bluuebunny/crossref_metadata_2025 huggingface dataset:
Taxonomic partitioning shedding light on the diversification of parasite communities
Authors: Mouillot David , Poulin Robert
Published: January 2004

Power relations were used for 297 parasite communities of fish, bird and mammal hosts between the number of genera (G) and the number of species (S) per community to test for the relative importance of different processes in their diversification. For the bird hosts the relation was G∝S0.92, and for fish hosts it was G∝S0.97, but for mammal hosts, the number of parasite genera increases more slowly as a function of species richness (G∝S0.83), suggesting, among other possibilities, a higher rate of within‐host parasite speciation in mammals than in other vertebrates.
Contact sensitizer nickel sulfate activates the transcription factors NF‐kB and AP‐1 and increases the expression of nitric oxide synthase in a skin dendritic cell line
Authors: Cruz M. Teresa , Gonçalo Margarida , Figueiredo Américo , Carvalho Arsélio P. , Duarte Carlos B. , Lopes M. Celeste
Published: January 2004

Abstract:  Nuclear factor kappa B (NF‐kB) and activating protein‐1 (AP‐1) transcription factors are ubiquitously expressed signaling molecules known to regulate the transcription of a large number of genes involved in immune responses, namely the inducible isoform of nitric oxide synthase (iNOS). In this study, we demonstrate that a fetal skin‐derived dendritic cell line (FSDC) produces nitric oxide (NO) in response to the contact sensitizer nickel sulfate (NiSO4) and increases the expression of the iNOS protein, as determined by immunofluorescence and Western blot analysis. The sensitizer NiSO4 increased cytoplasmic iNOS expression by 31.9 ± 10.3% and nitrite production, as assayed by the Griess reaction, by 27.6 ± 9.5%. Electrophoretic mobility shift assay (EMSA), showed that 30 min of FSDC exposure to NiSO4 activates the transcription factor NF‐kB by 58.2 ± 7.0% and 2 h of FSDC exposure to NiSO4 activates the transcription factor AP‐1 by 26.0 ± 1.4%. Together, these results indicate that NiSO4 activates the NF‐kB and AP‐1 pathways and induces iNOS expression in skin dendritic cells.
Induction of Hsp90 protein expression in malignant melanomas and melanoma metastases
Authors: Becker B. , Multhoff G. , Farkas B. , Wild P.‐J. , Landthaler M. , Stolz W. , Vogt T.
Published: January 2004

Abstract:  The heat‐shock protein Hsp90 has been shown to be essential for the functional integrity of the telomerase complex. The telomerase activity is enhanced in melanoma and stabilizes the chromosomal integrity in proliferating cells. Furthermore, overexpression of Hsp90 induces silencing of point mutations in transcription factors which, otherwise, would result in a loss‐of‐function phenotype. In melanocytic lesions there is a higher risk of mutations caused by the enhanced proliferation in melanocytic cells. By analyzing microdissected melanocytic tumors by semiquantitative PCR, we demonstrate an overexpression of Hsp90 mRNA in malignant melanomas (10/14) and in melanoma metastases (6/6) as well as in melanoma cell lines (9/9) when compared with melanocytic nevi (2/9). These results could be confirmed on protein level by immunohistochemistry. While melanocytic nevi show discrete Hsp90 expression only in a minor fraction (2/9), malignant melanomas and metastases show a positive Hsp90 immunohistochemistry in the majority of cases; (7/9) and (13/14), respectively. In addition, by analyzing melanoma metastases by flow cytometry we show that Hsp90 is expressed on the surface of tumor cells (7/8). From these data we conclude that Hsp90 is present in advanced malignant melanomas and may have a stabilizing effect on the cellular functions in proliferating cells of melanocytic lesions and could thereby be a prerequisite for the tumor progression. As Hsp90 is expressed on the cell surface, it might also be a potential immunorelevant target structure for immunotherapy of melanoma.
Nurse‐initiated thrombolysis: a systematic review of the literature
Authors: Smallwood Andrew
Published: January 2004

• This article aims to review, in a systematic manner, the current published evidence base for nurse‐initiated thrombolysis

• Reasons for this evolution in nursing practice are outlined

• Themes emerging from the review are identified

• Methodological issues are discussed

• This article outlines a conceptual framework for practice evolution

• Further research is needed to improve the strength of the evidence base by studies with improved design
The implications of physical activity in patients with chronic heart failure
Authors: Mondoa Catherine T
Published: January 2004

• The clinical syndrome of chronic heart failure is increasingly prevalent. It can be considered a multiorgan disorder that may exert a negative physical and psychological influence on a patient

• Medication and surgical intervention have important roles to play and have certainly improved both morbidity and mortality in this field, but clearly these interventions alone are not enough

• Excessive resource utilization for this group of patients has provided added impetus to research into non‐pharmacological interventions. These encompass dietary and other lifestyle measures, including smoking cessation and exercise

• Exercise has been shown to favourably affect the functional capacity and quality of life. There is also emerging evidence that it reduces mortality

• In the absence of contraindications, regular endurance exercise coupled with strength training is undoubtedly beneficial

• As with other cardiovascular research, there is a trend towards recruiting middle‐aged males. This effectively means that practitioners need to be cautious when evaluating and/or implementing research evidence

