bluuebunny/crossref_metadata_2025 huggingface dataset:
2% propofol for sedation in the intensive care unit
Authors: Ewart M. C. , Yau K. W. , Morgan M.
Published: February 2007

A 2% solution of propofol has been compared with the 1% formulation for sedation in patients whose lungs were being mechanically ventilated in an intensive care unit following coronary artery bypass surgery. There were no significant differences in the amount of propofol used in the two groups, the rate of propofol infusion or the number of changes made to the infusion rate to maintain the desired level of sedation. Recovery times and times to tracheal extubation were similar. The mean heart rates of those receiving 2% propofol were significantly higher throughout the period of the study for no apparent reason. Propofol 2% was found to be safe, easy to administer and a practical alternative to the 1% solution for sedating cardiac surgical patients.
Electronic and disposable patient‐controlled analgesia systems
Authors: Robinson S. L. , Rowbotham D. J. , Mushambi M.
Published: February 2007

We have compared the performance of the Baxter disposable with the Graseby electronic patient‐controlled analgesia system in 30 patients following major gynaecological surgery. Patients were allocated randomly to receive analgesia via the Baxter or Graseby device for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative pain relief or sedation as measured by visual analogue scale. Requirements for antiemetic drugs and patient acceptability were similar. Mean (SEM) morphine demanded over 30 h was 35.7 (6.6) in the Graseby group and 35.1 (8.5) in the Baxter group.
Effects of timolol ophthalmic solution on the intra‐ocular pressure rise induced by suxamethonium and tracheal intubation
Authors: Bricker S. R. W. , McGalliard J. N. , Mercert N. P. , Smith G. T. H. , Trimble R. B. , Mostafa S. M.
Published: February 2007

Thirtv patients received topical application of either timolol ophthalmic solution 0.25%, or normal saline, 2 h before elective ophthalmic surgery in a double‐blind study. The responses to suxamethonium and tracheal intubation were compared by measuring intra‐ocular pressure before induction of anaesthesia, 1 mm after administration of thiopentone 2–4 mg·kg−1 min after administration of suxamethonium 1 mg·kg−1, and I, 2.5 and 5 min after tracheal intubation. There was no significant difference between the groups.
Difficulty in extubation
Authors: BROCK‐UTNE J. G. , JAFFE R. A. , ROBINS B. , RATNER E.
Published: February 2007

Difficulties in removing the tracheal tube from the trachea are relatively uncommon. We report here a case of difficult extubation which was precipitated by pulling off the pilot balloon and valve assembly in order to deflate the cuff.
Preparation of the critically ill for interhospital transfer
Authors: RUNCIE C. J. , REEVE W. R. , WALLACE P. G. M.
Published: February 2007

Changes in monitoring and therapy during the preparation of 100 critically ill patients for interhospital transfer by a specialist team were documented prospectively with the aim of providing guidelines for nonspecialists. Severity of illness scores were recorded before and after preparation. Median duration of preparation for ambulance journeys was 50 min and for aeroplane journeys was 82 min. During preparation, a portable electrocardiogram and pulse oximeter were attached to 21 and 76 patients respectively and intra‐arterial pressure monitoring was continued or instituted in 88 patients. Supplemental oxygen and intravenous fluids were the therapies most commonly increased or instituted by the transport team; mechanical ventilation, positive end‐expiratory pressure and inotropic drugs were increased or instituted less frequently. Median therapeutic intervention scores before and after preparation were 21 and 23 respectively, highlighting the need to increase rather than withdraw support for transfer.
Intra‐operative patient‐controlled sedation
Authors: RUDKIN G. E. , OSBORNE G. A. , FINN B. P. , JARVIS D. A. , VICKERS D.
Published: February 2007

