bluuebunny/crossref_metadata_2025 huggingface dataset:
Horner's syndrome and vocal cord paralysis as a complication of percutaneous internal jugular vein catheterisation in adults
Authors: DAVIS P. , WATSON D.
Published: February 2007

Cases of neurological deficit following cannulation of the internal jugular vein in adults are reported. From a consideration of the techniques and topography the possibility of damage to the ansa subclavia and recurrent laryngeal nerve is highlighted.
The anaesthetist in the operating theatre
Authors: LODER R. E.
Published: February 2007

The author retired from active practice, as a consultant anaesthetist in the British National Health Service during 1980 at the age of 60. He kept a detailed diary for the last full year as a consultant. One of the Editors suggested that the diary, augmented by his considered views culled from the experiences of a professional lifetime, could form the basis of a series of essays on various aspects of the life and practice of a consultant anaesthetist during the second half of the twentieth century. This essay considers the often unrecognised influence the anaesthetist can have in ensuring that the best possible conditions for the successful surgical treatment of the patient are created in the operating theatre.
A comparative study of enflurane and halothane in children
Authors: O'NEILL MAUREEN P. , SHARKEY A. J. , FEE J. P. H. , BLACK G. W.
Published: February 2007

Equipotent concentrations of enflurane and halothane inhaled by children caused substantial hypotension and respiratory depression, these changes being more pronounced with the former agent.

Plasma catecholamine levels were unaltered indicating that enflurane, like halothane, elicits little sympatho‐adrenal response.

Induction of anaesthesia and recovery times were largely comparable but earlier and more frequent use of narcotic analgesics was required after enflurane anaesthesia.
Is there an optimal P50 of haemoglobin?
Authors: SOLD M. J.
Published: February 2007

The effect a permanent change in the oxygen‐haemoglobin affinity would have on the oxygen transport system is considered theoretically. The calculations were based on Hill's equation and its derivatives. It was demonstrated that in normoxia and at normal oxygen consumption the position of the oxyhaemoglobin dissociation curve of the human adult (P50 3.53 kPa) differs from the optimal position calculated and that a right‐shift (increase in P50) would be favourable. However, the higher the oxygen consumption and therefore the saturation change, and/or the more pronounced the hypoxia, the more the P50 found in vivo coincides with the theoretical optimum.
Minimal haemolytic effects from 0.8% chlormethiazole infusion in volunteer subjects
Authors: SEOW L. T. , RYALL R. G.
Published: February 2007

A solution of 0.8% chlormethiazole ethanedisulphonate was infused into the antecubital vein of 14 healthy volunteers for periods ranging from 60 to 120 minutes to examine any haemolytic effects in vivo. Plasma haptoglobin and haemopexin concentrations were measured before, during and after infusion. No evidence of intravascular haemolysis of any clinical significance was found.
The anaesthetist and intensive care
Authors: LODER R. E.
Published: February 2007

The author retired from active practice as a consultant anaesthetist in the British National Health Service during 1980 at the age of 60. He kept a detailed diary for the last full year as a consultant. One of the Editors suggested that the diary, augmented by his considered views culled from the experiences of a professional lifetime, could form the basis of a series of essays on various aspects of the life and practice of a consultant anaesthetist during the second half of the twentieth century. This essay considers the present and future role of the anaesthetist in intensive care and the need for proper policies of organisation and training in that discipline.
Effect of doxapram on postoperative oxygenation in obese patients
Authors: HOLLWAY T. E. , STANFORD B. J.
Published: February 2007

An infusion of doxapram in 5% dextrose at a rate of 2 mg/kg/hour for 6 hours, or of 5% dextrose alone, was given to 20 grossly obese patients who had undergone upper abdominal surgery. There was no statistically significant difference in the degree of hypoxaemia or the incidence of chest infections between the two groups.
Intra‐ocular pressure too low
Authors: CAMERON A. E.
Published: February 2007

Three instances are described where general anaesthesia may have resulted in such a profound reduction in intra‐ocular pressure as to prevent completion of the planned operations.
Midazolam/fentanyl. A total intravenous technique for short procedures
Authors: Holmes C. McK. , Galletly D.G.
Published: February 2007

Midazolam (RO 21‐3981), a water soluble benzodiazepine, was used in combination with fentanyl as a total intravenous anaesthetic for outpatient cystoscopy. It was compared with a similar technique using Althesin and fentanyl.

In both series good conditions were produced, and patient acceptance was high, with absence of pain on injection, no inappropriate muscle movements and no nausea or vomiting. The induction and recovery times were slightly longer in the midazolam series, but not undesirably so. There appeared to be a slight incidence of phlebitis with midazolam, but because the patients were discharged from hospital, the exact incidence could not be ascertained with certainty.
Safer sedation for ventilated patients. A new application for etomidate
Authors: Edbrooke D.L. , Newby D.M. , Mather S.J. , Dixon A.M. , Hebron B.S.
Published: February 2007

A technique is described for sedation of ventilated patients. Six patients who underwent major maxillofacial surgery were given low dose infusions of etomidate and fentanyl for postoperative sedation. Measurements of respiratory function were recorded before and during the period of intermittent positive pressure ventilation. Plasma etomidate levels were estimated.

