bluuebunny/crossref_metadata_2025 huggingface dataset:
Gelling of urea‐linked gelatin with fresh frozen plasma
Authors: MURRAY F. , HUTTON P.
Published: February 2007

Urea‐linked gelatin and succinylated gelatin were mixed with fresh frozen plasma and human albumin solutions in vitro, in varying concentrations and at different temperatures. Gelling was only seen in those mixtures that contained fresh frozen plasma and urea‐linked gelatin. It occurred at both room temperature and 37°C when the mixture contained more than 40% by volume of urea‐linked gelatin. Further tests confirmed that this was the result of calcium ions in the urea‐linked gelatin allowing coagulation to occur in the fresh frozen plasma.
Effect of buprenorphine on the cardiovascular response to tracheal intubation
Authors: KHAN F. A. , KAMAL R. S.
Published: February 2007

The effects of buprenorphine on the haemodynamic responses to tracheal intubation were studied in a placebo‐controlled double‐blind trial in 40 patients who had elective surgery. In one group saline was administered intravenously 8 minutes before induction, whereas the others received buprenorphine 2.5 μg/kg intravenously. Anaesthesia was induced in both groups with thiopentone 4 mg/kg followed by suxamethonium 1.5 mg/kg after 90 seconds. In the buprenorphine group, the maximum increase in systolic and diastolic arterial blood pressures, heart rate and rate pressure product were significantly lower compared to the control group. It is concluded that buprenorphine is partially effective in attenuating the cardiovascular response to laryngoscopy and intubation, but does not obliterate it.
Stellate ganglion block with bupivacaine
Authors: HARDY P. A. J.
Published: February 2007

Sympathetic blockade after stellate ganglion block with bupivacaine was assessed by liquid crystal thermography. The minimum concentration of bupivacaine required for successful block was between 325 and 406 μmol/litre. Further study of bupivacaine in a solution that contained potassium 5 mmol/litre showed that this reduced the minimum concentration of bupivacaine required for successful block to between 81 and 162 μmol/litre. We conclude that potassium has a major effect on the minimum concentration of bupivacaine required for sympathetic blockade.
Fluid flow through dural puncture sites
Authors: CRUICKSHANK R. H. , HOPKINSON J. M.
Published: February 2007

Leakage of artificial cerebrospinal fluid through human dura was measured in vitro after puncture by spinal needles. Fluid loss tailed off in all cases and ceased within 5 minutes in 10% of punctures made with a 22‐gauge needle, 28% made with a 26‐gauge and 65% made with a 29‐gauge needle (p < 0.05). The fluid loss was not reduced by alignment of the bevel of the needle parallel to the longitudinal direction of the fibres. Whitacre point needles of 22 gauge produced lower fluid loss than a 22‐gauge Quincke point needle inserted across the fibres (p < 0.05). Leakage rate was related to needle size, but not related to the alignment of a Quincke point. Little or no leakage occurred with 29‐gauge needles.
A modified expiratory valve for teaching
Authors: SANSOME A. J. , BACON R.
Published: February 2007

The shrouding of anaesthetic expiratory valves prevents the anaesthetist from either seeing valve disc movement or hearing clearly the escape of gas during expiration. A modification to one type of valve (Medishield II) is described which replaces this lost information by providing a direct indication of valve opening.
Crystalloid versus colloid for circulatory preload for epidural Caesarean section
Authors: MURRAY A. M. , MORGAN M. , WHITWAM J. G.
Published: February 2007

Sixty mothers were randomly allocated to receive either 2 litres of crystalloid or 1 litre of colloid solution (hydroxyethyl starch) in order to preload the circulation prior to elective Caesarean section under epidural anaesthesia. There were no differences in the incidence of hypotension, degree of haemodilution, umbilical cord blood gas tensions or umbilical blood osmolalities between the two groups.
Gastric emptying after head injury
Authors: POWER I. , EASTON J C. , TODD J. G. , NIMMO W. S.
Published: February 2007

Gastric emptying was measured in patients after head injury and compared with that of healthy volunteers using the rate of paracetamol absorption as an indicator of gastric emptying rate. There was a trend towards slower gastric emptying in the head injured patients, but the dyerences were not statistically significant.
Recurrent anaphylactoid reaction during Caesarean section
Authors: JACKSON I. J. B. , BRYSON M. R. , McPHAIL S. , BHALA B. B.
Published: February 2007

A 28‐year‐old woman presented for emergency Caesarean section at 31 weeks’gestation with deranged liver junction and a history of recurrent anaphylactoid reactions during previous pregnancy‐related anaesthetics. The anaesthetic management and outcome of this case is presented.
The effect of H2 antagonists on duration of action of suxamethonium in the parturient
Authors: Bogod D. G. , Oh T. E.
Published: February 2007

Fifteen patients who underwent elective Caesarean section were given sodium citrate, either alone or combined with oral cimetidine or ranitidine, as antacid premedication. No significant diflerences in time to 25 or 50% recovery of the first twitch of a train‐of‐four after administration of suxamethonium were found between any of the groups. It is concluded that H2‐antagonists do not significantly affect the duration of action of suxamethonium in parturients, in contrast to the findings of a study in nonpregnant patients.
Assessing collateral circulation in the hand—four methods compared
Authors: Glavin R. J. , Jones H. M.
Published: February 2007

