bluuebunny/crossref_metadata_2025 huggingface dataset:
Coma following ingestion of halothane
Authors: WIG JYOTSNA , CHAKRAVARTY SATISH , KRISHNAMURTHY K. , MEHTA DAVINDER
Published: February 2007

The management of a rare case of halothane ingestion and a review of the relevant literature is presented. A 35‐year‐old hospital technician who had ingested halothane was admitted to hospital in grade IV coma. He made an uneventful recovery after support in an intensive care unit.
Suxamethonium apnoea associated with pregnancy and liver dysfunction in a treated cretin
Authors: FERGUSON ANN , WHITTAKER MARY , BRITTEN JUDITH J. , PERRISS B. W.
Published: February 2007

A patient, with a history of cretinism, who developed suxamethonium apnoea as a consequence of a reduction in plasma cholinesterase activity secondary to the concurrence of pregnancy and liver dysfunction associated with pre‐eclampsia is reported. The patient had a normal phenotype for plasma cholinesterase.
Electroencephalographic changes and arousal time after atropine or glycopyrrolate
Authors: Cozanitis D.A. , Paloheimo M. , Jones C.J.
Published: February 2007

The Anaesthesia and Brain activity Monitor was used to determine if any electroencephalographic variation becomes evident following the administration to patients of either atropine sulphate or glycopyrrolate when given with neostigmine to reverse a non‐depolarising neuromuscular blockade. The apparatus was also used to study possible earlier arousal times by electroencephalography and electromyography in those patients who had received glycopyrrolate with neostigmine compared with those who had atropine as an anticholinergic. The apparatus was not sensitive enough to detect changes resulting from atropine injection but clearly demonstrated earlier arousal times by electromyography in patients who had received glycopyrrolate.
Total intravenous anaesthesia by an intermittent technique. Use of methohexitone, ketamine and a muscle relaxant
Authors: Knell P.J.W.
Published: February 2007

Good quality anaesthesia with smooth recovery can be induced by methohexitone 40 mg, ketamine 100 mg, diazepam 5 mg and alcuronium 15–20 mg and maintained with methohexitone 30 mg and ketamine 10 mg at 5‐minute intervals and controlled ventilation with 30% oxygen in air. The technique is economical in running and capital costs and may have special implications for avoiding atmospheric pollution, for use in developing countries, and in emergency situations.
Hypertensive anaesthesia for operations on the ear, nose and parotid gland. Use of intravenous metoprolol as an adjunct to sodium nitroprusside and halothane
Authors: Rollason W.N. , Kemp R.J. , Wills L.C.
Published: February 2007

Fifty‐seven patients had arterial hypotension induced by a technique with halothane and sodium nitroprusside during operations on the ear, nose and parotid gland. Metoprolol, a cardioselective beta‐adrenergic blocker, was used when required to maintain the pulse rate at 80 beats per minute or less and to assist in reducing the blood pressure. Metoprolol was used in 50 cases while 7 cases remained at a pulse rate of less than 80 bpm spontaneously.
Allergy, atopy and IgE
Authors: FISHER M. McD. , ROFFE D. J.
Published: February 2007

IgE levels were measured in 105 patients after immediate (101) and delayed (4) anaphylactoid reactions to anaesthetic drugs. It was not possible on the basis of allergic history and IgE levels in patients to determine the drugs to which the patients were likely to react. A history of allergy, atopy with or without elevated IgE levels, does not aid the selection of anaesthetic drugs for initial or repeat anaesthesia.
Damage to the right lymph duct
Authors: GWILT D. J.
Published: February 2007

The right lymph duct of a patient was damaged by the insertion of a temporary pacemaker. The anatomy and prognosis of this lesion is discussed.
Anaesthetic considerations in patients with paroxysmal supraventricular tachycardia
Authors: JONES R. M. , BROADBENT M. P. , ADAMS A. P.
Published: February 2007

Paroxysmal supraventricular tachycardia is a common cardiac dysrhythmia which may or may not be associated with heart disease. The underlying mechanisms in the genesis of this dysrhythmia are alterations in automaticity or re‐entry of the cardiac impulse. These mechanisms are reviewed in the context of the stresses of the peri‐operative and operative periods. The anaesthetic management of three patients, particularly prone to paroxysmal supraventricular tachycardia, is described based on principles derived from the pathophysiology of re‐entrant or ectopic atrial tachydysrhythmias.
Coaxial tubing for conventional anaesthetic systems
Authors: BOADEN R. W.
Published: February 2007

A simple connecting device is described which enables coaxial tubing to be used on many conventional ventilators and circle systems at low cost.
Oral bromazepam in premedication. A comparison with diazepam
Authors: Chalmers P. , Horton J.N.
Published: February 2007

Bromazepam, a relatively newly benzodiazepine with marked anxiolytic effects, was compared in a randomised, double‐blind manner with diazepam for its effectiveness as an oral premedicant drug. A scoring system was used to assess sedation, relief of anxiety, nausea, and cardiovascular effects in two groups of women having gynaecological operations. No difference was demonstrated between the effectiveness of the two drugs.
Failure of intravenous regional analgesia using a double cuff tourniquet
Authors: OGDEN P. N.
Published: February 2007

A case is presented of an elderly, obese patient with calcified peripheral vessels in whom an intravenous regional analgesic technique failed because arterial occlusion could not be achieved safely with a double cuff tourniquet. The possible causes and precautions are discussed.
Predicting the obstetric work‐load
Authors: CORMACK R. S.
Published: February 2007

