bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurogenic pulmonary oedema
Authors: WAUCHOB T. D. , BROOKS R. J. , HARRISON K. M.
Published: February 2007

Two young patients with head injuries subsequently developed neurogenic pulmonary oedema. The origin and pathways of the reflex response to cerebral trauma are discussed, with emphasis on the role of raised intracranial pressure and the sympathetic division of the autonomic nervous system in precipitating movement of systemic circulatory volume into the pulmonary circulation, Therapeutic measures are discussed which correct the progression of this condition by reducing intracranial pressure and blocking the systemic effects of autonomic reflex activity. This leads to the basis of a simple regime to treat future cases.
Factors associated with survival and eventual cerebral status following cardiac arrest
Authors: SOWDEN G. R. , ROBINS D. W. , BASKETT P. J. F.
Published: February 2007

Cardiac arrests at two acute hospitals were investigated over a 5‐month period. The outcome expressed as short‐term and long‐term survival was correlated with diagnosis, age, sex and technical details of the resuscitation. Survivors were followed up for 3 months to detect any remaining cerebral deficit.

Of 108 patients who suffered cardiac arrest, 23 (21.3%) survived to be discharged from hospital, 58 (53.7%) died immediately and 27 (25%) survived for periods ranging from I hour to 30 days following cardiac arrest, before eventual death. Evidence of cerebral impairment was present initially in three patients (2.7%) at discharge from hospital. After 3 months however cerebral impairment was present in only one patient (0.9%). Survival was highest in patients suffering ventricular fibrillation following myocardial infarction where 16 out of 35 (47%) survived.

Certain groups of patients were identified where the ultimate survival was predictably nil. Although some survived for short periods it was concluded that the attempted resuscitation in these patients was inappropriate and unjustified.
Anaesthesia for a patient with Down's syndrome and Eisenmenger's complex
Authors: BIRD T. M. , STRUNIN L.
Published: February 2007

A patient with Down's syndrome and Eisenmenger's complex presented for orthopaedic surgery on the elbow under general anaesthesia. During pre‐oxygenation, in order to prevent a subsequent fall in systemic vascular resistance, metaraminol 1 mg was administered intravenously. The patient immediately developed bradycardia, mild hypertension and became deeply cyanosed. His condition rapidly improved after atropine 0.6 mg was given intravenously. Following induction of anaesthesia with thiopentone and tracheal intubation facilitated by suxamethonium, anaesthesia was maintained by mechanical ventilation of the lungs with nitrous oxide and oxgen (40%) with intravenous increments of fentanyl for analgesia and pancuronium for muscle relaxation; residual neuromuscular blockade was reversed with neostigmine. The patient made an eventful recovery. Although general anaesthesia is tolerated by patients with Eisenmenger's complex, powerful vasoactive drugs should not be administered unless specifically indicated.
Venous pressures during simulated Bier's block
Authors: LAWES E. G. , JOHNSON T. , PRITCHARD P. , ROBBINS P.
Published: February 2007

Venous pressures in the forearm veins during the simulated performance of intravenous regional analgesia were measured. Pressures obtained equalled or exceeded the recommended occluding pressure of the tourniquet. This finding is proposed as one of the possible reasons for the occasional observation that convulsions may occur during Bier's block despite the presence of an intact tourniquet system.
Extradural analgesia and ichthyosis
Authors: SMART G. , BRADSHAW E.G.
Published: February 2007

Extradural analgesia is well established for relief of pain but in certain cases unusual difficulties may be encountered. We report our experiences of a patient with congenital ichthyosis who required extradural analgesia for the relief of pain in labour.
Controlled ventilation in dental outpatients
Authors: SALE J. P. , POOBALASINGAM N. , DALAL S. D.
Published: February 2007

This study compares anaesthesia with controlled ventilation of the lungs with atracurium and alfentanil analgesia with halothane anaesthesia. Recovery time, the incidence of dysrhythmias and postoperative morbidity were evaluated. Anaesthesia with controlled ventilation was found to reduce significantly the incidence of cardiac dysrhythmias during dental surgery, and to produce a significantly more rapid recovery than halothane anaesthesia. The incidence of subjective postoperative complications is similar. It is concluded that controlled ventilation with atracurium and aljentanil is a suitable outpatient dental technique.
Paraplegia following epidural potassium chloride
Authors: SHANKER K. B. , PALKAR N. V. , NISHKALA R.
Published: February 2007

A patient is presented in whom 15 ml of 15% potassium chloride (30 mM) mixed with bupivacaine was injected epidurally for relief of pain resulting from widespread pelvic malignancy. Within minutes the patient complained of severe pain in both the lower limbs and rapidly became paraplegic with bladder and bowel incontinence. The paraplegia was permanent. The transient symptoms of pain may have been partly due to the irritant effects of a hyperosmolar solution of potassium chloride in the epidural space, while the permanent neurological damage might have been due to the very high extracellular concentration of potassium leading on to a depolarising phenomenon initially followed by nerve tissue necrosis.
Delayed cardiac tamponade
Authors: CASSON W. R.
Published: February 2007

A case report of cardiac tamponade is described which did not manifest itself until the patient was allowed to breathe spontaneously. Changes in intrapericardial pressure during spontaneous and controlled ventilation are discussed.
Neuromuscular transmission and its blockade
Authors: JONES R. M.
Published: February 2007