Four ways to assess the collateral circulation in the hand were compared. No correlation was shown between the Doppler ultrasound method and those that used either the pulse monitor or the Ohmeda Biox 3700 pulse oximeter. The study was unable to confirm suggested benejits of these methods in assessing adequacy of collateral flow in the hands of unconscious patients.
Reversal of prolonged sedation using flumazenil in critically ill patients
Authors: Bodenham A. , Park G. R.
Published: February 2007

Thirteen critically ill patients received flumazenil after multiple doses, or an infusion, of midazolam was used as part of a sedation regimen to facilitate intensive care. All patients remained excessively sedated after the midazolam was stopped for 6 hours or longer. An improvement in conscious level occurred in eight patients (61%). In four of these eight patients, the duration of action of flumazenil necessitated its continued administration by an infusion to maintain the improvement in conscious level. The dose of flumazenil required each hour was less than estimated previously; this indicates that it may be subjected to similar alterations of elimination as those described for midazolam. Flumazenil appears to be a useful drug for the reversal of prolonged benzodiazepine sedation but repeated bolus doses or an infusion are needed if significant accumulation of benzodiazepines has occurred.
The effects of hypocapnic ventilation on mental function in elderly patients undergoing cataract surgery
Authors: JHAVERI R. M.
Published: February 2007

Mental function was studied using the Rivermead Behavioural Memory Test and the Unprepared Simple Reaction Time test in 83 elderly patients for cataract surgery. Three groups of patients were studied: Group N (n = 40) whose lungs were ventilated to a mean Paco2 of 4.9 kPa, Group H (n = 30) who were hyperventilated to a mean Paco2 of 2.9 kPa, and Group L (n = 13) who received local anaesthesia for surgery. The psychometric tests were administered on the day before the operation, and 4 days and 4 weeks after the operation. Statistically significant changes in the performance of hyperventilated patients could not be demonstrated using these tests.
Heat stroke—an uncommon presentation
Authors: van HEERDEN P. V. , COLLINS C. H.
Published: February 2007

A case of heat stroke is reported in which there was a delayed diagnosis and a fatal outcome. Recent literature is reviewed.
The attitudes of junior anaesthetists to research A survey
Authors: Gaylard D. G. , Lamberty J. M.
Published: February 2007

A survey was undertaken to investigate aspects of research work undertaken by junior anaesthetists. Two hundred and ninety‐five junior anaesthetists were surveyed. Forty‐seven percent of respondents were involved actively in research activities at the time of the survey, although 57% of senior house officers and registrars and 30% of senior registrars would not attempt to acquire publications except to improve their curriculum vitae. Few had received any formal training in research methods. The significance of these findings is discussed with regard to current training opportunities.
Lytic cocktail in children Rectal versus intramuscular administration
Authors: LAUB M. , SJØGREN P. , HOLM‐KNUDSEN R. , FLACHS H. , CHRISTIANSEN E.
Published: February 2007

The efficacy of the lytic cocktail (1 ml contains pethidine 28 mg, promethazine 7 mg, chlorpromazine 7 mg) administered intramuscularly or rectally as premedication was studied in 51 children aged 1–12 years who had minor elective otological surgery. One group received 0.05 ml/kg intramuscularly (maximum dose 2.0 ml) and the other 0.07 ml/kg per rectum (maximum dose 2.8 ml). Most were satisfactorily sedated before operation, but after operation the rectally premedicated children were less sedated, which was in agreement with lower plasma pethidine concentrations in this group. The rectal dose should be increased if prolonged postoperative sedation is desireable.
Malignant hyperthermia during isoflurane anaesthesia
Authors: McGuire N. , EASY W. R.
Published: February 2007

Two cases are presented which illustrate the essential features, diagnosis and management of malignant hyperthermia. Both cases occurred in association with isoflurane, and in patients who were exposed during previous anaesthetics to recognised trigger agents without apparent manifestation of the syndrome.
Monitoring of curarisation in patients with tetraparesis
Authors: FIACCHINO F. , BRICCHI M. , LASIO G.
Published: February 2007

Neuromuscular blockade induced by pancuronium was monitored on the trapezius and abductor digiti minimi muscles in three patients with upper motor neurone lesions: one patient was hemiparetic and two were tetraparetic. A greater sensitivity to pancuronium was always observed on the trapezius muscle. It is suggested that the assessment of curarisation is more reliable on proximal than on distal muscles if the patient's sensitivity to relaxants is expected to be generally low.
Hypotension due to unexpected cardiac tamponade
Authors: CYNA A. M. , RODGERS R. C. , McFARLANE H.
Published: February 2007

We report a case of profound hypotension, after induction of general anaesthesia, that resulted from unexpected cardiac tamponade. The differential diagnosis was complicated by the absence of any evidence to indicate that there was significant direct chest injury. Many of the recognised clinical signs of cardiac tamponade were absent, in particular, there was no compensatory tachycardia, and heart rate remained stable despite severe hypotension before surgical drainage of the pericardium. The possible aetiology and pathophysiology is discussed. It is suggested that after major trauma, cardiac tamponade should be considered as a possibility even in the absence of significantly abnormal cardiovascular signs, evidence of direct chest injury, or an abnormal chest X ray.
Pain on injection of propofol: the effect of injectate temperature
Authors: McCRIRRICK A. , HUNTER S.
Published: February 2007