The daily variation in the work‐load of a maternity unit during 1982 was analysed. The data fitted the Poisson distribution quite well, which suggests that future work‐loads can be predicted by this method. Other clinical data of a similar kind should be amenable to the same analysis.
Intracranial pressure after phenoperidine
Authors: GRUMMITT R. M. , GOAT V. A.
Published: February 2007

The problem of sedating patients requiring prolonged controlled ventilation has recently received considerable attention.1‐3 Various therapeutic regimes are available and there appears to be a general move away from the use of muscle relaxants towards sedative drugs. Phenoperidine is a popular agent for this purpose. One survey from a district general hospital reported that 66% of their ventilated intensive therapy unit patients received phenoperidine, either alone or as part of a sedation regime.4 However, enthusiasm for its use must be tempered by recent reports of cardiovascular collapse following its administration. 5,6 We wish to report a case of intracranial hypertension following the use of phenoperidine in a ventilated patient with a severe head injury.
Accumulation of thymol in halothane vaporizers
Authors: ROSENBERG P. H. , ALILA A.
Published: February 2007

Thymol may accumulate in halothane vaporizers and influence their accuracy. We determined the thymol concentration in residual liquid halothane of 28 vaporizers in regular use. Two halothane samples were brownish, probably due to a long exposure to light and irregular drainage. Irregularly drained vaporizers contained higher thymol concentrations than those drained weekly (p < 0.05). The highest individual thymol concentration was 19 times that found in fresh halothane. Halothane vapour concentration deviated most from setting in Fluotec Mark II vaporizers, but this did not correlate with thymol concentrations in halothane liquid. The need for weekly drainage and regular service of halothane vaporizers is stressed.
Effects of high‐dose fentanyl anaesthesia on the established metabolic and endocrine response to surgery
Authors: BENT J. M. , PATERSON J. L. , MASHITER K. , HALL G. M.
Published: February 2007

The effect of the administration of fentanyl 50 μg/kg body weight on the established metabolic response to pelvic surgery was investigated. In comparison with a control group of patients in whom anaesthesia was supplemented with halothane, fentanyl was associated with a significant decrease in only blood lactate concentrations and heart rate. There were no significant differences in blood glucose, plasma non‐esterified fatty acids, and plasma cortisol values between the two anaesthetic techniques. It is concluded that the administration of high‐dose fentanyl has little effect on the established metabolic response to surgery, compared with the marked changes observed when the same dose is given before the onset of surgical stimulation.
Premedication for children with oral trimeprazine and droperidol
Authors: LAYFIELD D. J. , WALKER A. K. Y.
Published: February 2007

In 60 children aged 1–9 years, weighing under 33 kg, oral trimeprazine and oral trimeprazine plus droperidol were compared as premedicants in a controlled, double‐blind clinical trial. The addition of droperidol to the trimeprazine syrup produces greater uniformity in pre‐operative sedation, a low incidence of postoperative vomiting, and a reduced requirement for postoperative analgesia.
Sleep apnoea following cervical cord surgery
Authors: VELLA L. M. , HEWITT P. B. , JONES R. M. , ADAMS A. P.
Published: February 2007

Two patients who developed sleep apnoea following upper cervical cord surgery are described. The underlying mechanisms and management of the sleep apnoea syndrome are discussed.
Laryngeal muscle recovery after suxamethonium
Authors: BAER G. A.
Published: February 2007

Complications due to intratracheal jet ventilation are often caused by the unrecognized recovery of laryngeal muscles. The rate of rise of pressure in a main bronchus alters with changes of the glottic aperture during jet ventilation. The special pressure curve monitor sets off an alarm when the steepness of the rising curve changes. During recovery these alarms, as well as the onset of phonation, coughing, spontaneous breathing and forearm muscle activity are recorded simultaneously. Forearm muscle activity always appears later than the alarm, and often later than the other recorded phenomena. Pressure curve monitoring provides advance warning of returning muscle activity in the larynx, but conventional muscle activity monitoring in the forearm does not.
Bupivacaine and prilocaine in intravenous regional anaesthesia
Authors: McKEOWN D. W. , MEIKLEJOHN B. , SCOTT D. B.
Published: February 2007

Six volunteers underwent intravenous regional anaesthesia of the non‐dominant arm on four occasions using two equipotent doses of bupivacaine and prilocaine, administered in a randomised double‐blind sequence. Equipotent doses produced similar degrees of motor and sensory blockade. Bupivacaine produced more rapid motor power loss and delayed motor recovery (p < 0.01). Prilocaine produced more prolonged objective blockade following tourniquet release (p < 0.01), although this was not clinically useful, and bupivacaine led to a marked prolongation of subjective blockade (p < 0.01). Increase of dose with both drugs gave more rapid and complete sensory and motor blockade and delayed recovery (p < 0.05). This was, however, associated with more marked toxicity. It is suggested that in intravenous regional anaesthesia there are no clinical differences between the drugs in equipotent solutions, and that the lower concentrations are the appropriate ones for standard use.
Acute acalculous cholecystitis following multiple skeletal trauma
Authors: BUCKLEY P. M. , HUNTER JENNIFER M.
Published: February 2007

