isoflurane in labour
Authors: McLEOD D. D. , RAMAYYA G. P. , TUNSTALL M. E.
Published: July 2010

Entonox (50% nitrous oxide in oxygen) and isoflurane (0.75% in oxygen) were compared as analgesics in the first stage of labour in 32 consenting women. The drugs were self‐administered and given in random sequence, each during five consecutive uterine contractions. Each patient acted as her own control. Linear analogue pain scores were signijicantly lower (p < 0.001) with isoflurane than with Entonox, but scores for drowsiness were higher for isoflurane. Further study is needed to assess the effects of more prolonged use of isoflurane in labour.
Isolated intrapulmonary haemorrhage
Authors: MURRAY J. M. , ALLEN P. , SWAN P.
Published: July 2010

A case of intrapulmonary haemorrhage following internal jugular vein cannulation is described and the subsequent treatment outlined. A cautionary note is expressed, especially when the procedure is performed in obese, thick‐set individuals with chronic lung disease.
Alfentanil and memory function
Authors: KENNEDY D. J. , OGG T. W.
Published: July 2010

Two groups of 20 patients undergoing day case vaginal termination of pregnancy received either methohexitone and alfentanil 7.5 μg/kg or methohexitone and fentanyl 1.5 μg/kg. Their recovery times and memory function at 1 and 2 hours after surgery were compared. No difference in the recovery of the 2 groups was noted bur at 2 hours after operation the alfentanil group showed impairment of memory for new facts compared with pre‐operative memory function testing. This was not evident in the fentanyl group. Apart from this finding alfentanil was adjudged to be a suitable agent for day case anaesthesia.
Recovery from day‐case anaesthesia
Authors: CARTER J. A. , DYE A. M. , COOPER G. M.
Published: July 2010

Sixty unpremedicated patients undergoing dilatation and curettage were allocated randomly to receive one of three inhalational agents (halothane, enflurane or isoflurane) to supplement 67% nitrous oxide in oxygen after induction of anaesthesia with methohexitone. Recovery was assessed by the time patients took to open their eyes, to give their correct date of birth, to regain their pre‐operative level of manipulative skill with a children's postbox toy, and by comparing pre‐operative and postoperative performance of a paper and pencil test (the p‐deletion test). There was no difserence in the time to open eyes or to regain their pre‐operative score with the postbox whether the patients received halothane, enflurune or isoflurane. Patients in the isoflurane group took longer than patients in the enflurane group to give their correct date of birth, but they performed better in the p‐deletion test postoperatively, completing more lines with the same number of errors. Patients receiving enflurane committed more errors postoperatively in the p‐deletion test. The incidence of complications was low and was not influenced by the choice of inhalational agent.
If in doubt, take it out
Authors: SAPSFORD D. J. , SNOWDON S. L.
Published: July 2010

This report describes an unusual case of tracheal tube obstruction, caused by a prominent aortic knuckle.
Peri‐operative dreaming in paediatric patients who receive suxamethonium
Authors: O'SULLIVAN E. P. , CHILDS D. , BUSH G. H.
Published: July 2010

A prospective study is described of peri‐operative dreaming in 144 paediatric patients aged 5–14 years who received suxamethonium for day case surgery. No case of awareness was elicited. One group received pretreatment with 80 mg/kg tubocurarine. The incidence of dreaming in the 72 patients who were not pretreated was 16.7% compared with 2.8% in the patients pretreated with tubocurarine. This difference is statistically significant. The use of an intermittent suxamethonium technique gives a high incidence of dreaming which may be caused by muscle spindle discharge that produces cerebral arousal. Pretreatment with a non‐depolarising agent decreases this risk of dreaming.
Paediatric postoperative analgesia
Authors: FELL D. , DERRINGTON M. C. , TAYLOR E. , WANDLESS J. G.
Published: July 2010