Propofol and midazolam were compared for intra‐operative patient‐controlled sedation in 40 Asa 1 day patients undergoing surgical extraction of third molar teeth under local anaesthesia. All patients initially received 0.7 ng.kg−1 fentanyl. Patients in the propofol group self‐administered 20 mg (2 ml over 6 s) bolus doses of propofol; successful demands averaged 8.0 (SD 4.4) and unsuccessful demands (during the 1 min lockout period) 2.8 (SD 4.1). The midazolam group self‐administered 0.5 mg (2 ml over 6 s) bolus doses and averaged 14.0 (SD 6.3) and 17.6 (SD 19.8) successful and unsuccessful demands respectively. Postoperative memory, measured with delayed free recall, and postoperative mental performance, measured with the frequency accrual speed test index, were both significantly less impaired in the propofol group. Although there was no significant difference in patient satisfaction, measured postoperatively, propofol was judged the more suitable agent for patient‐controlled sedation, because of its more rapid response to fluctuating intra‐operative requirements, superior recovery characteristics and beneficial effect on mood.
Propofol and hypothermic cardiopulmonary bypass
Authors: LAYCOCK G. J. A. , ALSTON R. P.
Published: February 2007

The effects of propofol during low flow (1.6 l.min−1.m−2) hypothermic (27–29°C) cardiopulmonary bypass on systemic haemodynamic and metabolic variables were studied in 20 patients in a parallel group comparison. Patients in the control group underwent two consecutive control periods, whereas those in the propofol group underwent a control period followed by a ‘propofol’ period during which they received an intravenous bolus of propofol 5 mg.kg−1 followed by an infusion at a rate of 20 mg.kg−1.h−1. Haemodynamic and metabolic variables were measured at the end of each period. The propofol group showed a significant reduction in both systemic vascular resistance (p < 0.001) and systemic oxygen uptake (p < 0.05). There was a small but significant fall in lactate in the control group (p < 0.02); however, there was no significant change in the propofol group. These findings could indicate impaired tissue perfusion, although they more likely indicate systemic metabolic depression with washout of lactate from previously hypoperfused tissues.
Thoracic epidural infusion for postoperative pain relief following abdominal aortic surgery: bupivacaine, fentanyl or a mixture of both?
Authors: GEORGE K. A. , CHISAKUTA A. M. , GAMBLE J. A. S. , BROWNE G. A.
Published: February 2007

Thirty patients who had undergone elective abdominal aortic surgery were studied in a prospective, randomised double‐blind comparison of thoracic epidural 0.2% bupivacaine alone, thoracic epidural fentanyl alone and thoracic epidural 0.2% bupivacaine combined with fentanyl. Pain relief, pulmonary function, cardiovascular stability and side effects were assessed. Pain relief was excellent in the combined bupivacaine‐fentanyl series, being significantly better than the other groups (p < 0.05) during the entire study period and was not accompanied by hypotension. Forced expiratory parameters were reduced in all groups throughout the study to 50–60% of the pre‐operative values, but there were no significant differences between groups. The incidence of side effects attributable to either epidural bupivacaine or fentanyl was low. This study supports the increasing use of epidural infusion analgesia for postoperative pain management after abdominal surgery.
The human wedge
Authors: Goodwin A.P.L. , Pearce A.J.
Published: February 2007

The important part of resuscitation in late pregnancy is the relief of aortocaval compression. A manoeuvre to relieve aortocaval compression (the human wedge) is described and evaluated. Eighteen qualified midwives performed basic life support in the supine and wedged position employing the human wedge. Performance was assessed using the Laerdal Resusci Anne Skillmeter. There was no difference (p = 0.4761) in performance of mouth‐to‐mouth expired air ventilation between the two positions. External cardiac compressions were performed significantly better (p = 0.0005) in the wedged position than in the supine position. The human wedge may provide an alternative to other methods of relieving aortocaval compression.
Patient‐controlled analgesia: a double‐blind study in burn patients
Authors: CHOINIERE M. , GRENIER R. , PAQUETTE C.
Published: February 2007

A double‐blind controlled study was performed to assess the efficacy and safety of patient‐controlled analgesia in burn patients. This method was compared with conventional analgesic therapy consisting of intermittent intravenous morphine injections. Twenty‐four adult patients hospitalised for burn injuries participated in the study. The McGill Pain Questionnaire, visual analogue scales and verbal‐numeric scales were administered at regular intervals to measure various components of the patients' pain experience, degree of pain relief, anxiety levels, adverse side effects and overall treatment efficacy. Although statistical significance was found in only one measure, the results suggested better pain control in patients who were administered morphine by patient‐controlled analgesia as compared with intermittent injections. Analysis of the side effects showed no difference between the groups. The amount of morphine administered over the trial period was also similar for the two groups but considerable interpatient variability was seen. Although further research is needed to determine the conditions for optimal use of patient‐controlled analgesia, it is concluded that it is a safe, effective and improved method for controlling pain in selected burn patients.
Fibreoptic intubation in cicatricial membranes of the pharynx
Authors: DIVATIA J. V. , UPADHYE S. M. , SAREEN R.
Published: February 2007