Three cases of acute acalculous cholecystitis are reported in patients with multisystem failure following major long‐bone trauma. The diagnosis should be suspected in any such patient who develops septicaemia from an unidentified site. A high index of suspicion should be maintained, especially in patients who are sedated or in receipt of mechanical ventilation of the lungs and in whom physical signs may be minimal or absent.
Emergency surgery complicated by thyrotoxicosis and thyrotoxic periodic paralysis
Authors: ROBSON N. J.
Published: February 2007

A general anaesthetic was administered for emergency surgery to a patient with a bleeding gastric ulcer in the presence of undiagnosed thyrotoxicosis. The case is presented to illustrate firstly how hyperthyroidism may be masked by other acute illnesses, and secondly an unusual complication of thyrotoxicosis. The anaesthetic management of thyrotoxic patients undergoing incidental emergency surgery is discussed.
Expiratory valves and anaesthetic reservoir bags
Authors: MOSTAFA S. M. , HALL I. D.
Published: February 2007

The pressure‐volume characteristics of 24 new and old ‘2‐litre’ anaesthetic reservoir bags of three different makes were measured. When inflated with gas to a pressure of 50 Pa all the new bags and six used ones contained 1.6 litres and when filled with 2 litres of gas, the pressure within them exceeded 700 Pa. The opening pressures and pressure drops to 30 litres/minute gas flow of scavenging adjustable pressure limiting valves were also investigated. Tests were carried out on 44 valves of four different types, all with their adjusting screws in the fully open position. All the valves had low opening pressures and pressure drops which were both further decreased when the orientation of the valves was changed to the inverted position. A substantial proportion of them remained permanently open. After one year's use th opening pressure and pressure drop tended to rise, the proportion of permanently open valves increased and the discs of some valves were damaged.
Anaesthesia equipment malfunction
Authors: HOLLEY H. S. , CARROLL J. S.
Published: February 2007

Anaesthetic equipment was studied to determine whether the accuracy was improved and failure rate decreased by routine maintenance and calibration by a biomedical technician. Each piece was evaluated, and then repaired and rechecked at intervals by the same technician. Equipment failures were divided into three types: first, equipment that was completely nonfunctional; second, equipment that was functional but inaccurate; and third, equipment that was functional and accurate but needed minor repairs. The percentage of equipment failures in each group was compared on initial evaluation and after 6 months. Of the 311 pieces of equipment, 40% needed repair at the time of the initial survey; 8% was nonfunctional, and 18% was functional but inaccurate. After six months on a maintenance schedule, only 15% of the equipment needed repair, 3% was nonfunctional, and 6% was functional but inaccurate. The difference between the total percentage of equipment failure initially and after six months was statistically significant. After a regular maintenance, calibration, and checkout schedule by a biomedical technician was instituted, there was a significant improvement in the accuracy of the equipment and a reduction in the percentage of equipment needing repair.
Selectatec switch malfunction
Authors: HOGAN T. S.
Published: February 2007

Malfunction of a Selectatec switch mechanism is reported which resulted in complete cessation of gas flow to the patient system. Anaesthetists are alerted to this potential hazard.
Moisture‐conserving efficiency of condenser humidifiers*
Authors: OGINO M. , KOPOTIC R. , MANNINO F. L.
Published: February 2007

The moisture‐conserving efficiency of commercially available condenser humidifiers (small, disposable, airway humidifiers) was studied. A comprehensive comparison of all currently available condenser humidifiers utilising a laboratory system which simulated a breathing, intubated patient in temperature, humidity, dead space, and respiratory pattern characteristics was undertaken. The percentage of moisture conserved, or efficiency, of the humidifiers was calculated gravimetrically from the water loss of the testing system with and without the condenser humidifiers. The Portex Humid‐Vent® and Trach‐Vent®, Siemens Servo 150® and the Terumo Brethaia® were evaluated.

The data revealed an inverse correlation between efficiency and tidal volume. The most efficient were the Portex Humid‐ Vent® at low tidal volumes and Siemens Servo 150® at the mid and high tidal volumes. To achieve a minimum inspired water content of 33 mg H2O/litre gas. a 79% condenser humidifier efficiency is necessary. None of these units met this requirement; however, they may be appropriate for limited clinical application.
Epidural sufentanil for postoperative pain relief
Authors: DONADONI R. , ROLLY G. , NOORDUIN H. , BUSSCHE G. VANDEN
Published: February 2007

An open pilot study was undertaken to evaluate the analgesic properties of epidurally administered sufentanil in the early postoperative period. After orthopaedic surgery of the lower extremity, four different groups of five adult patients each received either 15 μg (group 1), 30 μg (group 2), 50 μg (group 3) or 75 μg (group 4) sufentanil via an epidural catheter prviously used for the surgical procedure. Results were satisfactory in groups 3 and 4 with very good relief of pain and a mean duration of action of 372 and 307 minutes respectively. Dosage above 50 μg did not seem to improve the quality or duration of pain relief although the onset of action was faster with 75 μ;g. Sedation was always present in patients with effective analgesia. In the present study respiratory depression was not evident, but three patients complained of itching and two of urinary retention.
Suprofen compared to dextropropoxyphene hydrochloride and paracetamol (Cosalgesic) after extraction of wisdom teeth under general anaesthesia
Authors: ROSEN M. , WEBSTER J. A.
Published: February 2007