The role of two recently introduced muscle relaxants—atracurium and vecuronium—in contemporary anaesthetic practice is assessed. Recent advances in the physiology of neuromuscular transmission, particularly the roles of calcium and calmodulin, are reviewed, and new ideas concerning the reversal and monitoring of neuromuscular blockade are discussed.
Control of spinal blockade. A volume expansion technique with hyperbaric cinchocaine
Authors: Attygalle D.
Published: February 2007

Subarachnoid anaesthesia was performed using 2 ml of hyperbaric cinchocaine diluted with cerebrospinal fluid in 83 patients. When different volumes of the diluted cinchocaine (6 ml or 8 ml) were injected in the same manner into two comparable groups of patients in the height range of 150–180 cm, there was a statistically significant (p.<0.001) difference in the mean levels of the analgesia obtained. Individual values had a narrow range of spread for a given volume of injectate. There was no significant correlation between maximum analgesic levels and age and height in this group. When the smaller volume of 6 ml was given to 21 patients under 150 cm in height, there was a statistically significant correlation (r =− 0.74) between height and levels obtained. It is possible to obtain the required analgesic levels by varying the volume of dilution without altering the drug dosage, but height is an important consideration in patients of less than 150 cm.
Uptake of volatile anaesthetics in children
Authors: GALLAGHER THERESA M. , BLACK G. W.
Published: February 2007

The uptake of halothane is known to be more rapid in children than in adults, but comparable clinical data regarding other inhalational anaesthetics are not available. In this study, the rates of uptake of halothane, enflurane, isoflurane and methoxyflurane were compared in children of different ages. Expired (FE′) and inspired (FI) vapour concentrations were measured with an infrared analyser, and FE′/FI ratios were used to determine rates of uptake. Uptake rates of halothane, enflurane and methoxyflurane were more rapid in the younger than in the older children, but age had no effect on the uptake of isoflurane which was uniformly rapid in all the children studied.
Bronchial intubation. A comparison between polyvinyl chloride and red rubber double lumen tubes
Authors: Clapharn M.C.C. , Vaughan R.S.
Published: February 2007

Rid rubber and polyvnyl chloride bronchial double lumen tubes were compared. Polyvinyl chloride rubes are easier to puss, quicker to position und cause less damage to the mucosa of the respiratory tract than the red rubber equivalents.
Pentobarbitone formation during thiopentone infusion
Authors: Chan H. N. J. , MORGAN D. J. , CRANKSHAW D. P. , BOYD M. D.
Published: February 2007

The plasma concentrations and elimination half‐life of pentobarbitone were determined in 14 surgical patients receiving a continuous, exponentially decreasing, influsion of thiopentone (mean total dose, 1.05 g; SD 0.34; mean duration of infusion 2.4 hours, SD 0.7) as the primary anaesthetic agent. The plasma pentobarbitone concentration increased gradually, to reach a maximum of 1.49 μ/ml (SD 0.61) at the end of the thiopentone infusion, which was 15.5 per cent (SD 6.04) of the plasma thiopentone concentration. The elimination half‐life of pentobarbitone measured over the following 70 hours in nine of the patients was 34.3 hours (SD 8.2), which is within the range of values reported previously in several studies in which pentobarbitone was administered directly to volunteers. It was concluded that the formation of this active metaholite during 2–3 hour thiopentone infusions was unlikely to be of clinical relevance, but that significant concentrations may occur with longer thiopentone infusions.
A comparison between isoflurane and alfentanil supplemented anaesthesia for short procedures
Authors: SHORT S. M. , RUTHERFOORD CLARE F. , SEBEL P. S.
Published: February 2007

Sixty unpremedicated patients undergoing short urological and gynaecological procedures were randomly allocated to three groups to receive either methohexitone, alfentanil, nitrous oxide and oxygen, methohexitone, isoflurane and oxygen or methohexitone, isojurane, nitrous oxide and oxygen. The group receiving methohexitone, isoflurane and oxygen was abandoned after 11 patients had been studied, due to poor conditions during induction of anaesthesia. Therefore, data from only 51 patients are presented. Early recovery was assessed by time to opening eyes, giving correct name and date of birth; later, recovery was assessed by using the postbox test and deletion of‘p's. During anaesthesia and surgery, there was a high incidence of coughing and laryngospasm in the isoflurane groups. The patients in the alfentanil group opened their eyes and gave their names and dates of birth significantly faster post‐operatively (p < 0.01) than those in the isofurane groups. However, there were no significant differences between the three groups regarding the later tests of recovery. The late recovery after isofurane was equal to that obtained using an intravenous technique with alfentanil, although the peroperative complication rate was higher.
Plasma magnesium during epidural anaesthesia
Authors: KANCIR C. B. , PETERSEN P. H. , WANDRUP J.
Published: February 2007

The variations of plasma magnesium concentration in relation to protein concentration and plasma volume were studied in 12 patients during epidural anaesthesia for transurethral prostatectomy. The most significant changes in plasma magnesium concentration were observed during the onset of anaesthesia. From the arrival in the operating theatre to the start of operation, the concentration of plasma magnesium decreased from 0.88 (SD 0.10) mmol/l to 0.82 (SD 0.10) mmol/l. At the same time, the increase of 16 per cent in plasma volume was associated with a rise of 8.4 per cent in the total amount of magnesium in plasma. After commencement of surgery, the plasma magnesium concentration was unchanged throughout the remainder of the study period. The total plasma protein concentration and the erythrocyte volume fraction decreased during the onset of anaesthesia, remained stable during surgery and returned to initial values one hour postoperatively.

