bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery A comparison of thoracic and lumbar routes
Authors: Chisakuta A. M. , George K. A. , Hawthorne C. T.
Published: February 2007

Thirty‐three patients who had undergone elective open cholecystectomy were studied in a prospective, randomised comparison of thoracic (n = 17) and lumbar (n = 16) epidural routes of administration of a mixture of bupivacaine 0.2% with fentanyl 10μg.ml‐1 for postoperative pain. Pain relief cardiovascular stability, respiratory rate and side effects were assessed by a‘blinded’observer at specific times in the 24 h study period. The thoracic epidural route proved significantly more reliable than the lumbar and provided effective analgesia in all patients (p < 0.05). This was not accompanied by significant hypotension or respiratory depression. The incidence of side effects attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p < 0.05). This study supports the use of the thoracic epidural route for postoperative pain management after upper abdominal surgery.
Sedation with intravenous infusions of propofol or thiopentone
Authors: WILDER‐SMITH O. H. G. , KOLLETZKI M. , WILDER‐SMITH C. H.
Published: February 2007

The aim of this study was to investigate pain perception during thiopentone or propofol infusions for sedation. Thirty ASA 1 or 2 patients received a two step infusion of either thiopentone (step 1: 1.25 mg.kg‐1 followed by 2.5 mg.kg‐1.h‐1; step 2: 1.25 mg.kg‐1 and 12.5 mg.kg‐1.h‐1; n = 15) or propofol (step 1: 0.5 mg.kg‐1, 1 mg.kg‐1.h‐1; step 2: 0.5 mg.kg‐1, 5 mg.kg‐1.h‐1; n = 15) for sedation. At control and 10 min after the start of each infusion dosage, reaction times and thermal pain detection thresholds were determined. We found no clinically or statistically significant depression of thermal pain detection thresholds during propofol or thiopentone infusions and these are, therefore, unlikely to be associated with clinically relevant hyperalgesia.
Analgesia after Caesarean section
Authors: DENNIS A. R. , LEESON‐PAYNE C. G. , HOBBS G. J.
Published: February 2007

A double‐blind placebo‐controlled study was performed to assess the analgesic effect of rectal sodium diclofenac 100mg after Caesarean section using subarachnoid hyperbaric bupivacaine 0.5% and morphine 0.2mg. During the 48h follow‐up period, both placebo and diclofenac groups had comparable analgesia as measured by visual analogue scores (VAS) at rest and on movement. However, diclofenac prolonged the mean time to first analgesia by more than 5h from 13h 45 min in the placebo group to 18 h 58min (p < 0.03). The incidence of side effects (nausea, vomiting, itching, excessive lochia loss and the need for additional analgesia) were comparable in each group.
Postoperative analgesia with transdermal fentanyl following lower abdominal surgery
Authors: BROOME I. J. , WRIGHT B. M. , BOWER S. , REILLY C. S.
Published: February 2007

In a randomised, placebo‐controlled, double‐blind study involving 81 patients undergoing total abdominal hysterectomy, the postoperative analgesia provided by transdermal fentanyl given at 25, 50, or 75μg.h‐1 for 72h was compared with a placebo group. The efficacy of the Transdermal Therapeutic System was related to the rate of fentanyl delivery, higher rates being associated with significantly lower visual analogue pain scores (24, 20, 17 and 13, for placebo, 25, 50 and 75μg.h‐1 respectively) and reduced patient controlled analgesia morphine requirements (44, 38, 33 and 31 mg respectively). Patients’overall sedation scores were not increased by transdermal fentanyl, but respiratory rates decreased with higher transdermal fentanyl dosage.
The effect of maternal obesity on labour and labour pain
Authors: RANTA P. , JOUPPILA P. , SPALDING M. , JOUPPILA R.
Published: February 2007

Consecutive obese (n = 53) and non‐obese parturients (n = 609) were prospectively evaluated during labour to analyse the influence of maternal obesity on labour pain and outcome. Excessive pre‐pregnancy weight was classified as a body mass index of 30 kg.m‐2 or more. Pain intensity was measured using an 11 point visual scoring scale. Obese parturients had more complicated pregnancies (hypertension and diabetes) and their babies weighed significantly more (3865g versus 3592 g, p<0.001). These differences did not affect labour pain experience, or the duration or mode of delivery. Eighty‐five percent of the obese parturients and 83% of the controls had high maximal pain scores during the first stage (> 7). Both groups received similar analgesia. More technical problems (p = 0.03) were experienced in establishing epidural analgesia for obese parturients, but this did not influence the success of pain treatment. After delivery, obese women were significantly more content with the pain relief received; only 12% vs 23% in the control group complained of poor pain control (p = 0.03). In this study, obesity and increased fetal size did not complicate labour or its outcome. Critical patient assessment should be emphasised, however, due to the physiological and medical problems present in obese parturients.
Anterior spinal artery syndrome
Authors: Djurberg H. , Haddad M.
Published: February 2007

