bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhalation of ammonia vapour
Authors: O'KANE G. J.
Published: February 2007

Eight men were admitted to hospital following exposure to gaseous ammonia at a local factory. They were divided into three groups, according to their clinical condition. The clinical findings, chest radiographs and treatment are discussed. One case was very severely injured. His management is discussed in detail. He required mechanical ventilation, positive end expiratory pressure and tracheostomy.

The toxic effects of ammonia gas are discussed. A review of the literature is included. It was concluded that ammonia is an extremely irritant gas. capable of producing severe damage to all levels of the respiratory tract which may result in clinical impairment of respiratory function, ranging from mild to fatal. Prolonged respiratory support may he required. Superinfection may cause a late deterioration in those severely affected.
Ranitidine as an antacid before elective Caesarean section
Authors: McAULEY D. M. , MOORE J. , McCAUGHEY W. , DONNELLY B. D. , DUNDEE J. W.
Published: February 2007

In a preliminary study, 20 women in labour received ranitidine 50 mg intravenously. No significant changes were seen in the height, frequency or amplitude of uterine contractions or in fetal heart rate or pattern. No neonatal problems attributable to ranitidine were found. Ranitidine crossed the placenta, the mean fetal‐maternal ratio being 0.9. Levels in the infants 12 hours following delivery were all very low. Ranitidine 150 mg orally was given to 80 healthy women undergoing elective Caesarean section at varying times from 75 to 510 minutes pre‐operatively. From 2 to 6 hours following ingestion, the pH of gastric contents was greater than 2.5 in all but one patient. The mean volume aspirated (8 ml) was significantly lower than in a control group receiving magnesium trisilicate (mean volume 30 ml). Neonatal assessment included Apgar scoring, neurobehavioural examination, feeding progress, measurement of acidity and culture of gastric aspirates. No significant differences between groups were found. Blood levels indicated that the oral drug is readily absorbed by the parturient and that a smaller proportion is transferred to the fetus, mean fetal‐maternal ratio at delivery being 0.38.
Isobaric bupivacaine and hyperbaric amethocaine for spinal analgesia
Authors: TATTERSALL M. P.
Published: February 2007

A 15 mg dose of isobaric bupivacaine 0.5% solution for spinal analgesia was compared with a clinically indicated dose of hyperbaric amethocaine 1% solution (10–16 mg) in 123 patients undergoing orthopaedic, urological and general surgical procedures. The 63 patients who received bupivacaine had a more limited spread of analgesia, which lasted longer and was accompanied by less hypotension and fewer complications than those who received amethocaine.
Cold agglutinins and deep hypothermia
Authors: LEACH A. B. , VAN HASSELT G. L. , EDWARDS J. C.
Published: February 2007

A case is reported of cardiac surgery under deep hypothermia in a child with cold agglutinins with a brief discussion of the significance of different types of cold agglutinins. The screening potential of routine cross‐matching for significant cold agglutinins is emphasised.
Portable ventilators under field conditions
Authors: HARRIES M. G.
Published: February 2007

Twenty‐eight field rescue units using mechanical ventilators were questioned about the incidence of practical difficulties encountered with their equipment. Eleven (39%) had used the equipment in an emergency. Sixty‐one separate incidents were recorded, in 48 oxygen therapy alone was given but in 13 the equipment was used to ventilate the patients’ lungs. Seven units (25%) experienced some sort of practical difficulty. Six units complained of trouble with servicing, five of which were frustrated by delays with replacement oxygen cylinders.
Evaluation of a device for the measurement of the evoked tensions of the rectus abdominis muscle
Authors: GOUDSOUZIAN N. G. , WELCH J.
Published: February 2007

A device was developed to measure the evoked tensions of the rectus abdominis muscle which consisted of a fluid‐filled reservoir wedged between the rectus abdominis muscle and a self‐retaining retractor. The evoked contractions of the rectus muscle were compared with that of the tibialis anterior muscle in twelve dogs anaesthetised with pentobarbitone. Significantly greater amounts of tubocurarine were required to depress the response to train‐of‐four stimuli and the twitch tensions of the rectus muscle than the tibialis. The tibialis recovered faster, spontaneously or after neostigmine, than the rectus in eight of the animals; the opposite occurred in the other four. The present device can be useful during surgery for the evaluation of abdominal muscle tension.
Rapid and safe withdrawal of intravenous papaveretum after prolonged continuous infusion
Authors: MORGAN R. J. M.
Published: February 2007

A case is reported in which papaveretum was administered to a patient by continuous intravenous infusion for 60 days. Complete and rapid withdrawal of the narcotic analgesic at the end of that period, despite a massive established daily requirement, was relatively simple and apparently safe. Aspects of narcotic analgesic dependence as they pertain to the case are discussed and the prolonged administration of intravenous opiates with greater confidence by clinicians involved in the intensive therapy of similar patients is suggested.
Training in intensive care
Authors: HILLMAN K. , HINDS C. J. , WILLATTS SHEILA M.
Published: February 2007

A questionnaire was sent to senior registrars in General Medicine and Anaesthesia enquiring into the amount of training they received in Intensive Therapy and their attitudes to this in the light of their expectations for a consultant post. The results suggest that training is inadequate and that trainees are dissatisfied with the current situation.
Unexplained haemoglobinuria associated with extracorporeal circulation
Authors: DHAMEE M. S. , DONAHUE R. J. , GANDHI S. K.
Published: February 2007