The pre‐operative changes in the plasma magnesium concentration may have been the result of haemodilution and mobilisation of magnesium ion from its bone stores. Postoperatively, an increased urinary loss of magnesium must have followed the injection offrusemide at the end of surgery. The consequences of these variations in plasma magnesium concentration are unlikely to be of clinical significance, except in patients with pre‐existing subclinical magnesium deficiency.
Bullous cystic lung disease
Authors: NORMANDALE J. P. , FENECK R. O.
Published: February 2007

The anaesthetic management of a patient with bullous cystic lung disease is described. The problems of providing anaesthesia in such patients and the role of high frequency jet ventilation are discussed.
Athletic dysrhythmias
Authors: BULLOCK R. E. , HALL R. J. C.
Published: February 2007

A 36‐year‐old athlete was anaesthetised for a minor surgical procedure. His heart rate fell to 30 beats/minute during the operation, the electrocardiogram showed A‐V junctional rhythm. Sinus rhythm of 58 beats/minute was restored by atropine 1.2 mg. His resting 12‐lead electrocardiogram showed sinus bradycardia and features consistent with a diagnosis of ‘athlete's heart’. A review is presented of the physiological and electrocardiographical features of this phenomenon. The current popularity of running as a leisure pursuit makes it important that anaesthetists recognise the peculiarities of the trained athletic heart.
Epidural diamorphine and the metabolic response to upper abdominal surgery
Authors: NORMANDALE J. P. , SCHMULIAN C. , PATERSON J. L. , BURRIN J. , MORGAN M. , HALL G. M.
Published: February 2007

The effect of the administration of diamorphine 10 mg epidurally on the metabolic response to cholecystectomy was investigated and compared with a control group of patients given intravenous papaveretum. There were no significant differences in blood glucose, lactate and pyruvate, and plasma nonesterified fatty acid values between the epidural diamorphine group and the control group. Plasma cortisol concentrations were significantly lower in the epidural diamorphine group postoperatively and this was associated with a marked improvement in pain relief. We conclude that epidural opiates do not directly influence the metabolic response to surgery, but decrease the cortisol response postoperatively secondary to improved analgesia.
Anaesthesia in dysautonomia: further complications
Authors: SWEENEY B. P. , JONES S. , LANGFORD R. M.
Published: February 2007

A case is described of a patient, known to be suffering from idiopathic autonomic neuropathy, who underwent general anaesthesia for repair of a fractured neck of femur. In addition to profound hypotension, unexpected respiratory depression occurred which has not previously been described in this condition. Other unusua1, features of this patient's condition are also discussed.
The effect of atracurium or fazadinium on intra‐ocular pressure. A comparative study during induction of general anaesthesia
Authors: Tattersall M.P. , Manus N. J. , Jackson D.M.
Published: February 2007

The effect of atracurium 0.6 mg/kg (group A; n= 11) and fazadinium 1 mg/kg (group F; n= 11) on intraocular pressure (IOP) was investigated in 22 patienis during induction of anaesthesia with thiopentone 4 mg/kg and fentanyl 0.015 mg/kg. IOP was significantly reduced (p <0.01) in all patients following induction of anaesthesia. Intubation produced a rise in IOP in all patients hut this was not statistically significant and remained below pre‐induction values. The changes were similar in each group. Both of these neuromuscular blockers appear suitable relaxants to use for intraoculur surgery.
A comparison of alfentanil, halothane and enflurane for day‐case gynaecological surgery
Authors: Jellicoe J.A.
Published: February 2007

Sixty patients received either alfentanil, halothane or enflurane for maintenance of anaesthesia during short day‐case gynaecological procedures. The alfentanil group recovered more rapidly but there was no difference between halothane und enflurane in terms of recovery time. Apnoea and movement during surgery only occurred in the patients who received alfentanil. The incidence of other side effects was the same in each group, including late subjective feelings of drowsiness and unsteadiness.
Excision of giant haemangioma in the newborn using hypothermia and cardiopulmonary bypass
Authors: MILLIGAN N. S. , EDWARDS J. C. , MONRO J. L. , ATWELL J. D.
Published: February 2007

The use of cardiopulmonary bypass with deep hypothermia and circulatory arrest to provide suitable operating conditions for removal of a giant haemungioma in u newborn infant is described.
Radial artery cannulation and ishaemic damage: a review
Authors: Wilkins R.G.
Published: February 2007

A review of the literature concerning ischaemic complications following radial artery cannulation suggests that the Allen test has little predictive validity. Other methods of assessing the ulnar collateral circulation are discussed.
AIDS and anaesthesia
Authors: LEE K. G. , Soni N.
Published: February 2007

The Acquired Immune Deficiency Syndrome (AIDS) is a group of conditions which is reaching epidemic proportions. It is caused by a virus new to man, with an as yet poorly understood natural history, ominous prognosis and no known cure. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed AIDS patients and asymptomatic carriers in the fields of resuscitation, intensive therapy and theatre anaesthesia. The misunderstanding of AIDS is as extensive as the literature on the subject and a review of the current knowledge of the disease relevant to the anaesthetist is pertinent.
Delayed convulsions following enflurane anaesthesia
Authors: GRANT I. S.
Published: February 2007

A case of convulsions which occurred 3 days after recovery from enflurane anaesthesia is reported.
Anaesthesia and the subclavian steal syndrome
Authors: THOMPSON R. J.
Published: February 2007