A case of unexpected paraplegia after oesophageal resection under general anaesthesia combined with epidural analgesia and intra‐operative intercostal block is described. Patients with compromised cardiovascular and respiratory function undergoing thoracic or major abdominal surgery can benefit significantly intra‐operatively from a combination of general anaesthesia and regional analgesia. The continued use of regional analgesia into the postoperative period offers even more advantages. General anaesthesia administered before regional analgesia may, however, mask complications related to the regional technique and delay the instigation of corrective measures. The blood supply to the anterior part of the spinal cord, through the artery of Adamkiewicz, may be impaired intra‐operatively leading to neurological sequelae known as the anterior spinal artery syndrome, characterised by loss of motor function with intact or partially intact sensory function. Patients at risk of developing the syndrome can be identified pre‐operatively.
Edrophonium as an antagonist of vecuronium‐induced neuromuscular block in the elderly
Authors: Kitajima T. , Ishii K. , Ogata H.
Published: February 2007

Train‐of‐four stimuli were applied to the ulnar nerve using an accelograph in 10 elderly patients (aged 70–82 years) and 10 younger patients (aged 27–54 years). Anaesthesia was induced with thiopentone 5mg.kg‐1 and was maintained with nitrous oxide (66%) oxygen and sevoflurane (1 MAC). Vecuronium 0.1mg.kg‐1 was used for paralysis, and reversed with intravenous edrophonium 0.75mg.kg‐1 and atropine 0.015mg.kg‐1 when the train‐of‐four ratio returned to 25%. The times from initial administration of vecuronium to completion of maximal block were 211.5 (SD 66.9) s and 154.0 (SD 39.7) s in the elderly and younger patients, respectively (p < 0.05). The times from maximal block to 25% recovery of train‐of‐four ratio were 64.8 (SD 36.3) min and 61.8 (SD 36.3) min in the elderly and younger patients, respectively. There was no statistically significant difference between them. The reversal times from 25% to 75% of the train‐of‐four ratio after the administration of edrophonium were 210.0 (SD 136.7) s and 177.0 (SD 100.4) s in the elderly and younger patients, respectively. There was no statistically significant difference between them. The authors were unable to show that healthy elderly patients differ significantly from younger patients in the neuromuscular blocking effect of vecuronium and the reversal effect of edrophonium.
Variable‐dose patient‐controlled analgesia
Authors: OWEN H. , PLUMMER J. , ILSLEY A. , HAWKINS R. , ARFEEN Z. , TORDOFF K.
Published: February 2007

One size of patient‐controlled analgesia demand dose does not suit all patients after surgery. We have constructed a new patient‐controlled analgesia system (variable‐dose patient‐controlled analgesia) in which patients have a choice of demand dose sizes. In an initial trial, patients could choose between 0.5, 1.0 or 1.5mg morphine. Patients readily understood the system and were all 'satisfied’ (n = 1) or‘very satisfied’ (n = 9) with the system. Only two patients sought‘complete relief from pain, most reported seeking’ moderate relief. All patients obtained‘a lot of relief or‘complete relief with this patient‐controlled analgesia system. This preliminary experience suggests that variable dose patient‐controlled analgesia warrants further investigation and comparison with conventional patient‐controlled analgesia.
The use of the Hayek Oscillator during microlaryngeal surgery
Authors: MONKS P. S. , BROOMHEAD C. J. , DILKES M. G. , McKELVIE P.
Published: February 2007

An externally mounted cuirass ventilator, the Hayek Oscillator, was used on 41 patients undergoing surgery to the larynx without the use of a tracheal tube. Gas exchange and cardiovascular parameters remained satisfactory during the use of this technique, which offers a significant advance over existing tubeless methods of anaesthesia.
Retracted: The effect of the anticoagulation regimen on endothelial‐related coagulation in cardiac surgery patients
Authors: BOLDT J. , SCHINDLER E. , WELTERS I. , WITTSTOCK M. , STERTMANN W. A. , HEMPELMANN G.
Published: February 2007

Heparin is still the most commonly used anticoagulant in cardiac surgery necessitating cardiopulmonary bypass. In recent years, endothelial‐related coagulation (e.g. thrombomodulin I protein C‐system) has enlarged our knowledge of the regulation of haemostasis. In a controlled randomised study, the influence of different regimens of anticoagulation on the thrombomodulin I protein C‐system was studied. Sixty patients undergoing elective coronary artery bypass grafting were randomly allocated into four groups (n = 15) to receive: 300 IU.kg‐1 of heparin before bypass; 600 IU.kg‐1 of heparin; 300 IU.kg‐1 of heparin as bolus followed by a continuous infusion of 10 000 IU.h‐1 until the end of bypass; or 600IU.kg‐1 of heparin plus“high dose” aprotinin (2 million IU of aprotinin before bypass, 500 000 IU.h‐1 until the end of the operation and 2 million IU added to the bypass pump prime). Grouping was blinded for the surgeon and the anaesthetist. Plasma concentrations of thrombomodulin, protein C and (free) protein S as well as thrombin/antithrombin III were measured by enzyme ‐linked‐immunosorbent assays after induction of anaesthesia, during and after bypass, at the end of surgery, 5h after bypass, and on the first postoperative day. Activated clotting time was significantly longer during bypass in group 2 (566 (60)s) and group 4 (655 (59)s), whereas standard coagulation parameters showed no differences between the four groups. Blood loss and use of homologous blood and blood products were highest in groups 2 and 3. Thrombomodulin plasma levels were similar (and normal) at baseline (< 40 ng.l‐1), decreased during bypass and reached baseline values postoperatively without showing significant group differences. Protein C did not show any differences among the groups within the investigation period.‘Free’ protein S plasma levels were most reduced in group 1 (from 68 (8)% to 48 (9)% after bypass). Thrombin/antithrombin III plasma concentrations increased most in groups 1 (to 69 (14) μg.l‐1 after bypass) and 2 (to 48 (7) ng.l‐1 after bypass), whereas they remained significantly lower in groups 3 and 4. The thrombomodulin/protein C‐system was not significantly influenced by the regimen of anticoagulation. Administration of‘high‐dose’ heparin was associated with the highest blood loss, which could not be related to endothelial‐associated coagulation.
Severe hyperventilation and respiratory alkalosis during pressure‐support ventilation: report of a hazard
Authors: Chui P. T. , Joynt G. M. , Oh T. E.
Published: February 2007