Fifty children who underwent day case herniotomy received either a caudal injection of 1 ml/kg bupivacaine 0.25% or infiltration of the wound edges at the end of surgery with 0.5 mllkg bupivacaine 0.25%, allocated at random. Postoperative pain and demeanour were assessed initially by an observer and later by use of a parental questionnaire. Wound infiltration of local anaesthetic solution provided analgesia which was comparable to that associated with caudal block, and the incidence of side effects was similar in the two groups. Wound infiltration of local anaesthetic offers a simple, safe alternative to caudal block for provision of postoperative analgesia in this group of patients.
A comparison of oxygen therapy devices used in the postoperative recovery period
Authors: WILLIAMS A. B. , JONES P. L. , MAPLESON W. W.
Published: July 2010

Seventy‐one patients scheduled to undergo upper or lower abdominal surgical procedures were allocated at random to one of seven treatment groups: in the recovery room they were to receive oxygen via a 40% Ventimask with 10 litres/minute oxygen flow, or via either a Hudson mask or a nasal cannula with 3,6 or 9 litres/minute oxygen flow. The 40% Ventimask gave the most consistent, satisfactory postoperative values of PaO2 but the much cheaper nasal cannula at 6 or 9 litres/minute was generally adequate in conscious patients. The performance of the intermediately priced Hudson mask was similar to that of the nasal cannula at these flows. The unconscious state was associated with a 45% lower PaO2 than the rousable or awake states. Differences between the treatments with regard to postoperative PaCO2 were small and non‐significant. The nasal cannula with 6 litres, minute humidified oxygen flow is recommended for routine treatment, and the Ventimask for unconscious patients.
Cannulation of the epidural space
Authors: McNeill M. J. , Thorburn J.
Published: July 2010

A group of 685 obstetric patients were randomly allocated to have their epidural block performed using either a 16‐gauge or an 18‐gauge Tuohy needle. Bleeding was noted from needle or catheter trauma in 18% of patients and it proved impossible to insert the catheter in 3%. The majority of mothers experienced little discomfort during the procedure but 2% found insertion to be very uncomfortable. There was no significant difference in the complication rate, ease of use, or patient discomfort between the 18‐ or 16‐gauge needles. Epidural analgesia, although safe, is not without hazard. It may be difficult to perform and may, rarely, cause considerable discomfort.
Prolonged anaesthesia with isoflurane and halothane
Authors: JANTZEN J.‐P. A. H. , KLEEMANN P. P. , WITTON P. K. , MERTZLUFFT F. , KLEIN A. M. , DICK W. F.
Published: July 2010

Hepatic function was assessed pre‐operatively and on the first and sixth postoperative days in 40 healthy patients who underwent prolonged maxillofacial surgery with isoflurane or halothane anaesthesia. No major changes were observed in hepatic enzymes or bilirubin. One‐stage prothrombin time and Factor VII concentrations decreased on the first postoperative day and this change‐was more pronounced in the halothane group. The results support the use of isoflurane rather than halothane for prolonged anaesthesia in respect of the synthesising function of the liver.
A comparison of nalbuphine with fentanyl for postoperative pain relief following termination of pregnancy under day care anaesthesia
Authors: BONE M. E. , DOWSON S. , SMITH G.
Published: July 2010

A double‐blind investigation was undertaken to compare the efficacy of nalbuphine and fentanyl in the prevention of pain after day case termination of pregnancy. Forty patients were allocated randomly to receive nalbuphine 0.25 mg/kg or fentanyl 1.5 μg/kg immediately before induction of anaesthesia. The patients completed scores for pain and nausea, and performed a reaction time test to assess recovery. An observer assessed patient appearance at 1, 2 and 4 hours postoperatively. Patients who received nalbuphine had significantly lower pain scores at 1 hour (p < 0.01) and 2 hours (p < 0.05) and required significantly (p < 0.05) less postoperative analgesia. No significant differences were found between the groups for incidence of nausea or for observer assessment of appearance. There was some evidence of psychomotor impairment at 2 hours in the nalbuphine group. Freedom from Controlled Drug Act regulations and improved analgesia with nalbuphine, render it more satisfactory for day case surgery than the more commonly used fentanyl.
Injury to the axillary nerve
Authors: GWINNUTT C. L.
Published: July 2010