• By addressing the implications of physical activity for deconditioned patients with chronic heart failure, a holistic therapeutic regimen is fostered. This has been shown to improve the quality of life of patients and to enhance the quality of service delivered to this patient group
Urinary catheter care in the intensive care unit
Authors: Marklew Anna
Published: January 2004

• Urinary catheters are associated with a number of complications, and nurses are ideally suited to minimize the associated risks by utilizing the available research in their practice

• Urine tract infections caused by urine catheters are associated with increased mortality; however, urine catheter care is a nursing procedure, the importance of which is sometimes overlooked

• This study reviews recommended guidelines on urine catheter care and current published literature on the subject

• The aim of the study was to identify recommended practice and compare it with the current research and literature to conclude best practice

• Conclusions made from this study are that existing guidelines correspond to the recommendations and findings in recent research and literature. However, more detailed guidelines and further research on how to prevent catheter‐associated urine tract infections and other complications may be of benefit
Ward nurses' evaluation of critical care outreach
Authors: Richardson Annette , Burnand Valerie , Colley Heather , Coulter Catherine
Published: January 2004

• Following the recommendation to introduce critical care outreach, two different models on two hospital sites were introduced within a large teaching Trust

• To establish ward nurses' views and opinions of important components of the two outreach models, a questionnaire survey was undertaken involving 134 ward nurses on the awareness of outreach, accessibility of outreach and usage of outreach

• The results identified a high level of user satisfaction amongst ward nurses. Awareness of critical care outreach and how to access the service within a hospital site was good, with little differences between the two different models. Outreach was found to provide ward nurses with better skills, more knowledge, advice and support

• Providing a 24‐h service and continual critical care education and training opportunities are the suggested ways to improve outreach in the future
Comparison of the Nellcor N‐200 and N‐3000 pulse oximeters during simulated postoperative activities
Authors: Lie C. , Kehlet H. , Rosenberg J.
Published: January 2004

Twenty‐six healthy volunteers were monitored simultaneously with the Nellcor N‐200 and N‐3000 pulse oximeters during nonhypoxaemic simulated postoperative activity. The overall number of registered events (hypoxaemic episodes or loss of signal) was fewer with the N‐3000 than with the N‐200 (8 vs. 32, p < 0.00005). Episodes of ‘desaturation’ of ≥5% from baseline were significantly fewer with the N‐3000 than with the N‐200 (5 vs. 19, p =0.0001), and lowest values below 90% occurred nine times on the N‐200, but were not seen with the N‐3000 (p <0.00005). Furthermore, episodes owing to loss of signal were significantly rarer with the N‐3000 than with the N‐200 (3 vs. 13, p =0.001). The Nellcor N‐3000 oximeter may offer an advantage over the N‐200 model when monitoring patients in the postoperative period.
A prospective two‐month audit of the lack of provision of a high‐dependency unit and its impact on intensive care
Authors: Ryan D. W. , Bayly P. J. M. , Weldon O. G. W. , Jingree M.
Published: January 2004

All admissions into a six‐bedded intensive care unit were audited prospectively over a 2‐month period. Data were collected daily and classified according to criteria for intensive care or high‐dependency admission. There were 30 planned admissions (72 bed days) following elective major surgery, seven admissions following semi‐elective surgery (41 bed days) and 47 emergency admissions (185 bed days). Overall bed occupancy was 89%. Of 366 possible intensive care days, 66 (23%) were occupied by high‐dependency patients. Of the planned admissions all but five were discharged within 2 days. There were 39 major complications during the study period requiring life‐saving interventions and 16 lesser but significant complications. In 12% of patients discharge was delayed because of the absence of a high‐dependency unit. Four patients were transferred to an intensive care unit in another hospital and four patients were discharged prematurely because other patients required urgent admission. Seven patients were refused admission and three patients scheduled for elective operations had their surgery deferred. We estimate that over the study period 22 additional patients could have been cared for if a high‐dependency unit existed.
The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section
Authors: Warwick J. P. , Kearns C. F. , Scott W. E.
Published: January 2004

The effect of subhypnotic doses of propofol on intrathecal morphine‐induced pruritus was studied in a prospective, randomly allocated, double‐blind controlled trial. Fifty‐eight women undergoing elective lower segment Caesarean section for a singleton fetus received spinal anaesthesia with 2.5 ml hyperbaric 0.5% bupivacaine and 0.2 mg of preservative‐free morphine. They then received propofol 1 ml (10 mg) or Intralipid 1 ml (control group) intravenously after delivery. Pruritus was assessed using a five‐point verbal rating scale at hourly intervals for 8 h. A second dose of their allocated treatment drug was administered at the first recording of significant pruritus. The pruritus score was reassessed after 5 min and the treatment was repeated if pruritus remained. There were no differences between the groups in the onset of pruritus or its successful treatment. No adverse side‐effects were associated with this dose of propofol. There were no differences in the incidence of post‐operative nausea and vomiting between the two groups. Subhypnotic propofol is not an effective treatment for intrathecal morphine‐induced pruritus in women following Caesarean section.
Delayed upper airway obstruction A life‐threatening complication of Dettol poisoning
Authors: Joynt G. M. , Ho K. M. , Gomersall C. D.
Published: January 2004