A 53‐year‐old woman with a flaccid quadriparesis developed severe hyperventilation and respiratory alkalosis during pressure‐support ventilation. A gas leak in the ventilator system caused a loss of positive end‐expiratory pressure and autocycling of the ventilator. Large ventilator breaths were then delivered because a high level of pressure support was set in a patient with low respiratory impedance. The complication is rare and its occurrence requires a combination of patient and equipment factors. Awareness of the responsible factors will promote detection and prevention of the hazard.
Postoperative laryngeal competence
Authors: Stanley G. D. , Bastianpillai B. A. , Mulcahy K. , Langton J. A.
Published: February 2007

We investigated the incidence of postoperative laryngeal incompetence in 40 patients undergoing lower limb arthroplasty. Patients were randomly allocated to one of two groups using a standardised general anaesthetic/muscle relaxant technique; in group A the patients’ lungs were ventilated via a laryngeal mask airway and in group B via a tracheal tube. Following recovery from general anaesthesia, at a time when patients were considered safe for discharge back to the general ward, they were asked to swallow 20 ml of barium, and an immediate portable chest X ray was taken. The X rays were examined for evidence of tracheopulmonary aspiration. Contrary to previous studies the incidence of aspiration was low, occurring in only one patient. This aspiration was, however, clinically silent. The exact mechanism of this apparent laryngeal incompetence, which occurred in a patient from the tracheal tube group, is unclear. Due to the relatively small numbers of patients studied no conclusions can be drawn about the relative benefits of the use of the laryngeal mask airway with regard to postoperative laryngeal competence.
The anaesthetic management of Caesarean section for placenta praevia: a questionnaire survey
Authors: Bonner S. M. , Haynes S. R. , Ryall D.
Published: February 2007

The purpose of this study was to determine current UK anaesthetic practice regarding the use of regional anaesthesia in the management of patients with placenta praevia presenting for Caesarean section. We asked the members of the Obstetric Anaesthetists Association to complete a postal questionnaire in which a range of clinical situations involving varying degrees of placenta praevia were presented. In each case respondents were asked whether they would be willing to use regional anaesthesia. A wide variety of clinical practice was demonstrated. Anaesthetists with two or more obstetric sessions were more willing to use regional anaesthesia for Caesarean section in the presence of placenta praevia in both elective and emergency situations associated with haemorrhage.
Bilateral paravertebral analgesia for major abdominal vascular surgery: a preliminary report
Authors: Richardson J. , Vowden P. , Sabanathan S.
Published: February 2007

Paravertebral analgesia is highly effective in blocking unilateral afferent input from the trunk, but its bilateral use does not appear to have been described. Eight patients undergoing major abdominal vascular surgery had pre‐operative bilateral paravertebral catheters inserted. A dose of 25 ml of bupivacaine 0.5% divided between the two catheters provided the basis of an effective intra‐operative analgesic regimen which was continued postoperatively by infusion of bupivacaine for 4 days. Diclofenac and morphine completed a balanced analgesic regimen which was started pre‐operatively and continued for 5 and 3 days respectively. Cardiovascular stability was notable throughout surgery, even with aortic clamping and all patients were extubated at the end of surgery. Good quality analgesia was obtained as assessed by low postoperative pain scores at rest and on movement. Three patients were not admitted to the intensive care unit, where mean stays for the group was 10 h (range 0‐24 h) and mean hospital stay was 10 days (range 7–14). There were no additional demands made on the nursing staff and no postoperative pain‐related complications occurred. We conclude that bilateral paravertebral analgesia, as part of a balanced analgesic technique, is an alternative method of providing effective afferent blockage for major abdominal surgery.
An evaluation of two concentrations of hyaluronidase for supplementation of peribulbar anaesthesia
Authors: Brydon C. W. , Basler M. , Kerr W. J.
Published: February 2007

We studied the effect of the addition of hyaluronidase to a mixture of lignocaine 2% and bupivacaine 0.75% for peribulbar anaesthesia in 60 patients presenting for elective intra‐ocular surgery. Using a randomised, double‐blind design, patients were allocated to one of three groups: no hyaluronidase (group A) (n = 20); hyaluronidase 50 iu.ml‐1 (group B) (n = 20); hyaluronidase 150 iu.ml‐1 (group C) (n = 20). The speed of onset of the block, the presence of akinesia, analgesia and the need for supplementary injections were assessed. The addition of 150 iu.ml‐1 of hyaluronidase resulted in a mean (SEM) time to akinesia of 9.2 (0.9) min compared to 10.9 (0.9) min in the control group and 10.7 (1.1) min in those receiving the lower dose. Fewer patients in group C required a further injection (20%) than those in groups A (40%) or B (45%). None of the findings were statistically significant. Hyaluronidase was not associated with any complications.
Health and activity after intensive care
Authors: MUNN J. , WILLATTS S. M. , TOOLEY M. A.
Published: February 2007