After initial stabilisation an almost constant rate of infusion was used to provide a reproducible level of sedation from which the patients were easily aroused. All patients maintained an adequate minute volume when disconnected from the ventilator. All measured and derived respiratory indices remained within normal limits. Patients exhibited amnesia throughout the period of infusion. All patients found this method of sedation pleasant. This technique may be recommended as an alternative to conventional methods of sedation for ventilated patients.
Midazolam and diazepam for gastroscopy
Authors: AL‐KHUDHAIRI D. , WHITWAM J. G. , McCLOY R.F.
Published: February 2007

Midazolam 0.1 mg/kg was compared with diazepam 0.15 mg/kg intravenously in patients undergoing gastroscopy. The patients receiving midazolam were more sedated at the end of the procedure. The mean discharge times from the clinic for diazepam and midazolam patients were 85 and 102 minutes, respectively. The principal differences between the two drugs were that midazolam had a faster rate of onset, was virtually free from venous complications, provided much better amnesia (90% compared with 50%), and although the recovery time was longer with midazolam, the rate of recovery during the period of observation was faster. Neither drug caused any significant cardiorespiratory depression.
Premedication with atropine or glycopyrrolate in children Effects on heart rate and rhythm during induction and maintenance of anaesthesia
Authors: Mirakhur R.K.
Published: February 2007

Atropine 15 μg/kg and glycopyrrolate 5 or 10 μg/kg were studied as anticholinergic premedicants in groups of 20 children each. A control group of 20 children did not receive anticholinergic premedication. Both atropine and the higher dose of glycopyrrolate produced significant increases in heart rate prior to induction of anaesthesia. The subsequent increase during the process of induction was less than in those who had not received an anticholinergic drug or glycopyrrolate 5 μg/kg. Dysrhythmias during induction of anaesthesia occurred slightly less frequently in the patients given atropine or the higher dose of glycopyrrolate. Although the incidence was similar in these two groups, ventricular ectopic beats occurred less frequently following the use of glycopyrrolate. The control of secretions was also superior with this anticholinergic premedicant.
The anaesthetist and the day‐surgery unit
Authors: LODER R. E.
Published: February 2007

The author retired from active practice as a consultant anaesthetist in the British National Health Service during 1980 at the age of 60. He kept a detailed diary for his last full year as a consultant. One of the Editors suggested that the diary, augmented by his considered views culled from the experiences of a professional lifetime, could form the basis of a series of essays on various aspects of the life and practice of a consultant anaesthetist during the second half of the twentieth century. This essay considers the role of the anaesthetist in providing safe anaesthesia, suitable conditions, and speedy recovery in the currently rapidly expanding field of day‐case surgery.
An adverse reaction to the administration of disoprofol (Diprivan)
Authors: BRIGGS L. P. , CLARKE R. S. J. , WATKINS J.
Published: February 2007

A case history is reported of an adverse reaction following intravenous injection of ICI 35,868 or disoprofol (Diprivan) resulting in hypotension. flushing and bronchospasm. There was full recovery and investigation confirmed the involvement of complement C3 and C4. The risks with cremophor‐containing anaesthetics are again stressed.
Cockayne's syndrome
Authors: COOK S.
Published: February 2007

A case is described of a child with Cockayne's syndrome undergoing anaesthesia for dental extractions. Problems were encountered during intubation; the reasons for the difficulty and the management of the case are described and discussed. This syndrome is rare but presents an unusual combination of abnormalities of particular importance to anaesthetists, especially since anaesthesia in patients with Cockayne's syndrome has not previously been described.
Effect of dantrolene on leg metabolism in porcine malignant hyperthermia
Authors: HALL G. M. , LUCKE J. N. , ORCHARD C. , LOVELL R. , LISTER D.
Published: February 2007

The effect of the intravenous administration of dantrolene 3.5 mg/kg body weight on leg metabolism during porcine malignant hyperthermia (MH) was investigated in six Pietrain pigs. Arterial pH improved only slowly after dantrolene and was associated with the continuing efflux of lactate from the leg. Oxygen uptake by the leg had returned to control values 30 minutes after dantrolene. Glucose production by the leg was observed during malignant hyperthermia but this was rapidly abolished by dantrolene. It is concluded that the most useful indices for assessing the adequacy of the treatment of MH are those which reflect changes in oxidative muscle metabolism.
Pemphigus vulgaris: anaesthesia in the traumatized patient
Authors: VATASHSKY E. , ARONSON H. B.
Published: February 2007

The anaesthetic management of a patient with pemphigus vulgaris who required eight anaesthetics over a 3‐month period, after sustaining closed fractures of both legs and degloving of one leg is described. The slow intravenous infusion of a ketamine/diazepam mixture and steroid therapy provided excellent peri‐operative conditions, without the need for the introduction of an airway or a tracheal tube.
Acute pulmonary oedema due to laryngeal spasm
Authors: COZANITIS D. A. , LEIJALA M. , PESONEN E. , ZAKI H. A.
Published: February 2007

Postoperative laryngeal spasm is an emergency which generally responds to ventilation of the lungs without further complication. In the life‐threatening case presented here, severe laryngeal spasm was associated with the development of acute pulmonary oedema.
Respiratory problems and acromegaly
Authors: GOLDHILL D. R. , DALGLEISH J. G. , LAKE R. H. N.
Published: February 2007

A case of an acromegalic patient who developed upper airway obstruction and acute pulmonary oedema after removal of a tracheal tube is described. The reasons for this and the significance of his history of hypersomnia and periodic breathing are discussed. Conclusions are reached about the management of acromegalics having general anaesthesia.
Editorial
Authors: Donne John , Nunn J.F.
Published: February 2007

Any man's death diminishes me, because I am involved in mankind.
Plasma potassium after halothane—suxamethonium induction in children
Authors: HENNING R. D. , BUSH G. H.
Published: February 2007