Dettol liquid is a commonly used household disinfectant and although it is labelled nonpoisonous, serious respiratory complications have been reported in up to 8% of cases of Dettol ingestion. We report a case in which the delayed onset of upper airway obstruction was treated with emergency awake, fibreoptic guided nasotracheal intubation. Based on information available in published cases and on our own experience, we suggest that patients who have ingested large volumes of Dettol, have a history of vomiting or unprotected lavage, or have evidence of ongoing oropharyngeal inflammation, are at high risk of this complication. They should be closely observed for at least 48 h after ingestion and the facilities and staff required for emergency airway management should be immediately available.
Evaluation of thoracic epidural catheter position and migration using radio‐opaque catheters
Authors: Hendriks G. W. H. , Hasenbos M. A. W. M. , Gielen M. J. M. , Egmond J. v. , Barentsz J. O.
Published: January 2004

Migration of thoracic epidural radio‐opaque catheters was evaluated in 25 patients scheduled for thoracic surgery in the supine position (n = 5) or in the lateral position with lateral extension of the thoracic spine (n =20). Chest radiography was performed daily for 3 days after operation. Eighty‐nine per cent of catheter tips were visualised in the epidural space. The catheter tip position was unchanged in all patients operated upon in the supine position. In the group operated upon in the lateral position, the catheter tip retracted from day 1 to day 2 by an average of 0.69 cm (SD 1.08; p <0.05); from day 2 to day 3 the average retraction was 0.35 cm (SD 0.67; p <0.05).
Prediction of a small internal jugular vein by external jugular vein diameter
Authors: Stickle B. R. , McFarlane H.
Published: January 2004

The relationship between internal jugular vein diameter as measured with an ultrasound imaging machine (SiteRite, Dymax) and external jugular vein diameter was studied in 50 anaesthetised patients undergoing elective cardiac surgery. There was an inverse correlation between external jugular vein diameter and internal jugular vein diameter (r = −0.47, p < 0.001). All patients with an external jugular vein diameter of 7 mm or greater had an internal jugular vein diameter of less than 15 mm. No patient with an external jugular vein diameter of less than 7 mm had an internal jugular vein diameter of less than 20 mm. No other patient dimension (height, weight, body mass index, neck circumference) predicted internal jugular vein size. These results suggest that a large external jugular vein (i.e. 7 mm or greater in external diameter) may be associated with a small internal jugular vein. A size 5.0‐mm internal diameter tracheal tube may be used to provide a rapid assessment of external jugular vein diameter.
Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation
Authors: Bo¨ttiger B. W. , Sinner B. , Motsch J. , Bach A. , Bauer H. , Martin E.
Published: January 2004

We evaluated intermittent and continuous thermodilution cardiac output data in 12 patients undergoing orthotopic liver transplantation. Measurements were performed at 16 predefined time points between induction of anaesthesia and 3 h after reperfusion of the liver graft. Cardiac output measurements yielded 192 data pairs (intermittent cardiac output range: 1.8–18.9 l.min−1, continuous cardiac output range: 3.3–20.0 l.min−1). During most of the procedure the correlation between intermittent and continuous cardiac output measurements was significant (r = 0.87, p < 0.0001), accompanied with a bias of −0.240 l.min−1 and a degree of precision of 1.789 l.min−1 (< 10.0 l.min−1: 1.137 l.min−1, ≥10.0 l.min−1: 2.220 l.min−1). However, in the early phases after caval clamping and after reperfusion, accuracy was not acceptable. Only during these phases did the difference between the mean values of pulmonary artery blood temperature and rectal temperature increase (after caval clamping) or decrease (after reperfusion). In conclusion, despite acceptable levels of accuracy and precision between intermittent and continuous cardiac output measurement under stable conditions, both methods showed markedly decreased accuracy and precision in the early phases after caval clamping and after reperfusion, possibly owing to increased thermal noise.
Cholinesterase Its significance in anaesthetic practice
Authors: Davis L. , Britten J. J. , Morgan M.
Published: January 2004

Plasma cholinesterase is an enzyme which has importance to the anaesthetist primarily for its rôle in the metabolism of suxamethonium, although other anaesthetic related drugs that this enzyme metabolises are also increasingly important. In this article we review current thoughts on the function, profile and chemistry of plasma cholinesterase. Causes of variations in the activity of the enzyme are described and the basis of genetic variations is explained.
Is Hartmann's the solution?
Authors: White S. A. , Goldhill D. R.
Published: January 2004

As Hartmann's solution is commonly used by anaesthetists, we surveyed a group of Part III FRCA candidates to establish their knowledge of its constituents and the purpose and metabolism of the lactate in solution. Of the 82 candidates surveyed only three (4%) accurately recorded the electrolytes and their concentrations in Hartmann’s solution. Lactate was stated to be a source of bicarbonate by 52 (63%) and a source of glucose by 17 (21%). The descriptions of lactate metabolism were largely imprecise, none was complete and 24 (29%) of candidates offered no explanation. The constituents of Hartmann’s solution and their concentrations are designed to match those of plasma, reducing ion and fluid shifts postinfusion. The lactate in Hartmann’s solution is metabolised by both oxidation and gluconeogenesis, predominantly in the liver, and bicarbonate is generated by both processes over 1–2 h.
Critical incident reporting in the intensive care unit
Authors: Buckley T. A. , Short T. G. , Rowbottom Y. M. , Oh T. E.
Published: January 2004