In a randomised double‐blind trial in postoperative ambulant day case dental patients suprofen 200 mg (29 patients) was compared with dextropropoxyphene hydrochloride 65 mg and paracetamol 650 mg (Cosalgesic, 28 patients) both available four times daily for 3 days. Suprofen was better than cosalgesic in the patients' opinion of initial (p = 0.01) and overall pain relief (p = 0.08) compared to Cosalgesic and the second night's sleep was better (p = 0.01). Side effects were reported in six suprofen patients and 10 cosalgesic patients (two suffering from vomiting withdrew). Suprofen, a non‐steroidal anti‐inflammatory drug is as good as, or better than, a widely used opioiparacetamol mixture for ambulant patients with postoperative dental pain.
Urban hypothermia
Authors: FERGUSSON N. V.
Published: February 2007

A case is reported of a 23‐year‐old man who became hypothermic within 4 hours of exposure. Full physical recovery occurred within 5 hours of an asystolic cardiac arrest using simple rewarming techniques.
Use of vecuronium in the management of tetanus
Authors: POWLES A. B. , GANTA R.
Published: February 2007

A case of tetanus sufficiently severe to require treatment with neuromuscular blocking drugs and controlled ventilation is described. The use of an infusion of vecuronium helped to minimise the cardiovascular disturbances which accompanied the disease and permitted rapid spontaneous reversal of neuromuscular blockade when the infusion was stopped.
Resistance of tracheal tubes 3.0 and 3.5 mm internal diameter
Authors: BLOM H. , RYTLANDER M. , WISBORG T.
Published: February 2007

The resistance of RAE, Rüsch, Mallinckrodt paediatric and Portex plain nasal and oral tracheal tubes with internal diameters 3.0 mm and 3.5 mm was calculated at air flows of 1 to 10 litres per minute. The flow resistance profiles of RAE and Rusch tracheal tubes was generally higher than those of Mallinckrodt paediatric and Portex plain tubes. All RAE and Rüsch nasotracheal tubes of size 3.0 mm internal diameter and orotracheal tubes 3.0 mm internal diameter had a flow resistance exceeding 3.0 kPa litres/second at an airflow of 4 litres/minute. It is concluded that these tracheal tubes ought only to be used with assisted or controlled ventilation.
Thiopentone levels during cardiopulmonary bypass
Authors: MORGAN D. J. , CRANKSHAW D. P. , PRIDEAUX P. R. , CHAN H. N. J. , BOYD M. D.
Published: February 2007

Plasma total and unbound concentrations of thiopentone were investigated during exponentially decreasing infusions in seven patients undergoing cardiopulmonary bypass. Total plasma thiopentone concentrations reached a plateau (10.2, SD 2.1 μg|ml) soon after the initial bolus dose and commencement of the infusion. Concentrations were maintained until the onset of cardiopulmonary bypass, whereupon total plasma thiopentone concentration fell abruptly to 50.0 (SD 5.8) percent of the prebypass level. The unbound fraction of thiopentone increased from 16.6 (SD 1.9) percent before bypass to a maximum to 29.3 (SD 5.6) percent during bypass (p < 0.01), decreased to 22.9 (SD 3.3) percent at the end of bypass (p < 0.01), hut was still elevated 5–7 hours later (20.5, SD 2.5 percent). The result of the changes in binding was a smaller decline in unbound thiopentone concentration at the onset of bypass to 76.4 (SD 15.7) percent of the prebypass level. Also, unbound levels returned to the prebypass level by the end of bypass, whereas total levels remained low.
Computerised tomography guided lumbar sympathectomy
Authors: REDMAN D. R. O. , ROBINSON P. N. , AL‐KUTOUBI M. A.
Published: February 2007

Fifteen patients had lumbar sympathetic block using needle localisation by computerised tomography. The technique has the advantage that the needle route to the sympathetic plexus can be accurately planned, avoiding damage to other organs. In this study, 13 patients out of 15 had significant benefit, from the procedure.
Comparison of induction characteristics of four intravenous anaesthetic agents
Authors: Mccollum J. S. C. , Dundee J. W.
Published: February 2007

The induction characteristics of thiopentone, etomidate and methohexitone have been compared to those of propofol (2,6 di‐isopropyl phenol) in unpremedicated patients. Propofo1 2.5 mg/kg caused significantly more hypotension, excitatory side effects and pain on injection at the dorsum of hand than thiopentone 5 mg/kg. However, with regard to the latter two sequelae. etomidate 0.3 mg/kg and methohexitone 1.5 mg/kg caused similar or more frequent upset. Propofol 2.0 mg/kg was equipotent with thiopentone 4.0 mg/kg in terms of successful induction of anaesthesia. Hypotension may contraindicate the use of propofol in the hypovolaemic or unfit patient.
Compound sodium lactate (Hartmann's) solution. Caution: risk of clotting
Authors: Edwards M.P. , Clark D.J. , Mark J.S. , Wyld P.J.
Published: February 2007

We have observed blood clothing in blood administration sets were Hartmann's solution (Travenol) has preceded blood transfusion. This is due 10 calcium ions (Ca++) contained in the Hartmann's solution and is more likely to occur at 37°C. We suggest that this potential hazard be more widely realised and that the practice cease.
Influence of induction of anaesthesia with midazolam on the neuro‐endocrine response to surgery
Authors: DAWSON D. , SEAR J. W.
Published: February 2007

The effect of midazolam, for induction of anaesthesia, on the glycaemic and adrenocortical responses to lower pelvic surgery in female patients has been studied and compared with a comparable group of patients receiving thiopentone. Although midazolam has been shown to obtundadrenaline andnoradrenaline release to electrical or surgical stress in the rat and dog, there was no blunting of the glycaemic response to surgery in man. Plasma cortisol levels in response to surgery and anaesthesia were comparable in the two groups of patients.
Pressure changes in tracheal tube cuffs
Authors: CHANDLER M.
Published: February 2007