Two patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. In both patients, a single opening in the membrane provided access to both the larynx and oesophagus. Fibreoptic intubation allowed both a thorough assessment of the pathology and subsequently the passage of a cuffed tracheal tube to secure the airway. To overcome the problem of respiratory obstruction while thefibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre‐oxygenation and voluntary hyperventilation followed by breath‐holding during bronchoscopy, was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes fibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx.
Isosorbide dinitrate spray
Authors: Bijoria K. , Wig J. , Bajaj A. , Sapru R. P.
Published: February 2007

We evaluated the efficacy of isosorbide dinitrate buccal spray (Isomack) in attenuating the cardiovascular response to laryngoscopy and tracheal intubation in 60 patients undergoing elective surgery under general anaesthesia. Patients were allocated to one of three groups of 20 patients each. Group 1 patients were administered placebo buccal spray 90 s before induction of anaesthesia. Groups 2 and 3 had isosorbide dinitrate spray 30 and 90 s before induction of anaesthesia. Systolic, diastolic and mean arterial pressures and heart rate were monitored. After the spray, group 3 patients had a significant decrease in systolic arterial pressure (p < 0.01). At 1 min after intubation, systolic, diastolic and mean arterial pressures showed a significant increase in group 1 patients (24.9 mmHg, 14.2 mmHg and 18.7 mmHg respectively). In contrast, groups 2 and 3 showed a significant decrease in these parameters (p < 0.01). Although significant tachycardia was present following intubation in all the three groups, the degree of tachycardia was greater in groups 2 and 3 (p < 0.01).
Delayed profound respiratory depression after premedication with trimeprazine
Authors: CHAMBERS F. A. , O'LEARY E. , GORMLEY P. K. , FLYNN N. M.
Published: February 2007

Delayed, profound respiratory depression occurred in a 4‐year‐old boy, who had been premedicated with trimeprazine 4 h after tonsillectomy. This is a rare, but potentially fatal idiosyncratic reaction.
An evaluation of the Rapid Infusion System
Authors: ROTHEN H. U. , LAUBER R. , MOSIMANN M.
Published: February 2007

The performance of the Rapid Infusion System was evaluated in the laboratory. Using a conventional mixture of two units of packed red cells, two units of fresh frozen plasma and 500 ml crystalloid, a single line and a driving pressure of 300 mmHg, the highest flow in our study was 970 ml.min−1 (2.8 mm catheter, no stopcock). With a 1.6 mm venous cannula the measured flow was 640 ml.min−1. Additional diluting of the standard ‘blood cocktail’ did not add much to the performance of the system. When primed with tap water 21°C (12°C respectively), the fluid at the outlet of the system reached a maximum temperature of 37.8°C (37.4°C) after 6 min at a flow of 400 ml.min−1. At flows higher than 1150 ml.min−1 (priming with 12°C tap water: 800 ml.min−1), the system slowed down to flows of 700 to 1000 ml.min−1 in order to maintain an adequate temperature. We conclude, that the Rapid Infusion System is a valuable tool for situations where a rapid but controlled replacement with warmed blood at rates up to at least 1100 ml.min−1 is needed. The use of large bore intravenous catheters and avoiding additional resistors such as standard 3‐way stopcocks is highly recommended.
A multiple dose comparison of combinations of ibuprofen and codeine and paracetamol, codeine and caffeine after third molar surgery
Authors: MCQUAY H. J. , CARROLL D. , GUEST P. , JUNIPER R. P. , MOORE R. A.
Published: February 2007