The changes in plasma potassium following inhalation induction of anaesthesia with halothane followed by suxamethonium were studied in 48 normal children aged 1 to 10 years. Highly significant increases were found in both age groups studied (5 years and under, and 6 to 10 years). The mean percentage increase in plasma potassium and the proportion of children in whom an increase of 0.4 mmol/litre or greater was found, were both greater than in an earlier study on children after thiopentone induction and suxamethonium.
Accidental deep hypothermia due to exposure
Authors: VAAGENES P. , HOLME J. A.
Published: February 2007

Two cases of deep hypothermia due to exposure to cold are described. Although the underlying mechanism and degree of hypothermia were comparable, there was a striking dissimilarity between the observed disturbances of body homeostasis, response to rewarming technique, clinical course and outcome in the two cases. The first case was severely acidotic. She was rewarmed by immersion in warm water, but died from an acute cerebrovascular accident. The second case was moderately intoxicated by alcohol and revealed few disturbing features. She was treated by the use of thermal mattresses and survived without complications.
Uncalibrated anaesthetic scavenging systems with open reservoirs
Authors: JØRGENSEN S. , JACOBSEN F.
Published: February 2007

Fifty‐three of 114 uncalibrated scavenging systems with open reservoirs had evacuation rates of less than 20 litres/minute. Analysis showed that there was no correlation between the number of hours in use since the date of the last service and the demonstrated change in effectiveness. Calibrated systems which can be continuously monitored have definite advantages.
A postoperative pain recorder
Authors: WELCHEW E. A.
Published: February 2007

An electronic device for use by ward patients to display and record linear visual analogues of pain, sedation and nausea is described.
A new multifunction nerve stimulator
Authors: DRUMMOND G. B. , WRIGHT A. D. J.
Published: February 2007

A new peripheral nerve stimulator for monitoring neuromuscular transmission during relaxant use is described and evaluated. Performance was according to specification and the characteristics are suitable for reproducible monitoring. Useful facilities are a display of the stimulating current, and a rapid check of battery state.
Nitrous oxide and middle ear pressure
Authors: CASEY W. F. , DRAKE‐LEE A. B.
Published: February 2007

The effects of different methods of induction of anaesthesia on middle ear pressure were investigated in healthy children. An increase in middle ear pressure associated with positive pressure ventilation with a bag and mask was demonstrated. When nitrous oxide was used, middle ear pressure increased by 39 mmH2O/minute in spontaneously breathing patients and 63 mmH2O/minute in those who were ventilated. Maximum pressures, with venting through the Eustachian tube, could be reached within 5 minutes in the latter group.
Pre‐operative chest X‐rays in elderly patients
Authors: TÖRNEBRANDT K. , FLETCHER R.
Published: February 2007

Of 100 consecutive patients of 70 or more years of age who presented for elective surgery, only 27 were considered to lack a medical indication for chest X‐ray. Of these 27, 10 patients had abnormal findings on the X‐ray. These figures suggest that routine pre‐operative chest X‐rays in elderly patients are well worthwhile, and that the savings made by abandoning the practice would be more than outweighed by potential delays and disruptions to theatre lists and the loss of relevant information.
A comparison of the response to suxamethonium in post‐partum and gynaecological patients
Authors: GANGA C. C. , HEYDUK J. V. , MARX GERTIE F. , SKLAR G. S.
Published: February 2007

The response to suxamethonium was assessed in 20 women undergoing tubal ligation on the first or second post‐partum day and in 20 women undergoing interval tubal ligation. The dose of suxamethonium which produced 80% depression of control twitch height was significantly lower in the puerperal patients. Similarly, recovery times following injection of a 20‐mg bolus of the drug were significantly longer in the post‐partum than the non‐obstetric group. Cholinesterase activity, determined in six post‐partum women, was inversely related to the time to maximal recovery. Thus, smaller doses of suxamethonium are required in the early puerperium.
Comparison of midazolam and flunitrazepam for night sedation
Authors: SJÖVALL S. , KANTO J. , KANGAS L. , PAKKANEN A.
Published: February 2007

In a double‐blind randomised study midazolam 15 mg and flunitrazepam 2 mg caused a significantly better night's sleep than placebo. Midazolam had a moderate sedative effect the following morning but, in other respects studied, no residual effects were found. In contrast, flunitrazepam decreased both the degree of apprehension and excitement the following morning. Flunitrazepam also inhibited salivary secretion and caused less cardiovascular changes than placebo or midazolam. The dose of thiopentone needed for induction of anaesthesia was significantly lower in those given flunitrazepam. The results show that midazolam is a potent sedative agent with a short duration of action.
An aldosterone‐producing adrenal cortical adenoma
Authors: SHIPTON E. A. , HUGO J. M.
Published: February 2007

Primary aldosteronism, when caused by an aldosterone‐producing adenoma, is a surgically treatable condition. An operation was performed on a 44‐year‐old patient with this condition. The pre‐operative preparation and anaesthetic management are presented. The specific problems of hypertension, hypokalaemia, hypokalaemic alkalosis and renal lesions, and their importance to the anaesthetist are discussed.
A nasotracheal tube for faciomaxillary surgery
Authors: READ D. H. , DU BOULAY M.
Published: February 2007

A preformed, precut, cuffed nasotracheal tube for use in patients undergoing faciomaxillary surgery was designed on the basis of measurements in 50 patients.
A nomogram to reduce errors in paediatric drug dose calculations
Authors: Wilson M.E. , MacLeod K.R.
Published: February 2007