The pressure changes in tracheal tube cuffs can be explained by classical permeation theory. The transport of all gases contributes to pressure changes which may be negative or positive, depending upon the conditions. In vitro experiments were carried out to determine the applicability of this approach and the efjcacy of the methods for minimising the rise in cuff pressure.
Triazolam premedication
Authors: THOMAS D. , TIPPING T. , HALIFAX R. , BLOGG C. E. , HOLLANDS M. A.
Published: February 2007

A randomised, double blind study, of 58 female patients undergoing laparoscopic investigation was carried out to compare triazolam 0.25 mg, lorazepam 2 mg, or placebo as oral premedication. Each patient was assessed by only one of the authors both pre‐ and postoperatively with regard to anxiolysis, sedation and rapidity of recovery. Triazolam and lorazepam were each associated with a significant reduction in anxiety compared to the initial assessment, whereas placebo had no anxiolytic effect. Sixty minutes after premedication, patients who had received triazolam were significantly more sleepy than patients given placebo or lorazepam. Two hours after the operation, the patients who had had triazolam or lorazepam were significantly more sleepy than those who received placebo. However, at 6 hours postoperatively there was no difference between triazolam and placebo, whilst those who had been given lorazepam were still significantly more sleepy than those given placebo. Triazolam appears to offer advantages over either lorazepam or placebo in patients who require rapid recovery, sedation and reduction in pre‐operative anxiety.
The current status of pulse oximetry
Authors: Taylor M. B. , Whitwam J. G.
Published: February 2007

The history of the development of pulse oximetry is outlined and the principle of how the apparatus works is described. The instrument detects hypoxic hypoxia and the shape of the oxygen dissociation curve means that the minimum saturation alarm should be set at 94% in anaesthetic usage. It is accurate to within 2% and is usually unaffected by racial pigmentation, but accuracy can be aflected in low perfusion states, hypotherrnia and in the presence of abnormal forms of haemoglobin and pigments in the blood. Its clinical evaluation in the operating theatre and intensive care unit is reported. It was found to be useful and reliable and would appear to have logistical and other advantages over current methods of detecting hypoxia. Pulse oximetry may make a signijcant contribution to the safety of anaesthetic practice.
Topical nitroglycerin
Authors: Kamra S. , WIG J. , Sapru R. P.
Published: February 2007

In order to attenuate the pressor response to intubation of the trachea we have studied the effects of 2% nitroglycerin ointment rubbed on the forehead approximately 12 minutes prior to intubation. A double blind, randomized design was used in 56 consecutive patients. Of these, 30 patients received the ointment while 26 patients formed the control group. The maximum rise in the systolic arterial pressure was significantly lower (p < 0.001) in the group (7.66 mmHg. 6.2%) as compared to the control group (25.7 mmHg. 20.2%). The rise in arterial pressure persisted for up to 4 minutes in the control group, but lasted for only one minute in the nitroglycerine group. The pulse rate, however, increased in both groups to an equal extent. We have found the application of 2% nitroglycerine ointment to be a safe, inexpensive, comfortable and effective means of attenuating the pressor response to intubation of the trachea.
Selective oxygen leak
Authors: Williams A. R. , Hilton P. J.
Published: February 2007

A case is described where a patient received less oxygen than was set on the Rotameters. The cause was traced to a selective leak of oxygen via an open cyclopropane needle valve. Several recommendations are put forward to prevent a recurrence.
A double‐blind comparison of intramuscular pethidine and nalbuphine in labour
Authors: WILSON C. M. , McCLEAN E. , MOORE J. , DUNDEE J. W.
Published: February 2007

A double‐blind, between‐patient comparison of intramuscular pethidine 100 mg and nalbuphine 20 mg for the relief of pain during labour in 80 patients is described. Severity of pain was assessed before and after treatment by subjective pain scores and visual analogue scales. Neither of these methods showed a significant difference between the treatments. Nalbuphine was associated with less maternal nausea and vomiting than pethidine, but this possible advantage was somewhat offset by a tendency of the drug to produce more maternal sedation and dizziness. The mean umbilical vein/maternal vein ratio was significantly higher for nalbuphine (0.78. SEM 0.03) than for pethidine (0.61, SEM 0.02). which suggests easier placental transfer of the former. This finding was reflected in significantly lower 2–4 hour neurobehavioural scores for the infants of mothers given nalbuphine, but there was no significant difference between these scores at 24 hours. On the basis of this study, nalbuphine does not offer a substantial improvement over pethidine for pain relief in labour.
Pulmonary occlusion (wedge) angiography in adult respiratory distress syndrome
Authors: LAWLER P. G.
Published: February 2007

Pulmonary occlusion angiography was performed in 34 patients admitted to the intensive therapy unit with a diagnosis of adult respiratory distress syndrome. Twenty angiograms were normal. Ten patients survived. No patient with abnormal angiography survived.
Halothane hepatitis in an 11–month‐old child
Authors: WHITBURN R. H. , SUMNER E.
Published: February 2007

Halothane hepatitis is extremely rare in childhood. However, this occurred in an 11‐month‐old infant, following multiple exposure to halothane. The diagnosis was confirmed by detection of specific antibodies to halothane‐sensitised rabbit hepatocytes. The anaesthetic technique for a subsequent procedure with a halothane‐free breathing system is also outlined.
Psychomotor testing of oncall anaesthetists
Authors: Narang V. , Laycock J.R.D.
Published: February 2007