All patients discharged from a general intensive care unit over a 4.5 year period were sent a questionnaire 3 months after discharge which investigated aspects of their health and physical abilities. Replies were compared on the basis of age, diagnosis and sickness severity on admission. Five hundred and four questionnaires were analysed. Overall, 47% of patients described their health as good/very good, 42% as fair and 11% as poor/very poor. Activity level, compared to that before their admission, was unchanged in 59%, worse in 33% and improved in 8% of patients. There were no differences in health status or changes in activity with age, diagnosis or severity of sickness. Patients aged 76 years or older were more likely to perceive their health as‘better than average’ than younger patients (p < 0.01). Eight percent of patients would be unwilling to undergo intensive care again. An unacceptable health status after intensive care cannot be predicted in any group of patients.
External high frequency oscillation in normal subjects and in patients with acute respiratory failure
Authors: AL‐SAADY N. M. , FERNANDO S. S. D. , PETROS A. J. , CUMMIN A. R. C. , SIDHU V. S. , BENNETT E. D.
Published: February 2007

External high frequency oscillation was performed on 20 healthy volunteers using a cuirass‐based system, the Hayek Oscillator. Five‐min periods of oscillation were carried out on each subject at frequencies of 1, 2, 3, 4 and 5 Hz. Effective ventilation was measured in terms of the fall in alveolar partial pressure of carbon dioxide immediately after oscillation. The optimum frequency for oscillation was 1–3 Hz but most of the subjects were adequately ventilated over a wide range of frequencies. Thus, the Hayek Oscillator is capable of adequately ventilating normal subjects by means of chest wall oscillation. We also compared external high frequency oscillation with intermittent positive pressure ventilation in five patients with respiratory failure. Using the same inspired oxygen fraction, the external high frequency oscillation replaced intermittent positive pressure ventilation for a 30‐min period. External high frequency oscillation improved oxygenation by 16% and reduced the arterial carbon dioxide by 6%. These preliminary findings suggest that normal subjects and intensive care unit patients can be adequately ventilated by means of external high frequency oscillation.
Evaluation of a new method for determining tracheal tube length in children
Authors: FREEMAN J. A. , FREDRICKS B. J. , BEST C. J.
Published: February 2007

Most paediatric tracheal tubes are marked in centimetres from the tip. In 105 children, nasotracheal tube length was set at the level of the vocal cords such that all 3.0 and 3.5 mm internal diameter tubes were placed with the 3 cm mark at the cords, all 4.0 and 4.5 tubes were set at 4 cm at the cords and all 5.0 and 5.5 tubes were set at 5 cm at the cords. Subsequent chest X ray showed that 79% of the tracheal tubes were in the ideal midtracheal position, one tube was marginally short and 20% of the tubes were marginally long. Neither bronchial intubation nor accidental extubation occurred in any subject. This is an effective method to determine tracheal tube length which may be used for both oral and nasal intubation.
Comparison of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient‐controlled analgesia
Authors: Alexander R. , Lovell A. T. , Seingry D. , Jones R. M.
Published: February 2007

In a randomised, placebo‐controlled trial we have compared the efficacy of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient‐controlled analgesia after orthopaedic surgery. One hundred and forty five patients, ASA 1 and 2, undergoing major orthopaedic surgery were anaesthetised using a standardised technique. They were randomly allocated to receive patient‐controlled analgesia as morphine 1 mg.ml‐1 alone; morphine as before plus a single dose of 1.25 mg droperidol together with 0.083 mg.ml‐1 in the infusion syringe; or morphine as before plus 4 mg ondansetron and 0.13 mg.ml‐1 in the syringe. The patient‐controlled analgesia bolus dose was set at 1 ml with a 5 min lockout and a 4 h maximum dose of 30 mg morphine. There was no background infusion. The occurrence of nausea, vomiting and sedation was assessed every 4 h. The incidence of vomiting decreased from 59% in the morphine‐only group to 35% and 14% in the droperidol (p < 0.05) and ondansetron groups (p < 0.001) respectively. The number of patients suffering from nausea alone was not significantly different between the three groups, although those in the ondansetron group experienced less severe nausea (p < 0.05) when using a two point scale. The droperidol group had significantly higher sedation scores than the other two groups (p < 0.005). We conclude that ondansetron is superior to droperidol when used with patient‐controlled analgesia and causes less sedation.
A prospective study to assess the demand for a high dependency unit
Authors: And C. G. LEESON‐PAYNE , AITKENHEAD A. R.
Published: February 2007

We performed a prospective study in our teaching hospital to determine the demand for a High Dependency Unit where none had existed before. An admission criteria protocol was designed for medical and surgical patients and this was used in an intense surveillance of 22 acute wards over 2 weeks. It was predicted that a high dependency unit of eight beds would operate to capacity 50% of the time. An analysis of this type over a short period of time using similar admission criteria could be used to assist in the prediction of the necessary size of a High Dependency Unit facility in any hospital.
Prevention of nausea and vomiting after day case gynaecological laparoscopy
Authors: PAXTON L. D. , McKAY A. C. , MIRAKHUR R. K.
Published: February 2007