Anaesthetists lacking special paediatric experience were asked to calculate the dose of some anaesthetic drugs for children of various weights and ages. Using their own routine method of calculation the doses varied considerably. A nomogram resulted in quicker and more accurate predictions.
Total intravenous anaesthesia with etomidate‐fentanyl
Authors: JONES D. , LAURENCE A. S. , THORNTON J. A.
Published: February 2007

A total intravenous anaesthetic technique using etomidate, fentanyl and neuromuscular blocking drugs with artificial ventilation of the lungs has been used in 90 patients undergoing elective general and gynaecological surgery. A two‐step schedule was used, based on a pharmacokinetic model for rapidly eliminated, intravenously administered drugs. Etomidate 100 μg/kg/minute with fentanyl 1 μg/kg/minute were given for 10 minutes, followed by a maintenance dose at a rate of one‐tenth this amount. Concurrent evaluation of the technique led to variations in the adjuvant drugs used (atropine, droperidol and neuromuscular blocking agent). The basic dose schedule provided adequate surgical anaesthesia for 76% of patients (although dose adjustments were used in the remainder), with recovery limes of 10 minutes or less in 57% of patients. No further opiate analgesia was needed in 40%o of patients postoperatively. Those patients given atropine intravenously prior to induction had a significantly lower incidence of nausea and vomiting postoperatively.
Postnatal paraparesis following epidural analgesia and forceps delivery
Authors: NEWMAN B.
Published: February 2007

A case of temporary postnatal paraparesis following epidural analgesia and Kielland's forceps delivery is described. The patient was found to have a narrow lumbar spinal canal on X‐ray. The possible causes of the paraparesis are discussed.
The effect of 50% nitrous oxide in oxygen on lower oesophageal sphincter tone
Authors: Brock‐Utne John G. , Downing John W.
Published: February 2007

The effect of 50% nitrous oxide on the lower oesophageal sphincter was studied in eight healthy volunteers. No effect on the sphincter lone was noted in these subjects. The importance of this finding is discussed in relation to the depressant effects of nitrous oxide and other anaesthetic or sedative drugs on the reflex protective mechanisms safeguarding the respiratory tract and lungs from aspiration of acid gastric content and other foreign matter.
Neurogenic pulmonary oedema
Authors: CASEY W. F.
Published: February 2007

Neurogenic pulmonary oedema is a not uncommon condition with a mortality that may exceed 90%. A fatal case in a 17‐month‐old child is reported. The literature is reviewed and current theories of the pathogenesis presented. Suggestions are made on how the condition might best be managed.
Vascular resistance during cardiopulmonary bypass Its effect on cardiac performance in the immediate post‐bypass period
Authors: PUTNAM E. A. , MANNERS J. M.
Published: February 2007

A clinical study was undertaken to measure changes in systemic vascular resistance during cardiopulmonary bypass in 56 adults. Forty‐five patients snowed a rise in systemic vascular resistance and 77% required no inotropic support in the immediate post‐bypass period. Eleven of the 33 patients undergoing valve replacement surgery showed only a small increase or an actual decrease in systemic vascular resistance and required inotropic support. These results were statistically significant. Factors affecting cardiac performance are discussed.
Phaeochromocytoma in pregnancy
Authors: STONHAM J. , WAKEFIELD C.
Published: February 2007

Two cases are reported in which Caesarean section was successfully performed under epidural analgesia in patients whose pregnancy was complicated by a phaeochromocytoma. Pre‐operative phenoxybenzamine therapy together with careful peri‐operative monitoring produced cardiovascular stability and led in both cases to the delivery of a healthy infant.
Epidural buprenorphine for pain relief after major abdominal surgery
Authors: CAHILL J. , MURPHY D. , O'BRIEN D. , MULHALL J. , FITZPATRICK G.
Published: February 2007

In a controlled trial epidural buprenorphine was compared with epidural morphine as the sole means of analgesia after major abdominal surgery. Bolus injections of buprenorphine 60 μg in 10 ml or morphine 2 mg in 10 ml of normal saline were given on demand for the first 48 hours postoperatively. Both drugs produced significant reduction in pain scores as assessed by the linear visual analogue scale and both produced prolonged analgesia at this dosage, which could be extended by further ‘top‐ups’. The authors conclude that, for postoperative epidural analgesia, buprenorphine may be the opiate of choice and the reasons for this are discussed.
Fatal thrombosis after subclavian catheter
Authors: HANSEN E. K. , CHRISTENSEN K. M.
Published: February 2007

A case is presented of fatal thrombosis in the superior vena cava due to an indwelling catheter. The possibility of this complication arising should be kept in mind.
Accidental cross‐connexion of oxygen and nitrous oxide in an anaesthetic machine
Authors: BONSU A. K. , STEAD A. L.
Published: February 2007

Oxygen and nitrous oxide pipes were cross‐connected during the servicing of an anaesthetic machine. This resulted in the delivery of 100% nitrous oxide instead of 100% oxygen at the end of the operation. The patient fully recovered and was discharged on the 13th day.
An anaesthetist in a camp for Cambodian refugees
Authors: Bion J.F.
Published: February 2007

The author describes his experiences as the junior anaesthetist for a Red Cross surgical unit on the Thai‐Cambodian border, from July to October 1981.
Evaluation of a new range of air drawover vaporizers
Authors: BORLAND C. W. , HERBERT P. , PEREIRA N. H. , THORNTON J. A. , WILLIAMS N. , THORNTON J. G.
Published: February 2007

The ‘Ether Pac’ and ‘Fluo Pac’ temperature compensated vaporizers have been evaluated in the laboratory and the ‘field’. Rigorous testing has demonstrated that these vaporizers are robust and reliable. Shaking, tilting and overturning do not significantly affect their performance. Both vaporizers deliver lower concentrations of the vapour than the setting on the vaporizers at low tidal volumes (100 ml). The ‘Ether Pac’ vaporizer output declines progressively with ambient temperatures below 23°C and a similar result occurs with the ‘Fluo Pac’ at temperatures below 20°C.