Anaesthesia in two patients with subclavian steal syndrome is described. Both patients showed an interesting response to hyperventilation. The mechanism of this response and its implications for the anaesthetist are discussed.
Some aspects of epidural block provided for elective Caesarean section
Authors: CRAWFORD J. S. , DAVIES P. , LEWIS M.
Published: February 2007

We present here clinical data from 993 patients who were destined to undergo elective Caesarean section under epidural analgesia. In 29 cases the attempt to provide an epidural was abandoned before the operation started. In regard to this, the importance of monitoring the fetal heart rate during initiation of the epidural is emphasised. In 10 cases general anaesthesia was induced after delivery, and in a further 108 cases supplemental analgesia was administered, either systemically, by inhalation or by an additional epidural top‐up, after delivery. Satisfactory analgesia throughout the operation was achieved in 87.8%. In an appreciable proportion of cases the recommended maximum dose of bupivacaine, and the recommended maximum rate of bupivacaine administration, were exceeded without apparent complication. There was a tendency for the volume of Hartmann's solution infused intravenously before and during initiation of the epidural to he increased throughout the period under review (1971–85). The prevalence of hypotension diminished during that period. Characteristics of the data did not permit a close analysis of the main factors which could have led to an episode of maternal hypotension. However, it did appear that such an episode could he ascribed to too brief an interval between the first and second, or the second and third top‐up doses. The frequency with which blood was transfused during operation was markedly lower than that noted in a concurrent series of elective sections conducted under general anaesthesia. Brief reports of six unusual complications are included and attention is drawn to the prominence of the use of 0.75% bupivacaine in these, and also to the frequency with which use of that solution was associated with unsatisfactory analgesia.
Anaesthesia for transoral craniocervical surgery
Authors: Marks R.J. , Forrester P.C. , Calder I. , Crockard H.A.
Published: February 2007

Transoral surgery on lesions in the craniocervical region has been performed on 25 patients in this unit. The anaesthetic management is presented. Tracheostomy and nasotracheal intubation have both been used. Peroperative monitoring of cord compression remains an important and only partly solved problem. There were two deaths as a result of anaesthesia and surgery, and these are discussed.
Anxiety levels in junior anaesthetists during early training
Authors: Pinnock C. A. , Elling A. E. , Eastley R. J. , Smith G.
Published: February 2007

Trait anxiety levels (predisposition to anxiety) and personality profiles were recorded in four novice anaesthetists prior to the start of their training in anaesthesia. State anxiety (the extent of anxiety at the moment of testing) was also assessed before and afer the transition from accompanied to solo anaesthetic practice. There was no demonstrable difference in anxiety scores as a result of ‘going solo’ in any subject.
Blood glucose in anaesthetised children
Authors: REDFERN NANCY , ADDISON G. M. , MEAKIN G.
Published: February 2007

Blood glucose levels were measured immediately after induction of anaesthesia and again intra‐operatively in 26 children fasted overnight for operations in the morning and 28 children fasted from 8.00 a.m. for afternoon surgery. The mean post‐induction glucose concentration of the afternoon surgery group was significantly lower than that of the morning group. However, no child in either group was hypoglycaemic. Anaesthesia and surgery caused significant increases in blood glucose levels. It is concluded that pre‐operative fasting is well tolerated in healthy pre‐school children. regardless of the timing of surgery.
Bedford Square
Authors: FUGE C. A.
Published: February 2007

Nine Bedford Square has now been established as a Centre for Anaesthesia. It is a town house of considerable merit in the first square to have been planned on the London estate of the fifth Duke of Bedford. Built between 1775 and 1780, it is now the last complete Georgian square in Bloomsbury. This brief note on the history of Bedford Square shows that this part of London was prominent in nineteenth century medicine and, in particular, was involved in the early practice of mesmerism in this country. The place of mesmerism in the evolution of anaesthesia is restated and attention is drawn to the extraordinary coincidence that the new home that has been chosen for the Association of Anaesthetists of Great Britain and Ireland should be in an area which already has connexions with anaesthesia through mesmerism.
Repeated deep accidental hypothermia
Authors: DRENCK N. E. , STAFFELDT H. v.
Published: February 2007

Deep accidental hypothermia after self‐poisoning with drugs occurred twice in the same patient within 25 days. Initial rectal temperatures were 22.0°C and 23.3°C, respectively; the clinical conditions were otherwise identical. In the first instance, active rewarming by means of peritoneal irrigation was performed, while spontaneous rewarming was allowed on the second occasion. Normothermia was attained within 24 hours in both cases, and the patient was discharged in her habitual state of well‐being.

