bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantifying the complex adaptive workplace
Authors: Haynes Barry , Price If
Published: February 2004

Despite well‐publicised successes and failures, the evidence base for the impact of a workplace on an organisation’s business performance remains small and confused. Theoretical perspectives are, with few exceptions, limited to matching physical environment to task. The concept from complexity theory of “edge of chaos” – a critical density of connectivity (Kauffman’s K) between the agents in a network in which adaptability is maximised – may explain how workplaces enable, or retard innovation. Formal rectilinear open plan offices are conceived as freezing occupants in a state of connectivity as low as traditional cellular designs. Offices without minimal acoustic or visual privacy (high K) may create chaotic stress and reversion as individuals seek to recreate safety. In between are offices known to have enhanced informal conversation between their occupants and resultant innovation.
Benchmarking facility management: applying analytic hierarchy process
Authors: Gilleard John D. , Wong Yat‐lung Philip
Published: February 2004

This paper illustrates the theoretical framework of applying the analytic hierarchy process (AHP) when benchmarking facility management service provider performance. A case study is presented to demonstrate the structure and organization of the model. The case study also illustrates how AHP is particularly effective for handling performance measures that involves multi‐attribute multivariate qualitative and quantitative data. The paper concludes by identifying three critical features: ranking criteria, establishing consensual data input and applying sensitivity testing.
Procurement of construction facilities: a case study of design management within a design and construct organisation
Authors: Smith Jim , O’Keeffe Nellie , Georgiou Jim , Love Peter E.D.
Published: February 2004

As clients have become more aware and demanding of the construction industry, they are also becoming less tolerant of the problems and the risks involved in the delivery of major projects. Presents a case study of design management within a design‐construct organization on a large residential apartment project. Identifies and analyses issues concerned with the organization, responsibilities, relationships and stages of development in a typical design‐construct project.
Facilities management: a behavioural approach
Authors: Fleming David
Published: February 2004

Seeks out whether technical performance indicators may be challenged by perception data thereby forcing a paradigm shift in building assessment. Reports the development of a conceptual framework and thereby justification of methodological approaches for a currently undertaken research project. Employs a subjective approach, based on inhabitants’ perceptions of their own environments. Concludes the measure of productivity used herein may be questionable but the use of productivity as the performance variable (against cost) is recognition of peoples’ importance as occupiers and their views equally so.
Disputes arising from vaguely defined contractual responsibilities in building services maintenance contracts
Authors: Lai Joseph H.K. , Yik Francis W.H. , Jones Phil
Published: February 2004

A clear definition of the responsibilities of the contracting parties is crucial to any contract. However, many building services maintenance contracts contain vague terms that are often causes of disputes, suspension of work, unsatisfactory performance and financial losses. Common vague contract terms include those that require the contractor to be responsible for any replacement and restoration work arising from “fair wear and tear” and “vandalism”. Reports the findings of a survey of maintenance practitioners’ interpretations of these terms, and their experience with the use of such terms in building services maintenance contracts in Hong Kong.
Common property in strata titled developments in Singapore
Authors: Christudason Alice
Published: February 2004

In the face of Singapore's land scarcity problem, there is an increasing prevalence of strata‐titled developments providing private housing in Singapore. This paper considers the awareness in certain quarters of certain fundamental aspects of this unique form of property ownership. The particular aspect which this paper considers is the understanding and interpretation of the term “common property” among two important groups of people. The first group comprises those who purchase strata title properties – they are referred to as “subsidiary proprietors”. The second group comprises “managing agents” (MAs), who may be delegated this task of professionally managing and maintaining the strata‐titled development. The findings of a survey are that their understanding of this fundamental term is inadequate. Based on these findings, the paper concludes with recommendations for improving the level of professionalism among MAs through licensing and courses for continuing professional development. This will bode well for the overall state of strata‐titled developments which are not only here to stay, but are expected to increase in number in Singapore.
Brave new world
Authors: Chalmers Katherine , Holsapple Eric , Worzala Elaine
Published: February 2004

The expansion of computer and information technology firms combined with the simultaneous decline in traditional manufacturing firms in the 1990s argues for a re‐examination of economic base models in light of changing basic sectors within the economy. This paper reviews the literature and employs an in‐depth survey to describe the differences in the pattern of employment for traditional manufacturing firms and the “new economy” firms in Larimer County, Colorado, USA. This study indicates that traditional economic base analysis is not easily applied to communities with “new economy” firms and maintains that a more inclusive and comprehensive survey method remains the best way to adequately capture the essential makeup of a region's economic base.
Valuation accuracy
Authors: Stevenson Simon , Young James
Published: February 2004

This study examines the relationship between guide and sale prices for residential properties in Greater Dublin during the recent housing boom. The results indicate that degrees of divergence can be present, auctioned properties tend to sell more frequently at a premium to their guide price and that the average level of premium is also higher. These findings are confirmed by econometric analysis. It is proposed that the two potential causes behind this mis‐pricing are the speculative boom in the Dublin market during the period and the possibility that agents build into auction guide prices an element of underpricing in order to increase interest in the properties on the market.
The formation of owners’ corporations in Hong Kong’s private housing estates
Authors: Wai‐Chung Lai Lawrence , Yik‐Long Chan Pearl
Published: February 2004