Clinical trials in Nepal, Kenya, Burma and the UK have demonstrated that, when halothane is used, oxygen enrichment is necessary during spontaneous and controlled ventilation. When ether is used with controlled ventilation oxygen enrichment is probably not necessary even with ambient pressures as low as 619 mmHg.
The safety of atropine premedication in children with Down's syndrome
Authors: WARK H. J. , OVERTON J. H. , MARIAN P.
Published: February 2007

Forty‐five operative procedures were performed in 32 patients with Down's syndrome at the Royal Alexandra Hospital for Children, Sydney in a single year recently. Atropine premedication was administered to 25 patients with Down's syndrome on 38 occasions. Three dosage regimes of atropine were used: 20/μ/kg, 12 μg/kg, both intramuscularly, and 10 μg/kg intravenously. There was no statistically significant difference in the alteration of heart rate for the three dosage groups of atropine used when children with Down's syndrome were compared with weight‐matched control children having similar operative procedures performed.
Cardiomyopathy and phaeochromocytoma
Authors: GILSANZ F. J. , LUENGO C. , CONEJERO P. , PERAL P. , AVELLO F.
Published: February 2007

A ease is presented of phaeochromocytoma with catecholamine‐induced cardiomyopathy. The difficulties in the management when left ventricular failure occurred are reported and the importance of monitoring pulmonary artery pressure during the anaesthetic procedure is stressed.
Anaesthesia for lower limb amputation
Authors: MANN R. A. M. , BISSET W. I. K.
Published: February 2007

Amputation of the lower limb for vascular disease has a high morbidity and mortality. A comparative study in 60 patients was carried out between spinal analgesia with sedation and general anaesthesia with controlled ventilation which maintained end expiratory carbon dioxide between 4–4.5 kPa. The spinal technique had advantages over general anaesthesia during surgery and in the first 24 hours, but no long term benefits.

Meticulous pre‐operative preparation, intra‐operative care and careful postoperative management, including monitoring of end expiratory carbon dioxide tension, appeared to be major factors contributing towards the low morbidity and mortality.
Glycopyrrolate: pharmacology and clinical use
Authors: MIRAKHUR R. K. , DUNDEE J. W.
Published: February 2007

This is a review of glycopyrrolate whose function in clinical practice is compared with that of atropine.
Interscalene block for Colles' fractures
Authors: Hughes T.J. , Desgrand D.A.
Published: February 2007

Interscalene brachial plexus block was considered for analgesia in 100 outpatients requiring manipulation of a displaced Colles' fracture. Of the 96 blocks performed, 88 (92%) provided satisfactory analgesia, and there were no serious problems. The place of this technique in the accident and emergency department is discussed with particular relation to alternative anaesthetic techniques.
Anaesthesia for trigeminal nerve thermocoagulation
Authors: Lowe S.S. , Meurer Mary , Ingram G.S. , Thomas D.G.T.
Published: February 2007

We report our experience in developing a technique for sedation and anaesthesia suitable for patients undergoing percutaneous radiofrequency thermocoagulation to the Gasserian ganglion.
Intensive management of severe head injuries
Authors: MOSS E. , GIBSON J. S. , McDOWALL D. G. , GIBSON R. M.
Published: February 2007

Seventy‐six severely head‐injured patients, 67% of whom had Glasgow Coma scores of five or less on admission, were managed according to an intensive treatment regime which included controlled hyperventilation (under full muscular paralysis), high‐dose steroids, dehydrating agents, diuretics and hypnotics (Althesin and thiopentone). Intracranial pressure (ICP) was measured throughout the period of controlled ventilation. Treatment was directed to keeping the mean ICP below 25–30 mmHg and to the prevention of increases in ICP during chest physiotherapy and other noxious stimulation.

Six months after injury 46% of patients had died and 4% were vegetative survivors, whilst 43% had made a good recovery or were only moderately disabled. Features associated with worse than average prognosis were: low coma score, pupillary abnormalities, respiratory dysrhythmia and ICP > 30 mmHg. Spontaneous hyperventilation was a relatively good initial feature.