In a randomised, double‐blind, double‐dummy, multiple dose, crossover study in 30 patients we compared an ibuprofen/codeine combination (400 mg ibuprofen/25.6 mg codeine phosphate) with a paracetamol/codeine/caffeine combination (1 g paracetamol/ 16 mg codeine phosphate/60 mg caffeine) for pain relief over 6 days after two‐stage bilateral lower third molar removal. The ibuprofen combination produced significantly greater analgesia than the paracetamol combination, both on single‐dose analysis of the first and second days and on multiple‐dose measures for days 1, 2, 3 and 4. The mean incidence of adverse effects over the 6 days was 20% for both combinations. This trial design (crossover with multiple dosing in outpatients) is a sensitive way of testing for analgesia, and is potentially more predictive of adverse effect problems than single‐dose studies. It confirms that multiple dosing may show increased efficacy.
Patient‐controlled sedation using propofol in day surgery
Authors: GRATTIDGE P.
Published: February 2007

Patient‐controlled sedation using propofol was studied in 30 unselected patients aged 26–72 years undergoing day case general surgical or orthopaedic procedures under local or regional anaesthesia. Using a fixed propofol dose of 0.7mg.kg −1 body weight, the technique provided anxiolysis and sedation with few side effects and a high degree of patient satisfaction. Increasing age was significantly correlated with a deeper maximum level of sedation (p < 0.001), indicating a need for a lower bolus dose in the higher age groups. Interpatient variability in propofol requirement was reflected in the lack of significant correlation between propofol dose and procedure duration (p = 0.095) and patient age (p = 6.72).
Dermal patch anaesthesia for venous cannulation with 10% lignocaine gel containing glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter
Authors: Kano T. , Nakamura M. , Hashiguchi A. , Morioka T. , Mishima M. , Nakano M.
Published: February 2007

The clinical efficacy of transdermal 10% lignocaine gel mixture containing 3% w/w glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter was evaluated at venous cannulation in 17 paediatric (6–11 years) and 17 adult (29–65 years) patients. After about 60 min of occlusive application, the mean (SD) pinprick pain score was 0.7 (0.7) in the paediatric group, compared with 1.4 (1.3) in the adults (p < 0.05). Twenty‐five patients (14 children and 11 adults) who had a pinprick score of 0 or 1 underwent venous cannulation without intradermal local anaesthetic. The mean (SD) pain scores at venepuncture showed no significant differences between children and adults.
Does the laryngeal mask airway compromise cricoid pressure?
Authors: STRANG T. I.
Published: February 2007

The laryngeal mask airway was inserted in 10 cadavers. At postmortem the chest was opened and an infusion set primed with a dilute barium solution was inserted into the oesophagus and ligated in place. A cricoid force of 43 N was then applied and the infusion set was positioned so that when the clamp was opened it generated a pressure of 7.8 kPa within the oesophagus. The cricoid pressure was able to stop the flow of fluid into the oesophagus. This demonstrates that cricoid pressure is effective in preventing reflux at intragastric pressures which are encountered clinically and the presence of the laryngeal mask airway does not compromise this.
Repeated unilateral epidural blockade
Authors: McCrae A. F. , Whitfield A. , McClure J. H.
Published: February 2007

Unilateral epidural analgesia occurring in a parturient three times in successive pregnancies is reported. Possible causes are reviewed, and clinical and radiological evidence in support of the most likely explanation are presented.
Patient controlled analgesia—assessment of machine feedback to patients
Authors: Johnson T. W. , Luscombe F. E.
Published: February 2007

The effect of varying patient‐controlled analgesia machine feedback was studied in two groups of patients following a standard surgical procedure using patient controlled analgesia with morphine to control postoperative pain. Analgesic demands, morphine consumption, pain scores and side effects were compared and comments from the patients were noted. There was no significant difference between those whose machines signalled only successful demands compared with those who had every demand acknowledged. The patients in the former group appreciated the extra input and the nursing staff found this machine configuration to be less disturbing to the ward. There was no evidence of a clinically useful placebo effect in the latter group.
Pre‐oxygenation: the Hudson mask as an alternative technique
Authors: Ooi R. , Pattison J. , Joshi P. , Chung R. , Soni N.
Published: February 2007