We have compared the efficacy of ondansetron, metoclopramide, droperidol and placebo in the prevention of postoperative nausea and vomiting in 118 day stay patients undergoing laparoscopic gynaecological procedures. All received a standardised general anaesthetic offentanyl, propofol, nitrous oxide in oxygen and isoflurane. Three to five min before induction of anaesthesia, patients were allocated to receive ondansetron 4mg, metoclopramide 10 mg, droperidol 1 mg or placebo in a randomised, double‐blind manner. Visual analogue scores for nausea, the incidence of emetic episodes, and analgesic and antiemetic consumption were recorded for 48 h postoperatively. The scores for nausea were significantly lower in the ondansetron group (p < 0.01) compared with the other three groups at 1, 2 and 4h after operation; thereafter there was no difference. The incidence of erne sis was lower (p = 0.063) and time to first oral fluids was shorter (p < 0.05) in the ondansetron group. Oral analgesic requirements were significantly greater in the ondansetron group over the 48 h study period. Two patients, one each in the placebo and metoclopramide groups, had to remain in hospital overnight because of persistent emetic symptoms.
Somatosensory evoked potential changes following electro‐acupuncture therapy in chronic pain patients
Authors: KUMAR A. , TANDON O. P. , BHATTACHARYA A. , GUPTA R. K. , DHAR D.
Published: February 2007

Somatosensory evoked potentials were recorded in 20 healthy volunteers and 20 patients with chronic pain undergoing electro‐acupuncture therapy. The values of absolute peak latency and amplitudes of N19 and P22 in the control group were compared with the corresponding baseline values in the study group and after electro‐acupuncture therapy at three stages during a 10‐treatment cycle. On these occasions the intensity of pain was recorded using a 100 mm visual analogue scale score. Each patient in the study group had 10 treatments given on alternate days. The absolute peak latency of N19 was significantly delayed (p < 0.05) in chronic pain patients when compared to the control group. This increase in latency of N19 persisted after the first electro‐acupuncture treatment (p < 0.05), tended to revert to normal after the fifth treatment (p > 0.05) and reverted completely to control values after the 10th treatment (p > 0.05). Visual analogue scores also decreased significantly (p < 0.05) after the fifth and 10th electro‐acupuncture sessions. These observations suggest that there is an interaction of the neural mechanisms of electro‐acupuncture with the thalamic generator of somatosensory evoked potentials i.e. N19.
Prolonged starvation in paediatric surgery
Authors: Veall G. R. Q.
Published: February 2007

An evaluation of the pre‐operative preparation of 285 children attending Sheffield Children's Hospital for elective surgery showed that prolonged and unnecessary starvation takes place, particularly in children over 1 year of age who have their operation in the morning. Excessive starvation of children is unkind and unnecessary. In order to prevent it a revision of current starvation guidelines is required.
Discrepancy of recovery times related to potency between atracurium and mivacurium simultaneously administered in isolated forearms
Authors: KIM S. Y. , HWANG K. H. , OK S. Y. , KIM S. I. , KIM S. C. , PARK W.
Published: February 2007

Recovery from potent non‐depolarising muscle relaxants is slower than from the less potent agents. However, recovery from mivacurium, which is more potent than atracurium, is faster than from atracurium following systemic administration. In an attempt to confirm this discrepancy we compared recovery times following simultaneous administration of equipotent doses of atracurium and mivacurium into the isolated forearms of human volunteers (n = 10). This method enabled us to study the interaction of muscle relaxants with receptors at the neuromuscular junction separated from the effects of plasma drug concentration. In these experiments, the recovery times from maximum block to 50% recovery of control twitch height were significantly longer with mivacurium than with atracurium (mean 25.2(SD 4.7) versus 22.6(3.1) min, p < 0.01). We found that the evidence that mivacurium has a slower recovery than the less potent atracurium may be true using the bilateral isolated forearm technique and that the discrepancy might be due to a difference in the pharmacokinetic variables of the two drugs.
Improved P CO2 measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry
Authors: KNICHWITZ G. , MERTES N. , KUHMANN M.
Published: February 2007

The measurement of gastric intramucosal pH serves as a non‐invasive technique for early detection of gastrointestinal ischaemia in critically ill patients. The method is based on the determination of the partial pressure of carbon dioxide in a 0.9% saline solution using a standard blood gas analyser. However, the use of standard blood gas analysers leads to an underestimation of carbon dioxide partial pressure in saline. Instrumental biases of six blood gas analysers were investigated using either a saline or a phosphate‐buffered solution. Both test solutions were equilibrated with five defined carbon dioxide concentrations. Each blood gas analyser underestimated this defined partial pressure of carbon dioxide with a bias between ‐3.7% and ‐57.5% if saline was used. The phosphate‐buffered solution considerably improved instrumental precision, resulting in biases between +2.7% and ‐17.6%. Thus, a phosphate‐buffered solution increases the accuracy of gastric intramucosal pH measurement.
Hereditary angioneurotic oedema: current management in pregnancy
Authors: Cox M. , Holdcroft A.
Published: February 2007

