bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial sensory evoked muscle potentials during labour
Authors: ANDREWS P. J. D. , ACKERMAN W. E. , JUNEJA M. J. , VOGEL R.
Published: February 2007

We prospectively studied the relationship between upper facial sensory‐evoked muscle potential amplitude, uterine contraction amplitude and heart rate in 20 healthy parturients during the first stage of labour. Monitoring began when minimal pain was reported and continued until severe pain occurred and extradural analgesia was established. Pain intensity was assessed by each patient using a 10 cm visual analogue score. Heart rate was recorded using a pulse oximeter. Sensory evoked muscle potential was derived from frontalis biopotentials that were rectified, integrated and digitised by an Anaesthesia and Brain activity Monitor (Datex, Helsinki, Finland). An additional signal filter was included in the pre‐amplifier to improve the signal‐to‐noise ratio. The rms amplitude of successive 10 s samples of sensory evoked muscle potential, as well as heart rate and the output from an external tocotransducer, were then graphically displayed to allow assessment of temporal relationships. The data were assessed using correlation analysis and hypergeometric probability distribution. Before extradural analgesia (mean pain score 7.5 cm, SD 1.5cm) a significant relationship was demonstrated between sensory evoked muscle potential and uterine contraction, p < 0.001). No constant relationship was seen between heart rate and uterine contraction. Following extradural analgesia (mean pain scores of 2.1 cm, SD 1.3 cm) a variable relationship between sensory evoked muscle potential and uterine contraction amplitude, and heart rate and uterine contraction, was recorded. A continuous display of the relationship between filtered sensory evoked muscle potentials of the frontalis muscle and uterine contraction may, in the future, permit an objective assessment of the adequacy of analgesia following extradural analgesia for the pain of labour.
Double burst stimulation for monitoring neuromuscular blockade for tracheal intubation
Authors: JAIN A. K. , SHARMA P. K. , BHATTACHARYA A.
Published: February 2007

Responses to double burst stimulation were palpated every 15s after intravenous administration of vecuronium 0.2mg.kg‐1 in 60 adult patients under anaesthesia. Intubating conditions and neuromuscular responses to tracheal intubation were assessed at disappearance of one or both palpable responses to double burst stimulation in groups of 30 patients randomly divided, although in group A patients, tracheal intubation could be performed at disappearance of one palpable response to double burst stimulation; 27 out of 30 patients (90%) had mild to moderate bucking on intubation. In this group, only five patients (16.66%) had good intubating conditions. In group B, where tracheal intubation was attempted at disappearance of both palpable responses, intubating conditions were good in 28 out of 30 patients (93.33%) and there was no response to tracheal intubation in 26 out of 30 patients (86.66%). Palpation of evoked response to double burst stimulation can be used to predict intubating conditions and neuromuscular response to tracheal intubation with nondepolarising muscle relaxants such as vecuronium.
Massive lingual swelling following palatoplasty
Authors: CHAN M. T. V. , CHAN M. S. H. , MUI K. S. Y. , HO B. P. Y.
Published: February 2007

We report a case of upper airway obstruction as a result of delayed massive lingual swelling following routine cleft palate repair in an otherwise healthy 12‐month‐old girl. We believe that ischaemia and venous congestion were the causes of macroglossia, after prolonged use of the Digman Dott tongue retractor. In any difficult and lengthy repair, we recommend the prophylactic insertion of a nasopharyngeal airway under direct vision by the surgeons after surgery to prevent potential upper airway obstruction.
Anaesthetic considerations in a patient with Fraser syndrome
Authors: JAGTAP S. R. , MALDE A. D. , PANTVAIDYA S. H.
Published: February 2007

A 16‐year‐old girl with Fraser syndrome underwent abdominal hysterectomy under general anaesthesia. She had multiple congenital anomalies which included a cardiac defect and airway abnormalities. Intubation difficulties were circumvented by the retrograde technique of placement of the tracheal tube.
An evaluation of a new percutaneous tracheostomy kit
Authors: CALDICOTT L. D. , OLDROYD G. J. , BODENHAM A. R.
Published: February 2007

The Portex percutaneous trachestomy kit incorporates guidewire dilating forceps which pass over a guidewire and perform rapid dilatation. These forceps have curved jaws which are designed to reduce possible damage to the lateral and posterior walls of the trachea. The guidewire dilating forceps are first opened in front of the trachea to dilate the pretracheal tissues and then opened in the trachea to dilate the anterior tracheal wall. A tracheostomy tube is then passed over the guidewire and into the trachea. The procedure was rapid and successful in all 20 patients, with no serious complications. Mean time to perform tracheostomy was 4.9min (range 90s–15min). Overall, the Portex percutaneous tracheostomy kit worked well and proved a rapid and acceptable method for performing percutaneous tracheostomy.
A method of costing anaesthetic practice
Authors: BROADWAY P. J. , JONES J. G.
Published: February 2007