A double‐blind, randomised clinical study was undertaken to compare the effect of temperature on the incidence and severity of the pain experienced on injection of propofol. The number of patients who experienced pain and the severity of the pain were reduced significantly when propofol was administered at a temperature of 4°C. The efficacy of propofol as an induction agent appeared to remain unaltered.
Inhaled fentanyl as a method of analgesia
Authors: WORSLEY M. H. , MACLEOD A. D. , BRODIE M. J. , ASBURY A. J. , CLARK C.
Published: February 2007

A study was undertaken to investigate the use of fentanyl by aerosol for postoperative analgesia. Seven patients had placebo, six received fentanyl 100 μg and seven were given fentanyl 300 μg. A significant improvement in postoperative pain, as assessed by linear visual analogue scale, was achieved in the higher dose group, and in both fentanyl groups the time to alternative analgesia was significantly longer than in the control group. Serum fentanyl levels after inhalation of 100 μg reached a plateau around 0.04 ng/ml and after 300 μg at around 0.1 ng/ml after 15 minutes. Inhaled fentanyl may have a useful analgesic effect despite these low serum levels; this supports the hypothesis that the mode of analgesia from inhaled opioids may be different from that after other routes of administration. There were no adverse effects such as respiratory depression, bronchospasm, nausea or drowsiness.
Painful onset of intrathecal blockade
Authors: READ M. S. , DYE D. J.
Published: February 2007

A case is described in which a woman with well controlled epilepsy and minor abnormalities of peripheral nerve function in the lower limbs experienced intense pain during the onset of a spinal anaesthetic for operation on burns on her thighs. Possible mechanisms and treatments are discussed.
A comparison of the effects of alfentanil/droperidol or fentanyl/droperidol on intra‐ocular pressure
Authors: Coley S. , Jones G. W. , Lassey D. , May A. E. , Fell D.
Published: February 2007

The influence of two intravenous sedative regimens on intra‐ocular pressure was investigated in conjunction with retrobulbar local anaesthesia. Forty patients were allocated randomly to either group A (alfentanil and droperidol) or group F (fentanyl and droperidol). Measurements of intra‐ocular pressure, arterial pressure and oxygen saturation were made before operation, after premedication, after intravenous sedation and after surgery. Paco2 was also measured before and after operation. Each sedation technique caused a similar reduction in intra‐ocular pressure. There was less effect on Paco2 and oxygenation in group A.
Comparison of propofol and thiopentone as anaesthetic agents for electroconvulsive therapy
Authors: BOEY W. K. , LAI F. O.
Published: February 2007

Propofol and thiopentone were compared as anaesthetic agents for electroconvulsive therapy in 31 patients on four occasions in a repeated measure crossover study. Discomfort on injection was significantly more common with propofol (51.6% of anaesthetics) compared to thiopentone (1.6% of anaesthetics). The duration of seizure was shorter with propofol in both treatments but there was significant drug‐time interaction. Propofol gave a milder tonus and clonus during seizure when both treatments were considered together. The increase in systolic and diastolic arterial pressures and heart rate after treatment were significantly higher with thiopentone. Apnoea was significantly longer with propofol. The times to sitting up unaided and opening the eyes on command were the same for both drugs. The ability to walk 10 m 20 minutes after anaesthesia was significantly better with propofol (p < 0.0001).
The Dandy—Walker syndrome Relevance to anaesthesia and intensive care
Authors: EWART M. C. , OH T. E.
Published: February 2007

A case of the Dandy‐Walker syndrome and some of its attendant complications is described.
The end‐tidal carbon dioxide detector Assessment of a new method to distinguish oesophageal from tracheal intubation
Authors: O'FLAHERTY D. , ADAMS A. P.
Published: February 2007

A new method to distinguish oesophageal from tracheal intubation using an end‐tidal carbon dioxide detector was evaluated. In a prospective study on 50 healthy adult patients, the end‐tidal carbon dioxide detector was reliably used to detect initial oesophageal intubation in 22 cases, and then to confirm tracheal intubation in all 50 patients. We conclude from this study that the end‐tidal carbon dioxide detector is a reliable, rapid and easy method for the detection of oesophageal intubation.
A disposable blood pressure cuff. An assessment of its accuracy
Authors: DODD F. M. , ARMSTRONG P. , RAY D. C. , SCOTT D. H. T.
Published: February 2007

An empty 500‐ml infusion bag was used as the cuff for a Lifestat 100 oscillotonometer. The systolic and mean blood pressures obtained in 40 subjects were not significantly different from those measured with a standard cuff. The diastolic pressure was unrelated between the two cuffs. The empty bag is a cheap and hygienic option in patients who present a high infection risk.
Management of donors for heart and heart–lung transplantation
Authors: Ghosh S. , Bethune D. W. , Hardy I. , Kneeshaw J. , Latimer R. D. , Oduro A.
Published: February 2007

The quality of donor organs will determine the quality of life for the recipient and the importance of optimal management of the multi‐organ donor is that the organs may benefit up to five, critically ill, patients. The basic principle is to maintain sufficient preload to minimise the need for inotropic support and it is recommended that all multiple organ donors should have central venous and arterial pressure monitoring in addition to adequate venous access. The importance of the choice of fluid for volume expansion and the management of the hormonal disturbances which follow brain death are considered.
Needlestick injuries in anaesthetists
Authors: Maz S. , Lyons G.
Published: February 2007