The course of these nearly identical cases illustrates the possibility of a passive treatment for deep hypothermia.
In pursuit of relaxation
Authors: Payne J. P.
Published: February 2007

This is an account of personal research which spans nearly thirty years.
Buccal morphine premedication
Authors: Fisher A. P. , Vine P. , Whitlock J. , Hanna M.
Published: February 2007

Fifty patients were admitted to a double‐blind, double‐dummy study comparing buccal morphine 10 mg tablets and intramuscular morphine sulphate 13.5 mg as premedication. This investigation was performed on the basis of favourable results obtained in an earlier 25 patient pilot study designed to examine the efficacy, safety and patient acceptability of buccal morphine 10 mg tablets as pre‐anaesthetic medication, Both studies and sets of results are presented and show that, whilst buccal morphine is a safe alternative means of delivering opioid premedication, which is acceptable to the majority of patients, an equivalent intramuscular morphine dose is nevertheless a more effective premedicant in terms of anxiolysis and wakefulness, as assessed by linear analogue scores. Pharmacokinetic considerations are advanced both to explain the differing clinical efficacies of the two means of morphine administration and to indicate that improved per‐ and immediate postoperative analgesia might be obtainable in patients premedicated with buccal morphine.
Narcotic‐induced choledochoduodenal sphincter spasm reversed by naloxone A case report and review
Authors: BIRD K. J.
Published: February 2007

A case report of biliary colic induced by narcotic premedication and reversed by naloxone administration is described and the literature reviewed.
High frequency jet ventilation in fat embolism syndrome
Authors: LEE A. , Simpson D.
Published: February 2007

The use of high frequency jet ventilation in the management of a patient with fat embolism syndrome is described. Its principal advantage over conventional intermittent positive pressure ventilation is a reduction in the amount of sedation necessary.
Sleep and comfort after Caesarean section
Authors: Webster N.R. , Lyons G. , Macdonald Rosemary
Published: February 2007

To compare postoperative well‐being after general and epidural anaesthesia. 58 women undergoing Caesarean section were divided into a general anaesthetic group receiving intramuscular opioid postoperatively (26). and an epidural group receiving morphine via the epidural route (32). The epidural group required less analgesia (p < 0.01 at 0.5 and 8 hours, p < 0.001 at 4 hours). There was no difference in the use of oral analgesics. At 1,4 and 24 hours after delivery more patients in the general anaesthesia group described themselves as very comfortable (p < 0.05). More in the epidural group had a very good night's sleep during each night studied. Patients in the epidural group were slower to use the ward toilet (p < 0.01) and had more itching (p < 0.001). Our conclusion is that patients progressed well in both groups.
Respiratory disturbance and posterior fossa surgery
Authors: YATES A. P. , SUMNER E. , LINDAHL S. G. E.
Published: February 2007

This report, of a 16‐month‐old child recovering from surgery for a posterior fossa tumour, illustrates how pneumotachography, capnography and occlusion testing before and during CO2 challenge can be of clinical value in the analysis of a difficult respiratory disturbance in the early postoperative period. The application of these techniques to assist decisions regarding timing of extubation as well as for assessment of the influence of remaining tumour on respiratory competence is discussed.
Vecuronium and phaeochromocytorna
Authors: DAROWSKI M. J. , COUTINHO W. B. A. , POWER S. J. , JONES R. M.
Published: February 2007

Two patients presenting for removal of phaeochromocytoma are described. Vecuronium was used to provide neurornuscular blockade by two different methods of administration: an infusion and a large bolus dose. Both gave satisfactory results and we suggest that vecuroniurn may be the neuromuscular blocking agent of choice for patients with phaeochromocytoma.
A disposable device for infusion analgesia
Authors: REEKIE R. M. , CARTER K. B. , OWEN H.
Published: February 2007

The performance of the Travenol infusor when used to administer an intravenous infusion of analgesic after surgery has been investigated. Mean flow was very similar to the manufacturer's quoted figure of 2 ml/hour, but there was a large interindividual variation. Results from a laboratory study suggest that this was due to variation in the manufacture of the infusor.
Increased hepatic microsomal activity after halothane anaesthesia in children
Authors: ST. HAXHOLDT OLGA , LOFT S. , CLEMMENSEN ANETTE , HJORTSØ ELSE
Published: February 2007

The effect of anaesthesia and surgery on microsomal enzyme activity was studied in 19 children aged 4–9 years, scheduled for tonsillectomy. The children were randomly allocated to either halothane or ketamine anaesthesia. Antipyrine clearance was measured before and 4 days after surgery by u salivary one–sample technique. Statistically signijcant (p < 0.001) increases in antipyrine clearance was found in children who received halothane anaesthesia. The antipyrine clearance was increased by a mean of 26% 4 days after surgery, compared with a pre–operative control measurement. No significant change in antipyrine clearance was observed in children who received ketamine anaesthesia. There was also a significant difference in antipyrine clearance changes after surgery between the two groups (p < 0.05). Halothane has enzyme–inducing properties after a siigle exposure in children, while a single dose of ketamine does not.
Propofol and alfentanil infusion
Authors: KAY B.
Published: February 2007

In 42 patients undergoing major surgery, anaesthesia was induced by intravenous alfentanil 10 μg/kg together with methohexitone 1.5 mg/kg or propofol 2 mg/kg. An infusion of six times these doses per hour was then started; the rate was varied subsequently as indicated by the monitoring of arterial blood pressure, heart rate, EEG and frontalis electromyogram. The mean duration of infusion was 76.7 minutes for propofol and 74.5 minutes for methohexitone and the infusion was stopped about 10 minutes before the end of surgery in each group. The induction dose differed, but the total dose requirement for the two drugs was similar. In every case, anaesthesia was satisfactory. Methohexitone caused a significant rise in mean pulse rate throughout anaesthesia (p < 0.05, paired t–test). There was no change in mean puke rate during propofol infusion. The dose of alfentanil used provided excellent control of autonomic reflexes, with negligible respiratory depression. Naloxone was not required. Propofol provided better anaesthesia than methohexitone, with fewer side effects (p < 0.05. Chi squared test), easier control of the level of narcosis and faster recovery (p 0.001. t‐test after log transformation).
Anaphylaxis to precurarising doses of gallamine triethiodide
Authors: HARRISON J. F. , BIRD A. G.
Published: February 2007