This paper identifies the main factors involved in the cost of elective general anaesthetic practice. The costs of anaesthesia were divided into overheads and running costs, which are sensitive to the duration of anaesthesia, and fixed costs which are incurred by each patient but are not sensitive to the duration of anaesthesia. The overhead costs consisted of salaries, capital equipment and maintenance costs. The overhead cost of a consultant anaesthetist combined with a technical assistant's salary, monitoring equipment and anaesthetic machine was estimated at £45.05.h‐1 (using 1993 salary scales and prices). The fixed costs of pre‐operative assessment and nursing care in recovery were the same for all patients, £20.60 per patient. For the majority of anaesthetics the combined cost of the anaesthetist, overheads and postoperative care was about 70% of the total cost, the remainder being the running costs which included drugs, anaesthetic gases, vapours, intravenous fluids, sterile equipment and other disposable items. Four sample anaesthetics were costed in two ways: both methods used the same overhead and fixed cost per patient but one added the cost of all the individual drugs and consumables used, whereas the other grouped these together using a charge sheet which can be computerised and used prospectively to cost anaesthesia. There was close agreement between the costs derived with the two methods. The cost of a 30min delay in the start of an operating session was £27.30 (anaesthetist, assistant and nurse salary (£9.50.h‐1)) which is more than the cost of 2h of propofol infusion anaesthesia. There was a difference between the estimated costs of an anaesthetic as calculated by management and by our analysis. The cost apportioned by management for assistants and recovery nurses’salaries was nearly £50.h‐1 and the cost for anaesthetic equipment maintenance and anaesthetic capital costs was nearly £20.h‐1. These management figures were considerably greater than our estimates of £19.14.h‐1 and £3.20.h‐1 respectively. We advocate the use of a charge sheet for providing an easy estimate of anaesthetic cost rather than relying on management estimates.
Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography
Authors: Kitajima T. , Ishii K. , Kobayashi T. , Ogata H.
Published: February 2007

We evaluated possible differential effects of vecuronium on the thumb and great toe using two types of neuromuscular transmission monitor. Train‐of‐four stimuli were simultaneously applied to the ulnar nerve and tibial nerves using cutaneous electrodes. The responses were quantified with accelographs (thumb and left great toe) and an electromyograph (right great toe). Twenty ASA 1 or 2 patients received, by random allocation, one of two types of anaesthesia: neuroleptanaesthesia or sevoflurane‐based anaesthesia. With both techniques, the shortest time to maximum block after vecuronium 0.1 mg.kg ‐1 occurred in the thumb as measured by accelography. The average (SD) values with neuroleptanaesthesia were: 173(23) s for thumb using accelography; 220(16) s for great toe using accelography; 205(44) s for great toe using electromyography. The average (SD) valuefs) with sevoflurane‐based anaesthesia were: 137(15) for thumb using accelography; 179(21) for great toe using accelography; 153(23) for great toe using electromyography. The differences between the thumb and great toe were statistically significant during both types of anaesthesia when measured with the accelograph (p < 0.01). The time from completion of maximal block to 25% recovery of twitch height in the thumb was significantly longer than that of the great toe as measured by accelography during both types of anaesthesia (p < 0.05). In contrast, there were no statistically significant differences between time to maximum block and 25% recovery of twitch height of the thumb as measured by accelography compared to the values measured for the great toe using electromyography during either anaesthetic technique. The fastest recovery, therefore, was measured in the tibial nerve using accelography. The time to 25% spontaneous recovery after vecuronium 0.1 mg.kg‐1 during sevoflurane anaesthesia was significantly longer than that during neuroleptanaesthesia (p < 0.01).
Nathan Keep—William Morton's Salieri?
Authors: KEEP P.
Published: February 2007

Dr Nathan Cooky Keep (1800‐1875) was a Boston dentist and doctor who carried out pioneering work in both dentistry and anaesthesia. He worked with William Morton before the first public demonstration of ether anaesthesia, formed the world's first anaesthetic partnership with Morton but parted company with him and later opposed Morton's claim to be the sole inventor of ether anaesthesia.
Caesarean section in a patient with protein S deficiency
Authors: Fan S. Z. , Yeh M. , Tsay W.
Published: February 2007

Protein S is a nonenzymatic and vitamin K‐dependent cofactor of activated protein C. Without protein S, the anticoagulant function of protein C is almost depleted and thrombotic events occur. We report a parturient with hereditary protein S deficiency in whom the risk of thromboembolism was further complicated by pregnancy and who required emergency Caesarean section for fetal distress.
Transcervical endometrial resection syndrome
Authors: McSwiney M. , Myatt J. , Hargreaves M.
Published: February 2007

During transcervical endometrial resection the uterine cavity is irrigated under pressure with 1.5% glycine solution. This solution may be absorbed, with consequent fluid and electrolyte shifts. Plasma sodium concentration was analysed in 21 women undergoing transcervical endometrial resection and decreased in every case. In five cases this decrease was > 10mmol.l‐1. Hyponatraemia is a potential risk with this procedure.
The effects of 2% lignocaine gel on incidence of retching with the use of the laryngeal mask airway
Authors: Chan S. T. , Tham C. S.
Published: February 2007

This randomised, single‐blind study investigated the incidence of retching during emergence from general anaesthesia with a laryngeal mask airway in place. Eighty four patients, ASA grade 1 and 2, aged 15 to 60 years, were randomly divided into two groups. Each patient received fentanyl 1 μg.kg‐1 and propofol 2mg.kg‐1for induction. A laryngeal mask airway was then inserted and the patient breathed spontaneously on a nitrous oxide‐oxygen mixture with isoflurane. Lubafax gel was the lubricant in the control group and 2% lignocaine gel was used in the test group. The patients were allowed to wake up at the end of surgery with the laryngeal mark airway in place while a blinded observer observed for retching. The age, sex, weight and duration of surgery were similar in both groups. The test group had a significantly lower incidence of retching on emergence from general anaesthesia with the laryngeal mask airway in place (p < 0.005, Chi‐squared test).
Metabolic gas exchange during different surgical procedures
Authors: LIND L.
Published: February 2007