A survey of needlestick injuries among 42 anaesthetists at this university hospital was carried out over a 3‐month period to ascertain the rate of occurrence and the extent to which a revised protocol for the management of such injuries was followed. There were nine reported incidents, of which six were with contaminated needles. Three were reported. Eight anaesthetists had not taken up immunisation against hepatitis B. The rationale behind the revised protocol, and possible reasons for poor compliance are discussed.
A postoperative analysis of the patient's view of anaesthesia in a Netherlands’ teaching hospital
Authors: van Wijk M. G. F. , Smalhout B.
Published: February 2007

A postoperative questionnaire was used in 129 patients who had undergone a wide range of surgical procedures in order to investigate their personal experience of anaesthesia. The most frequent complaints were of feeling cold on waking up, sore throat, vomiting and muscle pains, all of which are capable of reduction by a change in anaesthetic technique. The total number of patients who had one or more complaints was 107 (82.9%). More than a third of the patients were afraid of the anaesthetic, as distinct from the operation. Most had received a pre‐operative visit from the anaesthetist which was greatly appreciated. A few patients believed they could have been better informed of possible sequelae. More than 30% were not visited by the surgeon before the operation. A routine postoperative interview, using a preformulated questionnaire, is a good way to assess and maintain a high quality of anaesthesia.
Autonomic dysfunction and Guillain‐Barré syndrome The use of esmolol in its management
Authors: CALLEJA M. A.
Published: February 2007

A 17‐year‐old girl with Guillain‐Barrè syndrome and autonomic dysfunction was treated successfully with esmolol. Esmolol may be an appropriate drug for the rapid assessment and control of tachyarrhythmias in critically ill patients.
The Engström Elsa anaesthetic machine An electronic system for anaesthesia
Authors: ALEXANDER J. P. , WATTERS C. H. , DODDS W. J. C. , McNEILL W. E.
Published: February 2007

Six Engström Elsa anaesthetic machines have been in regular use for 18–24 months. The machine incorporates a number of new concepts for anaesthetic delivery and monitoring. At flows below 1000 ml/minute, each machine delivered 20% more than the indicated value; at higher flows, the indicated value was within 10% of the flow delivered. Minute volume, tidal volumes and oxygen concentrations were within the manufacturer's specifications. However, vaporizer and vapour monitor performance was outside the (SD) 5% accuracy claimed by the manufacturers. It was noted that the bistable valve requires user familiarity for the change from controlled to spontaneous ventilation to be accomplished with ease. It was also possible to misconnect the breathing system and so isolate the excess pressure escape valve and high‐pressure alarm. Nevertheless, once familiarisation was achieved, the machines have proved easy to operate and are particularly satisfactory when used with low fresh gas flows.
Successful difficult intubation Tracheal tube placement over a gum‐elastic bougie
Authors: Dogra S. , Falconer R. , Latto I. P.
Published: February 2007

A randomised study was carried out to assess the effect of tracheal tube rotation on the passage of a tube over a gum‐elastic bougie into the trachea in 100 patients. The effect of the presence or absence of a laryngoscope on successful tube placement was also assessed. A grade 3 difficult intubation was simulated in patients with a laryngoscope. There was a significant difference in the rates for successful first‐time intubation in those patients with tube orientation of ‐90° (with the bevel facing posteriorly) as compared with a tube orientation of 0° (the normal orientation with the bevel facing left). The unsuccessful first‐time intubations with a 0° orientation were frequently converted to successful intubations with the ‐90° position at a second attempt. The presence of a laryngoscope in the mouth while rail‐roading a tube over the bougie also made a significant difference to the rate of successful first‐time intubations. The most successful method was to leave the laryngoscope in the mouth and rotate the tube to ‐90°.
Comparison of conventional and rapid inhalational induction of anaesthesia with enflurane
Authors: Rowbottom S. J. , Yukioka H. , Fujimori M.
Published: February 2007

Inhalational induction of anaesthesia using either a conventional method or a vital capacity breath of 4% enflurane in 67% nitrous oxide was compared in 30 adult surgical patients. Induction time was significantly faster in patients who took a vital capacity breath (71. SD 22 versus 132. SD 18 seconds, p < 0.01). There were no significant differences between groups in respect of systolic blood pressure, heart rate, arterial oxygen saturation or incidences of excitement or coughing. The vital capacity breath method was acceptable to 87% of patients.
Goldenhar's syndrome: an analysis of anaesthetic management A retrospective study of seventeen cases
Authors: Madan R. , Trikha A. , Venkataraman R. K. , Batra R. , Kalia P.
Published: February 2007

Seventeen patients with Goldenhar's syndrome who had surgery 28 times are presented. Various authors have reported problems in the anaesthetic management of these patients, but we encountered significant difficulties in only one. Three anaesthetic techniques were used. A thorough pre‐operative assessment with back‐up facilities for difficult intubation are important. Additional cardiorespiratory and craniovertebral anomalies may necessitate modifications in the basic techniques.
Intravenous fluid load and recovery A double‐blind comparison in gynaecological patients who had day‐case laparoscopy
Authors: COOK R. , ANDERSON S. , RISEBOROUGH M. , BLOGG C. E.
Published: February 2007

The effect of intra‐operative fluid and dextrose administration upon recovery was tested in a randomised, double‐blind trial. Three groups of 25 patients, each undergoing laparoscopic examination as day cases, were studied. The two groups who received fluid (20 ml/kg compound sodium lactate solution) showed significant improvement (p < 0.05) in the variables that reflected hydration. The fluid group who also received dextrose (1 g/kg) exhibited further significant improvement. Intra‐operative fluid and dextrose administration appears to confer some benefit upon recovery in patients who have minor surgery.
The Woolley and Roe case. A reassessment
Authors: HUTTER C. D. D.
Published: February 2007