Critical incident reporting was introduced into the intensive care unit (ICU) as part of the development of a quality assurance programme within our department. Over a 3‐year period 281 critical incidents were reported. Factors relating to causation, detection and prevention of critical incidents were sought. Detection of a critical incident in over 50% of cases resulted from direct observation of the patient while monitoring systems accounted for a further 27%. No physiological changes were observed in 54% of critical incidents. The most common incidents reported concerned airway management and invasive lines, tubes and drains. Human error was a factor in 55% of incidents while violations of standard practice contributed to 28%. Critical incident reporting was effective in revealing latent errors in our ‘system’ and clarifying the role of human error in the generation of incidents. It has proven to be a useful technique to highlight problems previously undetected in our quality assurance programme. Improvements in quality of care following implementation of preventative strategies await further assessment.
Interscalene patient‐controlled analgesia
Authors: Lucas M. A. , Harrop‐Griffiths A. W.
Published: January 2004

The case of a patient undergoing revision total shoulder replacement is described in which postoperative pain relief was provided by patient‐controlled analgesia via a catheter inserted into the sheath of the brachial plexus by the interscalene approach.
Tracheal intubation conditions after one minute: rocuronium and vecuronium, alone and in combination
Authors: England A. J. , Margarson M. P. , Feldman S. A.
Published: January 2004

Rocuronium is a recently introduced nondepolarising neuromuscular blocking agent with a rapid onset and intermediate duration of action. Experimental observations have suggested that during onset it acts synergistically with other nondepolarising agents, but that at a steady state the combined action is additive. In order to investigate whether synergism during onset produces a clinical benefit we performed the following study of tracheal intubation conditions. Consenting patients presenting for elective surgery which required tracheal intubation were randomly allocated to receive a standard anaesthetic and either a twice ED95 dose of rocuronium, or vecuronium, or an equipotent mixture of both drugs. Tracheal intubation conditions were assessed after 60 s and scored as excellent, good, poor or impossible. The conditions produced in the rocuronium and the mixture groups were similar and both were significantly better than those of vecuronium. Excellent intubation conditions were achieved in 57% of the rocuronium group, 70% of the mixture group and 27% of the vecuronium group. We conclude that a mixture of rocuronium and vecuronium acts synergistically during the early part of their action and a mixture containing one ED95 of both agents provides comparable conditions for tracheal intubation as an equipotent dose of rocuronium.
A comparison of acceleromyography and mechanomyography for determination of the dose–response curve of rocuronium in children
Authors: McCluskey A. , Meakin G. , Hopkinson J. M. , Baker R. D.
Published: January 2004

In order to compare an acceleromyograph (TOF‐GuardTM) with a mechanomyograph (Grass FT03), the dose–response relationship of rocuronium was simultaneously determined in both arms of 15 children aged 3–11 years during anaesthesia with thiopentone, alfentanil and nitrous oxide. Three subgroups of five children received rocuronium 120, 180 or 240 μg.kg−1 randomly. The effective doses to produce 50% and 95% depression of the first twitch of the train‐of‐four determined by acceleromyography were 206 and 337 μg.kg−1, respectively, while these values determined by mechanomyography were 151 and 331 μg.kg−1, respectively. The dose–response curve obtained by acceleromyography was steeper and shifted to the right compared with that obtained by mechanomyography (p < 0.0001). The difference between the effective dose producing 50% twitch depression determined by the two devices was highly significant (p < 0.0001). In 13 out of 15 children, the acceleromyograph control train‐of‐four ratio was significantly greater than unity. Although there was a good correlation (r = 0.85) between simultaneous pairs of measurements of neuromuscular block, the acceleromyograph exhibited a bias of −25% relative to the mechanomyograph with wide limits of agreement (−62 to +12%). We conclude that acceleromyographic and mechanomyographic measurements should not be used interchangeably when determining the potency of muscle relaxants.
Oxygenation of patients undergoing ophthalmic surgery under local anaesthesia
Authors: Risdall J. E. , Geraghty I. F.
Published: January 2004

The oxygenation of 30 patients undergoing elective ophthalmic surgery without sedation whilst breathing air was studied and was compared with two methods of oxygen supplementation. Arterial oxygen saturation, inspired and expired oxygen and carbon dioxide were analysed. The delivery of oxygen at 2 l.min−1 via nasal cannulae was shown to be superior to a method which directed oxygen from under the surgical drapes.
Haemodynamic effects of intravenous nimodipine following aneurysmal subarachnoid haemorrhage: implications for monitoring
Authors: Radhakrishnan D. , Menon D. K.
Published: January 2004