Surgery performed during general anaesthesia has been shown to induce an increase in oxygen consumption. It is postulated that this response might be influenced by the surgical procedure performed. Metabolic gas exchange was continuously measured by indirect calorimetry for 30min in 45 patients undergoing four different surgical procedures during general anaesthesia with propofol/fentanyl/vecuronium as follows: elective laparotomy (n = 13); emergency laparotomy (n = 10); elective knee joint arthroscopy (n = 10); gynaecological laparoscopy (n = 12). A significant increase in oxygen consumption occurred in all the groups within 5min of skin incision. The greatest increase was seen in those undergoing elective laparotomy (+13%, p < 0.001 at 15min), with similar smaller increases in the other three groups (+6 to + 7%, p < 0.05). Surgery induced an increase in systolic blood pressure in all four groups, being most pronounced in the elective laparotomy group (+47% 15min after skin incision, p < 0.001). These patients also experienced a significant rise in heart rate (+14%, p < 0.01 at 15min). Carbon dioxide production increased both in the laparoscopy patients (+9%, p < 0.05) and, transiently, in the elective laparotomy group (+6% at 15min, p < 0.01), but decreased in the other two groups (‐7 to ‐15%, p < 0.05). Surgery induced a parallel increase in both oxygen consumption and systolic blood pressure in all types of operations, although the magnitude varied. Continuous measurement of metabolic gas exchange may provide an additional method of evaluating the metabolic response to different types of surgery.
Prolonged tracheal intubation in an infant with tracheomalacia secondary to a vascular ring
Authors: Reah G. , Entress A.
Published: February 2007

We report a case in which the trachea of a 3‐week‐old infant with a double aortic arch and secondary tracheomalacia was intubated for nearly 10 months prior to tracheal surgery. Postoperatively no complications relating to surgery or intubation were seen.
The effect of cardiac output on the onset of neuromuscular block by vecuronium
Authors: Iwasaki H. , Igarashi M. , Yamauchi M. , Namiki A.
Published: February 2007

A relationship between cardiac output and the onset time of neuromuscular blockade administered into a peripheral vein was evaluated in 41 adult patients. Anaethesia was induced with midazolam and fentanyl and maintained with intermittent doses of fentanyl and 66% nitrous oxide in oxygen. After immobilisation of the forearm in a splint, the ulnar nerve in the other arm was stimulated supramaximally every 10 s and the adduction force of the thumb was recorded. The times from administration of vecuronium 0.08mg.kg‐1 to first and 95% depression of twitch response was 82.4(18.0) s and 191.7(33.5) s (mean, SD), respectively. A significant correlation between cardiac index and the onset time of blockade was observed. This study demonstrated that the rapidity of the onset of paralysis in the adductor pollicis muscle after vecuronium injection into a peripheral vein is clearly related to cardiac output.
The quality of breathing and capnography during laryngeal mask and facemask ventilation
Authors: IVENS D. , VERBORGH C. , THI H. PHAN , CAMU F.
Published: February 2007

Clinical measures of ventilation and the relationship between arterial and end‐tidal carbon dioxide tensions were studied during inhalational anaesthesia in 18 patients using a laryngeal mask airway or a facemask. Tidal volumes were similar in both groups but expired minute volume, respiratory rate and physiological deadspace ventilation were significantly increased in the facemask group. Both end‐tidal and arterial carbon dioxide tensions were higher in the laryngeal mask group. Mean arterial to end‐tidal carbon dioxide tension differences ranged from 0.13 to 4.13kPa in the facemask group and from 0–1.73kPa with the laryngeal mask airway. Pooled data analysis revealed a better correlation between arterial and end‐tidal carbon dioxide tensions during laryngeal mask ventilation as compared to facemask breathing. With both techniques the arterial to end‐tidal carbon dioxide tension difference was related to respiratory rate and physiological deadspace ventilation. Estimation of arterial carbon dioxide partial pressure by monitoring end‐tidal carbon dioxide tension is more reliable with the laryngeal mask airway than during facemask breathing, in particular at small tidal volumes.
Skin tethering after dilatational percutaneous tracheostomy
Authors: Whittet H. B. , Commins D. J. , Waldmann C. S.
Published: February 2007

Percutaneous tracheostomy is increasingly preferred for patients in the Intensive Care Unit. It is a convenient method with a low incidence of complications. Skin tethering has not previously been emphasized as a complication of this technique and, although primarily cosmetic, may result in significant morbidity.
Skin–epidural distance in children
Authors: Bösenberg A. T. , Gouws E.
Published: February 2007

The skin–epidural distance was measured in 274 children to assess the usefulness of 1 mm .kg–1 as a guideline. Children aged between 2 days and 16 years, weighing between 2 and 43 kg were investigated. Lumbar epidurals were performed under general anaesthesia using a midline approach in the L3‐4 interspace with the patient in the left lateral position. Good correlation between skin‐epidural distance and age and weight was demonstrated. No statistical difference was shown when plotting the best fit regression line: skin‐epidural distance (mm) = 0.8 weight (kg) + 3.93 (R2= 0.74) and its 95% confidence limits and skin‐epidural distance (mm) = weight (kg) for children between 6 months and 10 years. Poor correlation was noted below 6 months (n = 22) and over 10 years (n = 19). No dural puncture or bloody tap occurred. One mm. kg‐1 body weight was shown to be a useful guideline for children between 6 months and 10 years of age.
A comparison of diclofenac with ketorolac for pain relief after knee arthroscopy
Authors: Dennis A. R. , Leeson‐Payne C. G. , Hobbs G. J.
Published: February 2007