A case is described of a 32‐year‐old woman who showed signs of injury to the left axillary nerve after lumbar spine surgery. This rare complication is reviewed and the possible mechanisms of injury are discussed.
The antiemetic action of propofol
Authors: McCollum J. S. C. , Milligan K. R. , Dundee J. W.
Published: July 2010

Eighty patients who underwent minor gynaecological surgery were anaesthetised with either incremental propofol or incremental methohexitone after an opioid premedication. The group anaesthetised with propofol had significantly fewer emetic sequelae and the results suggest that propofol has a definite antiemetic action.
An additional tactile test
Authors: Horton W. A. , Perera S. , Charters P.
Published: July 2010

An additional clinical test to confirm laryngeal placement of tracheal tubes is described. Using the new test, placement was confirmed in all of 50 patients studied in whom difficulty would have been anticipated using previously described tactile tests (male patients with lower molar teeth). Two anaesthetists with small hands averaged 98% confirmations in two series each of 100 consecutive unselected intubations. A simple modification of the tests enables their application after nasotracheal intubation; even with small hands, a confirmation rate of 96% in 50 consecutive cases was found. The three tactile tests are reviewed and analysed. In the authors' combined experience of 14 cases of difficult laryngoscopy the tests gave reliable confirmation in 12 patients. Familiarity with these tests is stressed to be important for their reliable implementation.
Factors that influence cutaneous reactions following administration of thiopentone and atracurium
Authors: LYNAS A. G. A. , CLARKE R. S. J. , FEE J. P. H. , REID J. E.
Published: July 2010

Atracurium was administered by a variety of techniques to determine whether these influence the onset or duration of muscular relaxation, and the frequency of cutaneous reactions, after a standard induction dose of thiopentone. One‐hundred‐and‐fifty patients were allocated randomly to receive the drug by one of five methods: into a fast‐flowing crystalloid infusion in the antecubital fossa; into a winged needle in the antecubital fossa with flushing after the thiopentone; into a winged needle in the antecubital fossa without flushing; into a winged needle in the dorsum of the hand without flushing. The above groups received atracurium freshly removed from the refrigerator whereas the fifth group were given atracurium which had been maintained at room temperature for at least 2 weeks. The frequency of cutaneous reactions was between 60 and 70% overall and there were no significant differences either in this or in the onset or duration of action between the groups. A further 25 patients with a history of drug allergy were also investigated by the first method and showed no significant differences in response, but 25 patients aged over 70 years had a significantly lower frequency of cutaneous reactions with a higher frequency of hypotension than the other groups.
Postoperative recovery rooms
Authors: GOODCHILD C. S.
Published: July 2010

Postoperative recovery rooms have been used in the United Kingdom for just over 30 years. Anaesthetic and surgical practices have improved during this time but the clinical problems encountered are unchanged essentially. Several surveys have reviewed complications that occur; the most common causes of postoperative morbidity and mortality are still cardiovascular and respiratory problems, the latter particularly of the upper airway. In contrast there are no data available on the standard of staff and equipment in recovery rooms. The results of a survey of this aspect of postoperative recovery rooms in hospitals in Wessex, North West Thames and Yorkshire Regional Health Authorities are reported. Particular effort was made to define the facilities available. The results indicate that 70% of hospitals do not provide staffing levels and facilities which meet recommendations of the Association of Anaesthetists of Great Britain and Ireland. The implications of these findings with regard to anaesthetic morbidity and mortality are discussed.
Coronary vasospasm during percutaneous trigeminal rhizotomy
Authors: SWERDLOW B. , SHUER L. , ZELCER J.
Published: July 2010