The use of a simple oxygen facemask (Hudson) with high oxygen inflow (48 l.min−1) was investigated as a technique for pre‐oxygenation, comparing it with the Magill system (oxygen flow: 100 ml.kg−1.min−1). One hundred and thirty‐eight patients scheduled for elective gynaecological and orthopaedic surgery were studied: group 1. Hudson mask and group 2, Magill system (Asa 1–2, n = 107); group 3, Hudson mask and group 4, Magill system (Asa 3, n = 30). Pre‐oxygenation was assessed by measuring the times to 97%, 95% and 93% arterial desaturation (finger pulse oximetry) following 3 min of pre‐oxygenation. The times taken to achieve these end‐points in all the study groups suggest that the Hudson mask offers an alternative technique for pre‐oxygenation.
Thoracic electrical bioimpedance measurement of cardiac output and cardiovascular responses to the induction of anaesthesia and to laryngoscopy and intubation
Authors: SANDERS D. J. , JEWKES C. F. , SEAR J. W. , VERHOEFF F. , FOËX P.
Published: February 2007

Noninvasive methods of determining cardiac output (by thoracic electrical bioimpedance) and arterial pressure (by intermittent oscillometry) were used to record minute‐by‐minute changes in heart rate, mean arterial pressure, stroke volume, cardiac output and systemic vascular resistance following induction of general anaesthesia and laryngoscopy and intubation in 60 healthy female patients who were either unpremedicated, or premedicated with temazepam or papaveretum‐hyoscine. Anaesthesia was induced with a sleep dose (3–5 mg.kg−1) of thiopentone and maintained with 70% nitrous oxide in oxygen with 0.5–1% enflurane. Tracheal intubation was facilitated by administration of vecuronium 0.1 mg.kg−1. Mean arterial pressure and cardiac output decreased maximally 5 min after induction in all premedication groups by mean estimates of 21–25% and 14–22% respectively. Heart rate increased initially one minute after induction, but decreased to less than the baseline value 5 min after induction. Systemic vascular resistance was unchanged. The stimulus of laryngoscopy and tracheal intubation was accompanied by a significant pressor response and tachycardia one minute after intubation (with mean increases in mean arterial pressure and heart rate of 29–34% and 22–33% respectively). The increase in mean arterial pressure was secondary to an increase in systemic vascular resistance (36–57%), and was accompanied by a decrease in stroke volume (– 25 to –31%). These changes were significant in all three groups. Cardiac output decreased only in unpremedicated patients. There were wide variations in the different haemodynamic indices. The 5th and 95th centiles for the decreases in mean arterial pressure and cardiac output during induction were –17 to –26, –21 to –33, and –21 to –35mmHg, and –0.7 to –2.0, –0.7 to –2.3, and –0.2 to –1.31.min−1 respectively in unpremedicated patients and those premedicated with papaveretum‐hyoscine, or temazepam. Corresponding values for increases in mean arterial pressure and systemic vascular resistance, and decreases in stroke volume following laryngoscopy and intubation, were 16 to 33, 16 to 31.5, and 15 to 31 mmHg; 5.0 to 8.6, 3.5 to 10.2, and 4.3 to 7.8 mmffg.min.−1; and –19 to –31, –11 to –32.5, and –9 to –21 ml respectively.
The pre‐operative anaesthetic visit
Authors: Nightingale J. J. , Lack J. A. , Stubbing J. F. , Reed J.
Published: February 2007

One hundred and thirty‐two patients staying in hospital more than 24 h were visited pre‐ and postoperatively. Patients were asked a standard set of questions, and 39% could not remember accurately what they were asked. This has important medicolegal implications. In 15% of patients, information that significantly altered subsequent anaesthetic management was discovered, but in less than 3% would ignorance of the patient's condition have required postponement of the surgery. We conclude that the major reason for a pre‐operative visit by an anaesthetist is that patients appreciate it, rather than it being medically necessary.
Cardiovascular effects of forces applied during laryngoscopy
Authors: BUCX M. J. L. , VAN GEEL R. T. M. , SCHECK P. A. E. , STIJNEN T.
Published: February 2007