We performed a double‐blind controlled trial to compare the analgesic effect of two nonsteroidal anti‐inflammatory drugs. We compared rectal diclofenac 100 mg given 1 h before induction of anaesthesia with intravenous ketorolac 10 mg given immediately before anaesthesia in 40 patients undergoing arthroscopy of the knee as day cases. A visual analogue scale was used to assess pain prior to discharge. Pain, analgesic consumption, sleep disturbance and restriction of activities were recorded by telephone enquiry 24 h after surgery. There was no difference in the pain parameters, sleep disturbance, or restriction of activity between groups. We suggest that ketorolac 10 mg intravenously and diclofenac 100 mg rectally provide comparable postoperative analgesia in the first 24 h after arthroscopy of the knee.
Comparative study of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis
Authors: HERREGODS L. , FOUBERT L. , MOERMAN A. , FRANÇOIS K. , ROLLY G.
Published: February 2007

Intentional normovolaemic haemodilution is a blood saving technique which can be performed when major blood loss is expected. Severe coronary artery disease and particularly left main stenosis are considered a contraindication for intentional normovolaemic haemodilution. The effects and complications of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis scheduled for coronary artery bypass grafting were evaluated. Patients were randomly allocated to two groups: group A (n = 15) underwent limited intentional normovolaemic haemodilution to a haematocrit of 34%; group B(n = 15), no intentional normovolaemic haemodilution was performed. In both groups succinyl‐linked gelatin was used to maintain normovolaemia. Haemodynamic parameters were kept as constant as possible. In group A, a mean (SD) volume of 785 (250) ml of blood was withdrawn [range 500–1200 ml]. ST segment changes occurred on the ECG in three patients in each group. There were no statistically significant differences for frequency, maximum deflection and duration of ST‐segment changes. Limited intentional normovolaemic haemodilution can be performed safely in patients with left main coronary artery stenosis. In this study it was not associated with increased frequency, severity or duration of ST‐segment changes, or with arrhythmias or haemodynamic instability.
The effect of a cervical collar on the tidal volume of anaesthetised adult patients
Authors: DODD F. M. , SIMON E. , McKEOWN D. , PATRICK M. R.
Published: February 2007

Semi‐rigid cervical collars may be used to assist the stabilisation of the cervical spine during transport in patients suffering from major trauma. We have attempted to evaluate the effect of one such collar on airway patency in the presence of depressed airway reflexes. Thirty‐eight patients undergoing anaesthesia via facemask with spontaneous ventilation were studied. Tidal volume was measured with the airway in three different positions, both with and without a collar. The collar made no statistically significant difference to tidal volume in any position. Changing support of the airway increased tidal volume both with and without the collar. Patients fitted with an incorrectly sized collar may develop upper airway obstruction in the presence of impaired consciousness. Experience should be gained in the correct fitting of semi‐rigid collars.
Lessons from in vitro testing of spinal needles
Authors: LYONS G. , LESSER P. , BEMBRIDGE M.
Published: February 2007

In vitro testing of spinal needles is intended to identify a best buy, but such tests are not necessarily good indicators of clinical performance and some bench tests appear to conflict with mock clinical assessments. Discrepancies can be explained by examining the role of the hub. The Visual Probability Test, which assesses the needle as a complete unit, would appear to be more useful than the more complex measurements of shaft flow. Not all needle manufacturers use the same gauge, creating confusion when comparisons are made. Packaging frequently fails to give adequate information. Changes in hub design could permit earlier identification of dural puncture.
Cerebral oximetry: a useful monitor during carotid artery surgery
Authors: DUNCAN L. A. , RUCKLEY C. V. , WILDSMITH J. A. W.
Published: February 2007

Cerebral oximetry was evaluated as a monitor of oxygenation during carotid endarterectomy in 22patients. The oximeter was a reliable continuous monitor, identifying changes in cerebral oxygenation during episodes of hypotension and after arterial occlusion. Changes in oxygenation correlated well with the surgical assessment of backbleeding after arterial clamping, but less well with other methods which are used to make a decision on insertion of an arterial shunt. There was no correlation between internal carotid artery stump pressure and change in cerebral oxygenation after application of the arterial cross clamp. However, cerebral oxygenation correlated weakly with the change in middle cerebral artery velocity as measured by transcranial Doppler ultrasonography (r = 0.49, p < 0.02).
SCOTI—a new device for identification of tracheal intubation
Authors: MURRAY D. , WARD M. E. , SEAR J. W.
Published: February 2007

A new lightweight device for the detection of placement of a tracheal tube in the trachea or oesophagus is described. The device utilises a sonic technique detecting resonating frequencies in an open (trachea) or closed (oesophagus) structure. Evaluation of the device in a clinical environment is described and it has been shown to be capable of verifying the correct placement of the tracheal tube in the trachea in 98% of patients studied. Further evaluation of this intubating aid appears justified.
Resistance, reverse flow and opening pressure of unidirectional valves
Authors: LEIBUNDGUT D. , ZBINDEN A. M.
Published: February 2007