Haemoglobinuria occurred within a few minutes of institution of extracorporeal circulation which is not a common phenomenon. A case report is presented and several possible causes of haemoglobinuria are discussed. The cause of early haemoglobinuria on ECC in this case remains unexplained.
Nitrous oxide sedation in dentistry
Authors: SHER A. M. , BRAUDE B. M. , CLEATON‐JONES P. E. , MOYES D. G. , MALLETT J.
Published: February 2007

Nitrous oxide concentrations (V/V) at the delivery Rotameters block, nasal mask, pharynx and venous blood, were compared. There was a dilution of approximately 50% of the delivered nitrous oxide at the nasal mask which was further reduced in the pharynx. Venous blood concentrations 10 minutes after inhalation of nitrous oxide were low but as would be calculated from pharyngeal concentrations. After 5 minutes of oxygenation venous blood nitrous oxide concentrations were still relatively high. A total of 92% of subjects experienced a satisfactory effect with 30% nitrous oxide or less in the pharynx.
Evaluation of a new fibre‐optic pulmonary artery catheter in intensive care
Authors: WESTON G. A. , LEDINGHAM I. McA. , DOUGLAS I. H. S. , MacARTHUR K. J. D.
Published: February 2007

We have assessed the performance of a new fibre‐optic pulmonary artery catheter for the measurement of mixed venous oxygen saturation. The results obtained from this catheter compare well with those using standard techniques. Other information from the catheter allows oxygen consumption to be easily calculated and again the results obtained agree closely with those measured using standard techniques.
Reduction of gastric acid secretion
Authors: YILDIZ F. , TRYBA M. , KUEHN K. , HAUSDOERFER J.
Published: February 2007

Cimetidine 10 mg/kg orally was given at varying times from 60 to 240 minutes pre‐operatively to 100 healthy children between the ages of 6 months and 14 years. Cimetidine proved to be most effective when given between 120 and 180 minutes before the induction of anaesthesia. All patients in this group had a gastric pH of more than 2.5 and the mean volume aspirated was also significantly lower than that in the control group. The average peak blood concentration after 10 mg/kg oral cimetidine in four healthy children was 3.25 μg/ml (range 1.20‐4.80) and occurred 75 minutes after administration (range 60‐120 minutes). In these patients the mean (SD) hay‐life of cimetidine was 138 (18) minutes. The reduction of gastric juice volume and acidity produced by 10 mg/kg oral cimetidine given 120—180 minutes prior to induction of anaesthesia has important clinical implications.
Visceral injuries following external cardiac massage
Authors: BARROWCLIFFE M. P.
Published: February 2007

This case report describes a patient who sustained a laceration of the hepatic artery during external cardiac massage, a complication which has not previously been reported. The spleen was also damaged. The importance of recognising complications such as haemorrhage from injured abdominal viscera is emphasised and the literature relating to these injuries is briefly reviewed.
Continuous monitoring of blood Po2 in extracorporeal systems
Authors: CLAREMONT D. J. , PAGDIN T. M. , WALTON N.
Published: February 2007

The technique of intermittent sampling of blood during extracorporeal circulation and in vitro analysis to establish that the blood‐gas status of the patient is within acceptable limits has drawbacks which may be overcome by continuous monitoring. An evaluation of an oxygen monitoring system and a comparison with a blood gas analyser have been performed.

Blood of known PO2 was circulated at 15°, 25° and 37°C in an extracorporeal system and the monitor readings and results from samples analysed on a blood gas analyser were compared with calculated partial pressures. There was no significant difference between the calculated value and the monitor readings but the blood gas analyser results were significantly lower (p < 0.01) than the calculated values of the tonometered blood. The reasons for this difference and the potential clinical advantages of continuous monitoring are discussed.
Barrier pressure and muscle relaxants
Authors: HUNT P. C. W. , COTTON B. R. , SMITH G.
Published: February 2007

The effects of pancuronium and vecuronium on the lower oesophageal sphincter pressure were studied in 24 healthy patients anaesthetised with 0.5% halothane in nitrous oxide and oxygen. Following pancuronium 0.1 mg/kg intravenously, there was a significant increase in barrier pressure from a control value of 2.0 (SEM 0.14) kPa to 3.0 (SEM 0.27) kPa 1 minute after injection (p < 0.05). This increase was sustained throughout the 15 minute period of recording and was accompanied by a significant increase in heart rate (p < 0.001). Following administration of vecuronium 0.1 mg/kg intravenously there was an initial modest, though not significant increase in barrier pressure. This increase was significant (p < 0.05) at 15 minutes. There were no cardiovascular changes following vecuronium.
The effect of nitrous oxide on cerebral electrical activity
Authors: WILLIAMS D. J. M. , MORGAN R. J. M. , SEBEL P. S. , MAYNARD D. E.
Published: February 2007

Recordings of cerebral electrical activity produced by the cerebral function analysing monitor (CFAM) were obtained from nine healthy volunteers breathing increasing concentrations of N2O in O2. Concentrations of 30 and 50% N2O produced significant reductions in CFAM trace amplitude. Withdrawal of N2O resulted in an increase in amplitude with an initial increase above the control level. There were no consistent changes in the frequency distribution of the weighted electroencephalographic signal with increasing concentrations of N2O.
Midazolam and diazepam in ketamine anaesthesia
Authors: CARTWRIGHT P. D. , PINGEL S. M.
Published: February 2007