In 1953, two patients, Cecil Roe and Albert Woolley, sued their anaesthetist for alleged negligence because they had developed painful spastic paraparesis after spinal anaesthesia. The court found that phenol, which was used to sterilise the outside of the ampoules of local anaesthetic, had percolated the glass through invisible cracks, contaminating the solution, but that the anaesthetist could not have been aware of this risk. The case was important, despite the fact that judgement was in favour of the anaesthetist, because of the fears that it generated over the incidence of paralysis after spinal anaesthesia. The ’invisible crack’ theory has been the subject of much scepticism. New information has been obtained, and the case re‐examined objectively. The most probable source of contamination, which led to paralysis in the two patients, and in a third who received spinal anaesthesia on the same day, has been identified. A similar explanation may lie behind a number of other episodes of paralysis associated with spinal anaesthesia.
Platelet function after intramuscular diclofenac
Authors: POWER I. , CHAMBERS W. A. , GREER I. A. , RAMAGE D. , SIMON E.
Published: February 2007

A randomised double‐blind controlled study was performed to examine the effect of diclofenac on skin bleeding time and in vitro whole blood platelet aggregation. Twenty thoracotomy patients were studied; 10 were given diclofenac 75 mg intramuscularly at induction of anaesthesia, and 10 formed a control group. Skin bleeding times and platelet aggregation tests were performed the day before and repeated one hour after induction of anaesthesia. Diclofenac prolonged skin bleeding time and reduced platelet aggregation. There were no significant changes in the control group.
Retracted: Volume therapy with hypertonic saline hydroxyethyl starch solution in cardiac surgery
Authors: BOLDT J. , KLING D. , HEROLD C. , DAPPER F. , HEMPELMANN G.
Published: February 2007

The ideal solution for volume therapy remains controversial. In cardiac surgery, haemodynamic efficacy as well as the influence of extracorporeal oxygenation are of major interest when administering volume. The present study examines the effects of a new hypertonic saline hydroxyethyl starch solution in comparison to a 6% hydroxyethyl starch solution on haemodynamics and laboratory variables. Patients scheduled for elective aortocoronary bypass grafting received hypertonic saline hydroxyethyl starch (n = 10) or hydroxyethyl starch (n = 10) after induction of anaesthesia in order to double baseline pulmonary capillary wedge pressure. Ten patients without volume therapy served as a control group. Significantly less hypertonic solution than standard solution was effective in doubling pulmonary capillary wedge pressure. Fluid requirements in the patients who received the hypertonic solution were significantly less during, as well as after, cardiopulmonary bypass in comparison to those in the other groups. Cardiac index increased most in the patients who received the hypertonic solution (+ 34.8%), as did right ventricular end‐diastolic volume. Patients in that group showed the highest decrease in total systemic resistance (‐ 29.8%), whereas arterial pressure and right ventricular ejection fraction remained almost unchanged in all groups. No negative alteration in coagulation or organ function was demonstrated within the investigation period. It can be concluded that hypertonic saline hydroxyethyl starch solution seems to be a valuable alternative to conventional volume therapy in cardiac surgery.
Alkalinisation of prilocaine for intravenous regional anaesthesia. Suitability for clinical use
Authors: ARMSTRONG P. , WATTERS J. , WHITFIELD A.
Published: February 2007

Eighty unpremedicated patients undergoing day‐case hand surgery under intravenous regional anaesthesia were randomly allocated to receive, in a double‐blind study, either 40 ml 0.75% prilocaine hydrochloride, with 5 ml 8.4% sodium bicarbonate or 5 ml 0.9% saline. The alkalinised group had significantly less pain on injection (p = 0.0045), during surgery (p = 0.0074) and 5 minutes after the tourniquet was deflated (p = 0.0027). The time elapsed between insertion of the block and commencement of surgery was not affected.
Dural puncture during attempted stellate ganglion block
Authors: STANNARD C. F. , GLYNN C. J. , SMITH S. P.
Published: February 2007

Dural puncture is rarely reported as a complication of stellate ganglion blockade. Breach of the dura occurred in the case described because of the anatomy of the cervical spine.
Anaesthesia in the field. Spontaneous ventilation–a new technique
Authors: Restall J. , Thompson M. C. , Johnston I. G. , Fenton T. C.
Published: February 2007

In recent years the British Army has used the Triservice Anaesthetic Apparatus in the field. Trichloroethylene is no longer manufactured in the United Kingdom and halothane is not recommended for closely repeated anaesthetics. A method based on existing equipment is described for patients breathing spontaneously. A background infusion of ketamine, midazolam and alfentanil supplements the inhalation of isoflurane in oxygen‐enriched air.
Acute viral myocarditis A death associated with anaesthesia
Authors: BRAMPTON W. J. , JAGO R. H.
Published: February 2007

The death of a 35‐year‐old woman in the immediate postoperative period as a result of undiagnosed acute viral myocarditis is described. The presentation, diagnosis and course of the disease is discussed, It is recommended that wider use be made of routine electrocardiographs as a screening test.
Respiratory obstruction after posterior fossa surgery
Authors: HOWARD R. , MAHONEY A. , THURLOW A. C.
Published: February 2007