The critical flicker fusion frequency and choice reaction times of 16 on‐call anaesthetists were measured between 1400 and 1600, at 2300 and at 0200 hours. Critical picker fusion decreased between the afternoon and 2300; there was no further change between 2300 and 0200. No signgcant dijjferences in choice reaction times were found on any of these different occasions.
Oral lormetazepam in premedication. A comparison with diazepam
Authors: Jakobsen C.‐J. , Jensen J.‐J. , Hansen W. , Grabe N.
Published: February 2007

Summry

Lormetazepam, a relatively new benzodiazepine was compared in a randomised, double blind trial with diazepamfor its effectiveness as an oral premedicant drug. A scoring system was used to assess sedntion. relief of anxiety. nausea, dizziness and cardiovascular effects in two groups of patients having orthopaedic operations. Some statistical indication that lormetazepam has a greater anxiolytic effect than diazepam was found, but in assessing total eflect using a known scoring system, no difference was demonstrated between the two drugs.
The haemodynamic effects of bronchoscopy
Authors: Wark Katheryn J. , Lyons J. , Feneck R. O.
Published: February 2007

The cardiovascular responses to bronchoscopy under general anaesthesia were investigated in 36 premedicated patients. Twelve patients acting as controls received a standard intravenous anaesthetic of intermittent thiopentone and suxamethonium. A further 24 patients were given either fentanyl6 pgglkg or aventanil 18 pgglkg intravenously, one minute prior to induction. There were signijcant rises in systolic arterial bloodpressure (p < 0.05) and in rate pressure product (p < 0.05) in the patients in the controlgroup, but these changes were not seen in those patients receiving either fentanyl or awentanil. However, dysrhythmias and ST segment changes indicative of myocardial ischaemia were present in some patients in all three groups.
Raynaud's phenomenon precipitated by blood transfusion
Authors: MOORE JULIA K. , PROCTOR D. W.
Published: February 2007

A patient undergoing surgery with spinal anaesthesia received a transfusion of concentrated red cells. Whenever the rate of blood transfusion reached a certain critical value, the symptoms and signs of Raynaud's phenomenon appeared in the hand distal to the site of the intravenous cannula. Possible causes of this transfusion‐induced vasospasm are discussed.
Caudal analgesia for perianal surgery
Authors: BAILEY P. M. , SANGWAN S.
Published: February 2007

Seventy‐three patients undergoing elective perianal surgery were randomly divided into a control group, a group who received a caudal injection of 20 ml bupivacaine 0.5% plain and a group who received diamorphine 2.5 mg in 10 ml normal saline by caudal injection; a comparison was then made of postoperative analgesia requirements. The bupivacaine group had better analgesia than the control group for the first 8 hours, after which there was no difference. The diamorphine group had better analgesia than the control group for the first 24 hours postoperatively. Side effects were less in the diamorphine group than the control, or the bupivacaine group. In particular, 41% of the bupivacaine group complained of some degree of urinary retention and one patient required temporary catheterisation. It is concluded that caudal diamorphine gives good postoperative analgesia for perianal operations, particularly when motor blockade is not wanted by the surgeon.
The prevalence of serological markers for hepatitis B virus infection amongst anaesthetists in the Oxford region
Authors: SINCLAIR M. E. , ASHBY M. W. , KURTZ J. B.
Published: February 2007

A total of 125 anaesthetists from nine hospitals within the Oxford region were surveyed to study the prevalence of serological markers for hepatitis B virus (HBV) infection. No anaesthetists were positive for Hepatitis B Surface Antigen (HBsAg) and only four (3.2%) were positive for HBsAg antibody (anti‐HBsAg). This result is in marked contrast to other studies and suggests that anaesthetists in the United Kingdom do not constitute a high risk population. The reasons for this are discussed.
Severe acute anaemia in a Jehovah's Witness
Authors: HOWELL P. J. , BAMBER P. A.
Published: February 2007

A case is described in which a Jehovah's Witness underwent emergency surgery following which her haemoglobin fell to 1.8 g/dlitre. She was successfully treated in an intensive care unit with intermittent positive pressure ventilation of the lungs, high inspired oxygen concentrations and transfusions of large volumes of gelatin solution.
The neuroleptic malignant syndrome
Authors: ALLSOP P. , TWIGLEY A. J.
Published: February 2007

Following the administration of fluphenthixol (a depot phenothiazine) for a psychotic illness, a 44‐year‐old woman developed weakness, rhabdomyolysis and renal failure, together with hyperthermia (42°C) and signs of both autonomic and central nervous System dysfunction. She died following massive intestinal haemorrhage, intra‐abdominal sepsis and probable disseminated intravascular coagulation. A diagnosis of neuroleptic malignant syndrome had been made, but treatment with dantrolene sodium was probably instituted too late to prevent the progress of the complications she had developed. This syndrome, which follows the use of phenothiazines or butyrophenones, is rare, potentially fatal and probably underdiagnosed. It has been likened lo malignant hyperthermia, but a review of the literature points to many differences. Both dantrolene sodium and dopaminergic drugs (bromocriptine, amantidine and L‐dopa) have been shown to be efficacious and their continued use, despite a failure in this case, is advocated until more is known about this syndrome.
The severance of epidural catheters
Authors: HUTCHISON G. L.
Published: February 2007