Nimodipine is widely used in patients with aneurysmal subarachnoid haemorrhage for the prevention and treatment of delayed ischaemic neurological deficits. Intravenous nimodipine has significant vasodilatory properties and may compromise the achievement of haemodynamic targets in patients who receive hypertensive hypervolaemic haemodilution therapy. We have studied 22 patients who received postoperative therapy with intravenous nimodipine and show that in a substantial minority (29%) hypotension was not reversed by simple volume loading or low doses of inotropes. Formal haemodynamic assessment in these patients showed widely varying haemodynamic variables, with differences in the need for inotropic and vasopressor therapy. We conclude that optimal haemodynamic management in this subgroup of patients will require the use of pulmonary artery catheterisation.
Public perceptions of postoperative pain and its relief
Authors: Scott N. B. , Hodson M.
Published: January 2004

In order to evaluate the general public's knowledge of postoperative pain and its management, a simple questionnaire was devised and sent out to five general practices in Scotland and Yorkshire. Questionnaires were completed voluntarily by 529 people attending their general practitioner for reasons not related to surgery. Five hundred and fifteen completed questionnaires were analysed. Two hundred and thirty‐nine (46.4%) responders had undergone previous major surgery whereas 267 (51.8%) had not. Attitudes to pain varied greatly and confirm the findings of other surveys that amongst the general public there is little or no understanding of the nature of postoperative pain or of the methods available to treat it. Despite the published literature, the public have a high degree of confidence in the ability of doctors and nurses to treat such pain. Widespread public and professional education is required before further improvements can be made to such a universal and basic clinical problem.
Peri‐operative use of nonsteroidal anti‐inflammatory drugs in children: analgesic efficacy and bleeding
Authors: Rømsing J. , Walther‐Larsen S.
Published: January 2004

Nonsteroidal anti‐inflammatory drugs are effective in the management of mild to moderate postoperative pain in children. They can decrease or even eliminate the need for opioid analgesics, thus reducing or eliminating opioid‐induced side‐effects. The increasing peri‐operative use of nonsteroidal anti‐inflammatory drugs in children has, however, raised concerns about complications secondary to impaired haemostasis. To examine the extent of this unwanted side‐effect, this paper reviews the published literature on analgesic efficacy and bleeding following the peri‐operative use of nonsteroidal anti‐inflammatory drugs in children. The reviewed literature confirms that haemorrhagic events in the postoperative period occur, but results remain inconclusive regarding the association between peri‐operative use of nonsteroidal anti‐inflammatory drugs and disordered haemostasis. In order to maximise the benefit of nonsteroidal anti‐inflammatory drugs in children, the risks must be recognised and patients, clinical indications, the individual drug, timing and route of administration must be selected carefully. Nonsteroidal anti‐inflammatory drugs appear to play a valuable role in the further improvement of postoperative pain management in children.
Patients' memories of events during general anaesthesia
Authors: Bailey A. R. , Jones J. G.
Published: January 2004

Awareness remains a serious complication of general anaesthesia with potential adverse psychological sequelae. Even during seemingly adequate general anaesthesia, implicit memory may be retained along with the ability to subconsciously process auditory stimuli. As a result behaviour may be modified and postoperative progress influenced. We shall discuss the structure of memory and the effects of increasing doses of general anaesthesia on cognitive processes. In addition methods of assessing the depth of anaesthesia will be reviewed.
Peri‐operative stroke in general surgical patients
Authors: Kam P. C. A. , Calcroft R. M.
Published: January 2004

The incidence and aetiology of peri‐operative stroke in patients undergoing general surgical procedures are reviewed. Some general recommendations on the peri‐operative anaesthetic management of these patients are summarised.
Nitric oxide: description of a pipeline delivery system
Authors: Whiteley S. M. , Cohen A. T. , Laycock D. , Arrowsmith W. M. , Henrys P. D.
Published: January 2004

We describe a pipeline system suitable for the delivery of nitric oxide gas to an 18‐bed intensive care unit. The pipeline was developed and installed according to the current UK regulations HTM 2022, which relates to the supply of piped medical gases. Where HTM 2022 did not specify the appropriate standard, we consulted widely to achieve a safe solution. We continue to monitor all aspects of the performance of the pipeline to ensure safe operating practices and recommend changes to the standards.
The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol
Authors: Thompson J. P. , West K. J. , Hill A. J.
Published: January 2004

The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol were examined in two groups of 10 ASA 2 & 3 patients undergoing pulmonary surgery in a double blind, placebo‐controlled study. Endobronchial intubation was associated with a significant increase in arterial pressure and heart rate (p = 0.004), and a significant increase in plasma noradrenaline concentrations (p < 0.01) in the control group. The haemodynamic changes were smaller (p < 0.001) in the patients who received esmolol compared with the changes in the the control group. The increase in plasma noradrenaline concentrations was significantly greater (p < 0.05) in the esmolol group. The pressor response to endobronchial intubation in this study was of a similar magnitude to that known to occur in response to tracheal intubation.
Analgesia after day case laparoscopic sterilisation#A comparison of tramadol with paracetamol/dextropropoxyphene and paracetamol/codeine combinations
Authors: Crighton I. M. , Hobbs G. J. , Wrench I. J.
Published: January 2004