A 20‐year‐old primiparous woman, with a history of type 1 hereditary angioneurotic oedema, presented for induction of labour. She was hirsute, obese and presented technical difficulties for both general and epidural/spinal anaesthesia. Her management included prophylactic C1 esterase inhibitors and epidural analgesia for pain relief. A spontaneous vaginal delivery was achieved and no adverse complications occurred. Five days after delivery she had abdominal pain which was investigated and resolved spontaneously. The management of this condition is discussed.
The role of continuous positive airway pressure during weaning from mechanical ventilation in cardiac surgical patients
Authors: BAILEY C. R. , JONES R. M. , KELLEHER A. A.
Published: February 2007

We investigated the effects of providing patients with continuous positive airway pressure during a short weaning period from mechanical ventilation to extubation. Following elective primary aortocoronary bypass surgery employing cardiopulmonary bypass, 80 patients received intermittent positive pressure ventilation for 5 h. At the end of this time patients were randomly allocated to one of the following three groups for a 2 h period of spontaneous respiration prior to extubation: group CPAP0 = T‐piece circuit (n = 27); group CPAP5 = 5cmH2O of continuous positive airway pressure (n = 27); group CPAP10 = 10cmH2O of continuous positive airway pressure (n = 26). Following extubation, pulmonary gas exchange was assessed after 1,2,4, and 24 h. All patients had good pre‐operative lung function. There was a significant increase in the median alveolar‐arterial oxygen partial pressure difference and a decrease in the oxygenation index in all three groups during the period of added inspired oxygen which persisted until 24 h post‐extubation, but there were no differences between the groups. In patients with good pre‐operative lung function requiring primary aortocoronary bypass surgery, the use of continuous positive airway pressure confers no advantage over a simple T‐piece attachment during the short period of weaning from mechanical ventilation to extubation.
Movement of oral and nasal tracheal tubes as a result of changes in head and neck position
Authors: HARTREY R. , KESTIN I. G.
Published: February 2007

The tracheas of 20 ASA grade 1 and 2 patients were each consecutively intubated with an oral and nasal cuffed tracheal tube. Measurements of tube movement, as the position of the head and neck altered, were made with a fibreoptic bronchoscope. Both oral and nasal tubes moved an average distance of 15 mm towards the carina with head and neck flexion and 8.5 mm away with head and neck extension. Movement in both directions occurred with lateral rotation of the head. Optimal placement of tracheal tubes can be aided with a single guide mark placed 3 cm proximal to the cuff and 8 cm proximal to the distal end, which may reduce complications arising from this movement. This is a better method in women than inserting a pre‐determined length of tracheal tube measured from the lips or nares. However, current guide marks vary in their position relative to the cuff and tip of the tube.
The effect of nasal oxygen flow and catheter position on the accuracy of end‐tidal carbon dioxide measurements by a pharyngeal catheter in unintubated, spontaneously breathing subjects
Authors: ØBERG B. , T. WALDAU  , LARSEN V. H.
Published: February 2007

Reliable recordings of carbon dioxide concentrations during spontaneous respiration can be obtained from a catheter positioned in the hypopharynx. The present study investigated the possible influence on end‐tidal carbon dioxide measurement of nasal oxygen administration, position of the sampling catheter and mouth breathing. The study demonstrated that not only can reliable capnographic tracings be obtained from a thin catheter placed in the unintubated airway, but the subject may also receive up to 6 l.min‐1 of oxygen via the nasal route without interference with the accuracy of the measurements. Furthermore, the exact position of the sampling catheter tip in the airway is not critical, which means that it may be placed where it causes the patient least discomfort. Finally, mouth breathing caused a mean decrease in end‐tidal carbon dioxide of 0.25kPa compared to nose breathing.
The TOF‐Guard neuromuscular transmission monitor
Authors: LOAN P. B. , PAXTON L. D. , MIRAKHUR R. K. , CONNOLLY F. M. , McCOY E. P.
Published: February 2007

The TOF‐Guard neuromuscular monitor uses an accelerometer to measure the response to nerve stimulation. In this study, we have compared it to a standard mechanomyographic monitor, the Myograph 2000, for neuromuscular monitoring in 28 subjects. A train‐of‐four mode of stimulation was used in both cases. The times taken for onset of block, and for the recovery of T1 (the first response in the train of four) to 25% of control, the time from recovery of T1 from 25–75% and for the recovery of the train of four ratio to 0.7 were compared with the two monitors. There was a good correlation between the two devices for both onset and recovery times. However, differences were highlighted when the data were analysed by the method of Bland and Altman. The 95% limits of agreement for the T1 recovery to 25%, as measured by the TOF‐Guard, ranged from 5 min less to 8 min more than when measured by the Myograph 2000. For recovery of the train of four ratio to 0.7, the limits of agreement were approximately 6 min in either direction. The 95% limits for the TOF‐Guard measured train of four ratio were from 0.47 to 0.99, at the Myograph reading of 0.7. We recommend that information from the TOF‐Guard and the Myograph 2000 should not be used interchangeably. However, the TOF‐Guard is likely to improve considerably on tactile evaluation of the responses to stimulation.
An assessment of portable carbon dioxide monitors during interhospital transfer
Authors: DONNELLY J. A. , SMITH E. A. , HOPE A. T. , ALEXANDER R. J. T.
Published: February 2007