Four groups of Portex Minipack epidural sets were tested to measure the force required to sever the catheter on the needle bevel. The 18‐gauge radio‐opaque catheter was found to sever at a significantly lower applied force and to stretch significantly less before breaking than the 18‐gauge clear catheter or either of the 16‐gauge catheters. The other catheters tested had breaking strains of between 10–20 Newtons (1–2 kg force) and stretched by more than 30% of their lengths before breaking, ft is suggested that these other catheters may therefore be a preferable alternative to the 18‐gauge radio‐opaque.
Bradycardia associated with the use of vecuronium. A comparative study with pancuronium with and without glycopyrronium
Authors: Cozanitis D.A. , Pouttu J. , Rosenberg P.H.
Published: February 2007

One hundred and twenty patients undergoing anaesthesia for elective surgery received either pancuronium or vecuronium for muscle relaxation. Within each of these two groups, half were given glycopyrronium and the remainder an inert placebo. The incidence of bradycardia or bradydysrhythmias was higher in the group having vecuronium compared with those given pancuronium. Glycopyrronium afforded protection against undesirable vagal activity.
Magill versus Mallinckrodt tracheal tubes. A comparative study of postoperative sore throat
Authors: Sprague N.B. , Archer P.L.
Published: February 2007

An attempt to assess the relative merits of Magill and Mallinckrodt tracheal tubes is described. One hundred patients scheduled for routine gynaecological operations were randomly allocated to one of two groups of 50; in one, Magill red rubber tubes were used and in the other, Mallinckrodt lubes. The incidence and severity of postoperative sore throat were assessed on the day after operation. Fifty percent of those intubated with Magill lubes suffered sore throats, compared with 28% with Mallinckrodt (p < 0.05). In both groups, sore throat was more frequent in younger patients undergoing short operations: smokers intubated with Magill tubes had significantly more sore throat than smokers in whom Mallinckrodt tubes were used.
Should air‐oxygen replace nitrous oxide‐oxygen in general anaesthesia?
Authors: MOSELEY H. , KUMAR A. Y. , SHANKAR K. BHAVANI , RAO P. S. , HOMI J.
Published: February 2007

The use of compressed air‐oxygen mixtures to replace nitrous oxide‐oxygen in general anaesthesia was investigated in 378 patients. There were neither prolongations of recovery time nor instances of awareness under anaesthesia. The cost of general anaesthesia using compressed air‐oxygen was about half that for nitrous oxide‐oxygen mixtures.
Paroxysmal nocturnal haemoglobinuria
Authors: TAYLOR M. B. , WHITWAM J. G. , WORSLEY A.
Published: February 2007

The peri‐operative management of a patient with paroxysmal nocturnal haemoglobinuria and associated hypoplastic anaemia, who underwent successful elective surgery for the complication of Budd‐Chiari syndrome, is described. Anaesthesia in patients with paroxysmal nocturnal haemoglobinuria should be based on drugs and materials least likely to cause complement activation. The reasons for use of a technique based on benzodiazepines, opioids, isoflurane and the avoidance of nitrous oxide are discussed.
Contamination control in long‐term ventilation
Authors: GALLAGHER J. , STRANGEWAYS J. E. M. , ALLT‐GRAHAM J.
Published: February 2007

Twenty‐eight patients who required periods of mechanical ventilation for up to 22 days in the intensive therapy unit were studied to evaluate the clinical use of the Pall Ultipor Breathing System Filter (BB50T) as a heat‐ and moisture‐exchanging bacterial filter. Results in this group of patients showed that there was no longer any need to sterilise breathing systems or decontaminate ventilators if these filters were used. They also performed satisfactorily as a heat and moisture exchanger in patients in need of long‐term ventilation, and their use appears to offer substantial advantages as regards cost, ease of use and patient safety.
Prolongation of neuromuscular blocking effect of vecuronium by antibiotics
Authors: JEDEIKIN R. , DOLGUNSKI E. , KAPLAN R. , HOFFMAN S.
Published: February 2007

A case is described of prolonged neuromuscular block in a patient who was given the muscle relaxant vecuronium followed by bolus injections of the antibiotics gentamycin and clindamycin.
Histamine levels and cardiovascular responses during splenectomy and splenorenal shunt formation in a patient with systemic mastocytosis
Authors: SMITH G. B. , GUSBERG R. J. , JORDAN R. H. , KIM B.
Published: February 2007

Systemic mastocytosis is a rare disorder characterised by the infiltration of many tissues by abnormal numbers of mast cells. Life‐threatening episodes of bronchospasm and hypotension are common in response to a variety of triggers which cause mast cell degranulation. We present the case history of a patient with severe mast cell disease who successfully underwent splenectomy and portocaval anastomosis. Peri‐operative therapy was directed towards mast cell stabilisation, and histamine‐releasing drugs were avoided. Cardiovascular data, together with blood histamine levels and thrombin times, indicated that mast cell degranulation did not occur. A review of the current literature concerning mast cell disease as it relates to anaesthesia is presented and suggestions for the safe management of such cases are given.
Arterial oxygen saturation during general anaesthesia for paediatric dental extractions
Authors: Bone M. E. , Galler D. , Flynn P. J.
Published: February 2007