This paper uses a probit model to analyse 100 observations in terms of three hypotheses about the formation of owners’ corporations in high‐density private housing estates in Hong Kong within the context of Mancur Olson’s group theory. The findings do not reject the theory, revealing that it is more likely for an older urban estate with fewer owners to form owners’ corporations. The discussion includes a brief introduction to Olson’s group theory and the development of the probit analysis. Some speculative thoughts about public participation in local level urban management and planning are offered in the conclusion.
Performance indicators in online distance learning courses: a study of management education
Authors: Alstete Jeffrey W. , Beutell Nicholas J.
Published: February 2004

Examines student performance indicators in online distance learning courses offered on the Internet at a mid‐sized private college in the USA. A sample of 74 undergraduate and 147 graduate business students in ten courses were selected for statistical analysis of their grade performance and the relationship with various indicators. The research results include findings that gender and age are related differently for undergraduate and graduate students to performance in distance learning courses, and that undergraduate grades, age, work experience, and discussion board grades are significantly related to overall course performance. However, standardized test scores (SATs, GMATs) and organization position level are not related to the performance in distance learning courses. Makes recommendations for further qualitative and empirical research on distance learning student performance in online computer‐mediated courses and programs.
E‐learning challenges in the Arab world: revelations from a case study profile
Authors: Abouchedid Kamal , Eid George M.
Published: February 2004

The overwhelming traditional knowledge delivery system for higher education in the Arab world demonstrates the pronounced information technology (IT) gap between Arab countries and the developed world. This study demonstrates the problems and possibilities of implementing e‐learning in Arab educational institutions through analysing the attitudes of university professors (n = 294) in Lebanon towards three a priori e‐learning dimensions. Favourable attitudes towards e‐learning attested to faculty members’ interest to get engaged in a fully‐fledged e‐learning programme in a country where the primary delivery educational model is essentially traditional. Discusses these attitudes in the light of the social, political and economic hindrances that impede the implementation of e‐learning in the Arab region. A series of K‐independent Kruskal‐Wallis tests yielded significant attitudinal variations between males and females as well as between computer daily users and occasional users. Furthermore, daily computer users documented more favourable attitudes towards e‐learning than their occasional user counterparts. Offers recommendations for the implementation of e‐learning in “traditionally” demarcated educational systems in countries where the deployment of information and communications technologies is not widespread.
“Off‐campus support” in distance learning – how do our students define quality?
Authors: Smith Alison
Published: February 2004

The nature of quality teaching and learning in higher education has been subject to ongoing research and debate. In distance learning programmes, “teaching” comprises several distinct tasks including the provision of distance learning materials and the support of students’ learning when they are away from the campus. This study examined the nature of quality in terms of the provision of “off‐campus support” to students in a particular postgraduate distance education context. A questionnaire was administered to investigate students’ perceptions and expectations regarding off‐campus support. While students identified support related to their academic work as being the most important component of an off‐campus support system, issues related to the availability and accessibility of this support were also highlighted. These findings informed the development of a model of quality off‐campus support in the context of advanced level, distance learning programmes.
Importance‐performance analysis: a useful tool for directing continuous quality improvement in higher education
Authors: O’Neill Martin A. , Palmer Adrian
Published: February 2004

This paper addresses the issue of service quality evaluation within the higher education sector and stresses the need to develop measures that are both psychometrically and practically sound. The paper argues that recent debate surrounding the development of such measures has been too strongly geared toward their psychometric performance, with little regard for their practical value. While the paper supports the need to develop valid, reliable and replicable measures of service quality, it is suggested that educators must not lose sight of the original purpose for which these measures were designed, i.e. their practical value in informing continuous quality improvement efforts. It critiques the use of disconfirmation models and reports on a study of students’ perceptions of quality using importance‐performance analysis (IPA). The technique allows specific failings in the quality of support issues to be identified and their importance to a quality improvement programme assessed.
Transforming supply chain operations in response to economic reform: the case of a motorcycle manufacturer in India
Authors: Kapoor Vivek , Ellinger Alexander E.
Published: February 2004

Economic reforms that stimulate commercial activity in semi‐industrialized nations are often associated with significant increases in demand for consumer products. This paper focuses on a description of the transformation of a motorcycle manufacturer’s supply chain in response to the recent liberalization of the Indian economy, and on insights gained from that experience. The authors believe that this organization’s success in applying supply chain management practices that are more commonly utilized in industrialized nations has wide applicability, and that it will be insightful as a role model for managers at firms facing similar challenges of integrating supply chain operations to meet surges in demand.
A review and analysis of supply chain operations reference (SCOR) model
Authors: Huan Samuel H. , Sheoran Sunil K. , Wang Ge
Published: February 2004