Based on a new preliminary standard of the‘Comité Européen de Normalisation’, the following unidirectional valves were tested with regard to resistance, opening pressure, reverse flow and dislocation: the Dräger inspiratory and expiratory valves, the Engström inspiratory valve, the Ohmeda valve, the Siemens Ventilator 710 inspiratory and expiratory valves, the Siemens Ventilator 900C unidirectional valve of the absorber and the Megamed 700 inspiratory and expiratory valves of the circle system 219 (Megamed 700 CS 219). The following valves fulfilled all Comité Européen de Normalisation requirements: Dräger inspiratory and expiratory valves, Siemens 900 absorber valve and Megamed 700 CS 219 inspiratory valve. The Siemens 710 valve and the Megamed 700 CS 219 expiratory valve did not meet the requirements for flow resistance. The Ohmeda and Siemens 710 valves and the Engström inspiratory valve did not fulfil the Comité Européen de Normalisation requirements for reverse flow. In addition, the Engström inspiratory valve did not comply with the dislocation test. The requirements for the opening pressure were met by all the valves tested. Valves with the disc in a horizontal position achieved better results than those with the disc in a vertical position. These measurements, showing the differences in the performance of various types of valves confirm the feasibility of the standards proposal.
Cardiovascular and catecholamine response to surgery in brain‐dead organ donors
Authors: FITZGERALD R. D. , DECHTYAR I. , TEMPL E. , FRIDRICH P. , LACKNER F. X.
Published: February 2007

Eleven brain‐dead organ donors were studied during surgery. Plasma levels of adrenaline and noradrenaline were measured before and after skin incision, upon sternotomy and 15, 30 and 45min thereafter. Haemodynamic changes were measured continuously throughout the observation period. Blood pressure and heart rate increased after skin incision, remained high at sternotomy then decreased towards the end of the observation period in six of the 11 patients. Plasma catecholamines increased promptly with the onset of surgical stimuli. We conclude that surgical stress can evoke an excessive rise of plasma adrenaline and noradrenaline and thus could impair allograft function.
The output of an‘empty’ Tec 3 vaporizer
Authors: GRAHAM S. G. , SZAFRANSKI J. , BLAND D. , LANGTON J. A.
Published: February 2007

The output of 30 Tec 3 vaporizers (halothane, enflurane and isoflurane) was studied, starting at the point where no liquid was visible in the content window. At 6l.min‐1 and 1% v/v initial output, consistent delivery was on average maintained for in excess of 90 (range 55–120) min. Thereafter, output declined rapidly. At the flows and concentrations studied there is a significant reserve in the vaporizing chamber, but it is likely that when higher flows and concentrations are used this reserve may be substantially reduced.
Anaesthetic and postoperative recovery rooms
Authors: ZUCK D.
Published: February 2007

From time to time questions are asked about the origins and history of anaesthetic and postoperative recovery rooms. Early accounts of the use of these facilities, and their introduction into hospital planning, are reviewed.
Analgesia following day‐case knee arthroscopy—the effect of piroxicam with or without bupivacaine infiltration
Authors: Morrow B. C. , Milligan K. R. , Murthy B.V.S.
Published: February 2007

Sixty patients presenting for day‐case arthroscopy of the knee under general anaesthesia were studied. Patients were randomly allocated to receive, in addition to intramuscular piroxicam 20mg, either bupivacaine 0.25% 20 ml applied locally to the knee at the end of the procedure (n = 30) or no further intra‐operative analgesia (n = 30). Visual analogue pain scores were significantly lower at 1,2 and 4 h postoperatively in the bupivacaine group (p < 0.05). A higher proportion of patients in the piroxicam‐only group required supplemental analgesia before discharge from hospital. The combination of piroxicam and bupivacaine provided superior analgesia to piroxicam alone.
Utilisation of the pre‐operative ECG
Authors: CALLAGHAN L. C. , EDWARDS N. D. , REILLY C. S.
Published: February 2007

The utilisation of the pre‐operative ECG in patients undergoing routine surgery was investigated in 354 adult patients over a 2‐week period. Sixty‐four percent of patients had an ECG pre‐operatively. An ECG was not performed in 17% of patients who, current hospital policy suggests, should have had one. In contrast, an ECG was performed in 33% of patients who, hospital policy suggests, have no need of one (all of which were normal), which represented 18% of the total number of pre‐operative ECGs performed. In 62% of patients with known cardiac disease, and 44% of patients with strong risk factors for ischaemic heart disease (in the absence of known disease) the ECG was abnormal. This compares with only 7% of patients aged over 50 with no risk factors in whom the ECG was abnormal. These findings suggest that there is room for improvement in the utilisation of the pre‐operative ECG, which may have cost implications.
The uptake of enflurane during anaesthesia
Authors: DEVCHAND D. , CHAKRABARTI M. K. , LOCKWOOD G. G.
Published: February 2007

The uptake of enflurane at a constant end‐expired concentration of 2% in oxygen was studied in 38 patients, ASA 1 or 2, undergoing elective orthopaedic procedures. The anaesthetic was administered using a computer‐controlled closed circle system. Following an initial 4 min period during which the expired concentration of enflurane was established, the rate of uptake of enflurane showed a triexponential decline. The mean cumulative use of enflurane after 60min was 10.7ml, and after 120min was 18.4ml.
The effects of thiopentone and propofol on delayed hypersensitivity reactions
Authors: DEVLIN E. G. , CLARKE R. S. J. , MIRAKHUR R. K. , McNEILL T. A.
Published: February 2007