We report a case, of acute upper airway obstruction after tracheal extubation 24 hours after surgery. The respiratory complications of surgery for posterior fossa lesions are discussed.
Intra‐operative pulmonary embolism Detection by pulse oximetry
Authors: MICHAEL S. , FRASER R. B. , REILLY C. S.
Published: February 2007

A case is presented of a 49‐year‐old patient who had a pulmonary embolism during ovarian cystectomy. The only evidence of its occurrence was a sudden, marked reduction in arterial oxygen saturation as detected by a pulse oximeter. The diagnosis was confirmed 24 hours later by a chest radiograph and a ventilation perfusion scan. Anticoagulant treatment was instituted.
Laryngeal mask airway for Caesarean section
Authors: McCLUNE S. , REGAN M. , MOORE J.
Published: February 2007

The use of a laryngeal mask airway is described in a patient for emergency Caesarean section, when tracheal intubation was not possible. Provision of the laryngeal mask airway for use in the Maternity Unit is discussed.
The effect of exhaled alcohol on the performance of the Datex Capnomac
Authors: FOLEY M. A. , WOOD P. R. , PEEL W. J. , JONES G. M. , LAWLER P. G.
Published: February 2007

We investigated the response of the Datex Capnomac to alcohol in expired air. The greatest response was seen when the Capnomac was set to monitor halothane. There was an approximately linear correlation with blood alcohol levels. This effect is of sufficient magnitude to introduce inaccuracies in the measured concentration of halothane.
Is crystalloid preloading useful in spinal anaesthesia in the elderly?
Authors: Coe A.J. , Revanäs B.
Published: February 2007

Sixty ASA grude 1 or 2 patients, aged 60 years or over, scheduled for surgery to the lower abdomen or lower limbs under spinal anaesthesia were allocated randomly to one of three treatment groups. Group A received 16 ml/kg of Ringer's acetate solution immediately before spinal anaesthesia, group B received 8 ml/kg and group C received no volume preload. Heart rate, arterial pressure and anaesthetic level were recorded by an independent observer. The overall incidence of systemic arterial hypotension (defined as a decrease of 25% or more in systolic arterial pressure) was 27%; there were no significant differences among groups. The overall incidence of hypotension was 60%, when temperature sensation was blocked to T7 and above (n = 25). The number of patients with hypotension which required treatment increased as block height increased above T7; at a level of T4 or higher, all patients required ephedrine. Crystalloid preloading had no effect on the incidence of hypotension after spinal anaesthesia in fit, elderly patients.
Pressor responses to tracbeal intubation after sublingual captopril A pilot study
Authors: McCarthy G. J. , Hainsworth M. , Lindsay K. , Wright J. M. , Brown T. A.
Published: February 2007

The effect of sublingual captopril on the pressor response to intubation was studied in 40 patients. Captopril was used in one of two doses (12.5 mg and 25 mg) 25 minutes before tracheal intubation. Both doses were associated with a significant reduction in the pressor response to intubation (p < 0.05) compared to placebo, but no significant difference existed between the two doses. Neither dose controlled changes in heart rate at intubation. Untoward hypotension occurred in the treatment groups. Caution is advised in the peri‐operative use of angiotensin‐converting enzyme inhibitors.
Haemodynamic and neurohumoral effects of xenon anaesthesia A comparison with nitrous oxide
Authors: BOOMSMA F. , RUPREHT J. , VELD A. J. MAN IN'T , JONG F. H. DE , DZOLJIC M. , LACHMANN B.
Published: February 2007

Thirty‐two patients were randomly allocated to be anaesthetised either with nitrous oxide or xenon. Those who received nitrous oxide required significantly more fentanyl peroperatively. Arterial blood pressure and heart rate were adequately controlled during surgery in both groups. Plasma noradrenaline and prolactin increased peroperatively in both groups, but plasma adrenaline and cortisol, which increased in the nitrous oxide group, did not change in the xenon group. Growth hormone was below control in those given xenon, but not in the nitrous oxide group, while dopamine remained unchanged in both groups. Postoperative plasma concentrations of noradrenaline, adrenaline, cortisol and prolactin (in both groups) and dopamine (in the nitrous oxide group) were elevated, and slowly returned to control. No differences were seen between the two gases in effects on plasma sodium and potassium. Xenon, because of its favourable haemodynamic, neurohumoral and antinociceptive properties, deserves a more prominent place in anaesthetic practice than it has so far occupied.
Detecting awareness during general anaesthetic Caesarean section An evaluation of two methods
Authors: BOGOD D. G. , ORTON J. K. , YAU H. M. , OH T. E.
Published: February 2007

Seventy‐four patients received general anaesthesia for Caesarean section. Seven percent of the elective group and 28% of the emergency patients reported dreaming or recall of voices during the procedure (p < 0.05) at postoperative interview. One patient from each group reported feeling pain or suffocation. All patients were monitored for awareness using the isolated forearm technique and lower oesophageal contractility. Provoked lower oesophageal contractility was the most effective of the different indices. A value greater than 35 mmHg on at least one occasion had a false negative rate of 33%, a false positive rate of 28% and a predictive value of 25%. A value greater than 13 mmHg picked up all patients who dreamed, with a false positive rate of 68%. Both of the ‘aware’patients had provoked lower oesophageal contractility response of greater than 70 mmHg, an attribute shared by only 8% of the rest. The isolated forearm was particularly ineffective.
Latency of brachial plexus block The effect on onset time of warming local anaesthetic solutions
Authors: HEATH P. J. , BROWNLIE G. S. , HERRICK M. J.
Published: February 2007