Midazolam 0.07 mg/kg was compared with diazepam 0.12 mg/kg intravenously as an adjuvant to ketamine anaesthesia in healthy patients undergoing minor gynaecological operations of less than 15 minutes duration. The occurrence of induction and emergence sequelae, and patient acceptance of the technique was assessed by means of a questionnaire. The incidence of unpleasant dreams was 6.7% with midazolam and 26.7% with diazepam. There was no significant difference in any other sequelae. Overall patient acceptance was high at 96.7%.
Anaesthesia and severe skin disease
Authors: SMITH G. B. , SHRIBMAN A. J.
Published: February 2007

A review of the anaesthetic management of severe skin disease is presented. Erythroderma, urticaria pigmentosa, hereditary angioedema, epidermolysis bullosa, pemphigus, pemphigoid, the Stevens‐Johnson syndrome, Behcet's syndrome, scleroderma, Ehlers‐Danlos syndrome and congenital anhidrotic ectodermal defect are discussed.
The Macintosh laryngoscope
Authors: JEPHCOTT A.
Published: February 2007

It is 40 years since Sir Robert Macintosh discovered the principle of indirect elevation of the epiglottis and developed the laryngoscope which bears his name. The author celebrates the anniversary of this revolution in intubation with some notes on the early commercial history of the instrument and a description of a Longworth version made about 1945.
Plasma catecholamine concentrations
Authors: TAYLOR S. , ACHOLA K. , SMITH G.
Published: February 2007

Plasma catecholamine concentrations were measured in 19 patients allocated randomly to receive submucous infiltration with 4 ml of either 0.5% lignocaine with adrenaline 1:200 000 or prilocaine 0.5% with octapressin 0.03 iu per ml. Venous blood samples were obtained before and at 2, 5, and 10 minutes following infiltration. Plasma adrenaline increased from 0.35 to 1.72 p mol/ml at 2 minutes infiltration with the former solution whilst there was little change in plasma noradrenaline concentration. No similar peak in adrenaline concentration occurred after infiltration with prilocaine/octapressin solutions but with both solutions there was a small increase in plasma noradrenaline and adrenaline concentrations 10 minutes after infiltration, at the time of surgical stimulation.
Magnesium trisilicate mixture BP
Authors: CRAWFORD J. S. , POTTER S. R.
Published: February 2007

Study of samples of magnesium trisilicate mixture BP obtained commercially has shown that redistribution of the mixture into a reasonably well‐dispersed suspension becomes increasingly difficult the longer the mixture is stored. This process of compacting is hastened in response to an increase of environmental temperature. It is possibly for this reason that to administer the mixture at some time later than shortly after it has been prepared contravenes the recommendation of the British National Formulary, that‘it should be recently prepared.’These findings were reflected in the contrast between gastric aspirates obtained from anaesthetised patients who had received the commercially‐obtained antacids and those whose antacid had been prepared by the hospital pharmacy. There was a higher incidence of patients‘at risk’because of aspirates with pH value < 3.0 in the former group. Among the latter group of 131 patients, only one was found to have been‘at risk’. The importance of administering a final dose of antacid within the 15‐minute period before induction of anaesthesia is emphasised. The results of assays of the magnesium concentration in the gastric aspirates varied widely, and bore no systematic relationship to the total dose of antacid administered, the time elapsing since the last dose was given, or the pH value of the same aspirate.
The analgesic effect of a low dose of alfentanil
Authors: BLACK T. E. , KAY B. , HEALY T. E. J.
Published: February 2007

The effect of a single small dose of alfentanil (6 μg/kg) on postoperative pain was compared with saline using a double blind study. Pain was assessed using a linear analogue scale und shown to decrease at 2, 5 and 10 minutes after injection of alfentanil (p < 0.01). The Pe'co2 was increased at 2 and 15 minutes (p < 0.05) and 5 and 10 minutes (p < 0.01) after injection of alfentanil. There were no changes in pain or Pe'co2 in the control group throughout the study. Intravenous alfentanil given to patients in pain provides quick effective analgesia for a short period of time, but respiratory depression may occur.
Isobaric bupivacaine for spinal anaesthesia in acute war injuries
Authors: BION J. F.
Published: February 2007

Twenty nine patients with acute war injuries of the lower limbs or perineum were anaesthetised with intrathecal bupivacaine. Eleven patients (38%) were shocked on arrival with systolic arterial blood pressures less than 90 mmHg; in three the blood pressure was unrecordable. All patients were resuscitated and ready for surgery within 30 minutes of arrival at the field hospital. Hypotension occurred two minutes after injection of bupivacaine in three of the eleven shocked patients, but was corrected with fluids and metaraminol without difficulty. Patients with a fever were found to be less likely to develop hypotension. The early onset of hypotension and the necessity for a head‐down tilt gives bupivacaine a significant advantage over hyperbaric agents, and the technique can be recommended.
Electromyography in anaesthesia A comparison between two methods
Authors: PUGH N. D. , KAY B. , HEALY T. E. J.
Published: February 2007