These results support the employment of intensive care in severely head‐injured patients, particularly those with diffuse brain injury.
Hypotension following cimetidine administration during cardiopulmonary bypass
Authors: HEINING M. , GROOM J. , LUTHMAN J. , APS C.
Published: February 2007

Intravenous administration of cimetidine may occasionally cause profound hypotension. Cimetidine 200 mg was administered as a bolus injection to patients whilst on cardiopulmonary bypass and subsequent changes in systemic arterial pressure were recorded. A statistically significant fall in arterial pressure was observed (P < 0.001), which was attributable to a fall in systemic vascular resistance.
The urinary catheter as a bronchial blocker
Authors: CONACHER I. D.
Published: February 2007

Two cases are described in which problems with double lumen bronchial tubes occurred during thoracic surgery. A urinary catheter inserted down one lumen of each of the tubes enabled one lung anaesthesia to be continued without disturbing the surgery. This technique should be considered before abandoning one lung anaesthesia in those few cases where double lumen tubes fail to function as desired.
An assessment of the Dinamap 845
Authors: HUTTON P. , DYE J. , PRYS‐ROBERTS C.
Published: February 2007

The accuracy of the Dinamap 845 automatic blood pressure recorder was assessed by comparing its own indirect determinations of blood pressure with direct intra‐arterial recordings. It was found that in the majority of cases it was capable of producing reliable trend information during anaesthesia. The instrument may not be able to interpret pressure signals from a patient with a severe dysrhythmia. It is probably an unsuitable monitor for use with very rapidly acting drugs such as sodium nitroprusside.
Beta‐adrenoceptor blockade and anaesthesia for thyroidectomy
Authors: HAMILTON W. F. D. , FORREST A. L. , GUNN A. , PEDEN N. R. , FEELY J.
Published: February 2007

The administration of beta‐adrenoceptor blocking drugs in the pre‐operative preparation and operative management of thyrotoxic patients undergoing subtotal thyroidectomy is reviewed. Particular reference is made to some of the recent advances and it is emphasised that there has been a considerable reduction in the incidence of problems following judicious use of these drugs. The choice of anaesthetic technique employed for thyroidectomy is less important than the degree of control of thyrotoxicosis by the beta‐adrenoceptor blocking drug. Propranolol has proved safe and effective for the majority of patients. The longer acting agent nadolol is easier to administer, particularly in the peri‐operative period. Patients are rendered less thyrotoxic and safety thereby enhanced by adding potassium iodide for 10 days pre‐operatively. The combination of nadolol and potassium iodide offers real advantages in the preparation of the thyrotoxic patient for surgery.
A rare complication of extradural analgesia
Authors: PEARSON R. M. G.
Published: February 2007

A case is reported of probable subdural injection of bupivacaine during attempted extradural analgesia for an operative obstetric procedure.
Immune reaction to propanidid*
Authors: CHRISTMAS D.
Published: February 2007

An adverse reaction to the intravenous anaesthetic agent propanidid is described in which the main features were hypotension, facial erythema, and abdominal pain. Changes in serum complement levels and differential white cell counts indicate that this was an immune reaction mediated by the classical complement pathway. The immune reaction apparently involved antibodies other than those of the IgE (reagin) class, and circumstantial evidence suggests that it was specific to propanidid rather than to the entire formulation or to Cremophor EL.
Dantrolene sodium and dystrophia myotonica
Authors: PHILLIPS D. C. , ELLIS F. R. , EXLEY K. A. , NESS M. A.
Published: February 2007

A patient with dystrophia myotonica was given dantrolene sodium to try to provide muscle relaxation during a cholecystectomy. Dantrolene was used as it is accepted that the drug has a place in the control of spasticity and also causes muscle relaxation, whereas conventional muscle relaxants are unable to control myotonia of muscle origin. Dantrolene alone did not provide good enough intubating and operating conditions in this subject. Later studies showed that, after dantrolene, EMG recordings from the patient were not significantly altered, although an impression of a slight increase in the myotonic potentials was gained.
A modified blood microfilter
Authors: WALKER A. K. Y.
Published: February 2007

A simple modification to a blood microfilter is described which has advantages particularly during the transfusion of concentrated red cells.
Ankylosing spondylitis
Authors: SINCLAIR J. R. , MASON R. A.
Published: February 2007

The major problems of long‐standing ankylosing spondylitis are described and the surgical and anaesthetic literature reviewed. The upper airway problems are discussed with reference to four cases and the advantages of an awake intubation technique are stressed.
Etomidate by infusion for neuroanaesthesia
Authors: SEAR J. W. , WALTERS F. J. M. , WILKINS D. G. , WILLATTS S. M.
Published: February 2007

An etomidate infusion was used to anaesthetise twelve patients for spinal surgery; six (group I) with 67% nitrous oxide and six (group II) with oxygen enriched air. Anaesthesia was induced with infused etomidate at a rate of 100 μg/kg/minute for 10 minutes and maintained at a rate of 10 μg/kg/minute.

Recovery was assessed as the time to opening eyes on command (t1) and the time to giving correct date of birth (t2). In group I, mean value for t1 was 37.9 minutes and t2 59.1 minutes which is significantly longer than in group II where mean value for t1 was 9.0 minutes and t2 15.1 minutes. Blood was taken for estimation of etomidate levels. In group I the maintenance level was 501 ng/ml and the plasma clearance 20.9 ml/kg/minute. In group II the maintenance level was 367 ng/ml and plasma clearance 27.3 ml/kg/minute. Etomidate infusion appears to be a suitable alternative for neuroanaesthesia when nitrous oxide is contra‐indicated.
Postoperative spasticity and shivering
Authors: GOOLD J. E.
Published: February 2007

The cause of postoperative shivering is not known. The theories and possible remedies are reviewed. Five hundred patients were observed for the possible effect of lissive doses of gallamine, and of analgesic or benzodiazepine premedication. Diazepam premedication appeared to reduce the incidence of post‐halothane shivering.
Liquid crystal thermometry during anaesthesia
Authors: LACOUMENTA S. , HALL G. M.
Published: February 2007

The use of cutaneous liquid crystal thermometry (EZ Temp) as an estimate of core temperature during routine surgery was investigated in 20 patients. Seventeen per cent of the recordings made with the EZ Temp were more than 1°C different from oesophageal temperature. There was a poor correlation between EZ Temp values and both oesophageal and aural temperatures (r = 0.54 for both sites). We conclude that liquid crystal thermometry of the forehead is not sufficiently accurate to be used as an indicator of core temperature during routine surgery.
Intradural morphine and diamorphine
Authors: PATERSON G. M. C. , McQUAY H. J. , BULLINGHAM R. E. S. , MOORE R. A.
Published: February 2007

This open study of 81 patients having major orthopaedic surgery reviews the duration of analgesia and side‐effects of 0.625, 1.25 or 2.5 mg of morphine or 1.25 or 2.5 mg of diamorphine given intradurally in combination with 7.5 mg of cinchocaine at induction of anaesthesia.