Research on supply chain management can be broadly classified into three categories, namely, operational, design, and strategic. While many analytical and numerical models have been proposed to handle operational and design issues, formal models for strategic planning are scarce. The supply chain operations reference (SCOR) model, developed by the Supply Chain Council, is a strategic planning tool that allows senior managers to simplify the complexity of supply chain management. It is firmly rooted in industrial practices and is poised to become an industrial standard that enables next‐generation supply chain management. This paper gives a brief introduction to the SCOR model, analyzes its strength and weakness, and discusses how it can be used to assist managers for strategic decision making.
Understanding the meaning of collaboration in the supply chain
Authors: Barratt Mark
Published: February 2004

Despite its infancy, some authors are already suggesting that the writing may be on the wall for supply chain collaboration. It has been reported that supply chain collaboration has proved difficult to implement; there has been an over‐reliance on technology in trying to implement it; a failure to understand when and with whom to collaborate; and fundamentally a lack of trust between trading partners. This paper proposes that a supply chain segmentation approach, based on customer buying behaviour and service needs, is the most appropriate context for collaboration. The paper also proposes the need for a greater understanding of the elements that make up supply chain collaboration, and in particular how the relevant cultural, strategic and implementation elements inter‐relate with each other.
A seamless supply chain management model for construction
Authors: Love Peter E.D. , Irani Zahir , Edwards David J.
Published: February 2004

Presents a holistic approach to construction project SCM. Specifically, a seamless project supply chain management (SCM) model is proposed that integrates the design and production processes of construction projects. The proposed model was subjected to validation by a sample of industry practitioners and their comments are presented and reflected upon. Direction for future research is provided and such work aims to: explore the legalities of implementing the model; develop an appropriate benchmarking framework; explore the use of quality function development; and probity issues when selecting project team members.
Applying the theory of constraints to supply chain collaboration
Authors: Simatupang Togar M. , Wright Alan C. , Sridharan Ramaswami
Published: February 2004

Supply chain collaboration amongst independent firms often provides larger benefits from effectively satisfying end customer needs than working in isolation. However, a lack of awareness about the existence of constraints along the supply chain prevents the benefits of collaboration from being fully realised. This paper attempts to apply the theory of constraints approach to overcome difficulties in realising the potential benefits of supply chain collaboration. Specifically, it shows how the theory of constraints approach can be used to expose an inherent dilemma of collaboration and establish collaborative replenishment policy and collaborative performance metrics so that the chain members can work together to advance supply chain profitability. Several opportunities for future research are recommended.
SMEs and supplier alliances use: an empirical analysis
Authors: Marco Lajara Bartolomé , García Lillo Francisco
Published: February 2004

The present paper analyses how small Spanish manufacturing firms develop supplier partnerships with the aim of improving their competitiveness. More precisely, the study tries to find out, on the one hand, the causes for the creation of alliances, whereas, on the other hand, the interest focuses on the examination of the benefits derived from such partnerships, as well as some of the features that define them.
Development of a case based intelligent supplier relationship management system – linking supplier rating system and product coding system
Authors: Choy King L. , Bun Lee Wing , Lo Victor
Published: February 2004

An intelligent supplier relationship management system (ISRMS) integrating a company’s customer relationship management (CRM) system, supplier rating system (SRS) and product coding system (PCS) by the case based reasoning (CBR) technique to select preferred suppliers during the new product development (NPD) process is discussed. By using ISRMS in Honeywell Consumer Product (Hong Kong) Limited, it is found that the outsource cycle time from the searching of potential suppliers to the allocation of order, as well as the delay in delivery of goods of suppliers after order allocation, are greatly reduced. In addition, performance of suppliers can be monitored effectively.
Rethinking the supply chain: an automotive perspective
Authors: Doran Desmond
Published: February 2004

This paper contends that the description of tiering within automotive supply chains is likely to require redefining in light of the development of modular supply and that a natural consequence of modular supply will be the transfer of value‐adding activity throughout the supply chain. Two concepts are presented to illustrate the characteristics that are likely to be required for suppliers to succeed within a modular environment. These concepts are applied to a supply chain currently in the process of accommodating modular supply. The findings suggest that whilst modularity accrues a number of tangible benefits to both the original equipment manufacturer (OEM) buyer and the modular supplier, the skills required to become a modular supplier are likely to result in a number of first‐tier suppliers either exiting the industry or becoming second or third‐tier suppliers.
Supplier source integration in a large manufacturing company
Authors: Cousineau Melissa , Lauer Thomas W. , Peacock Eileen
Published: February 2004

Presents a description of the implementation of a supplier source integration (SSI) program at a large manufacturing company, and the challenges faced in the pursuit of new processes, methodologies and techniques. Discusses issues pertaining to the management of interfaces with the supplier over the entire product development life cycle. There is particular focus on the choice of the supplier and overcoming problems arising from the in‐house design team. Previous experiences of the company with SSI have given the current design team a number of positive and negative results together with a set of recommendations that can be used in the current implementation of SSI for an exhaust system. These can also provide the basis for determining a future strategy.
Altered brain exposure of morphine in experimental meningitis studied with microdialysis
Authors: Tunblad K. , Ederoth P. , Gärdenfors A. , Hammarlund‐Udenaes M. , Nordström C.‐H.
Published: February 2004

Background:  During pathologic conditions such as meningitis and traumatic brain injury the function of the blood–brain barrier (BBB) is disturbed. In the present study we examined the cerebral pharmacokinetic pattern of morphine in the intact brain and during experimentally induced meningitis using a pig model. Secondly, the use of intracerebral microdialysis as a potential tool for monitoring damage in the BBB by studying the pharmacokinetics of morphine is addressed.