Two instruments measuring evoked compound muscle action potentials (EMG) produced by train of four stimulation of the ulnar nerve were compared. The neuromuscular transmission section of a Datex Anaesthesia and Brain Monitor (ABM), which utilises an integration technique to measure the EMG, and the Medelec MS6, by which amplitude of the EMG was recorded and measured were attached to the same electrodes placed over adductor pollicis. Eight patients scheduled for surgery requiring non‐depolarising neuromuscular blockade were studied. The changes in neuromuscular transmission measured by the two methods correlated well, with no statistically significant difference in results. The ABM provides a simple and accurate automatic measurement of evoked EMG for use in the study of neuromuscular transmission.
Premedication by controlled‐release morphine
Authors: Kay B. , Healy T.E.J.
Published: February 2007

In a double‐blind investigation the effect of oral controlled‐release morphine (MST 30 mg) on pre‐operative anxiety was assessed in 50 patients undergoing cholecystectomy. The effects on anaesthetic requirements and recovery, and postoperative pain were also studied. The patients who received morphine treatment were more sedated than those who received the placebo: however there was no significant difference in the anxiety scores for both groups of patients. During anaesthesia there were no significant differences between the groups, although the group of patients who received morphine required less anaesthetic supplement, and appeared to recover more slowly than the placebo group. One hour postoperatively, the morphine group had significantly less pain and were more sedated than the placebo group: the time to the administration of a postoperative analgesic was also significantly longer in the morphine group than the placebo group.
Enflurane as an analgesic in labour
Authors: McGUINNESS Carol , ROSEN M.
Published: February 2007

A comparison of the analgesic efficacy of enfrurane 1% in air with Entonox (50% nitrous oxide in oxygen) was performed in 20 consenting women during the first stage of labour. The two drugs were given in a random sequence to each woman, who also acted as her own control. Pain scores were significantly lower with enfrurane than Entonox, although drowsiness scores were higher. No untoward effects were reported with either agent. The use of enflurane as an analgesic in the first stage of labour warrants further investigation.
Percutaneous arterial cannulation in children
Authors: MARSHALL A. G. , ERWIN D. C. , WYSE R. K. H. , HATCH D. J.
Published: February 2007

For percutaneous arterial monitoring in children, the Medicut (polypropylene) is an appropriate choice of cannula. Morbidity associated with its use is low. We studied blood flow and clinical signs relating to 70 arterial cannulations in 62 patients. In the few patients exhibiting flow disturbances either whilst the cannula was in situ or following decannulation, we observed no associated clinical signs of vascular insufficiency of the forearm, wrist or digits. Also, most patients showed normal, antegrade blood flow past the cannula in situ and following decannulation. Eight patients showed retrograde flow which, in six cases, spontaneously reverted to normal whilst the child was still in hospital. The results of this study increased our conjidence in the appropriateness, safety and ease of use of these polypropylene cannulae in children where peripheral arterial vessel diameters are small.
Forum
Authors: Heath Margaret L.
Published: February 2007

Serious accidents in which the possibility of equipment‐related hazards are raised have been reported to the Scientific and Technical Branch of the Department of Health and Social Security. The author has examined anonymous summaries of 23 such reports of events which occurred over a 5‐year period. The principle cause of catastrophe in seventeen of the incidents was user error involving disconnexion or misconnexion. Faulty systems of equipment management combined in some cases with inadequate pre‐anaesthetic checking of apparatus were responsible for the other instances. Appropriate systems of equipment management and checking together with meticulous basic clinical monitoring are recommended as the best safeguards in anaesthetic practice.
Anaesthetic considerations in the mucopolysaccharidoses
Authors: KING David H. , JONES Ronald M. , BARNETT Michael B.
Published: February 2007

The anaesthetic problems we have encountered in eight patients with the mucopolysaccharidoses are described and the pathophysiology of this group of clinically progressive inherited diseases is reviewed with emphasis on the aspects of importance to the anaesthetist.
Nausea and vomiting during spinal anaesthesia
Authors: SPELINA K. R. , GERBER H. R. , PAGELS I. L.
Published: February 2007

A randomised, double‐blind investigation was undertaken into the value of metoclopramide and domperidone as anti‐emetics in orthopaedic patients who received spinal anaesthesia. Seventy‐seven patients were divided into three statistically comparable groups: Group I received 10 mg metoclopramide, Group II 10 mg domperidone, and Group III NaCl as placebo. These substances were given intravenously before the spinal puncture. There was a comparable decrease in mean arterial blood pressure (MAP), level of sensory block and dose of tetracaine in all three groups. The patients who were nauseated and/or vomited showed a greater decrease in MA P. The incidence of nausea and/or vomiting in the metoclopramide and the placebo group were similar, 20% and 15% respectively, whereas this complication was apparent in 35% of patients who received domperidone. We conclude that metoclopramide and domperidone in the dosages used are ineffective in alleviating nausea and vomiting after spinal anaesthesia.
Continuous sciatic nerve block
Authors: SMITH B. E. , FISCHER H. B. J. , SCOTT P. V.
Published: February 2007

A technique of continuous sciatic nerve block is described. The method was used to relieve pain from ischaemic gangrene of the foot for 2 days before below‐knee amputation and, combined with a continuous inguinal paravascular block, to provide regional anaesthesia both for the surgery and for the first 2 postoperative days.
Sacro‐iliitis in a heroin addict
Authors: GOMAR C. , LUIS M. , NALDA M. A.
Published: February 2007

A case is presented of a pregnant heroin addict patient, with a septic sacro‐iliitis due to Staphylococcus aureus. The incidence of joint infections in heroin addicts and the difficulty of diagnosis is discussed with the potential risks of spinal or extradural anaesthesia when there is infection in joints close to the needle site. Caution is advised with patients addicted to heroin who have low, back pain and may have infectious sacro‐iliitis.
Diazepam premedication in children
Authors: FELL D. , GOUGH M. B. , NORTHAN A. A. , HENDERSON C. U.
Published: February 2007