A case of myocardial infarction as a result of coronary vasospasm during percutaneous trigeminal rhizotomy is presented. Potential consequences of the profound sympathetic response during this procedure are discussed. Invasive haemodynamic monitoring as well as prophylaxis with nitrates and calcium antagonists may be useful in patients prone to coronary vasospasm who undergo this procedure.
Continuous blockade of the lumbar plexus after knee surgery—postoperative analgesia and bupivacaine plasma concentrations
Authors: DAHL J. B. , CHRISTIANSEN C. L. , DAUGAARD J. J. , SCHULTZ P. , CARLSSON P.
Published: July 2010

In a double blind, randomised, controlled investigation the analgesic effect of a continuous block of the lumbar plexus with bupivacaine compared with sodium chloride was examined in 20 patients with postoperative pain after knee‐joint surgery. The infusion was given through a catheter inserted in the neurovascular fascial sheath of the femoral nerve, according to the three‐in‐one block technique. The patients treated with bupivacaine had significantly lower pain scores and a significantly lower demand for morphine. Side effects related to the catheters or the infusions of bupivacaine were not observed.
Long‐term performance of Tec vaporizers
Authors: CARTER K. B. , GRAY W. M. , RAILTON R. , RICHARDSON W.
Published: July 2010

We reviewed the maintenance records of lee vaporizers which had been in clinical use for up to 4 years. Tec 4s and Enfluratec 3s were found to be extremely reliable, but Fluotec 3s suffered progressively from mechanical and calibration problems. Their most recurrent fault was sticking valves caused probably by thymol crystallising on the valve faces. This fault did not occur with Fluotec 4s, which are designed to prevent liquid agent reaching the valve surfaces. We found, in a study of the effects of thymol accumulation, that only occasional draining of a Fluotec vaporizer is required to keep thymol concentration below the level at which its output is reduced. We conclude that, if regular field calibration checks are carried out as a safety measure, the service interval for Tee vaporizers could be extended beyond Ohmeda's present recommendation of one year.
Intravenous fluids in minor gynaecological surgery. Their effect on postoperative morbidity
Authors: Spencer E. M.
Published: July 2010

Postoperative morbidity was assessed in 100 patients who underwent minor gynaecological procedures. Fifty patients received intra‐operative crystalloid (1000 ml compound sodium lactate solution) and the remaining fifty none. Identical short‐acting intravenous anaesthetic techniques were used in both groups. There was no statistically significant difference between the groups in symptoms of nausea, vomiting, headache, and drowsiness within the first 6 hours after operation. Patients who received intra‐operative fluids exhibited a decreased incidence of dizziness within the first 6 hours and a decreased incidence of nausea when questioned at 3 days compared with those who did not receive any fluid; the difference was statistically significant.
Anxiety and informed consent
Authors: ANTROBUS J. H. L.
Published: July 2010

Forty‐three consecutive patients were interviewed on the eve of elective gynaecological surgery to determine the effect of anxiety on the granting of informed consent to participate in an hypothetical study. Anxiety was assessed using the Spielberger state‐trait anxiety inventory and 10‐cm linear analogue scale. A standardised explanation of an hypothetical premedication study was given and the patients' consent requested. Results were grouped for those who granted (n = 33) and those who withheld (n = 10) consent: anxiety scores for the latter were significantly higher (p < 0.01). It is concluded that patients with high pre‐operative anxiety levels are more likely to withhold consent for inclusion in premedication studies than are those who are less anxious. Seeking informed consent would introduce bias into studies of anxiolytic premedication.
Intranasal sufentanil for pre‐operative sedation
Authors: VERCAUTEREN M. , BOECKX E. , HANEGREEFS G. , NOORDUIN H. , VANDEN BUSSCHE G.
Published: July 2010

Sufentanil, a short‐acting and potent narcotic agent, was studied as a premedicant administered by the nasal route. A total dose of 5 μg appeared to be too low, while either 10 or 20 μg was very effective in producing sedation. Side effects were minor. There appeared to be no differences between nose drops and spray. In a further study, sufentanil nose drops were compared with saline (0.9% in a double‐blind fashion. Sedation of rapid onset but of limited duration was observed in the majority of patients who received sufentanil.
Benzodiazepine intoxication treated with flumazenil (Anexate, RO 15–1788)
Authors: KNUDSEN L. , LONKA L. , SØRENSEN B. H. , KIRKEGAARD L. , JENSEN O. V. , JENSEN S.
Published: July 2010