The effects of thiopentone and propofol on delayed hypersensitivity reactions and T lymphocyte proliferation were studied in nine healthy volunteers (five women and four men). Thiopentone 5 mg.kg‐1 and propofol 2.5mg kg‐1 were given as a 10 min infusion on two separate occasions. The volunteers were exposed to a skin multitest antigen before and after administration of the two agents and their skin reactions assessed. T lymphocyte responses were studied using phytohaemagglutinin (PHA)‐induced proliferation. Results showed that both drugs caused a significant depression of skin reactions in vivo but no depression in the T lymphocyte proliferation.
Intubating conditions following 1R CIS, 1′R CIS atracurium (51W89)
Authors: LITTLEJOHN I. H. , ABHAY K. , EL SAYED A. , BROOMHEAD C. J. , DUVALDESTIN P. , FLYNN P. J.
Published: February 2007

51W89 besylate, a new intermediate acting non‐depolarising muscle relaxant, consisting of a single stereo‐isomer of the commercial preparation of atracurium has been assessed in respect of intubating conditions during nitrous oxide‐propofol‐isoflurane anaesthesia. Intubating conditions at 2min were acceptable in 67% of patients following a dose of 0.1 mg.kg‐1 and in 90% of patients following a dose of 0.15 mg.kg‐1. Intubating conditions at 1.5 min were acceptable in 76% of patients following a dose of 0.2mg.kg‐1. In comparison, intubating conditions at 2min were acceptable in 95% of patients following 0.5mg.kg‐1 of atracurium. The intubating conditions at 2 min following a dose of 0.1 mg.kg‐1 51W89 besylate were significantly worse than the other three groups (p < 0.05); however, there was no significant differences between the scores in the other three groups. There was no clinical evidence of histamine release in the groups receiving 51W89 besylate compared to two out of the 19 patients who had cutaneous flushing following the administration of atracurium. Our results suggest that 51W89 besylate provides acceptable intubating conditions at 2 min following a dose of 0.15 mg.kg‐1 and may prove to be an acceptable alternative to atracurium if studies in progress confirm its greater cardiovascular stability and reduced propensity to release histamine than its parent compound.
Dose‐responses for edrophonium during antagonism of vecuronium block in young and older adult patients
Authors: McCARTHY G. J. , MIRAKHUR R. K. , MADDINENI V. R. , McCOY E. P.
Published: February 2007

The dose‐response relationship for edrophonium during antagonism of vecuronium‐induced neuromuscular blockade was studied in two groups of adult patients of mean (SD) age 35(10.0) years (n = 42) and 77 (5.4) years (n = 42) respectively. Neuromuscular block was monitored by recording the force of contraction of the adductor pollicis muscle following train‐of‐four stimulation. Six patients in each age group received 0.1, 0.3, 0.5, 0.7, 1.0, or 1.5mg.kg‐1 of edrophonium, or normal saline at 10% recovery of T1 (first response in the train‐of‐four) after a single dose of vecuronium 0.08mg.kg‐1. The train‐of‐four ratios were recorded continuously over the next 10 min and the values at 1 min intervals from 5min onwards were used to construct the dose‐response curves. The dose‐response curves showed no significant difference between the two age groups except at 10 min. The estimated dose of edrophonium required for attaining a train‐of‐four ratio of 0. 7 at 10 min was 0.9 and 1.3 mg.kg‐1 in the younger and older groups, respectively (p < 0.05).
Rate of‘onset’ and‘offset’ of four non‐depolarising neuromuscular blocking drugs
Authors: FELDMAN S. A. , WU X. , ENGLAND A.
Published: February 2007

There is evidence that onset time and potency of non‐depolarising neuromuscular blocking drugs are related. The relationship between onset time and rate of recovery has not been investigated. In this study, using the isolated forearm technique, the onset time of four different non‐depolarising drugs have been compared with their recovery times. It has been demonstrated that there is a strong relationship between these parameters. It is proposed that the relationship between onset time and offset time suggests a common mechanism that influences both events and that this may also explain the relationship between potency and the rate of onset.
Haemodynamic effects of tracheally administered adrenaline in anaesthetised patients
Authors: KESTIN I. G. , McCRIRRICK A. B.
Published: February 2007

Ten patients undergoing arterial surgery in the leg received a combined general anaesthetic, which included muscle relaxation and intubation of the trachea, and a regional anaesthetic using a lumbar extradural catheter. The radial arterial pressure was measured. Adrenaline 0.1 μg.kg‐1 was administered intravenously and the heart rate, arterial pressure and oxygen saturation were recorded every 15 s for l0min. Adrenaline in 5 ml of saline was given into the trachea at 10 min intervals. The first was saline only, and successive injections contained 0.5 μg.kg‐1, 1 μg.kg‐1, 2 μg.kg‐1, and 3 μg.kg‐1 of adrenaline. The mean maximum rise in systolic arterial pressure after adrenaline given intravenously was 30 (SD 11) mmHg, and 15 (SD 16) mmHg after the maximum dose of adrenaline given into the trachea (p < 0.05). The mean systolic arterial pressure was significantly increased between 45 s and 4.5 min after the adrenaline given intravenously, and 2 min after adrenaline given into the trachea. Of seven patients who received adrenaline 3 μg.kg‐1 into the trachea, six had no noticeable effect and in the other patient, the increase in arterial pressure was less than 90% of the maximum rise after the adrenaline. We conclude that adrenaline given into the trachea is unreliable in humans with very large doses necessary in some patients to produce a clinically useful haemodynamic effect.
Prolonged interval jet ventilation
Authors: CONACHER I. D.
Published: February 2007