A double‐blind study was set up to investigate the effect of warming local anaesthetic solutions on the latency of onset of subclavian perivascular brachial plexus blocks. Twenty‐four adult patients were randomly allocated into two equal groups. In group A the local anaesthetic was injected at room temperature, while in group B the local anaesthetic solution was prewarmed to 37°C in a thermostatically controlled heating block. All blocks were performed using 0.5 ml/kg of a solution prepared by mixing equal volumes of 0.5% bupivacaine with adrenaline 1:200 000, and 1% prilocaine. The speed of onset of sensory blockade was significantly increased when the temperature of the local anaesthetic solution was increased to 37°C. There were no adverse side effects in either group.
Postoperative nefopam and diclofenac Evaluation of their morphine‐sparing effect after upper abdominal surgery
Authors: MOFFAT A. C. , KENNY G. N. C. , PRENTICE J. W.
Published: February 2007

The aim of the study was to assess the relative morphine‐sparing effects of nefopam and diclofenac when used singly or in combination after upper abdominal surgery. Eighty‐four patients of ASA grade 1 or 2 were allocated randomly to one of three groups. Group A received nefopam 20 mg by intramuscular injection 6 hourly after surgery for the 24‐hour study period. Group B received diclofenac 75 mg 12‐hourly and placebo injections at 6 and 18 hours after surgery. Group C received both 6‐hourly nefopam and 12‐hourly diclofenac. Supplemental analgesia was given on demand via a patient‐controlled analgesia system which delivered intravenous morphine. Morphine requirements in the diclofenac group were significantly lower than in either of the other groups (p < 0.01). Patients who received the combination of nefopam and diclofenac required significantly less morphine than those who received nefopam alone (p < 0.01). Pain scores assessed 6 hours after surgery were significantly lower in the diclofenac and combination groups compared with the nefopam group (p < 0.01).
Recovery of bowel motility after high dose fentanyl or morphine anaesthesia for cardiac surgery
Authors: YUKIOKA H. , TANAKA M. , FUJIMORI M.
Published: February 2007

Recovery of bowel function was investigated after cardiac surgery. The time to first passage of flatus was measured using a carbon dioxide analyser as an indication of the return of coordinated bowel motility in 22 adult patients who received high‐dose fentanyl (56.3, SD 20.9 μg/kg) or morphine (1.3, SD 0.7 mg/kg) anaesthesia. The time from the patient's arrival in the intensive care unit to passage of the first flatus in patients who received fentanyl anaesthesia was significantly longer than in those who received morphine (p < 0.05). There was a significant relationship between the time to first flatus and the total dose of fentanyl, but no such relationship could be demonstrated for morphine. It is concluded that high‐dose fentanyl anaesthesia delays recovery of bowel motility in a dose‐dependent manner.
Iatrogenic anaemia? A survey of venesection in patients in the Intensive Therapy Unit
Authors: Tarpey J. , Lawler P. G.
Published: February 2007

In 30 consecutive patients admitted to the Intensive Therapy Unit, the volume of blood taken for investigations was recorded. Results were available for 26 patients. Total venesection volume averaged 336 ml. Venesection volume averaged 55.7 ml/day after the first 24 hours. The mean haemoglobin on admission was 11.5 g/dlitre. Blood loss was related to both APACHE score and length of stay (APACHE.day), to the presence of arterial and central venous catheters, and to the need for mechanical ventilation. Iatrogenic blood loss of this magnitude will cause anaemia if it continues.
Intravenous cannulae colour coding A perennial source of confusion
Authors: Tordoff S. G. , Sweeney B. P.
Published: February 2007

There is no standard colour code for intravenous cannulae in the United Kingdom. A questionnaire was sent to the manufacturers to compile a table of available cannulae, and to assess their views and plans with regard to colour coding. Present moves to establish an international standard are outlined. A simple colour coding standard is proposed.
Introducing patient‐controlled analgesia for postoperative pain control into a district general hospital
Authors: Notcutt W. G. , Morgan R. J. M.
Published: February 2007

Patient‐controlled analgesia was introduced in a district general hospital in order to improve postoperative pain control. Techniques of management were developed with effectiveness, safety and practicality as the main objectives. An analysis of the first 1000 patients to use the system is presented. Problems were encountered with slow respiratory rate, monitoring, equipment function and ward management. Identification of specific hazards and management problems led to improvements in system safety. Patient‐controlled analgesia has become the standard technique for postoperative pain control after major surgery in this hospital.
Postoperative analgesia in children who have genito‐urinary surgery A comparison between caudal buprenorphine and bupivacaine
Authors: Girotra S. , Kumar S. , Rajendran K.M.
Published: February 2007

A study conducted on 40 children, aged 1–11 years, who had genito‐urinary surgery compared the quality and duration of analgesia after caudal blocks in two groups of patients. Group 1 (n = 20) received caudal bupivacaine 0.25% and group 2 (n = 20) caudal buprenorphine 4 μg/kg; each received 0.5 ml/kg body weight. Patients were operated on under general anaesthesia. Postoperative behaviour and severity of pain were measured on a 3‐point scale. The results indicate that caudal buprenorphine provides excellent postoperative analgesia in children comparable to caudal bupivacaine in the early postoperative period. Buprenorphine proved better in the late postoperative period. Analgesia lasted from 20 hours to more than 24 hours after caudal buprenorphine with fewer side effects.
An unusual complication of tracheal intubation
Authors: GRAY B. , HUGGINS N. J. , HIRSCH N.
Published: February 2007