The efficacy and safety of flumazenil were assessed in comparison to placebo in a double‐blind randomised study of 31 adults intoxicated with benzodiazepines. The criteria of efficacy were the degree of sedation, and orientation in time and space. Patients who received flumazenil awoke within minutes but central depression returned partly one hour later, which reflects the short elimination half‐life of the drug. Side effects were few and the results indicate that flumazenil is effective in the primary management of benzodiazepine overdose and in states where benzodiazepines have been taken with other drugs.
A comparison of rectal diclofenac with intramuscular papaveretum or placebo for pain relief following tonsillectomy
Authors: BONE M. E. , FELL D.
Published: July 2010

A controlled investigation was conducted to compare the effectiveness of diclofenac and papaveretum in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 3 and 13 years of age were randomly allocated to receive rectal diclofenac 2 mg/kg, intramuscular papaveretum 0.2 mg/kg or no medication immediately after induction of anaesthesia. Pain and appearance were assessed 1, 3 and 6 hours postoperatively, and the following morning. The assessments were double‐blind and performed by the same observer. No significant differences in postoperative pain were found between the groups at any time. The use of diclofenac was associated with a significantly more rapid return to calm wakefulness and had significantly less effect upon respiratory rate. Consumption of paracetamol on the day of operation was significantly less in the diclofenac group. Diclofenac may offer advantages compared to papaveretum with regard to safety and convenience for use in the treatment of pain after tonsillectomy in children.
Nalbuphine combined with midazolam for outpatient sedation
Authors: SURY M. R. J. , COLE P. V.
Published: July 2010

Eighteen healthy volunteers were studied in a double‐blind trial to determine which dose of nalbuphine (0.05, 0.1 or 0.2 mg/kg) may be combined with midazolam 0.05 mg/kg to provide a safe outpatient intravenous sedative technique. The ventilatory response to carbon dioxide and end tidal Pco2 were measured before and after the drugs were administered. A mild degree of respiratory depression occurred, which was maximal at 3–30 minutes after injection. This was not related to dose except that nalbuphine 0.05 mg/kg resulted in the slowest respiratory rates. The implications of these findings for clinical practice are discussed.
Free radicals
Authors: ROYSTON D.
Published: July 2010

Free radical species are ubiquitous in plant and animal life. This article describes briefly the formation of certain oxygen‐centred free radicals which are essential for aerobic metabolism and host defences in humans. The mechanism of cytotoxicity of excess or inappropriate free radical production is described. The potential relevance of free radical tissue injury to the anaesthetist is illustrated using oxygen toxicity, adult respiratory distress syndrome and halothane hepatitis as examples.
Silent regurgitation in day case gynaecological patients
Authors: Miller C. D. , Anderson W. G.
Published: July 2010

The effect of metoclopramide premedication on the incidence of gastric regurgitation and postoperative nausea and vomiting was studied in 101 women during gynaecological procedures performed under mask anaesthesia. All patients were premedicated orally with carmine red and temazepam. A treatment group of 48 women also received oral metoclopramide. Anaesthesia was standardised in both groups. None of the women regurgitated gastric contents. Pharyngeal pH was measured in the last 68 patients and found to be > 5 in all instances. Postoperative nausea and vomiting were significantly less frequent in the treatment group.
Critical incident reporting in an anaesthetic department quality assurance programme
Authors: SHORT T. G. , O'REGAN A. , LEW J. , OH T. E.
Published: July 2010