Methods:  Six pigs were studied under general anaesthesia. One occipital and two frontal microdialysis probes and one pressure transducer were inserted into the brain tissue. Another probe was placed into the jugularis interna. Morphine 1 mg kg−1 was administered as a 10‐min infusion, and morphine concentrations were then measured for 3 h. Meningitis was subsequently induced by injecting lipopoly‐saccharide into the cisterna magna. When meningitis was established, the morphine experiment was repeated.

Results:  The unbound area under the concentration‐time curve (AUCu) ratio of morphine in brain to blood was 0.47 (0.19) during the control period, and 0.95 (0.20) (P < 0.001) during meningitis. The increase in the brain/blood AUCu ratio during meningitis implies decreased active efflux and increased passive diffusion of morphine over the BBB. The half‐life of morphine in brain was longer than in blood during both periods, and was unaffected by meningitis.

Conclusion:  This study demonstrates that the morphine exposure to the brain is significantly increased during meningitis as compared with the control situation.
The validity of the static‐charge‐sensitive bed in the detection of fentanyl‐induced respiratory depression
Authors: Nikkola E. M. , Leino K. A. , Takala R. S. K. , Kirvelä O. A. , Salonen M. A. O.
Published: February 2004

Background:  Only a few methods for the measurement of breathing are non‐invasive and do not interfere with measured parameters. The static‐charge‐sensitive bed (SCSB) could be such a monitor. The aim of this study was to evaluate the validity of the SCSB compared with the respiratory inductive plethysmograph (RIP) using a fentanyl‐induced respiratory depression model.

Methods:  Eight healthy male volunteers were infused with intravenous (i.v.) fentanyl (15 µg/kg/h) until a decrease in SpO2 below 90% for 1 min emerged. Breathing was continuously and simultaneously measured with SCSB and RIP. Oxygenation, hemodynamics, arterial blood gas analysis, and subjective opioid‐related effects were monitored. Fentanyl concentration was measured from an arterial blood sample. The respiratory rate data of the SCSB (automated analysis and manual calculation) were compared with the corresponding RIP data, using analysis of variance for repeated measures. The validity of the SCSB compared with RIP was evaluated using an intra‐class correlation coefficient.

Results:  Mean fentanyl dose was 629 µg. A statistically significant association was found between the RIP and SCSB data in the manual SCSB analysis (P < 0.0001), but not in the automated SCSB analysis (P = 0.91). After adjusting for the effect of time and the SCSB method, an intra‐class correlation coefficient between the manually calculated SCSB values and the RIP values was 0.66.

Conclusion:  Clinically significant changes in respiratory rate were detected with the SCSB, but the results had to be analyzed manually. The SCSB best suits situations, where comprehensive data are needed. It is not suitable for on‐line respiratory monitoring, as the automated analysis did not calculate the respiratory rate correctly.
Massive hydroxychloroquine overdose
Authors: Yanturali S. , Aksay E. , Demir O. F. , Atilla R.
Published: February 2004

We report a case presenting with massive overdose of hydroxychloroquine who survived without any sequelae. A 17‐year‐old girl presented to the Emergency Department 45 min after the ingestion of 22 g of hydroxychloroquine in a suicide attempt. We believe this is highest dose yet reported in the medical literature. The patient developed hypotension, life‐threatening ventricular arrhythmias and mild hypokalemia. She was managed with saline infusion and dopamine for hypotension, gastric lavage and activated charcoal for decontamination, lidocain, magnesium sulfate and defibrillation for pulseless ventricular tachycardia. Potassium replacement and bicarbonate administration were performed. Quick treatment of hypotension, gastric decontamination, continuous long‐term cardiac monitoring, and treatment of arrhythmias are the cornerstones of hydroxychloroquine overdose management.
Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS
Authors: Póvoa P. , Almeida E. , Fernandes A. , Mealha R. , Moreira P. , Sabino H.
Published: February 2004

Background: To evaluate the effect of a recruitment maneuver (RM) with constant positive inspiratory pressure and high positive end‐expiratory pressure (PEEP) on oxygenation and static compliance (Cs) in patients with severe acute respiratory distress syndrome (ARDS).

Methods: Eight patients with ARDS ventilated with lung‐protective strategy and an arterial partial pressure of oxygen to inspired oxygen fraction ratio (PaO2/FIO2) ≤100 mmHg regardless of PEEP were prospectively studied. The RM was performed in pressure‐controlled ventilation at FIO2of 1.0 until PaO2reached 250 mmHg or a maximal plateau pressure/PEEP of 60/45 cmH2O was achieved. The RM was performed with stepwise increases of 5 cmH2O of PEEP every 2 min and thereafter with stepwise decreases of 2 cmH2O of PEEP every 2 min until a drop in PaO2>10% below the recruitment PEEP level. Data was collected before (preRM), during and after 30 min (posRM).