The relationship between the forces applied during laryngoscopy and cardiovascular changes were studied in patients undergoing laryngoscopy with or without intubation. This enabled us to differentiate between the cardiovascular effects of laryngoscopy and the effects of tracheal intubation. The forces applied during laryngoscopy were only weakly related to the cardiovascular changes, whereas tracheal intubation had a major influence. The many difficulties encountered in interpreting results from these studies are discussed. It is concluded that tracheal intubation causes more cardiovascular changes than laryngoscopy in routine uncomplicated procedures.
Effect of extradural anaesthesia on the ventilatory response to hypoxaemia
Authors: SAKURA S. , SAITO Y. , KOSAKA Y.
Published: February 2007

The eflect of lumbar or thoracic extradurul anaesthesia on the ventilatory response to progressive isocapnic hypoxaemia was studied in two groups of 10 unpremeditated patients. The ventilatory measurements were taken twice, before and 20 min after the administration of 10 ml of lignocaine 2%. Lumbar extradural anaesthesia did not change the slope of the hypoxic response curve, but it significantly increased minute ventilation by 27% at an arterial oxygen saturation of 90%. Thoracic extradural anaesthesia was not associated with any changes in either index. We conclude that neither lumbar nor thoracic extradural anaesthesia impairs the ventilatory response to progressive isocapnic hypoxaemia.
Sedation with propofol during surgery under local blockade
Authors: SKIPSEY I. G. , COLVIN J. R. , MACKENZIE N. , KENNY G. N. C.
Published: February 2007

The ability of a target‐controlled propofol infusion system to provide sedation for 40 patients undergoing surgery under regional blockade was assessed. Eighty‐eight per cent of the total infusion time was at the desired sedation level with little oversedation. This was achieved with a median blood propofol concentration of 0.93 μg.ml−1. The pharmacokinetic algorithm performed as well when used for sedation as for total intravenous anaesthesia. The predicted and measured blood propofol concentrations showed a bias of—12% and a precision of 34%.
The minilink breathing system: resistance and suitability for spontaneous ventilation
Authors: O'MEARA M. E. , BHATT S. B. , BREEN D. , BENNETT N. R.
Published: February 2007

The Portex infant breathing/ventilation systems with 8.5 mm and 15 mm internal diameter connectors were compared with a standard T‐piece which had a 15 mm connector and 22 mm internal diameter tubing. The differential pressures across each system were measured at constant fresh gas flows up to 30 l.min−1 dry air. Resistance was calculated at flows compatible with quiet respiration and peak inspiratory flow. Flow resistance of the 3.0 mm internal diameter tracheal tube in conjunction with the minilink breathing systems were similar to those previously reported for tracheal tubes alone. However, the minilink breathing system assumed a greater influence on resistance when tracheal tubes of larger internal diameter were used. It added considerably more resistance than the standard tubing. This may have a deleterious effect during spontaneous ventilation in older children.
Interaction of H2‐receptor antagonists and benzodiazepine sedation
Authors: SANDERS L. D. , WHITEHEAD C. , GILDERSLEVE C. D. , ROSEN M. , ROBINSON J. O.
Published: February 2007

H2‐receptor antagonists differentially inhibit cytochrome P450 and this may affect the rate at which benzodiazepines are metabolised. However, it is not known whether this delayed clearance results in prolonged psychomotor impairment. In a randomised double‐blind trial 28 healthy volunteers received two single doses of midazolam (0.07 mg.kg−1) at an interval of one week during which they took cimetidine 400 mg, ranitidine 150 mg or placebo, each twice daily. Recovery from the benzodiazepine was monitored on each occasion over a 12 h period using a battery of psychometric tests. There was wide individual variation in performance; however, an overall measure of impairment indicated a significant difference at 2.5 h (p < 0.05), the cimetidine group having a high impairment score. This decrement appeared to be in cognitive and psychomotor functions and was not reflected in the subjective assessment.
Topical nitroglycerine prevents the pressor response to tracheal intubation and sternotomy in patients undergoing coronary artery bypass graft surgery
Authors: MAHAJAN R. P. , RAMACHANDRAN R. , SAXENA N.
Published: February 2007