The critical incident technique was introduced as an additional form of quality assurance to an anaesthetic department of a major Hong Kong teaching hospital. In one year, 125 critical incidents were reported from over 16000 anaesthetics. The most common incidents reported concerned the airway, breathing systems, and drug administration, with inadequate checking of equipment a frequent associated factor. Human error was a factor in 80% of incidents. Critical incidents were reported for the time during which the patient was under the anaesthetist's care. The majority occurred at induction or during anaesthesia, and were reported for all surgical subspecialties. Half of the incidents were detected by the anaesthetist and one third by monitoring equipment. Although there were improvements in anaesthetic care as a consequence of increased vigilance, critical incidents still occurred. Critical incident reporting highlighted problems not otherwise covered by case and peer reviews, and complemented our quality assurance programme.
An evaluation of gastric emptying times in pregnancy and the puerperium
Authors: Whitehead E. M. , Smith M. , Dean Y. , O'Sullivan G.
Published: July 2010

In a controlled study, gastric emptying was measured during the three trimesters of pregnancy and after delivery, using an indirect paracetamol absorption technique. The peak plasma paracetamol concentration, time to reach the peak, and the area under the plasma paracetamol concentration‐time curve, were determined. As compared to nonpregnant controls, there were no significant differences in the gastric emptying times of women in the three trimesters of pregnancy and of mothers from 18 h after delivery onwards. Gastric emptying was significantly delayed in mothers within 2 h after delivery (p < 0.01); median (range) values of peak paracetamol concentration, time to reach the peak and the area under the paracetamol concentration‐time curve for this group were 12.5 (0.2–30.5) mg.l−1, 120 (30–120) min and 3.8 (0.1–16.6) mg.l−1.h respectively, and 20.8 (8.6–64.5) mg.l−1, 40 (10–120) min and 13.5 (5.5–28.8) mg.l−1.h respectively, for the nonpregnant control group (p < 0.01). Repeated measurements of gastric emptying in these women on the second postpartum day showed no significant delay.
Current practice of epidural analgesia during normal labour
Authors: Davies M. W. , Harrison J. C. , Ryan T. D. R.
Published: July 2010

A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24‐h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivicaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top‐ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top‐up, whereas 0.25% was most often used during the first stage of labour. Midwife top‐ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top‐ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.
Pacemaker failure during transurethral resection of the prostate
Authors: KELLOW N. H.
Published: July 2010

A case is described of the intra‐operative failure of an implanted pacemaker during transurethral prostatic resection caused by a diathermy‐related increase in capture threshold which coincided with massive haemorrhage from the operative site.
Skin necrosis following continuous positive airway pressure with a face mask
Authors: SMURTHWAITE G. J. , FORD P.
Published: July 2010

A 60‐year‐old woman with respiratory.failure required ventilatory support using a continuous positive airway pressure face mask. She developed extensive necrosis of the skin of the bridge of the nose. A number of precipitating factors are discussed and suggestions made to minimise the risk qf this complication.
Cardiac arrest under anaesthesia in a child with previously undiagnosed Jervell and Lange‐Nielsen syndrome
Authors: HOLLAND J. J.
Published: July 2010

A 7‐year‐old Sikh boy with a history of syncopal attacks and congenital deafness was admitted for elective adenoidectomy and examination of his ears under general anaesthesia. Immediately after induction of anaesthesia an Ecg demonstrated T wave inversion in the CM 5 lead. The child subsequently developed multifocal ventricular extrasystoles and later, ventricular fibrillation. Deftbrillation was achieved using two 50 J DC shocks. A 12‐lead ECG performed later demonstrated a prolonged Q‐Tc interval (0.52s). The child was diagnosed as having the Jervell and Lange‐Nielsen syndrome.
Pleural drainage systems
Authors: KAM A. C. , O'BRIEN M. , KAM P.C.A.
Published: July 2010

The physics and the physiological principles of pleural or chest drainage systems are reviewed. The clinical management and complications of pleural drainage are summarised.
A comparison of the effect of isoflurane and propofol on arterial carbon dioxide tensions following intracranial surgery
Authors: WILSON R. , BERRIDGE J. , MOSS E. , POWELL D.
Published: July 2010