Results: The PaO2/FIO2increased from 83 ± 22 mmHg preRM to 118 ± 32 mmHg posRM (P = 0.001). The Cs increased from 28 ± 10 ml cmH2O−1preRM to 35 ± 12 ml cmH2O−1posRM (P = 0.025). The PEEP was 12 ± 3 cmH2O preRM and was set at 15 ± 4 cmH2O posRM (P = 0.025). The PEEP of recruitment was 36 ± 9 cmH2O and the collapsing PEEP was 13 ± 4 cmH2O. The PaO2of recruitment was 225 ± 105 mmHg, with five patients reaching a PaO2  ≥ 250 mmHg. The FIO2decreased from 0.76 ± 0.16 preRM to 0.63 ± 0.15 posRM (P = 0.001). No major complications were detected.

Conclusions: Recruitment maneuver was safe and useful to improve oxygenation and Cs in patients with severe ARDS ventilated with lung‐protective strategy.
Ketamine suppresses endotoxin‐induced NF‐κB activation and cytokines production in the intestine
Authors: Sun J. , Wang X. D. , Liu H. , Xu J. G.
Published: February 2004

Background:  Ketamine has been advocated for anesthesia in endotoxemic and other severely ill patients because it is a cardiovascular stimulant. However, ketamine also suppresses serum levels of endotoxin‐induced tumor necrosis factor‐alpha, and reduces mortality in mice in endotoxin shock. Our study was designed to investigate the protective effect of ketamine on the endotoxin‐induced proinflammatory cytokines and nuclear factor kappa B (NF‐κB) activation in vivo.

Methods:  Adult male Wistar rats were randomly divided into six groups: saline controls; rats challenged with endotoxin (5 mg kg−1) and treated with saline; challenged with endotoxin (5 mg kg−1) and treated with ketamine (0.5 mg kg−1); challenged with endotoxin (5 mg kg−1) and treated with ketamine (5 mg kg−1); challenged with endotoxin (5 mg kg−1) and treated with ketamine (50 mg kg−1); and saline injected and treated with ketamine (50 mg kg−1). TNF‐α, IL‐6 and NF‐κB were investigated in the tissues of the intestine (jejunum) after 1, 4 and 6 h.

Results:  Endotoxin caused transient production of TNF‐α and IL‐6 and activation of NF‐κB in the intestine at peak times of 1, 4 and 1 h, respectively. Ketamine 0.5 mg kg−1 suppressed endotoxin‐induced TNF‐α elevation and inhibited NF‐κB activation in the intestine; a dose of 5 mg kg−1 was required to inhibit IL‐6.

Conclusion:  Ketamine suppresses the production of proinflammatory cytokines such as TNF‐α and IL‐6 in the intestine, possibly via inhibition of NF‐κB.
Pressure‐volume relationships in acute lung injury: methodological and clinical implications
Authors: Nunes S. , Uusaro A. , Takala J.
Published: February 2004

Background:  Pressure‐volume relationships (PV curves) are the only available method for bedside monitoring of respiratory mechanics. Alveolar recruitment modifies the results obtained from the PV curves. We hypothesized that method‐related differences may influence PV‐curve guided ventilatory management.

Methods:  Twelve acute lung injury (ALI) patients [PaO2/FiO2 13.0 ± 1.5 kPa (97.6 ± 11.3 mmHg), bilateral pulmonary infiltrates] were studied. Two PV curves [one at variable, and another at constant level of positive end‐expiratory pressure (PEEP)] were obtained from each patient using constant inspiratory flow and end‐inspiratory and ‐expiratory occlusions. Upper and lower inflection points (UIP, LIP) were estimated. Recruitment due to PEEP and during inflation was assessed by respiratory inductive plethysmography (RIP).

Results:  (1) Pressure‐volume curves at constant PEEP tended to provide higher LIP values compared with curves at variable PEEP (mean difference  ± SEM 5.1 ± 1.9 cmH2O); and (2) recruitment occurred throughout the PV curve with no relationship with LIP or UIP.

Conclusion:  Pressure‐volume curves obtained using variable PEEP translate a different physiological reality and seem to be clinically more relevant than curves constructed at constant PEEP. If curves constructed at constant PEEP are used to set the ventilator, unnecessarily high PEEP levels may be used. Respiratory inductive plethysmography technology may be used for monitoring of recruitment at the bedside.
Accuracy in estimating the correct intervertebral space level during lumbar, thoracic and cervical epidural anaesthesia
Authors: Lirk P. , Messner H. , Deibl M. , Mitterschiffthaler G. , Colvin J. , Steger B. , Rieder J. , Keller C.
Published: February 2004

Background:  Even in the absence of factors concealing anatomical landmarks, high failure rates in correctly determining a given lumbar interspace have been reported.

Methods:  Therefore, it was the aim of the present study to compare the assessed and factual level (determined by computed tomography) of epidural puncture in attending a regional anaesthesia cadaver workshop. Eighty‐two anaesthetists performed 117 punctures.