We report a previously undescribed complication of tracheal intubation. The complication arose as a result of tracheal intubation performed as an emergency procedure in a patient with an abnormal anteriorly placed larynx. Subsequent corrective laryngeal surgery was required after a temporary tracheostomy had been performed.
Cytogenetic damage in operation theatre personnel
Authors: Natarajan D. , Santhiya S. T.
Published: February 2007

The study in a group of 24 (11 anaesthetists and 13 support staff) was planned to ascertain the cytogenetic risk in a group of theatre personnel who worked in various city hospitals. Their exposure in terms of duration of service vary from 3–30 years. The control group (n = 24) consisted of people with different occupations matched for possible confounding variables. Cytogenetic risk was assessed in terms of chromosome aberration and sister chromatid exchange in 72‐hour lymphocyte cultures. A significant increase in the percentage of chromosome aberration was observed. The sister chromatid exchange was double that of the baseline value in 20% of the exposed individuals. These findings indicate the possible risk of cytogenetic damage for staff working in unscavenged rooms.
Influence of temperature of bupivacaine on spread of spinal analgesia
Authors: CALLESEN T. , JARNVIG I. , THAGE B. , KRANTZ T. , CHRISTIANSEN C.
Published: February 2007

A prospective, randomised study was performed to investigate the influence of temperature on sensory blockade in spinal anaesthesia. Three ml of plain bupivacaine 0.5% were injected intrathecally at either 4°C, room temperature, or 37°C. There were 10 patients in each group, who were kept sitting for 2 minutes after injection. The maximum level of sensory blockade was significantly higher (p < 0.01) in the group who received the solution adjusted to 37°C, and variability of level was smaller (p < 0.05). Time to two‐segment regression was shorter in the 37°C group than in the 4°C group (p < 0.05). Hypotension required administration of ephedrine more often in the 37°C group (p < 0.05). It is concluded that the use of plain bupivacaine 0.5% adjusted to 37°C results in a higher and more predictable sensory blockade.
Propofol for induction and maintenance of anaesthesia at Caesarean section A comparison with thiopentone/enflurane
Authors: YAU G. , GIN T. , EWART M. C. , KOTUR C. F. , LEUNG R. K. W. , OH T. E.
Published: February 2007

A propofol infusion regimen and a standard general anaesthetic were compared in 40 Chinese women undergoing elective Caesarean section. Twenty patients received propofol 2 mg/kg for induction of anaesthesia followed by propofol 6 mg/kg/hour, while 20 patients received thiopentone 4 mg/kg with enflurane 1% for maintenance of anaesthesia. All patients were given atracurium and their lungs ventilated with nitrous oxide 50% in oxygen until delivery of the neonate. The hypertensive response after intubation was of shorter duration in the propofol group compared with the thiopentone group. Induction to delivery times ranged from 5 to 14 minutes and neonates from both groups had similar and satisfactory Apgar scores, Neurologic and Adaptive Capacity Scores and umbilical cord blood gas analysis. However, a prolonged propofol infusion time before delivery may cause lower Neurologic and Adaptive Capacity Scores. There were no differences in maternal recovery times or psychomotor performance.
Non‐drug related asystole associated with anaesthetic induction
Authors: KEANE T. K. , HENNIS P. J. , BINK‐BOELKENS M. TH. E.
Published: February 2007

A patient is presented where routine venepuncture associated with anaesthetic induction resulted in bradycardia and asystole. The case highlights the need for special caution with, and ECG monitoring throughout induction for, patients with a history of syncope. It also demonstrates the need for caution when attributing cardiovascular events during induction to the effect of the induction agents used.
Awareness during Caesarean section
Authors: Lyons G. , Macdonald R.
Published: February 2007

Between 1982 and 1989 over 3000 patients were questioned about recall and dreaming after general anaesthesia for Caesarean section. Some 28 (0.9%) patients were able to recall something of their operation and 189 (6.1%) reported dreams. There was uniform adherence to a rigid anaesthetic protocol up to and including 1985, but a much publicised incident reported from the courtroom stimulated a relaxation of this regimen. Consequently the incidence of awareness decreased from 1.3% to 0.4%, and the incidence of dreaming was also reduced. Recollections of surgery were confined to manipulations, noises and voices. None of our patients complained of pain at the time of interview, although one since has. The inadequacies of the initial protocol and an approach to informed consent are discussed.
Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve
Authors: HOPKINS P. M. , ELLIS F. R. , HALSALL P. J.
Published: February 2007

An assessment of local anaesthetic blockade of the lateral femoral cutaneous nerve using a standard technique was made. The rate of successful blockade was high, but the area of sensory loss was inconsistent between patients and was more anterior and distal than described in textbooks of anatomy.
The anaesthetic management of congenital tracheal stenosis
Authors: MURPHY P. M. , LLOYD‐THOMAS A.
Published: February 2007

Congenital tracheal stenosis is a rare and potentially lethal condition. Two case reports are presented which demonstrate the problems encountered in the anaesthetic management of this condition.
Williams syndrome: masseter spasm during anaesthesia
Authors: PATEL J. , HARRISON M. J.
Published: February 2007

A 4‐year‐old boy with Williams syndrome developed masseter spasm after halothane and suxamethonium. He did not develop malignant hyperthermia; the surgery was accomplished with a nontriggering anaesthetic and no further problems.