In a prospective, double‐blind trial we compared the analgesic efficacy of tramadol during the first 24 h after day case laparoscopic sterilisation with two commonly prescribed combination analgesics. Seventy‐five women were allocated randomly to receive oral paracetamol 325 mg/dextropropoxyphene hydrochloride 32.5 mg, tramadol 50 mg or paracetamol 500 mg/codeine phosphate 30 mg as required after a standardised anaesthetic technique. There were no significant differences in average or worst pain, sleep disturbance, mobility, number of tablets taken, satisfaction or preference for stronger analgesia (26.2% of all patients). The incidences of nausea and vomiting were comparable between groups. There was a trend towards a lower incidence of central nervous system side‐effects (drowsiness, dizziness, headache) in the paracetamol/codeine group. Tramadol may be considered an alternative analgesic for day case surgery although analgesic regimens of greater efficacy are required for many patients. The relative incidence of side‐effects for tramadol and other analgesics requires further evaluation.
Nausea and vomiting in the postoperative patient‐controlled analgesia environment
Authors: Woodhouse A. , Mather L. E.
Published: January 2004

Despite common clinical opinion that patient‐controlled analgesia should be renamed ‘patient‐controlled nausea’, there is little evidence in support of the notion that postoperative nausea and vomiting are exacerbated by the method. Indeed, data indicate that opioid‐sparing techniques are not associated with less postoperative nausea and vomiting. Although some evidence suggests that certain opioids are less emetogenic than others, this too does not stand scrutiny when compared across patients, although research is still required to find whether individual patients are better treated with a particular opioid. Similarly, the emerging practice of combining anti‐emetics with patient‐controlled analgesia needs wider study before it can be supported.
Gastric tonometry and prediction of outcome in the critically ill#Arterial to intramucosal pH gradient and carbon dioxide gradient
Authors: Gomersall C. D. , Joynt G. M. , Ho K. M. , Young R. J. , Buckley T. A. , Oh T. E.
Published: January 2004

Splanchnic ischaemia is thought to be of central importance in the development of multi‐organ failure and hence death in critically ill patients. It has been suggested that the arterial to gastric intramucosal pH gradient and the difference in partial pressure of carbon dioxide between gastric mucosa and arterial blood are more sensitive markers of splanchnic ischaemia than gastric intramucosal pH itself and thus should be predictors of mortality in the critically ill. We studied 62 critically ill patients within 6 h of admission to the intensive care unit and found no significant difference at 0, 12 or 24 h after admission to the study in either the arterial to gastric intramucosal pH gradient or the difference in partial pressure of carbon dioxide between gastric mucosa and arterial blood between survivors and nonsurvivors. We conclude that in contrast to gastric intramucosal pH neither the arterial to gastric intramucosal pH gradient nor the difference in partial pressure of carbon dioxide between gastric mucosa and arterial blood distinguish survivors from nonsurvivors.
Are coagulation studies on blood sampled from arterial lines valid?
Authors: Heap M. J. , Ridley S. A. , Hodson K. , Martos F. J.
Published: January 2004

Coagulation tests were performed on two venous blood samples and two blood samples from arterial lines taken from 79 patients on an intensive care unit. For the first arterial sample the discard volume was 4.5 ml and for the second arterial sample the discard volume was 16 ml. From each pair of venous samples a mean venous coagulation value was calculated. There were statistically significant differences between arterial and venous results and between the two arterial samples for activated partial thromboplastin time and thrombin time assays but not for prothrombin time, reptilase time and fibrinogen assays. However, these differences were sufficiently small to be of little clinical significance. The bias for the difference in activated partial thromboplastin time values between the first arterial sample and the venous sample was +1.24 s (limits of agreement: −4.39 to +6.87 s) and between the second arterial sample and the venous sample the bias was +0.89 s (limits of agreement: −3.25 to +5.03 s). Only 3.8% of first arterial samples and 1.3% of second arterial samples produced activated partial thromboplastin time values that were more than 10% longer than the corresponding venous values. No heparin was detectable in these arterial samples using a heparin assay (< 0.02 iu.ml−1). The differences between arterial and venous activated partial thromboplastin times were slightly but not significantly greater in subgroups of patients with moderately or severely deranged coagulation compared with a group with normal coagulation. We conclude that samples from arterial lines provide valid activated partial thromboplastin time results using a discard volume of either 4.5 ml or 16 ml.
Laryngeal mask lubrication
Authors: Keller C. , Sparr H. J. , Brimacombe J. R.
Published: January 2004

We compared 2% lignocaine gel with saline as a lubricant for the laryngeal mask airway in 126 patients receiving possible pressure ventilation in whom cuff pressures were limited to 60 cmH2O and peak airway pressures to less than 17 cmH2O. The incidence of sore throat was similar for both groups and there were no emergence problems. There were significantly more intra‐ and postoperative complications in the lignocaine group (p < 0.05) but the frequency of sore throat was similar when the device was inserted at the first. Positive pressure ventilation to normal end‐tidal CO2 values was possible in all patients. Lignocaine gel is an unsuitable lubricant for the laryngeal mask airway. Cuff pressure limitation to 60 cmH2O does not necessarily impede ventilation and may be an important factor in reducing emergency and postoperative complications.
A noninvasive method for evaluating the effect of thoracotomy on shunt and ventilation perfusion inequality
Authors: De Gray L. , Rush E. M. , Jones J. G.
Published: January 2004