A significant dose‐response relationship for duration of analgesia measured by time to first requirement of postoperative analgesic was found with morphine; 1.25 and 2.5 mg of morphine produced analgesia of longer duration than 0.625 mg. No such dose‐response was found for side‐effects. There was no significant difference in duration of analgesia between diamorphine 1.25 and 2.5 mg. and the duration was similar to that seen with the higher doses of morphine. An intradural dose of between 0.625 mg and 1.25 mg of either morphine or diamorphine used with cinchocaine and without additional parenteral opiate, may he appropriate.
Inhalation sedation with 25% nitrous oxide
Authors: EDMUNDSand D. H. , ROSEN M.
Published: February 2007

A field trial is reported of the use of a fixed concentration of 25% nitrous oxide to produce sedation in anxious dental patients. Three hundred and ninety‐four patients were treated on 1005 occasions. Ninety‐nine per cent of patients were treated successfully without any incidence of loss of consciousness, including 47 children who were treated on 88 occasions.
High frequency jet ventilation
Authors: JOHNSTON J. R. , COPPEL D. L. , WILSON J. J. , McLAUGHLIN B. F. , HILDEBRAND P. J.
Published: February 2007

A case is described where high frequency jet ventilation was used to avoid the cardiovascular depressant effects associated with conventional ventilation. Early weaning from inotropic and ventilatory support proved possible.
Anaesthetic vapour concentrations in the EMO system
Authors: SCHAEFER H.‐G. , FARMAN J. V.
Published: February 2007

Measurements of the vapour concentrations delivered by the EMO and Oxford Miniature Vaporizers (OMV) were made with both continuous (plenum mode) and intermittent (drawover mode) air flows. Leakage of ether, halothane and trichloroethylene vapours through the corrugated elephant tubing was also measured.

Both vaporizers performed most consistently with the intermittent flows, for which they were designed. Outputs were minimal at very low carrier gas flows, reached their greatest at the higher settings in the middle flow range and tended to be low at the highest flows. These effects were far more notable with continuous than with intermittent flows. Minimal amounts of ether were lost through the tubing but halothane losses were appreciable, while losses of trichloroethylene were enough to reduce the concentrations available to the patient.

The EMO is not suitable for plenum use with carrier gas flows below about 10 litres/min. The OMV is a useful plenum vaporizer although the outputs are generally lower than indicated at higher flows.
Postoperative analgesia in hip surgery A controlled comparison of epidural buprenorphine with intramuscular morphine
Authors: Murphy D.F. , MacGrath P. , Stritch M.
Published: February 2007

In a randomised controlled trial, epidural buprenorphine was compared with intramuscular morphine for postoperative analgesia in patients after hip surgery. Analgesia was given on demand and consisted of epidural boluses of 60 μg of buprenorphine in 10 ml of normal saline or intramuscular morphine 0.15 mg/kg. Both forms of analgesia produced excellent pain relief as assessed by the linear analogue scoring system. In both quality and duration of pain relief, no significant difference was found between the two forms of analgesia, but the total dose of epidural buprenorphine required was Jive times less than the equivalent dose of intramuscular morphine. No side effects attributable to epidural buprenorphine administration were found. The authors conclude that low dose epidural buprenorphine provides an excellent alternative to intramuscular opiates for pain relief after hip surgery.
Systems modification in obstetric analgesia
Authors: Levack I.D. , Tunstall M.E.
Published: February 2007

The need is identified of certain women in labour for a more potent analgesic than entonox. We describe a modification of the Entonox demand system incorporating an Oxford Miniature Vaporizer and there is a discussion directed towards its supervision.
Ventilatory response during halothane and enflurane anaesthesia
Authors: CHARLTON A. J. , LINDAHL S. G. E.
Published: February 2007

In six children with body weights between 11.4–18.7 kg, minute ventilation, tidal volume, respiratory rate, end‐tidal CO2 concentration and CO2 elimination were measured during both CO2 free breathing and CO2 breathing due to low fresh gas flows (maximal inspired CO2 about 2%) or the addition of CO2 from Rotameters (mean inspired CO2 about 1.5%) during both halothane and enflurane anaesthesia. All patients were undergoing hypospadias repair, received caudal analgesia prior to surgery and were intubated and allowed to breathe halothane/enflurane in O2/N2O (Fio2 0.5) spontaneously through a modified T‐piece system (Mapleson F). End‐tidal CO2 concentrations were similar with both agents during CO2‐free breathing and did not increase during CO2 breathing because of increased minute ventilation, of the same magnitude with both agents, which was achieved by larger tidal volumes. Respiratory rates were unchanged. No differences were found between halothane and enflurane at the light levels of general anaesthesia made possible by combination with caudal block.
Fibre‐optic assessment of tracheal tube position. A comparison of tracheal tube position as estimated by fibre‐optic bronchoscopy and by chest X‐ray
Authors: O'Brien D. , Curran J. , Conroy J. , Bouchier‐Hayes D.
Published: February 2007