Thirty‐four adult patients undergoing elective craniotomy were randomly allocated to receive either isoflurane or propofol to supplement nitrous oxide and fentanyl for maintenance of anaesthesia. Arterial blood gases were measured pre‐operatively before premedication and at 5, 15, 30 and 60 min after tracheal extubation. The arterial carbon dioxide tension was higher than the pre‐operative value 5 min after tracheal extubation in both groups (p < 0.01), but there was no difference between the two groups at any time. It is concluded that the degree of postoperative respiratory depression after intracranial surgery is short‐lived and minimal following maintenance of anaesthesia with either propofol or isoflurane.
Avoidance of intermittent positive pressure ventilation in tetanus with dantrolene therapy
Authors: CHECKETTS M. R. , WHITE R. J.
Published: July 2010

Two patients with features of severe tetanus who were successfully treated with dantrolene are reported. Neither patient required treatment with neuromuscular blocking agents so mechanical ventilation, with all its disadvantages, was avoided.
Subcutaneous emphysema, pneumomediastinum and pneumothorax complicating laparoscopic vagotomy
Authors: CHUI P. T. , GIN T. , CHUNG S. C. S.
Published: July 2010

Two patients developed subcutaneous emphysema and pneumomediastinum during laparoscopic vagotomy. One of the patients also had a pneumothorax which produced a sudden increase in end‐tidal carbon dioxide concentration preceding arterial oxygen desaturation. The pneumothorax was drained with an intercostal cannula. The patient required a twofold increase in minute ventilation to maintain normocarbia, probably because of the additional absorption of carbon dioxide through the pleural cavity. Despite the presence of a peritoneopleural communication, surgery was successfully completed. We believe that gas under tension in the peritoneal cavity dissected along tissue planes around the oesophagus opened up during surgery. Thus pneumomediastinum, subcutaneous emphysema and pneumothorax are definite risks associated with this new procedure.
Haemodynamic responses to surgery in brain‐dead organ donors
Authors: PENNEFATHER S. H. , DARK J. H. , BULLOCK R. E.
Published: July 2010

In a prospective study we documented the haemodynamic response to surgery in 14 brain‐dead organ donors. The haemodynamic responses to the first 30 min of surgery were predominantly due to alterations in vascular resistance. The mean systemic vascular resistance increased significantly (p = < 0.01) from 936 to 1217 dyn.s.cm−5 after 6 min, then decreased significantly (p = < 0.001) to 642 dyn.s.cm−5 after 30 min of surgery. In two patients, the decrease in systemic vascular resistance was associated with haemodynamic decompensation. The left cardiac work index increased significantly (p = < 0.05) during surgery. We conclude that retrieval surgery causes significant haemodynamic effects. The early effects are predictable and may jeopardise organ perfusion. We advance arguments that organ preservation may be compromised by the use of inotropic agents. When practical, we suggest that a pulmonary artery catheter should be used during retrieval surgery in multi‐organ donors to facilitate a reduction in the use of inotropic drugs.
True patient‐controlled sedation
Authors: COOK L. B. , LOCKWOOD G. G. , MOORE C. M. , WHITWAM J. G.
Published: July 2010

A modified patient‐controlled analgesia pump provided doses ofpropofol 3 mg or midazolam 0.1 mg in 0.3 ml, over 5.4 s, with no lockout, during transvaginal oocyte retrieval. Alfentanil 0.2 mg was administered at three points during the procedure, and on request. Patients were randomly assigned to receive either propofol (25 patients) or midazolam (22 patients). The mean age, weight, duration of procedure and dose ofalfentanil were similar in both groups. Onset of sedation with propofol or midazolam took 70.6 (SD 22.4) and 106.3 (50.7) s respectively. Mean doses over the first 5 min were midazolam 2.7 (1.2) mg, and propofol 54 (18) mg. Thereafter requirements decreased: midazolam 0.065 (0.065) mg.min−1, propofol 2.1 (1.3) mg.min−1. All patients successfully completed the procedure; none required additional sedation. P‐deletion, reaction time, and critical flicker fusion tests revealed similar depression in both groups immediately postoperatively. After 30 min the p‐deletion and critical flicker fusion scores were still impaired in the midazolam, but not in the propofol, group.