A new noninvasive method was used to evaluate gas exchange in 12 patients undergoing thoracotomy for a variety of surgical procedures. A plot of inspired oxygen partial pressure versus oxygen saturation was analysed to calculate the independent contribution of shunt and intermediate ventilation/perfusion ratio which occurs during general anaesthesia for thoracotomy. A model based on the inspired to arterial oxygen difference involving the shunt equation was used to show how the relationship between inspired oxygen partial pressure and oxygen saturation could be used to derive two parameters of oxygen exchange, the virtual shunt and an index of low ventilation/perfusion ratio. In all cases, there was a very good fit of the data to the model. Thoracotomy caused a mean increase in shunt from 13.8% to 20.8% and a worsening ventilation/perfusion ratio from 0.5 to 0.2, the magnitude of which depended on the underlying pathology. In two patients, the ventilation/perfusion ratio decreased to less than 0.1. The method enables the prediction of oxygen saturation at different inspired oxygen partial pressures and allows the two components of gas exchange to be isolated using simple routine measurements of inspired oxygen and pulse oximetry.
Complete airway obstruction during awake fibreoptic intubation
Authors: Shaw I. C. , Welchew E. A. , Harrison B. J. , Michael S.
Published: January 2004

Awake fibreoptic intubation is well established as the optimum method of securing the airway in patients in whom difficulty is anticipated. We report a patient undergoing awake fibreoptic intubation in whom the use of topical local anaesthetic precipitated acute loss of the airway so that urgent surgical intervention was required.
Epidural abscess following epidural steroid and local anaesthetic injection
Authors: Knight J. W. , Cordingley J. J. , Palazzo M. G. A.
Published: January 2004

Epidural abscess is a well‐recognised but rare complication of epidural catheter placement. We have found only five previous reports of epidural abscess from noncatheter‐related administration of steroids and/or local anaesthetic. We describe a further case which led to critical illness and emphasise the association between diabetes mellitus and epidural infection.
Audit of opioid prescribing: the effect of hospital guidelines
Authors: Humphries C. A. , Counsell D. J. , Pediani R. C. , Close S. L.
Published: January 2004

The effects of prescribing guidelines for analgesia were assessed by auditing prescriptions for opioids before and after the introduction of hospital prescribing guidelines. Opioid prescriptions were collected by the pharmacy department over a 2‐week period in November 1994 and repeated in November 1995. Following the initial audit, analgesic prescribing guidelines were introduced. A statistically significant increase was achieved in the number of prescriptions that were correct for both dose and frequency according to both the British National Formulary recommendations (40–61%; p < 0.001) and our Acute Pain Service guidelines (16–26%; p < 0.05). There was a statistically significant decrease in the number of prescriptions that were inadequate for both dose and frequency according to both the British National Formulary recommendations (18–3%; p < 0.001) and our Acute Pain Service guidelines (36–17%; p = 0.001). The use of accessible prescribing guidelines promotes demonstrable improvements in opioid prescribing.
The Oxyvent#An anaesthetic machine designed to be used in developing countries and difficult situations
Authors: Eltringham R. J. , Varvinski A.
Published: January 2004

The Oxyvent is an anaesthetic machine designed specifically for use in the developing world and difficult situations. It is made up of four components, each of which has, in its own right, already proved to be of great value in difficult situations. These are the drawover system, the Penlon Manley Multivent Ventilator, the DeVilbiss Oxygen Concentrator and the air compressor. The four components are mounted on a simple trolley carrying two oxygen cylinders. The Oxyvent can be used to provide anaesthesia in the absence of electricity or oxygen or both. It is simple, robust and easily serviceable. It is versatile and can be used both as an anaesthetic machine in the operating theatre and as a ventilator in an intensive care unit.
Effects of a single pre‐operative dexmedetomidine dose on isoflurane requirements and peri‐operative haemodynamic stability
Authors: Lawrence C. J. , De Lange S.
Published: January 2004

In a double‐blind, placebo‐controlled study we investigated the effect of a single pre‐induction intravenous dose of dexmedetomidine 2 μg.kg−1 on anaesthetic requirements and peri‐operative haemodynamic stability in 50 patients undergoing minor orthopaedic and general surgery. Patients were anaesthetised with nitrous oxide/oxygen/fentanyl, supplemented if necessary with isoflurane. The mean (SD) intra‐operative isoflurane concentration was lower in the dexmedetomidine‐treated patients than controls (0.01 (0.03)% compared to 0.1 (0.1)%; p = 0.001) although six of the 25 treated patients required isoflurane at some stage. The haemodynamic response to tracheal intubation and extubation was reduced in the dexmedetomidine group as was intra‐operative heart rate variability; postoperative analgesic and anti‐emetic requirements and peri‐operative serum catecholamine concentrations were lower in the dexmedetomidine group. Hypotension and bradycardia occurred more frequently after dexmedetomidine.
Ease of insertion of the laryngeal mask airway by inexperienced personnel when using an introducer
Authors: Dingley J. , Baynham P. , Swart M. , Vaughan R. S.
Published: January 2004