Two cases are described in which patients developed acute anaphylactic reactions to precurarhing doses of gallamine. Life threatening complications can arise from the use of small doses of drugs as adjuncts to anaesthesia and raises the question whether the benefts of precurarisation outweigh the risks of anaphylaxis.
No moving parts
Authors: CALHAEM M.N.
Published: February 2007

Interchange between ventilatory and spontaneously breathing modes using a Bain system and a Penlon Nuffield 200 ventilator may be achieved by the single action of switching the ventilator on or off. No alteration is made to the expiratory valve, reservoir bag, ventilator tubing or scavenging system and there are no levers.
Ventilation and the oculocardiac reflex
Authors: MIRAKHUR R. K. , SHEPHERD W. F. I. , JONES C. J.
Published: February 2007

A randomised prospective study was carried out in children undergoing surgery for squint correction, to determine the value of controlled ventilation as a prophylaxis against the occurrence of the oculocardiac reflex. One hundred patients anaesthetised with nitrous oxideloxygen and halothane were randomly assigned to either ventilated or spontaneously breathing groups of 50 each. Half the patients in each group received glycopyrronium 7.5 μg/kg intravenously at the time of induction of anaesthesia. Heart rate, rhythm, blood pressure and end tidal CO2 concentration were monitored throughout. A positive oculocardiac reflex. defined as a fall in heart rate of 20% or more and/or the occurrence of dysrhythmias, was observed in 72% of spontaneously breathing patients and in 100% of ventilated patients not receiving prophylactic intravenous glycopyrronium. The incidence of a positive reflex in patients receiving glycopyrronium was 10% (4 and 16% respectively in spontaneously breathing and ventilated patients). It is concluded that controlled ventilation is of no value as a preventive measure against the occurrence of the oculocardiac reflex in patients undergoing squint surgery and that prophylaxis is safely achieved with the use of intravenous glycopyrronium.
Acquired C1 esterase inhibitor deficiency
Authors: RAZIS P. A. , COULSON I. H. , GOULD T. R. , FINDLEY I. L.
Published: February 2007

A case of acquired C1 esterase inhibitor deficiency and its anaesthetic implications is presented. Prophylaxis against angioneurotic oedema using danazol and tranexamic acid is described and the resultant complication of mesenteric venous thrombosis reported.
Nuclear magnetic resonance
Authors: Nixon C. , Hirsch. N. P. , Ormerod I. E. C. , Johnson G.
Published: February 2007

The theory and practice of clinical nuclear magnetic resonance (NMR) imaging is reviewed. Problems which the anaesthetist will encounter are considered, and recommendations are proposed. Possible uses of NMR in anaesthesia are discussed.
In vitrobuffering capacity of Alka Seltzer Effervescent
Authors: Murrell G. c. , Rosen M.
Published: February 2007

The variety of antacids used as a prophylaxis for acid aspiration syndrome reflects dissatisfaction with each agent. Alka Seltzer Effervescent is a proprietary product without aspirin. We have shown that it can easily be dissolved in a small volume, readily mixes with hydrous fluids, and has a satisfactory neutralising capacity. Its non‐particulate nature, storage in individual packages and palatability, indicated by commercial acceptance overseas, show that further trials in vivo as a method of raising gastric pH may be useful.
Time course of action of combinations of vecuronium and pancuronium
Authors: Pandit S. K. , Ferres C. J. , Gibson F. M. , Mirakhur R. K.
Published: February 2007

Vecuronium 0.1 mg/kg, puncuronium 0.1 mg/kg, vecuronium 0.075 mg/kg t pancuronium 0.025 mg/kg, vecuronium + pancuronium 0.05 mg/kg each and vecuronium 0.025 mg/kg + pancuronium 0.075 mg/kg were compared with respect to time tuken to onset oj effect, duration of clinical relaxation and intubation conditions in jive groups of 20 patients each. Thi. time to onset and intubating conditions were similar in all thc groups. indicating that the combinations have no advantage over the individual drugs. The duration of clinicul relaxation was 25 minutes with vecuronium, and increased as the proportion of pancuronium in the niixturc increased, being 56 minutes with pancuronium 0.I mg/kg.
All that wheezes is not asthma
Authors: Lloyd‐Thomas A. R. , Bush G. H.
Published: February 2007

A case is presented in which the inhalation of a foreign body caused a respiratory arrest and was subsequently diagnosed and treated as an attack of acute asthma. The presentation, diagnosis. investigation and treutment of this condition is discussed and a review of the literature is presented.
Anaesthesia for surgical occlusion of the basilar artery
Authors: Child C. S. , Heining M. P. D. , Calder I. , Crockard H. A.
Published: February 2007

A case is described of a giant fusiform aneurysm of the basilar artery which was treated successfully by proximal surgical occlusion of the artery. The anaesthetic management involved the intra‐operative awakening of the patient in order to assess neurological function immediately after application of the clip. The difficulties involved in this type of surgery are discussed.
A pre‐induction test dose for suxamethonium
Authors: CARNIE J.
Published: February 2007

A two‐part experimental and clinical study was conducted to determine the effects of administration of a pre‐induction dose of suxamethonium, and to see whether the symptoms produced could form the basis of a test dose, to determine sensitivity to suxamethonium prior to administration of a full intubation dose. Suxamethonium was shown to produce distinctive clinical features characterised by signs of both extra‐ocular muscle contraction and paresis, manifest by symptoms of eye and eyelid heaviness without generalised paresis. The dose response was determined in individuals with normal plasma cholinesterase, to a test dose of suxamethonium chloride of between 20 and 1 μg/kg. Individuals with abnormal plasma cholinesterase were shown to exhibit sensitivity to these low doses and were easily distinguished from those with normal enzyme.