The distance between the tip of a tracheal tube and the carina was measured in twenty five patients who required tracheal intubation and artificial ventilation of the lungs. Two methods of evaluation of this distance—limited fibre‐optic bronchoscopy and chest X‐ray—were compared. There was no significant difference between the distance measured by either method. The advantages of checking tracheal tube placement by fibre‐optic bronchoscopy are discussed.
Comparison of oral slow release morphine (MST) with intramuscular morphine for premedication
Authors: PINNOCK C. A. , DERBYSHIRE D. R. , ELLING A. E. , SMITH G.
Published: February 2007

Oral morphine sulphate slow‐release (MST) 40 mg and intramuscular morphine sulphate 10 mg, each administered with intramuscular atropine 0.6 mg, were compared in a randomised double‐blind trial as premedication agents in 30 patients undergoing abdominal hysterectomy. Both formulations produced sedation but no anxiolysis in the anaesthetic room, as measured by 10 cm, horizontal linear analogue scales. There was no significant difference between the preparations in terms of postoperative pain, recorded either by the linear analogue scales or using a patient questionnaire. The usage of analgesics and anti‐emetics postoperatively was comparable in both groups.
Patient‐controlled postoperative analgesia with alfentanil
Authors: WELCHEW E. A. , HOSKING JANE
Published: February 2007

A double‐blind study comparing aventanil and pethidine given intravenously by an adaptive, patient‐controlled on‐demand analgesic system is described. It was demonstrated that, despite its well‐known rapid onset of effect, alfentanil took several hours to achieve good quality analgesia. Nevertheless, it had a much more predictable consumption pattern than pethidine. Alfentanil was associated with significantly less sedation during the postoperative period than pethidine, and was also associated with a significantly greater urine output during the 24–hour period of study. There was no evidence of tolerance or accumulation with either of the two drugs.
The ‘Mini O2’ and ‘Healthdyne’ oxygen concentrators
Authors: HARRIS C. E. , SIMPSON P. J.
Published: February 2007

Two oxygen concentrators designed for home use, the ‘Healthdyne’ and the ‘Mini O2’, have been assessed with particular reference to their possible role in anaesthesia. Both were found to be a reliable source of oxygen enriched gas. Neither was fully capable of driving a gas powered ventilator satisfactorily, but both could potentially be very useful in normal and field anaesthetic practice.
Induction and recovery characteristics of isoflurane and halothane anaesthesia for short outpatient operations in children
Authors: Pandit Uma A. , Steude Georgine M. , Leach A.B.
Published: February 2007

Induction and recovery characteristics of isoflurane anaesthesia were compared with halothane anaesthesia during outpatient myringotomy and placement of Sheely ventilation tubes in 101 unpremedicated children. Compared with halothane, isoflurane resulted in prolonged induction times and inferior induction scores due to increased salivation, coughing, breathholding and laryngospasm. However, when modified by halothane induction, isoflurane anaesthesia decreased induction time and improved induction scores. Induction with thiamylal 4 mg/kg did not improve induction scores significantly. Recovery times from halothane plus isoflurane and pure isoflurane anaesthesia were quicker than pure halothane and thiamylal plus isoflurane, although this was not statistically significant. Compared to halothane, anaesthetic induction using isoflurane is associated with an increased incidence of respiratory problems in unpremedicated children.
Volume‐controlled high frequency positive pressure ventilation for upper abdominal surgery
Authors: BABINSKI M. F. , SMITH R. B. , SJÖSTRAND U. H.
Published: February 2007

Volume‐controlled high‐frequency positive pressure ventilation was evaluated and compared to intermittent positive pressure ventilation during anesthesia in 74 patients undergoing biliary tract surgery. There were no statistically significant differences in oxygenation or ventilation. Significantly lower airway pressures and lower tidal volumes were recorded during high frequency positive pressure ventilation. This technique was also used in eight morbidly obese patients during gastric stapling surgery, and provided adequate oxygenation and ventilation. Used intra‐operatively, it also produced a quiet operative field, which the surgeons appreciated during cannulation of the biliary duct and stapling of the stomach. At the end of the anaesthesia, high frequency positive pressure ventilation was superimposed on spontaneous breathing and operated as a new mode of intermittent mandatory ventilation. This reduced the risk of hypoxia at the time of emergence from anaesthesia and at tracheal suctioning.
The armlift test
Authors: BAR Z. G.
Published: February 2007

The armlift test was assessed as an alternative to the headlift test for recovery from neuromuscular blockade. Forty comparisons of inspiratory force, duration of arm‐lift and duration of headlift were performed in 27 intubated patients after anaesthesia, which included the use of non‐depolarising neuromuscular blockade. Patients' ability to keep one arm raised (with the elbow clear of the bed) correlated well with inspiratory force (r = 0.67). All patients capable of an armlift duration of 45 seconds or more were also found to have an inspiratory force of at least – 2.5 kPa and were safely extubated. The headlift test was found to be less discerning (r = 0.34) and of 40 determinations of headlift and inspiratory force there were 18 false negatives and two false positives.
Anaphylactoid reaction to oxytocin in pregnancy
Authors: SLATER R. M. , BOWLES B. J. M. , PUMPHREY R. S. H.
Published: February 2007

A case of an allergic reaction to Syntocinon (synthetic oxytocin) administered during Caesarean section is reported.