The Portex introducer for the laryngeal mask airway was designed as an aid to successful insertion, acting as an idealised ‘artificial hard palate’ to guide the tip of the laryngeal mask into the correct position. A number of authors have investigated laryngeal mask insertion by unskilled personnel in certain situations, one example being nurses during in‐hospital cardiopulmonary resuscitation. We investigated whether the introducer had any effect on the incidence of first‐time successful LMA placement by unskilled personnel. These were nonanaesthetist doctors, randomly assigned to have one attempt at LMA insertion in an anaesthetised patient, with and without the introducer. In 44 patients with the LMA being inserted according to the manufacturer's instructions, there was a 68% success rate (14 failures). In 45 patients with the LMA being inserted with the aid of a Portex introducer, there was a 96% success rate (two failures). This was a highly significant improvement (p < 0.001).
Addition of adrenaline to pethidine for epidural analgesia after Caesarean section
Authors: Kee W. D. Ngan , Ma M. L. , Khaw K. S.
Published: January 2004

We have investigated the addition of adrenaline to epidural pethidine for postoperative analgesia in 40 patients after Caesarean section. In a randomised, double‐blind study, patients received pethidine 25 mg with adrenaline 50 μg (adrenaline group, n = 20) or pethidine 25 mg without adrenaline (plain group, n = 18) epidurally at the first request for postoperative analgesia. The median duration of analgesia was longer in the adrenaline group (196 min; IQR 123–286) compared with the plain group (96 min; IQR 43–113; p = 0.002) and plasma concentrations of pethidine in the first 30 min after injection were lower in the adrenaline group (p = 0.003). Visual analogue scale pain scores in the first 30 min after injection and onset of analgesia, defined by the time for pain scores to decrease by 50%, were similar between groups. Addition of adrenaline to epidural pethidine has advantages for analgesia after Caesarean section.
The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil
Authors: Bazin J. E. , Massoni C. , Bruelle P. , Fenies V. , Groslier D. , Schoeffler P.
Published: January 2004

We compared the duration of analgesia produced by a mixture of lignocaine and bupivacaine, either alone or combined with morphine (75 μgkg−1), buprenorphine (3 μgkg−1) or sufentanil (0.2 μgkg−1) in 80 patients after brachial plexus block for orthopaedic surgery of the upper limb. The characteristics of analgesia were evaluated hourly using a visual analogue scale. The analgesia was considered satisfactory for scores of 30 or less. The median duration (range) of satisfactory analgesia was: 11.5 (8–15) h without an opioid, 21 (9–27) h with morphine, 20 (14–34) h with buprenorphine and 24.5 (11–38) h with sufentanil. We conclude that the addition of an opioid to a local anaesthetic mixture lengthens the duration of analgesia.
Airway obstruction following internal jugular vein cannulation
Authors: Kua J. S. W. , Tan I. K. S.
Published: January 2004

A patient developed neck swelling following removal of an internal jugular vein cannula. Although tracheal extubation was delayed, severe airway obstruction occurred resulting in a cardiac arrest. He was successfully resuscitated. Doppler ultrasonography revealed a huge cervical haematoma surrounding a carotid artery pseudoaneurysm. The carotid artery pseudoaneurysm was obliterated using radiological intervention.
The effect of cricoid pressure and neck support on the view at laryngoscopy
Authors: Vanner R. G. , Clarke P. , Moore W. J. , Raftery S.
Published: January 2004

Fifty female patients were studied to compare the view of the larynx at direct laryngoscopy under general anaesthesia with and without cricoid pressure applied. We also compared the view using the standard technique of cricoid pressure with that using cricoid pressure in an upward and backward direction and further investigated whether these views were improved with a firm foam rubber neck support. The order in which the types of cricoid pressure were applied was randomised and also blinded with a drape over the neck. Cricoid pressure was simulated on weighing scales after each case and a mean force of 3.2 kg was applied. The majority of views at laryngoscopy (95%) were grade 1, with too few grade 2 and 3 views for statistical comparison. Both types of cricoid pressure applied without neck support were more likely to give a better view than no cricoid pressure (p < 0.01) and cricoid pressure in an upward and backward direction was more likely to give a better view at laryngoscopy than the standard technique (p < 0.01). Neck support during the standard technique of cricoid pressure did not improve the view of the larynx at laryngoscopy. Cricoid pressure is likely to improve the view at laryngoscopy which may be further improved by applying it in an upward and backward direction.
A comparative multicentre trial of spinal needles for Caesarean section
Authors: Hopkinson J. M. , Samaan A. K. , Russell I. F. , Birks R. J. S. , Patrick M. R.
Published: January 2004

We studied 681 patients in a randomised, multicentre, double‐blind, parallel group trial designed to assess the incidence of headache following spinal anaesthesia for Caesarean section using four different pencil point spinal needles. The needles used were: Whitacre 25G (n = 170), Polymedic 25G (n = 170), Sprotte 24G (n = 173) and Polymedic 24G (n = 168). The incidence of all headaches prior to discharge was 11.1%. Only five headaches (0.75%) were severe with features of post dural puncture headache (PDPH) and required an epidural blood patch: Whitacre 25G = 0, Polymedic 25G = 1 (0.6%), Sprotte 24G = 2 (1.2%), Polymedic 24G = 2 (1.2%). There was no statistically significant difference between the four groups for PDPH. We conclude that all four needles studied performed satisfactorily and comparably.