Four portable carbon dioxide monitors were assessed by a mobile intensive therapy team during interhospital transfer of critically ill patients. Particular attention was paid to practical considerations such as size, battery life and ease of use. All the monitors performed well in terms of accuracy but problems with size and battery life made some less suitable for use outside hospital.
Lifting and handling of patients by anaesthetists
Authors: Luntley J. B. , Ross J.
Published: February 2007

The process of transferring patients from the operating table was assessed in a district general hospital. The survey was conducted in two parts; a confidential questionnaire was sent to all members of the department and a month long assessment of three anaesthetists’ caseload was undertaken. All the anaesthetists questioned had scanty knowledge of the relevant manual handling regulations. Although 70% of anaesthetists questioned lift and transfer patients on a regular basis, none had received any relevant training. Ninety‐six percent of patient transfers were performed by two staff alone, even though there were five or more staff available to assist at 95% of transfers. Difficulty in transferring patients occurred in 32% of cases. Improvement of training anaesthetists in safe manual handling procedures is recommended.
Awareness during anaesthesia for implantable cardioverter defibrillator implantation
Authors: Moerman A. , Herregods L. , Foubert L. , Poelaert J. , Jordaens L. , D'Hont L. , Roily G.
Published: February 2007

Implantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. After induction, anaesthesia was maintained using continuous infusions of propofol and atracurium and intermittent boluses of alfentanil. Propofol was given in the same arm as the implantation side. In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.
Difficult direct laryngoscopy in patients with cervical spine disease
Authors: CALDER I. , CALDER J. , CROCKARD H. A.
Published: February 2007

Two hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classification proposed by Cormack and Lehane. The overall prevalence of difficulty (grades 3 and 4) was 20%. Patients with disease that includes the occipito‐atlanto‐axial complex have a higher prevalence of difficulty than those with disease below the axis vertebra. Occipito‐atlanto‐axial disease is associated with poor mandibular protrusion. The best single predictor of difficulty was reduced separation of the posterior elements of the first and second cervical vertebrae on lateral radiographs. The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator of poor cranio‐cervical extension. Difficulty was rare in patients with class A mandibular protrusion, and invariable in patients with class C protrusion.
The effect of nitrous oxide on the performance of psychomotor tests
Authors: CHEAM E. W. S. , DOB D. P. , SKELLY A. M. , LOCKWOOD G. G.
Published: February 2007

The effect of different nitrous oxide concentrations on the performance of psychomotor tests (inspection time, tapping frequency, critical flicker fusion, picture memory and time sense) was investigated in seven healthy volunteers. The results show a dose‐related impairment of memory, a reduction in tapping frequency and an increase in inspection time. A paradoxical increase in critical flicker‐fusion threshold was observed. There was no effect on critical fusion‐flicker threshold or time sense. Recovery was incomplete for memory tests performed 20 min after withdrawal of nitrous oxide. Subjective effects persisted for several hours.
The clinical pharmacology of doxacurium in young adults and in elderly patients
Authors: MARTLEW R. A. , HARPER N. J. N.
Published: February 2007

Neuromuscular blockade induced by doxacurium 30 μg.kg‐1 was compared in 21 young (18–55years) and 17elderly (65–85years) patients. Anaesthesia was induced with thiopentone and maintained with fentanyl, nitrous oxide in oxygen and isoflurane. Neuromuscular blockade was measured electromyographically (Datex Relaxograph) at the adductor pollicis using train‐of‐four stimuli at 20 s intervals. The depth of maximum neuromuscular blockade was similar in young and elderly patients (median 100% compared to 96%). However, the onset was significantly slower in the elderly: their mean (SD) time to 90% suppression of the first response of the train‐of‐four was 7.7 (1.8)min compared to 5.7 (1.7)min in the young (p = 0.002). Four min after doxacurium, the conditions for tracheal intubation were significantly poorer in the elderly (p < 0.001). Mean (SD) recovery of first response of the train‐of‐four to 25% of control was unaffected by age: young 79.0 (41.6)min; elderly 66.2 (32.1)min (p > 0.05). When the first response had reached 25% of control, neuromuscular blockade was antagonised with neostigmine 60 μg.kg‐1. The mean time to first response to 90% of control was similar in the young and the elderly patients (9.1 min compared to 10.4 min). Recovery of the train‐of‐four ratio to 0.7 was significantly slower in the elderly: mean (SD) 17.1 (10.6) min compared to 10.1 (7.0) min (p = 0.03). Doxacurium was associated with clinically insignificant haemodynamic changes in both groups.
The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children
Authors: Gadiyar V. , Gallagher T. M. , Crean P. M. , Taylor R. H.
Published: February 2007

Both caudal anaesthesia and non‐steroidal anti‐inflammatory drugs have been used in the management of postoperative pain in children. The aim of the present study was to evaluate the combination of caudal analgesia and rectally administered diclofenac in the treatment of pain following minor surgery in children. Thirty‐nine, ASA grade 1 or 2, children undergoing inguinal or penoscrotal surgery were randomly assigned to receive either a caudal block using 0.125% bupivacaine with adrenaline or a similar caudal block in combination with rectally administered diclofenac 1 mg.kg‐1. Children given a caudal block alone were more likely to need analgesia in the first 24 h postoperatively. It would appear that the combination of a caudal block and rectal diclofenac in children undergoing minor lower abdominal surgery reduces the need for subsequent analgesia.
Is there a need for a new inhalational anaesthetic agent?
Authors: JONES R. M. , WARD P. M.
Published: February 2007