Oral diazepam 0.25 mg/kg or 0.5 mg/kg was employed as premedication in one hundred and one children undergoing elective surgery. The drug failed to modify the rise in cardiorespiratory indices of pre‐anaesthetic anxiety compared with control values, and there was no difference between the two doses assessed by a sedation scoring system. 0.25 mg/kg diazepam produced less sedation in children under 5 years old, compared with those 5 years and older, whereas 0.5 mg/kg produced no difference between the older and younger age groups. The plasma levels of diazepam were greater postoperatively in the 0.5 mg/kg group. There was no relationship between plasma diazepam and recall at induction, and pre‐anaesthetic amnesia was not enhanced with the higher premedication dose.
Variations on a theme: splitting ratio
Authors: Leigh J.M.
Published: February 2007

An expression for the splitting ratio (bypass gas/gas through vaporizing compartment) is derived formally. The factors affecting volatile agent gaseous fraction and, more importantly, partial pressure are discussed in relation to changes in temperature and barometric pressure. Low‐boiling point, high saturated vapour pressure anaesthetics are more susceptible to the influence of barometric pressure variations.
A comparison of the induction characteristics of thiopentone and propofol (2, 6‐di‐isopropyl phenol)
Authors: FAHY LEONORA T. , van MOURIK G. A. , UTTING J. E.
Published: February 2007

A study has been undertaken to compare the induction characteristics of the new intravenous anaesthetic agent 2,6 di‐isopropyl phenol, newly prepared in a lipid emulsion (propofol) with those of thiopentone. Despite a significantly higher incidence of pain on injection and spontaneous movement, the new agent was felt to perform comparably to thiopentone as an induction agent. Unfortunately, propofol caused decreases in blood pressure which were significantly greater than those seen after thiopentone. This feature may prove to be a considerable hurdle to the general acceptance of propofol.
Respiratory effects of epidural fentanyl
Authors: AHUJA B. R. , STRUNIN L.
Published: February 2007

Respiratory, function following single bolus doses as well as continuous infusions of epidural fentanyl were studied in 21 patients. Respiratory rate decreased significantly and end‐tidal CO2 showed a non significant increase following single doses of epidural fentanyl (1.5 μg/kg). These changes occurred within minutes of injection, hut could not be attributed solely to rapid systemic absorption of fentanyl from the epidural space. Prior administration of parenteral morphine resulted in significantly higher end‐tidal CO2 concentrations and lower respiratory rates following epidural fentanyl. Continuous epidural fentanyl infusion (0.5 μg/kg/hour) started 60 minutes after the bolus dose had no effect on end‐tidal CO2 concentration or respiratory rate for up to 18 hours. Infusions were continued after the study terminated for up to 9 days, during which there was no clinically significant respiratory depression.
Paradoxical air embolism during neurosurgery
Authors: CLAYTON D. G. , EVANS P. , WILLIAMS C. , THURLOW A. C.
Published: February 2007

Four cases of air embolism which occurred during neurosurgical procedures in the sitting position are described, in whom the signs could be due to air in the coronary or cerebral arteries. It is suggested that, during venous air embolism in the sitting position, a significant number of patients are haemodynamically at risk from paradoxical air embolism, and that the serious consequences of venous air embolism in neurosurgery may be due to this.
Phaeochromocytoma removal and postoperative hypoglycaemia
Authors: MEEKE R. I. , O'KEEFFE J. D. , GAFFNEY J. D.
Published: February 2007

A case of postoperative hypoglycaemia, following removal of a phaeochromocytoma is presented. The hypoglycaemia is due to a reactive rise in insulin and is augmented by alpha adrenoceptor blocking agents. Beta adrenoceptor blockers impair recovery, from this hypoglycaemia. Frequent monitoring of blood glucose and the administration of an appropriate solution of dextrose both during and after this operation is recommended.
Hyperpyrexia following psychotropic drug overdose
Authors: PEEBLES‐BROWN ANNE E.
Published: February 2007

A case of overdose of tricyclic antidepressants associated with severe pyrexia is reported in a patient taking monoamine oxidase inhibitors, and its management described. The similarities to and differences from the malignant hyperpyrexia syndrome are discussed.
Spinal anaesthesia for outpatient surgery
Authors: Flaatten H. , Raeder J.
Published: February 2007

In a prospective study of 51 young male outpatients given spinal anaesthesia through a 25‐gauge needle, we found a 37.2% incidence of postdural puncture headache. In addition, 54.9% complained of backache after surgery. Occurrence of headache significantly prolonged the sick‐Cave from work. General anaesthesia would be preferred by 31.4% of patients for a similar procedure in the future. These patients had a higher incidence of postoperative backache and pain during lumbar puncture. It is concluded that spinal anaesthesia is not a satisfactory technique for outpatient procedures in young men.
Controlled comparison of nalbuphine and morphine for post‐tonsillectomy pain
Authors: KRISHNAN A. , TOLHURST‐CLEAVER C. L. , KAY B.
Published: February 2007