A protocol is suggested which can conveniently establish, prior to induction, those individuals with a reduced ability to hydrolyse suxamethonium.
An investigation of factors affecting postoperative rewarming of adult patients
Authors: CARLI F. , GABRIELCZYK M. , CLARK MARGARET M. , ABER V. R.
Published: February 2007

Aural canal temperature was measured for one hour after arrival in the recovery room in 200 adult patients who underwent one of the following types of major surgery: abdominal, pelvic, vascular, orthopaedic or prostatic. One group of 100 patients was studied in the recovery room of Hammersmith Hospital which was not equipped with a controlled system for constant ventilation and humidification, while the other 100 patients were studied in the recovery room of Edgware General Hospital. which had a constant ambient temperature and controlled relative humidity with 20 air changes/hour. The rate of rewarming was found to be similar in both groups. Within the range of ambient temperatures and relative humidities measured, patients over 60 years of age rewarmed more slowly than did patients under 60 years (p < 0.05). General anaesthesia was associated with significantly faster rewarming than was local anaesthesia (p < 0.01).
Atracurium infusions in patients with renal failure on an ITU
Authors: GRIFFITHS R. B. , HUNTER JENNIFER M. , JONES R. S.
Published: February 2007

An infusion of atracurium was used (after an initial bolus dose) in five patients with renal and respiratory failure, who were being subjected to intermittent positive pressure ventilation before renal dialysis. Neuro‐muscular function was monitored by the train‐of‐four pattern of stimulation. In three patients, atracurium 0.6–0.7 mg/kg/hour completely abolished the twitch response; in the other two (both of whom were markedly oedematous) this did not occur, even with a dose of 1.0 mg/kg/hour. although satisfactory clinical control was obtained. In all patients. there was rapid spontaneous recovery when the infusion was stopped. One patient convulsed, but plasma laudanosine levels taken at this time were below the toxic range. Atracurium infusions appear to provide easily controllable neuromuscular blockade in the intensive therapy unit, although these preliminary results suggest that larger doses may be required in the oedematous patient.
Changes in skin thermal clearance during anaesthesia
Authors: SAUMET J. L. , DEGOUTE C. S. , DITTMAR A. , BANSSILLON V.
Published: February 2007

Thermal and vascular side effects occuring during general anaesthesia are related to skin blood flow. A new, noninvasive probe which measures skin thermal clearance, a variable closely related to skin blood flow, was used in nine patients under phenoperidine, droperidol, propanidid anaesthesia. Statistically significant increases in skin thermal clearance clearly preceded the drop in mean arterial blood pressure and the rise in skin temperature. It is concluded that general anaesthesia induced an early increase in skin blood flow and that thermal clearance is a better technique than skin thermometry to monitor skin blood flow.
Anaesthesia for congenital analgesia
Authors: Layman P. R.
Published: February 2007

Bilateral amputations were performed without analgesia on a patient with congenital insensivitivity to pain (congenital analgesia). Positioning, vasomotor control and possible sensitivity to anaesthetic drugs are discussed.
Morbidity after day case laparoscopy. A comparison of two techniques of tracheal anaesthesia
Authors: Skacel M. , Sengupta P. , Plantevin O.M.
Published: February 2007

A comparison was made of postoperative morbidity following two anaesthetic techniques for day case laparoscopies. One group of patients was allowed to breathe spontaneously after intubation under suxamethonium. The second group received atracurium and their lungs were mechanically ventilated. Patients in the controlled ventilation group experienced significantly less severe sore throats and muscle pain in the first 24 hours postoperatively than the patients who breathed spontaneously. Both techniques proved to be safe and are suitable for day case laparoscopy. The safety of patients is discussed in relation to the choice of anaesthetic technique used.
Fire in the operating theatre. Evacuation pre–planning may save lives
Authors: Moxon Mary A. , Ward M.E.
Published: February 2007

An operating theatre fire and the steps taken to deal with it are described: the difficulties encountered in evacuating anaesthetised patients are highlighted. Measures which might be taken to prevent recurrence of these problems, and recommendations on the institution of fire drills for the safety of patients and staff are given.
Beta‐adrenoceptor blockade and suxamethonium‐induced rise in plasma potassium
Authors: Maryniak J. K. , Henderson A. M. , Woodall N. M. , Lim M. , Simpson J. C.
Published: February 2007

The effects of beta‐adrenergic blockade on the suxamethonium‐induced rise in arterial plasma potassium were studied in patients who presented for open heart surgery. No potentiation of the immediate rise in plasma potassium was observed.
Lung water during the puerperium
Authors: MACLENNAN F. M. , MACDONALD A. F. , CAMPBELL D. M.
Published: February 2007