The initial clinical experience of using a technique of prolonged interval jet ventilation is reported. Periodic pulses, of from three to nine breaths, were delivered in rapid sequence from a jet ventilator during one‐lung ventilation. The expiration phase was free to atmosphere, without added artificial expiratory assist or resistance, and of from 30 to 50 s duration before delivery of the next pulse of jet ventilation. The aim of the technique was to evaluate during anaesthesia the practicalities of securing a prolonged period during which intrathoracic pressure is low and hence optimal for venous return and deflation of pathological pulmonary regions with long time constants. The system used is flexible enough to allow for conventional positive pressure techniques to be applied if necessary. As the gas delivery was of oxygen of high concentration, episodes of hypoxaemia were minimal in this group of high risk patients and due to technical rather than physiological causes. The delivery of a minute volume adequate to prevent hypercapnia was not always possible and the technique may be contraindicated in those conditions in which a raised carbon dioxide concentration is disadvantageous.
Effect of demand frequency on lockout period
Authors: MILNER A. R. , HARWOOD R. J. , MILLARD J. , BOGOD D. G. , CURRAN J. P.
Published: February 2007

An Abbott Provider 5500 Patient Controlled Analgesia machine was noticed to have developed a prolonged lockout period when frequent analgesic demands were being made. This study tested five other machines and demonstrated that the duration of the lockout period was influenced by the frequency of analgesic demands. This finding could have clinical implications and we recommend that the duration of the lockout period should be specifically examined during the testing of patient‐controlled machines.
Propofol and postanaesthetic shivering
Authors: Cheong K. F. , Low T. C.
Published: February 2007

Sixty ASA grade 1 unpremedicated patients scheduled for minor elective surgery were randomly allocated to receive general anaesthesia consisting of either propofol‐nitrous oxide in oxygen or a conventional technique of thiopentone–isoflurane–nitrous oxide–oxygen. Baseline axillary temperature readings, duration of operation and intra‐operative decrease in axillary temperature were similar in both groups. The patients who received propofol—nitrous oxide—oxygen anaesthesia had a significantly lower incidence of postanaesthetic shivering than the control group. A propofol‐nitrous oxide‐oxygen technique may be preferable when postanaesthetic shivering is deemed undesirable.
Ineffective analgesia after extradural tramadol hydrochloride in patients undergoing total knee replacement
Authors: Grace D. , Fee J. P. H.
Published: February 2007

Postoperative analgesia after two extradural tramadol regimens was compared with that obtained using a standard extradural morphine regimen in patients undergoing total knee replacement. Extradural anaesthesia with light general anaesthesia was used. Patients received extradurally either: tramadol 50mg by bolus injection followed by infusion (5mg.h‐1 for 12 h and 2.5mg.h‐1 for a further 12 h) (group T50), tramadol 100 mg by bolus injection followed by infusion (10 mg.h‐1 for 12 h and 5mg.h‐1 for a further 12 h) (group T100) or morphine sulphate 2 mg by bolus injection followed by infusion (0.2 mg.h‐1 for 12 h and at 0.1 mg.h‐1 for a further 12 h) (group M). Analgesia was allocated according to a controlled double‐blind design. Visual analogue pain scores were markedly poorer (p < 0.05) and patient‐controlled analgesic consumption was significantly greater (p < 0.01) in the two tramadol groups when compared with the morphine group. The study was discontinued after recruitment of 12 patients, as analgesia was deemed inadequate in those receiving tramadol extradurally. However, further study of this drug may be warranted to examine its effectiveness where postoperative pain is expected to be less severe, and to assess the effect of larger extradural doses and of co‐administration of tramadol and morphine by this route.
The antiemetic effectiveness of droperidol during morphine patient‐controlled analgesia
Authors: Roberts C. J. , Millar J. M. , Goat V. A.
Published: February 2007

This prospective, double‐blind study examined the antiemetic effectiveness of the addition of droperidol to a morphine solution for use in patient‐controlled analgesia in a group of 50 patients undergoing elective lumbar laminectomy. The addition of 20 mg droperidol to 120 mg morphine in 60 ml saline given by a Baxter‘Infusor’ patient‐controlled analgesia device reduced the incidence of vomiting as compared to the addition of sodium chloride from 42.8% to 12.5% (p = 0.028) and of nausea from 71.4% to 29.2% (p = 0.005). The proportion of patients requiring rescue antiemetic therapy was reduced from 47.6% to 16.7% (p = 0.025) and the time interval to the first use of rescue antiemetic agent was significantly prolonged (p = 0.029). The use of droperidol was associated with an increased degree of sedation during the first 12 h after operation.
Does dead space ventilation always alleviate hypocapnia?
Authors: WATT J. W. H. , DEVINE A.
Published: February 2007