A controlled investigation was conducted to compare the effectiveness of morphine and nalbuphine in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 4 and 12 years old were randomly allocated to receive intramuscular morphine 0.2 mg/kg, nalbuphine 0.3 mg/kg or no medication approximately 5 minutes before the conclusion of surgery. Pain and restlessness were assessed 1 and 2 hours after injection, and side effects were recorded. The assessments were made double‐blind. Both nalbuphine and morphine decreased restlessness and pain 1 hour (p<0.01) and 2 hours (p<0.05) after surgery. No significant differences were found between the two groups of patients who received opioids. Both nalbuphine and morphine caused more drowsiness than placebo 2 hours after surgery (p < 0.001). Other side effects were uncommon. Nalbuphine may ofSer advantages compared with morphine in regard to safety and convenience of use for the treatment of post‐tonsillectomy pain in children.
Gas exchange in the partially atelectatic lung
Authors: FLETCHER R. , LARSSON A.
Published: February 2007

An 11‐month‐old girl was anaesthetised for resection of a coarctation of the aorta. The child took part in a research project in which functional residual capacity (FRO and alveolar deadspace were being monitored on‐line. Initial measurements during controlled ventilation showed an unexpectedly low Pao2 and an alveolar deadspace more than double the normal value. After manual hyperventilation and tracheal suction, FRC increased by 25% and Pao2 and the alveolar deadrpace fraction reverted towarak normal values for an infant. We therefore had strong grounds for suspecting atelectasis, although the shunt through the atelectatic lung was, in theory, too small to account for the increase in olveolar deadspace. We also noted that the shape of the expired CO2 trace was improved after hyperinflation, as was the time needed to wash out SF, (the tracer gas used to measure FRO from the lung. From these observations, we conclude that atelectasis may be associated with more widespread disturbances of gas exchange than is generally realized, perhaps because of distension of adjacent lung regions.
Controlled neck compression in neurosurgery
Authors: PFITZNER J. , McLEAN A. G.
Published: February 2007

Bilateral compression of the jugular veins to raise temporarily cerebral venous pressure, is a manoeuvre recommended frequently in the immediate management of venous air embolism during neurosurgery. One method of compressing the neck veins is to inflate a pneumatic cuff secured around the neck with adhesive tape. This method of neck vein compression had been assessed in upright anaesthetised sheep and found to be an easily controlled and efficient way to raise the cerebral venous pressure. Advantages, dangers and potential problems associated with the use of an inflatable cuff in the clinical situation are discussed.
Wolff‐Parkinson‐White syndrome
Authors: JACOBSON L. , TURNQUIST K. , MASLEY S.
Published: February 2007

A patient with Wolff‐Parkinson‐White syndrome, susceptible to tachydysrhythmias, presented for eye surgery under general anaesthesia. He developed a supraventricular tachycardia refractory to a variety of treatments. Phenylephrine consistently abolished the dysrhythmia, probably by acting directly to stimulate the arterial baroreceptors and hence vagal output. Vasopressor therapy should be considered in Wolff‐Parkinson‐ White syndrome tachyarhythmias, when circumstances permit.
Indoramin‐induced hypotension. An evaluation during ear, nose and throat surgery
Authors: Millar S.W. , Thurlow A.C. , Findley I.L.
Published: February 2007

Indoramin, a competitive α1‐adrenoceptor antagonist, was administered intravenously to 12 fit patients aged 20–49 years during general anaesthesia with either halothane or enfluranefor ear, nose and throat surgery. A mean decrease of systolic blood pressure of 6 mmHg followed the initial dose of 0.1 mg/kg. Systolic blood pressures of 70–80 mmHg were achieved in nine patients using 0.29–4 mg/kg. The maximum effect of every dose was achieved within 3 minutes, with a probable duration of action of at least 30 minutes. Large changes of heart rate did not occur, though there was gradual slowing of the heart during each series of incremental administrations. Junctional rhythm, sometimes with bradycardia and hypotension, occurred in five patients (four in halothane group; one in en‐flurane group). Because of this, and the greater than ten‐fold variation in decrease of blood pressure for a single weight‐related dose, indoramin is not recommended for the reduction of blood pressure during halothane anaesthesia.
The haemodynamic effects of intravenous induction
Authors: GROUNDS R. M. , TWIGLEY A.J. , CARLI F. , WHITWAM J. G. , MORGAN M.
Published: February 2007

The haemodynamic changes following induction of anaesthesia with equipotent doses of propofol and thiopentone have been compared. Propofol caused a significant fall in arterial blood pressure and total peripheral resistance, with a slight fall in cardiac output. There were no changes in heart rate. Apart from an initial, but statistically insignificant increase in heart rate, similar changes were produced by thiopentone, but to a lesser degree. It is concluded that induction of anaesthesia with propofol results in acceptable haemodynamic changes, but that the agent is more depressant to the cardiovascular system than thiopentone.
Failed intubation
Authors: LYONS G.
Published: February 2007

Between 1978 and 1983, the tracheas of eight patients could not be intubated in the maternity unit of St James' University Hospital, Leeds. The incidence of failed intubation on our labour ward is approximately one for every 300 general anaesthetics given. The results of postoperative investigations in these patients are reported.
Haemodynamic changes during induction of anaesthesia with midazolam and diazepam (Valium) in patients undergoing coronary artery bypass surgery
Authors: KAWAR P. , CARSON I. W. , CLARKE R. S. J. , DUNDEE J. W. , LYONS S. M.
Published: February 2007