Results:  Vertebral interspaces between T8–L4 were correctly identified more often than those between C3–T5 (P <  0.05). Identification of an arbitrarily chosen vertebral interspace was excellent in both the cervical/high thoracic and thoracic/lumbar regions.

Conclusion:  As previously conjectured only for the lumbar region, we could confirm the tendency of anaesthetists to perform neuraxial puncture more cranially than expected also for the thoracic and cervical regions. The large majority of punctures (93.7%) was performed within one interspace of the predicted level.
Application of a mandibular nerve block using an indwelling catheter for intractable cancer pain
Authors: Kohase H. , Umino M. , Shibaji T. , Suzuki N.
Published: February 2004

We report a case in which a mandibular nerve block using an indwelling catheter was employed for pain management in a terminal case of orofacial cancer.

The patient was a 74‐year‐old female weighing 27 kg. She had a 27‐month history of mouth floor and tongue cancer. The cancer recurred and spread to bilateral face and neck. The severest pain mainly originated from the right mandibular region. Two steps of pain relief were performed for the patient. First, pain control using 1% lidocaine or 0.25% bupivacaine administered intermittently or continuously through an indwelling catheter in the mandibular nerve was performed for 1 week to estimate the amount of pain relief thereby obtained. Second, a neurolytic block was applied to the mandibular nerve through the catheter. After the neurolytic block, the total dosage of morphine and diclofenac remained unchanged for 2 months. We conclude from the present case that this technique is an excellent means of obtaining long‐term pain control in patients with intractable orofacial cancer pain.
Desflurane–remifentanil–nitrous oxide anaesthesia for abdominal surgery: optimal concentrations and recovery features
Authors: Billard V. , Servin F. , Guignard B. , Junke E. , Bouverne M. N. , Hédouin M. , Chauvin M.
Published: February 2004

Background:  Intraoperative combinations of volatile and opioid agents are used to achieve unconsciousness, hypnotic sparing, haemodynamic stability and uneventful recovery. This study describes the influence of different remifentanil concentrations on these variables when combined with desflurane during abdominal surgery.

Methods:  Sixty‐one healthy adult patients were randomly allocated to one of five predefined remifentanil target concentrations (3, 5, 7, 10 or 15 ng ml−1). Anaesthesia was titrated to maintain mean blood pressure (MBP), heart rate (HR) and BIS™ within predetermined values by adjusting desflurane delivery. Postoperative analgesia using propacetamol and morphine was initiated 30–45 min before skin closure, and continued using morphine PCA.

Results:  Desflurane requirements adjusted to both BIS and haemodynamics were not significantly modified by the remifentanil concentration (median FetDES 2.7% before incision, 2.5% intraoperatively, and 2.2% during closure), resulting in a calculated drug consumption of 0.22–0.25 ml min−1 (with 1.5 l min−1 fresh gas flow). High remifentanil concentration decreased MBP and HR, and reduced the duration of tachycardia, but increased the duration of hypotension. The optimal balance was obtained with a remifentanil concentration of 5–7 ng ml−1 for intubation, 3 ng ml−1 until incision, 10 ng ml−1 during intra‐abdominal surgery and 5–7 ng ml−1 during closure. Post‐operative morphine requirements were not significantly modified by intraoperative remifentanil concentrations (median 30 mg/24 h, range [2–88]).

Conclusion:  Remifentanil target concentrations from 3 to 15 ng ml−1 had little influence on desflurane requirements or postoperative morphine consumption, but markedly modified intraoperative haemodynamic stability, suggesting that the target concentration should closely follow the successive noxious stimulations.
Analgesic effect of dextromethorphan in neuropathic pain
Authors: Carlsson K. C. , Hoem N. O. , Moberg E. R. , Mathisen L. C.
Published: February 2004

Background:  Dextromethorphan, a clinically available N‐methyl‐D‐aspartic acid (NMDA) receptor antagonist, has an analgesic effect in patients with diabetic neuropathy. The aim of this study was to evaluate the analgesic and adverse effects of a single high dose of dextromethorphan on spontaneous pain in patients suffering long‐term neuropathic pain of traumatic origin.

Methods:  Fifteen patients with post‐traumatic neuropathic pain participated in this placebo‐controlled, double‐blind, randomized crossover study. On two separate occasions, the participants received 270 mg of dextromethorphan hydrobromide or placebo. Pain intensity, adverse effects and serum concentrations of dextromethorphan and metabolites were registered.

Results:  Dextromethorphan had a statistically significant analgesic effect compared with placebo, but the effect varied markedly among the patients. Light‐headedness was the most important adverse effect reported. Extensive metabolizers of dextromethorphan had an apparently better analgesic effect than poor metabolizers.