Long‐term tracheostomy‐ventilated patients have better speech with a cuffless tracheostomy tube and a large tidal volume. Moderate day time hyperventilation from a pressure‐limited ventilator is necessary in these patients to avoid hypoxia during sleep due to the variable insufflation leak. This study sought to confirm whether a dead space of 3 ml.kg‐1 could help to provide normocapnic hyperventilation during waking time without causing hypercapnia and hypoxaemia during sleep. Transcutaneous blood gas studies were performed on 11 patients with high tetraplegia undergoing pressure‐limited pulmonary ventilation with room air. Recordings were made for 120 min each when awake and asleep, with and without dead space. The mean derived arterial P CO2without the dead space was 2.95 kPa awake and 3.21 kPa asleep, whilst the corresponding tensions with dead space were 3.39 kPa and 3.79 kPa. These small increases associated with the dead space, both awake and asleep, were statistically significant. There was a statistically, though not clinically significant decrease in oxygen tension when the patients without dead space went to sleep. The fact that the carbon dioxide tension was higher during sleep when dead space was in situ indicates that, despite the insufflation leak in these patients, there is significant rebreathing back through the dead space. Amelioration of hypocapnia during waking and sleeping is achievable using a dead space extension in these patients.
A fibreoptic laryngoscope for paediatric anaesthesia
Authors: WRIGLEY S. R. , BLACK A. E. , SIDHU V. S.
Published: February 2007

A technique for the use of the Olympus LF‐P as an aid to tracheal intubation, via the oral route, in 40 anaesthetised, spontaneously breathing children is described. The technique was completely successful in 30 (75%) of the children. Complications occurred in the remaining ten (25%); two developed laryngospasm and in seven the fibrescope flipped out of the trachea during the initial passage of the tracheal tube over the fibrescope. In one child the wrong tracheal tube was initially chosen. The two children who developed laryngospasm and three of the children in whom the fibrescope flipped out of the trachea required conventional laryngoscopy and tracheal intubation. Whilst this technique allowed for training in the use of the LF‐P in paediatric anaesthesia there were a number of complications.
Oxygen therapy reduces postoperative tachycardia
Authors: Stausholm K. , Kehlet H. , Rosenberg J.
Published: February 2007

Concomitant hypoxaemia and tachycardia in the postoperative period is unfavourable for the myocardium. Since hypoxaemia per se may be involved in the pathogenesis of postoperative tachycardia, we have studied the effect of oxygen therapy on tachycardia in 12 patients randomly allocated to blinded air or oxygen byfacemask on the second or third day after major surgery. Inclusion criteria were arterial hypoxaemia (oxygen saturation ≤ 92%) and increased heart rate (> 90 beat.min‐1). Each patient responded similarly to oxygen therapy: an increase in arterial oxygen saturation and a decrease in heart rate (p < 0.002). Thus, postoperative supplementary oxygen has a positive effect on the cardiac oxygen delivery and demand balance.
Effect of general anaesthesia and surgery on neutrophil function
Authors: KHAN F. A. , KAMAL R. S. , MITHANI C. H. , KHURSHID M.
Published: February 2007

The effects of general anaesthesia and surgical trauma on neutrophil function were studied in 60 female ASA 1 and 2 patients undergoing anaesthesia for gynaecological surgery. Patients were divided into three groups depending on the degree of trauma and duration of surgery. Group 1 (n = 15) were patients for dilatation and curettage (minor surgical trauma) and were given 2% halothane. Group 2 (n = 30) had laparoscopic surgery (moderate surgical trauma) and received either 0.5% halothane or 1% enflurane. Group 3 (n= 15) were those having hysterectomy (major surgical trauma) and received 0.5% halothane for a longer duration. Venous samples were taken 30 min before anaesthesia (control value), 10 min after induction of anaesthesia, 10 min after the start of surgery, 30 min after the end of anaesthesia and 24 h later. Phagocytic index, nitroblue tetrazolium reduction test, total leucocyte count, and differential leucocyte counts were performed on each sample. Data were analysed by paired t‐test to compare findings in the same patient and by unpaired t‐test for differences between groups. Anaesthesia with halothane 0 5% to 2% caused a dose‐related depressant effect on leucocyte function which reversed. Enflurane 1% on the other hand caused significantly greater depression of leucocyte function compared with 0.5% halothane which persisted during the recovery period and recovered on the first postoperative day. Total leucocyte counts also showed a fivefold increase in the major surgery groups.
Anaesthesia for Caesarean section in a patient with Klippel‐Feil syndrome
Authors: Dresner M. R. , Maclean A. R.
Published: February 2007

A 34‐year‐old woman with severe kyphoscoliosis, an immobile cervical spine, and short stature due to the Klippel‐Feil syndrome presented for elective Caesarean section. She expressed a strong desire to remain awake during the procedure. We chose a technique using a spinal microcatheter to provide spinal anaesthesia on the basis that incremental control of the dose of bupivacaine would reduce the risk of‘high’ block. Awake inspection of the larynx was performed as a precaution in the event of respiratory embarrassment. A total of 6.25 mg heavy bupivacaine, 7.5 mg plain bupivacaine, and 10 μg fentanyl were administered over 20 min. This provided anaesthesia up to T5 without significant effects on respiratory or cardiovascular function. The patient was successfully delivered of a healthy boy.
Paravertebral blockade
Authors: Lönnqvist P. A. , MacKenzie J. , Soni A. K. , Conacher I. D.
Published: February 2007

The failure rate and complications were studied prospectively in 367 paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1%; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1.1%; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.