New anaesthetic agents are continually being developed in an effort to prepare the ideal agent. Isoflurane is the first choice of many anaesthetists, although it clearly falls short of the ideal on a number of counts. The need and place for any new agent depends on comparing the properties of a theoretically ideal agent with those of isoflurane and the new agent. Desflurane is a step towards a more ideal inhaled agent; however, there is still the need to synthesise and evaluate new chemical entities in order that the ideal can more nearly be approached.
Physicochemical properties and pharmacodynamics of desflurane
Authors: EGER E. I.
Published: February 2007

Desflurane is a new volatile, inhaled anaesthetic that differs significantly from presently available inhaled agents in being halogenated solely with fluorine. This fluorination produces a lower solubility and increased resistance to biodegradation. The lower solubility provides a more precise control over, and a more rapid awakening from, anaesthesia. The resistance to biodegradation suggests that toxicity from desflurane may be minimal or non‐existent. Limitations include a lesser potency and greater pungency at concentrations exceeding 1 minimum alveolar concentration (MAC). Other pharmacological properties are similar to those of isoflurane.
Circulatory effects of desflurane
Authors: CORIAT P.
Published: February 2007

The cardiovascular properties of desflurane and some other inhalational anaesthetics are outlined and compared, and the way in which they may be effectively used in clinical practice is considered. Desflurane appears to offer some advantages compared with currently available anaesthetics. Its effects on left ventricular function are moderate and the solubility of the agent in blood and tissue is remarkably less than isoflurane, enflurane, or halothane.
Recovery from outpatient anaesthesia
Authors: KORTTILA K.
Published: February 2007

In 1994, 66% of all surgery in the USA was performed as ambulatory surgery. Day surgery is also expanding to otlter countries worldwide. To provide safe anaesthesia and good outcomes for longer and more extensive operations performed in ambulatory facilities, patients must be carefully evaluated before surgery, their home readiness must be assessed, and they must fully understand all relevant information. Good outcome requires adoption of policies for safe discharge from the hospital. If a patient does not have an escort home, the surgical procedure should be cancelled or the patient admitted to the hospital. As the number of patients and complexity of scheduled surgical procedures increases, the outcome of day surgery will increasingly depend on the anaesthetist's skills. The recently introduced short‐acting drugs may further improve the outcome after day surgery by facilitating rapid recovery and an early return to normal daily activities.
A 5‐year survival study of general surgical patients aged 65 years and over
Authors: EDWARDS A. E. , SEYMOUR D. G. , MCCARTHY J. M. , CRUMPLIN M. K. H.
Published: February 2007

A prospective 5‐year survival study of 900 patients, aged 65 years and over, undergoing a general surgical procedure, demonstrated that following an initial high mortality rate the survival of the group as a whole approached that of an age‐matched population. Non‐elective admissions, age 75 years and over, ASA grade 4–5 and major surgery were associated with a high early mortality. Mortality associated with malignancy extended over 1 year. The study reinforces the conclusion that age alone should be no bar to surgery and anaesthesia, endorses the findings of the National Confidential Enquiry into Peri‐operative deaths and emphasises the need to re‐examine the provision of anaesthetic and surgical services in District General Hospitals. The benefits of elective admission in the very old are highlighted, along with the potential for extension of day case surgery.
Uptake of desflurane during anaesthesia
Authors: WALKER T. J. , CHAKRABARTI M. K. , LOCKWOOD G. G.
Published: February 2007

The amount of desflurane required to maintain an end‐expired concentration of 8% was measured in 30 ASA 1 and 2 patients undergoing elective spinal surgery. The anaesthetic was administered using a computer‐controlled closed circle system. After an initial period during which the expired concentration of desflurane was stabilised (4 min) the rate of uptake showed a bi‐exponential decline. Mean cumulative usage of desflurane was 10.1 ml of liquid at 30min, 14.8ml at 60min, 25.4ml at 120min, 35.8 at 180min.
Antiemetic efficacy of prophylactic ondansetron in laparoscopic cholecystectomy
Authors: KOIVURANTA M. K. , And E. LÄÄRÄ , RYHÄNEN P. T.
Published: February 2007

The antiemetic efficacy of ondansetron given prophylactically was investigated in a randomised, double‐blind, placebo‐controlled trial of 63 patients undergoing laparoscopic cholecystectomy. The patients received intravenously prior to anaesthesia either ondansetron 4 mg or placebo. The same standardised general anaesthetic technique was used. Nausea, emetic episodes and the need for rescue medication were recorded for 24 h postoperatively. Nausea was experienced by 64% of the patients in the ondansetron group and 56% in the placebo group, and emetic episodes occurred in 45% and 50% of the patients in the two groups, respectively. The proportions of patients given rescue antiemetic medication were 45% and 44%, respectively. No clinically important adverse events were observed. In conclusion, ondansetron given prior to anaesthesia in a dosage of 4mg did not prevent postoperative nausea and vomiting after laparoscopic cholecystectomy.