Midazolam 0.3 mg/kg and diazepam 0.5 mg/kg were used for induction of anaesthesia in two groups of 10 patients each undergoing coronary artery bypass surgery. Haemodynamic variables were measured during induction of anaesthesia, after pancuronium and following tracheal intubation. Haemodynamic indices were derived, from these measurements using standard formulae. The induction of anaesthesia with midazolam produced a slight but significant increase in heart rate. There was a significant fall in systemic arterial pressure and pulmonary artery pressure following both drugs. Despite the fall in systemic arterial pressure, the cardiac index was maintained in patients who received midazolam. The cardiostimulatory effect of laryngoscopy and tracheal intubation was not prevented by either of the benzodiazepines and morphine in the dosage used. Midazolam is a suitable alternative to diazepam as part of an intravenous induction regimen in patients with ischaemic heart disease.
The ‘wake‐up test’
Authors: CHAMBERLAIN M. E. , BRADSHAW E. G.
Published: February 2007

A case is presented in which there was a need for a ‘wake‐up test’. A technique is described, employing alfentanil and vecuronium given by infusion, and the problems of anaesthetic management are discussed.
The end of the crystalloid era?
Authors: TWIGLEY A. J. , HILLMAN K. M.
Published: February 2007

The metabolic response to surgery causes sodium and water retention. It does not seem logical to pour crystalloid solutions into patients in the peri‐operative period, particularly when these solutions can cause deterioration in lung function. Plasma volume must be maintained to prevent a decreased blood flow to vital organs such as the kidneys. Blood or colloid solutions, not crystalloid solutions, should be used for this purpose, since the latter are distributed throughout the whole extracellular space and are less effective in maintaining plasma volume. Water given as 5% dextrose should be given in minimal quantities to maintain intracellular hydration. Patients undergoing minor to moderate surgery when they are likely to be drinking within 24 hours do not usually require any intravenous infusion. Moreover, to administer intravenous fluids to these patients may cause harm. No fluid regimens should be inflexible and the patient's size, age and fluid losses should be taken into account.
Intravenous regional anaesthesia with ketamine
Authors: Amiot J.F. , Palacci J.H.
Published: February 2007

Ketamine, 40 ml 0.5% solution, was used in the technique of intravenous regional anaesthesia in 14 patients undergoing upper limb surgery. Satisfactory analgesia was obtained in 12 of the patients. The method is limited by the fact that all patients became unconscious within a few minutes of tourniquet release, and that this could not be prevented by naloxone.
Stanley Rowbotham
Authors: CONDON H. A. , GILCHRIST E.
Published: February 2007

Stanley Rowbotham was born in 1890 and spent the first years after qualification in 1915 with the Royal Army Medical Corps (RAMC). His career in anaesthesia began after the Armistice, when he was posted with Ivan Magill to Harold Gillies's plastic surgery unit at Sidcup. Together. they laid the foundations of tracheal anaesthesia. A versatile and inventive anaesthetist. Stanley Rowbotham later pioneered in the fields of thyroid anaesthesia, basal narcosis, local and intravenous analgesia and in the use of muscle relaxants. He also introduced cyclopropane into this country.
Epidural buprenorphine for postoperative analgesia. A controlled comparison with epidural morphine.
Authors: Wolff J. , Carl P. , Crawford M.E.
Published: February 2007

In a double‐blind controlled study. epidural buprenorphine 0.3 mg was compared with 4 mg of epidural morphine for postoperative pain relief the first 24 hours after major orthopaedic surgery. The degree of analgesia was equal and sarisfactory in both groups. Duration of action was 620 minutes with buprenorphine and 580 minutes with morphine, which was not significantly deferent. The only serious side effects were recorded in the morphine group, with two patients complaining of pruritus and give of urinary retention. In conclusion, epidural buprenorphine did not offer any advantages in preference to morphine for postoperative pain relief following orthopaedic surgery.
Ketamine by continuous infusion in status asthmaticus
Authors: STRUBE P. J. , HALLAM P. L.
Published: February 2007

A 13‐year‐old girl was admitted to the intensive care unit with status asthmaticus. Conventional bronchodilator therapy failed to relieve her bronchospasm. In order to try and avoid artificial ventilation, a continuous intravenous infusion of ketamine was used with success. The total dose rate was 40 μg/kg minute for a period of 8 hours; this was given at a decreasing rate. She regained consciousness 30 minutes after the end of the infusion and became well orientated after one hour. Ketamine is a useful drug in the intensive treatment of status asthmaticus and should be tried before a decision is taken to start mechanical ventilation.
Diabetes mellitus and open heart surgery
Authors: WATSON B. G. , ELLIOTT M. J. , PAY D. A. , WILLIAMSON M.
Published: February 2007

A method, based on bedside determinations of blood glucose by nursing staff, was designed to control the administration of insulin to diabetic patients during and following open heart surgery. A computer‐controlled intravenous infusion pump was used to deliver the insulin. Excellent control of the hyper‐glycaemia normally associated with open heart surgery was achieved, with 84 percent of measured blood glucose values falling within 2 mmol/litre of the target value of 6 mmol/litre. The method proved to be simple, effective, and safe.
Midazolam in conservative dentistry
Authors: Dixon R. A. , KENYON C. , MARSH D. R. G. , THORNTON J. A.
Published: February 2007