Conclusion:  This report indicates that a single high dose of dextromethorphan has an analgesic effect in patients with neuropathic pain of traumatic origin. The main metabolite dextrorphan seems to be important for the analgesic effect. At the relatively high dose studied, the clinical usefulness of dextromethorphan is limited to that portion of the patient population experiencing analgesia without an unacceptable level of adverse effects.
Predictive value of mechanomyography and accelerometry for pulmonary function in partially paralyzed volunteers
Authors: Eikermann M. , Groeben H. , Hüsing J. , Peters J.
Published: February 2004

Background:  Accelerometry (ACM) of adductor pollicis muscle has been used for monitoring of neuromuscular blockade but its validity compared with the gold standard, mechanomyography (MMG), has been questioned. During neuromuscular blockade we compared these methods and we assessed pulmonary function.

Methods:  In awake partially paralyzed volunteers we spirometrically assessed pulmonary function every 5 min until recovery. Rocuronium (0.01 mg kg−1 + 2–10 µg kg−1 min−1) was administered to maintain train‐of‐four (TOF)‐ratios (assessed every 15 s) of approximately 0.5 and 0.8 over a period of more than 5 min. The TOF‐ratio associated with ‘acceptable’ pulmonary recovery [forced vital capacity (FVC) and forced inspiratory volume in 1 s (FIV1) of ≥90% of baseline] was calculated using a linear regression model. During 5‐min periods of repetitive nerve stimulation we compared the squared residuals of the FVC and FIV1 estimates from TOFACM vs. TOFMMG, and compared variance of values derived from ACM and MMG using Wilcoxon's test.

Results:  Limits of agreement of TOF‐ratio derived from ACM and MMG were wide [0.15±0.016 (SD)], and variability of TOFACM exceeded that of TOFMMG[variance: 77±105 vs. 51±55% (P<0.01)]. Calculated TOFACM and TOFMMG ratios of 0.56 (0.22–0.71) [mean (95%CI) and 0.6 (0.28–0.74)], respectively, predict ‘acceptable’ (90%) recovery of FVC while FIV1 remains impaired until TOF‐ratios of 0.91 (0.82–1.07) and 0.95 (0.82–1.18), respectively. In turn, TOFMMG (TOFACM) of unity predicted ‘acceptable’ recovery of FVC and FIV1 in 94 (93) % and 68 (73) % of measurements, respectively.

Conclusions:  Accelerometry predicts effects of relaxation on pulmonary function as valid as the gold standard mechanomyography. We recommend that recovery of TOF ratio to 0.9–1.0 should be used as an indication of sufficient neuromuscular recovery in daily practice.
Continuous popliteal sciatic nerve block for outpatient foot surgery – a randomized, controlled trial
Authors: Zaric D. , Boysen K. , Christiansen J. , Haastrup U. , Kofoed H. , Rawal N.
Published: February 2004

Background:  A major problem in outpatient foot surgery is severe postoperative pain that is not sufficiently treated by peroral analgesics.

Methods:  Sixty‐three patients underwent foot surgery under spinal anesthesia. Immediately on conclusion of the operation, sciatic and saphenous nerve blocks were performed. The sciatic nerve was blocked in the popliteal fossa with 30 ml of ropivacaine 5 mg ml−1 and a perineural catheter was passed through the cannula. The patients were randomized to receive either ropivacaine 2 mg ml−1 (n=30) or saline (n=30) in the catheter through a disposable elastomeric pump with a fixed infusion rate of 5 ml h−1 for 55 h.

Results:  Analgesia was excellent until 23 h 44 min (14 h 34 min) in the treatment group and 18 h 16 min (7 h) in the placebo group [mean (SD), P=0.07]. Thereafter, pain was significantly less in the treatment group on the first and second postoperative days (P=0.001). Sleep disturbances because of the pain in the foot were experienced by 25% of the treatment group on the first night at home and by 50% of the control group (P=0.29). There were no differences between the groups in their need for rescue opioid medication. None of the patients had any major problem with the catheter or pump, and none had any toxic effect referable to the technique.

Conclusion:  This randomized, double‐blind study shows that continuous blockade of the sciatic nerve in the popliteal fossa reduces postoperative pain and has no untoward effects in a patient group known to experience severe pain after ambulatory surgery.
Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: A randomized, double‐blind trial
Authors: Dierking G. , Duedahl T. H. , Rasmussen M. L. , Fomsgaard J. S. , MØiniche S. , RØmsing J. , Dahl J. B.
Published: February 2004

Background:  Preliminary clinical studies have suggested that gabapentin may produce analgesia and reduce the need for opioids in postoperative patients. The aim of the present study was to investigate the opioid‐sparing and analgesic effects of gabapentin administered during the first 24 h after abdominal hysterectomy.

Methods:  In a randomized, double‐blind study, 80 patients received oral gabapentin 1200 mg or placebo 1 h before surgery, followed by oral gabapentin 600 mg or placebo 8, 16 and 24 h after the initial dose. Patients received patient‐controlled analgesia with morphine at doses of 2.5 mg with a lock‐out time of 10 min for 24 h postoperatively. Pain was assessed on a visual analogue scale (VAS) at rest and during mobilization, nausea, somnolence and dizziness on a four‐point verbal scale, and vomiting as present/not present at 2, 4, 22 and 24 h postoperatively.