Arterial oxygen saturation (Sao2) was measured in 50 healthy children undergoing dental extractions under general anaesthesia. An inhalational anaesthetic technique was employed, with an inspired oxygen concentration of 33%. There were decreases in Sao2 of greater than 5% of the baseline value in 70% of patients, and greater than 10% in 26% of patients. The majority of these decreases were associated with teeth extractions or during placement of dental prop and pack. Non‐Caucasion children showed a significantly (p < 0.05) greater maximum decrease in Sao, from baseline value compared to Caucasian children. The maximum decreases in Sao2 from baseline value in children anaesthetised by supervised dental students, and in children whose extractions were performed by dental students, were significantly (p < 0.05) greater than in children whose anaesthetic and surgery were performed by members of staff.
Monitoring neuromuscular blockade
Authors: DUNDAS C. R. , LEVACK I. D. , BROCKWAY M. S.
Published: February 2007

A simple and inexpensive force transducer made from a stainless steel table knife is described. Construction is straightforward and utilises strain gauges that are readily available. Amongst its attributes are lightness, ease of application, low sensitivity to postural changes and linearity over extended periods of time.
The respiratory depressant effects of nalbuphine and papaveretum as intramuscular premedication
Authors: RUTTHR G. G. R. , AVELING W. , TUSIEWICZ K.
Published: February 2007

Forty‐four patients scheduled for routine gynaecological surgery through a Pfannenstiel incision were given either nalbuphine or papaveretum as premedication, with hyoseine. Respiratory depression was measured by carbon dioxide rebreathing before and one hour after premedication. Both combinations produced significant respiratory depression as measured by the rebreathing test but no significant difference could be shown between the drugs in this respect.
The effect of rotation of an epidural needle
Authors: MEIKLEJOHN B.H.
Published: February 2007

A study using postmortem dura mater demonstrated that rotation of the epidural needle significantly decreases the force required to puncture the dura. It is recommended that epidural needles should not he rotated after insertion of the tip into the epidural space.
Subarachnoid block with hyperbaric lignocaine
Authors: EWART M. C. , RUBIN A. P.
Published: February 2007

A double‐blind study was carried out in 20 patients to compare 5% hyperbaric lignocaine and 0.5% hyperbaric bupivacaine Jar subarachnoid block. The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects and the frequency of side effects were studied. Cephalad spread of analgesia was high (T4–5) with both solutions. Bupivacaine produced a longer duration of action in the lumbar and sacral segments but the duration in the thoracic segments was similar. There was a considerable degree of hypotension in both groups but this responded readily to ephedrine. Hyperbaric lignocaine is an alternative to hyperbaric bupivacaine and its shorter duration of action in the lumbar and sacral segments is advantageous when a fast recovery is desirable.
Spinal cord compression during chronic epidural morphine administration in a cancer patient
Authors: van DIEJEN D. , DRIESSEN J. J. , KAANDERS J. H. A. M.
Published: February 2007

A case is described of thoracic spinal cord compression that occurred during continuous epidural administration of morphine. Sensory loss and motor weakness in the legs disappeared after catheter removal and antibiotic treatment.
Upper airway obstruction in neurofibromatosis
Authors: CROZIER W. C.
Published: February 2007

A patient with von Recklinghausen's neurofibromatosis developed severe upper airway obstruction at the induction of anaesthesia and required emergency cricothyroidotomy. The cause was a neurofibroma at the base of the tongue. Features of von Recklinghausen's neurofibromatosis which may be of importance to the anaesthetist are reviewed.
Anaesthetic management for carbon dioxide laser surgery in tracheobronchial lesions
Authors: Hunton J. , Oswal V.H.
Published: February 2007

There are technical difficulties associated with anaesthesia in patients who undergo laser surgery to the trachea and main bronchi using the carbon dioxide laser. An anaesthetic technique using spontaneous ventilation is described which has been used successfully in 33 patients.
Potential leaks from anaesthetic machines
Authors: McQUILLAN P. J. , JACKSON I. J. B.
Published: February 2007

Twenty anaesthetic machines were examined to detect leakage of fresh gas through open Rotameter flow control valves and empty cylinder yokes. Significant leakage was demonstrated in most machines. Any leakage in machines which comply with ISO 5358, where oxygen is the last gas into the common gas manifold, is selective for nitrous oxide and, conversely, it is selective for oxygen in machines where oxygen is the first gas into the common gas manifold. Leakage is augmented by back pressure from ventilators that function as minute volume dividers. In ventilated patients the leakage described may contribute to hypoventilation and patient hypoxia or to pollution of the operating theatre and patient awareness.
Serum fluoride levels in morbidly obese patients: enflurane compared with isoflurane anaesthesia
Authors: STRUBE P. J. , HULANDS G. H. , HALSEY M. J.
Published: February 2007

Obese patients are known to metabolise anaesthetic agents more than patients of normal weight. The extent of this was investigated by the measurement of serum fluoride concentrations in 10 morbidly obese patients undergoing gastroplasty. Five were allocated to receive enflurane and five to receive isoflurane supplemented anaesthesia. The mean peak serum fluoride concentrations after enflurane anaesthesia were greater (22.7 μmol/litre, SE 2.9) than after isoflurane anaesthesia (6.5 μmol/ litre. SE 0.6). The mechanisms and implications of this finding are discussed.
Brachial plexus block
Authors: MANARA A. R.
Published: February 2007

A supraclavicular brachial plexus block was performed which resulted in unilateral sensory and motor blockade of the thoracic and abdominal walls. General anaesthesia was therefore used and postoperatively it was noticed that analgesia of the upper limb had developed. It is likely that the blockade resulted from an intrapleural injection of local anaesthetic.