In a double‐blind trial, 50 patients were randomly allocated to receive up to 0.29 mg/kg diazepam (Valium 5 mg/ml) or 0.14 mg/kg of midazolam (midazolam hydrochloride 5 mg/ml) intravenously at a first session of conservative dentistry, the alternative being administered at the second session. Good operating conditions were reported under each sedative and no important physiological differences were observed. Most patients failed to return to ‘street fitness’ 30 minutes after either session of treatment. Previous reports of reduced incidence of venous thrombophlebitis with midazolam were not convincingly confirmed in this trial, but data quality was poor. For about half the patients, the amnesic effect was stronger following midazolam.
Arterial to end tidal carbon dioxide tension difference during Caesarean section anaesthesia
Authors: Shankar K. B. , MOSELEY H. , KUMAR Y. , VEMULA V.
Published: February 2007

The relationship between arterial carbon dioxide tension and end tidal carbon dioxide tension was studied in 19 patients during general anaesthesia for Caesarean section. Thirteen patients scheduled for elective abdominal hysterectomy formed a nonpregnant group. There was significant correlation between arterial and end tidal CO2 tensions in both groups. During Caesarean section, this difference was significantly less than in the nonpregnant group.
Nitrous oxide anaesthesia and vomiting
Authors: LONIE D. S. , HARPER N. J. N.
Published: February 2007

Eighty‐seven patients undergoing routine laparcscopy were divided randomly into two groups to study the effect of nitrous oxide anaesthesia on the incidence of postoperative vomiting. Patients in group A received nitrous oxide as part of their anaesthetic, while in group B nitrous oxide was omitted. Significantly fewer patients in group B vomited when compared with group A (17 percent and 49 percent respectively; p < 0.005). We suggest that an anaesthetic technique which avoids nitrous oxide may be especially indicated in patients undergoing laparoscopy.
The anaesthetist and the obstetric flying squad
Authors: CALLANDER C. C. , HUTTON P.
Published: February 2007

The demands made upon the Bristol obstetric flying squad over the past 14 years have been analysed. During this period, the number of calls received per year has decreased dramatically. The reasons for this are discussed in the context of current obstetric practice. The management of retained placenta is reviewed. Of importance to anaesthetists is the gross reduction in the number of cases where it is necessary to give anaesthesia ‘in the field’. This may lead to complacency and lack of familiarity with the equipment carried by the flying squad.
Anaesthetic management of Takayasu's arteritis
Authors: THORBURN J. R. , JAMES M. F. M.
Published: February 2007

A case of type IV Takayasu's arteritis in whom a renal autotransplant was performed is presented. Extensive cardiovascular measurements were made, which enabled the assessment of vascular responsiveness to various anaesthetic manipulations. The management of the condition is discussed and certain recommendations made in light of the experience gained.
Bronchospasm following the use of vecuronium
Authors: O'Callaghan A. C. , Scadding G. , Watkins J.
Published: February 2007

A case history is presented which records bronchospasm due to vecuronium. Immunological investigations, including basophil degranulation tests, indicated that the bronchospasm was not caused by direct histamine release and was not IgE mediated. It was of interest that intradermal testing gave a positive whealresponse against neuromuscular agents other than those involved in the anaesthetic procedure under investigation. A positive reaction to vecuronium was only obtained when given in a high concentration and accords with the general belief that vecuronium has extremely low potential for histamine release.
Oxygenation during electroconvulsive therapy
Authors: LEW J. K. L. , Eastley R. J. , HANNING C. D.
Published: February 2007

Oxyhaemoglobin saturation was monitored continuously during electroconvulsive therapy in two groups of patients. All patients were anaesthetised using methohexitone (40‐100 mg) and suxamethonium (25–50 mg). In group I (n = 48), the patients' lungs were ventilated manually with oxygen in air (40–50%) during the modified convulsion. In group 2 (n = 47), the convulsion was allowed to subside before recommencing manual ventilation with a similar gas mixture. Eight patients in group I and seven patients in group 2 received more than one shock and were excluded, leaving 40 patients in each group. In group 1, one patient had a minimum oxygen saturation of less than 90% after the electric shock as opposed to I1 in group 2 (p < 0.01). Five of the patients in group 2 had a saturation of less than 80%. It is concluded that patients undergoing electroconvulsive therapy should be ventilated with an oxygen‐enriched gas mixture during the convulsion induced by the electric shock in order to avoid hypoxaemia.
Ilioinguinal nerve block in children
Authors: Markham S. J. , Tomlinson J. , Hain W. R.
Published: February 2007

Fifty‐two boys undergoing herniotomy, orchidopexy or ligation of patent processus vaginalis under general anaesthesia had supplementary analgesia; 26 had a caudal epidural block and 26 an ilioinguinal block. Analgesia was assessed both during and after surgery. Ilioinguinal block provides a useful alternative to caudal block.
Respiratory monitoring with a new impedance plethysmograph
Authors: Hoffman S. , Jedeikin R. , Atlas D.
Published: February 2007

A new impedance plethymograph respiratory monitor, (AR‐8800). was tested on anaesthetised dogs. Decreases in tidal volume and total apnoea were brought about by partial and complete airway obstruction and by partial and total muscle paralysis. The changes in respiration were reliably detected by the monitor and its alarms activated within 15–20 seconds. The misinterpretation of gross body movement as normal breathing did not occur. Our findings suggest that the AR‐8800 is a safe and dependable monitor which has distinct advantages and may be of particular use in the monitoring of patients at risk of developing respiratory depression or obstruction, whether in the intensive care unit, the general ward or at home.