Results:  Thirty‐nine patients in the gabapentin group, and 32 patients in the placebo group completed the study. Gabapentin reduced total morphine consumption from median 63 (interquartile range 53–88) mg to 43 (28–60) mg (P < 0.001). We observed a significant inverse association between plasma levels of gabapentin at 2 h postoperatively, and morphine usage from 0 to 2 h, and from 0 to 4 h postoperatively (R2 = 0.30, P = 0.003 and R2 = 0.24 P = 0.008, respectively).

No significant differences in pain at rest or during mobilization, or in side‐effects, were observed between groups.

Conclusion:  Gabapentin in a total dose of 3000 mg, administered before and during the first 24 h after abdominal hysterectomy, reduced morphine consumption with 32%, without significant effects on pain scores. No significant differences in side‐effects were observed between study‐groups.
Inclusion of epinephrine to hyperbaric tetracaine and the supine position enhance the cephalad spread of spinal anaesthesia compared with hyperbaric teracaine alone in the lithotomy position
Authors: Inoue S. , Kawaraguchi Y. , Kitaguchi K. , Furuya H.
Published: February 2004

Background:  Intrathecal epinephrine can produce prolongation of duration of spinal anaesthesia by reducing vascular absorption of the local anaesthetics. The patient's positioning can change the cephalad spread of hyperbaric local anaesthetics by affecting the lordosis of the vertebral canal. These factors combined are expected to affect the cephalad spread of sensory block levels. The purpose of this study was to investigate whether combined use of epinephrine with hyperbaric tetracaine in the supine position can enhance the cephalad spread of sensory block levels compared with hyperbaric tetracaine alone in the lithotomy position.

Methods:  ASA physical status I or II 48 urological (lithotomy group) and 48 orthopaedic patients (supine group) scheduled to undergo elective surgical procedures in the lithotomy or supine position under spinal anaesthesia were enrolled. Patients in each group were randomly divided into two subgroups to receive intrathecal 10 mg of hyperbaric tetracaine with or without 0.2 mg of epinephrine (Groups L, LE, S, and SE). The extent of sensory blockade was assessed by loss of cold sensation. After achievement of sensory blockade up to T10, the patients in Groups L and LE were immediately placed in the lithotomy position. Patients in Groups S and SE were maintained in the supine position.

Results:  The highest sensory blockade in the SE Group was on average statistically significantly higher than in the L Group. The mean time taken to the highest sensory blockade in the SE Group was statistically significantly longer than in Groups L and S. Atropine for bradycardia was used more frequently in the SE Group than in the other groups.

Conclusions:  Combined use of epinephrine with hyperbaric tetracaine in the supine position can enhance the cephalad spread of sensory block levels compared with hyperbaric tetracaine alone in the lithotomy position.
Bilateral hypoglossal nerve injury following the use of the laryngeal mask without the use of nitrous oxide
Authors: Sommer M. , Schuldt M. , Runge U. , Gielen‐Wijffels S. , Marcus M. A. E.
Published: February 2004

Hypoglossal nerve injury is a rare complication of anaesthesia airway management in adults. Until now the use of nitrous oxide for anaesthesia supposedly contributed to this complication. We present a case of bilateral hypoglossal nerve injury following the use of a laryngeal mask airway without the use of nitrous oxide.

At the conclusion of 3 h of surgery in extreme side rotation, a 15‐year‐old boy of 88 kg could not extend his tongue beyond his teeth. An MRI confirmed the absence of pharyngeal haematoma and the absence of thrombosis of the basilar artery.

We conclude that even when patients have no medical history and nitrous oxide is not being used, prolongation of the operation in an extreme position might increase the risk of major complications with a laryngeal mask.
Anaesthesiological airway management in Denmark: Assessment, equipment and documentation
Authors: Mellado P. F. , Thunedborg L. P. , Swiatek F. , Kristensen M. S.
Published: February 2004

Background:  Failed intubation remains one cause of anaesthesia‐related morbidity and mortality. In a recent survey in Denmark, 20% of respondents reported preventable mishaps in airway management.

Methods:  Assessment of the airway, and its documentation, as well as the availability of various equipment to manage a difficult airway, and the existence of a failed intubation plan were surveyed by mailing a questionnaire to the clinical directors of all 69 anaesthesia departments in Denmark.

Results:  Fifty‐six departments (81%) returned the questionnaire. Pre‐operative airway evaluation is performed in 90% of the departments. The tests included the mouth‐opening test (77%), Mallampati score (48%), lower jaw protrusion (34%), neck mobility (63%), the measurement of the thyromental (11%) and sternomental distance (4%). The result of the tests are documented by 38% of the departments in the anaesthetic chart (96%), in the record (54%), on a card given to the patient (23%), in a letter sent to the patient's general practitioner (2%) or in a database (13%). The patients are personally informed in 82% of the departments. Only 54% of the departments have a failed intubation plan readily available.

Conclusion:  The preoperative assessment of the airways and its documentation is still unsatisfactory, as is communicating with the patient after a case of a difficult/impossible intubation. The adoption of internationally recognized recommendations might improve airway management and teaching to the best standard possible in the already well‐equipped Danish anaesthetic departments.