An alteration in pulmonary water balance might be expected during pregnancy and the puerperium, as a result of the physiological adaptations to pregnancy. A preliminary investigation of this hypothesis was conducted using a radiological method of lung water measurement in 20 normal primigravidae during the early puerperium. Evidence of interstitial lung water was found in seven of the 20 mothers. There was a significant correlation with plasma volume (p < 0.05) and fluid turnover (p < 0.05) in the group with excess lung water. The implications of increased interstitial lung water and its possible causes during pregnancy are discussed.
A new percutaneous infraclavicular approach to the axillary vein
Authors: NICKALLS R. W. D.
Published: February 2007

A new percutaneous infraclavicular approach for cannulating the axillary vein is described. The technique was devised using surface landmarks established by cadaver dissection. This is a relatively safe procedure with no risk of pneumothorax, provided that the tip of the needle remains inferior to the clavicle.
Vecuronium—A variable dose technique
Authors: Feldman S.A. , Liban J.B.
Published: February 2007

Vecuronium was administered to patients in doses of 100, 150, 200 and 250 μg/kg and the duration of action recorded by noting the time to recovery of the first twitch in a train‐of‐four to 10% of the control twitch. The recovery times ranged from a mean of 28.4 minutes (100 μg/kg) to 72.4 minutes (250 μg/kg). It is suggested that for operations of medium to long duration the use of a large initial bolus dose of vecuronium is a technique with advantages over the use of an infusion or frequent incremental doses.
Vomiting after ophthalmic surgery
Authors: VAN DEN BERG A. A. , LAMBOURNE A. , YAZJI N. S. , LAGHARI N. A.
Published: February 2007

The usefulness of intra‐operative antiemetics and postoperative oral fluid restriction in the prevention of vomiting following anaesthesia for ophthalmic surgery, was studied in 200 patients. They were allocated into four groups of 50 and given either saline (as control), droperidol, metoclopramide or prochlorperazine. Oral intake was restricted postoperatively in half of the patients of each group. Anaesthesia comprised morphine and atropine premedication and a halothane, nitrous oxide and oxygen spontaneous breathing technique. No significant beneficial effects resulted from intra‐operative antiemetics; vomiting incidences of 26% after saline and droperidol, 28% after metoclopramide and 14% after prochlorperazine were observed. Younger patients and females vomited most frequently. Restriction of oral fluids did not decrease the incidence of vomiting but demonstrated that approximately half of those patients who vomit do so with their first postoperative oral intake. Vomiting was observed more frequently after non intra‐ocular surgery than after intra‐ocular surgery (37% cf. 16%, p < 0.01) and postoperative analgesics were required by more non intra‐ocular patients than by intra‐ocular patients (25% cf. 5%, p < 0.001). Squint patients vomited most frequently (48%) and most frequently required postoperative analgesia (35%).
Economy in the use of muscle relaxants Vecuronium after pancuronium
Authors: KAY B. , CHESTNUT R. J. , SUM PING J. S. T. , HEALY T. E. J.
Published: February 2007

Vecuronium is an intermediate duration, non‐depolarising muscle relaxant. When used during prolonged procedures, it may be given by intermittent injection, by continuous infusion or by a single very large dose at the start of anaesthesia. It may also be used to maintain relaxation after the initial use of a long‐acting agent, such as pancuronium. This study demonstrates that the effect of a dose of vecuronium used in this fashion is increased when interaction with pancuronium takes place. The clinical and theoretical implications of this observation are discussed.
Respiratory obstruction following vocal cord injection
Authors: BODENHAM A. , LATIMER R. , BETHUNE D.
Published: February 2007

Two patients who each had a paralysed left vocal cord are discussed. Both had poor coughing ability preoperatively. The affected cords had been injected with tetrafluoroethylene (Teflon) paste 3 days before operation and this had given immediate improvement in coughing and speech. During induction of anaesthesia, respiratory obstruction occurred that was related to the injected cord. This cause of obstruction has not been reported previously. The potential benefits of cord injection for voice, cough and laryngeal competence are reviewed.
Drawover anaesthetic systems
Authors: MACKIE A. M.
Published: February 2007

The factors that determine the inspired oxygen concentration delivered by drawover anaesthetic systems were studied in the laboratory and in anaesthetised patients. The inspired oxygen concentration is dependent upon oxygen flow, reservoir volume and total ventilation; respiratory rate and inspiration: expiration ratio have a small influence. A reservoir of at least of 1 m corrugated tube (internal volume 415 ml) makes optimal use of a 4 litres/minute oxygen flow. Delivery of a safe inspired oxygen concentration can be ensured with economical oxygen flows.
Concurrent drug therapy in patients undergoing surgery
Authors: Duthie D.J.R. , Montgomery J.N. , Spence A.A. , Nimmo W.S.
Published: February 2007

In a retrospective study of 57 176 patients and a prospective study of 216 patients undergoing surgery, 24–32% of patients were receiving some concurrent medication. Between 10 and 16% were taking drugs for cardiovascular disease. Of these, only 71% had their normal medication prescribed before surgery and only 41% received their drugs on the day of surgery.
Value of pre‐operative carotid sinus massage
Authors: McCONACHIE I.
Published: February 2007

The usefulness of carotid sinus massage in pre‐operative assessment is discussed with case examples. The technique and risks of carotid sinus massage are described. Carotid sinus massage is of particular value in the demonstration of sino‐atrial and atrioventricular node disease in the absence of definitive abnormalities on the routine resting electrocardiogram, and in the identification of patients who show a hypersensitive response to vagal stimulation. These patients should be identified prior to procedures that involve marked vagal activity, since prolonged sinus arrest may occur.