Thirty adult patients who underwent coronary artery bypass graft surgery were allocated randomly to one of two equal groups to receive either 2% nitroglycerine, or a placebo ointment, applied topically over an area of 5 cm by 10 cm, in a double‐blind manner, 1 h before induction of anaesthesia. Premedication consisted of oral diazepam 5–10 mg, intramuscular morphine 0.2 mg.kg−1 and promcthazine 0.4 mg.kg−1. Anaesthesia was induced with morphine 0.15–0.2 mg.kg−1 and thiopentone 3–5 mg.kg−1. Laryngoscopy and tracheal intubation were facilitated by suxamethonium 1.5 mg.kg−1, and pancuronium 0.1 mg.kg−1 was used for subsequent muscle relaxation. Anaesthesia was maintained with 0.5% halothane and 40% oxygen in nitrous oxide. A significant increase in blood pressure occurred during and after laryngoscopy and tracheal intubation, and following midline sternotomy in the control group. These changes were absent in patients pretreated with topical nitroglycerine. The nitroglycerine group also maintained a lower rate‐pressure product than the control group. We conclude that topical nitroglycerine is a simple and useful pretreatment to prevent the pressor response to tracheal intubation and midline sternotomy in patients undergoing coronary artery bypass graft surgery.
Leg elevation and wrapping in the prevention of hypotension following spinal anaesthesia for elective Caesarean section
Authors: ROUT C. C. , ROCKE D. A. , GOUWS E.
Published: February 2007

Ninety‐seven parturients undergoing elective Caesarean section were allocated randomly to have their legs elevated to approximately 30° on pillows or elevated and wrapped with elasticated Esmarch bandages or neither (controls) following spinal anaesthesia. All patients received intravenous crystalloid (20 ml.kg−1 over 20 min) prior to spinal injection and were placed in the left lateral tilt position. Significant hypotension was treated with intravenous ephedrine in 5 mg bolus doses. Leg wrapping resulted in a significant reduction in the incidence ofpostspinal hypotension in comparison to the control group (18% compared to 53%, p = 0.004). This represents a five‐fold reduction in the likelihood ofpostspinal hypotension (odds ratio 5.3, 95% CI 1.7–16.3). Leg elevation alone did not significantly reduce the incidence of hypotension (39%). There was no significant difference in the time of onset of hypotension between the groups. For those patients requiring ephedrine, there was no significant difference in mean dose requirements between the groups. The use of leg compression immediately postspinal provides a simple means of reducing the accompanying hypotension and should be used more widely.
Ventilatory effects of pneumoperitoneum monitored with continuous spirometry
Authors: BARDOCZKY G. I. , ENGELMAN E. , LEVARLET M. , SIMON P.
Published: February 2007

Inspiratory and expiratory tidal volume, peak and plateau airway pressure, compliance of the respiratory system, pressure‐volume and flow‐volume loops were monitored continuously and recorded in seven women undergoing laparoscopy with carbon dioxide insufflation to an intra‐abdominal pressure of 1.6 kPa. All patients were anaesthetised using a total intravenous technique and a constant minute ventilation was maintained. Peak airway and plateau airway pressures increased by 50% and 81% respectively, whilst the compliance of the respiratory system decreased by 47% during the period of increased intra‐abdominal pressure. Following release of the pneumoperitoneum, peak and plateau pressures remained elevated by 37% and 27% respectively, and the compliance was 86% of the pre‐insufflation value. On‐line monitoring of respiratory volumes, pressures and compliance may be helpful during general anaesthesia for laparoscopic procedures to avoid the potential harmful effects of increased airway pressures occurring with increased intra‐abdominal pressure.
The Miller tracheal cuff pressure control valve
Authors: PAYNE K. A. , MILLER D. M.
Published: February 2007

A constant pressure differential valve for the control of tracheal tube cuff pressure was tested under clinical conditions. Fifty‐one patients underwent controlled ventilation and 20 patients were allowed to breathe spontaneously. Nitrous oxide 66% with oxygen 33% and halothane were used via a circle system. With controlled respiration at afresh gas flow of 3–10 l.min −1, the expiratory cuff pressures of 10.1–16 cmH2sO and the inspiratory cuff pressures of 23.4–32.4 cmH2O were below venous and arterial mucosal capillary perfusion pressures respectively. Cuff pressures were unaltered with time. Methylene blue instilled into the larynx did not appear in the trachea. Fifty‐two control patients had the same incidence of sore throat (40%) and hoarseness (30%) at 24 h. With spontaneous ventilation, fresh gas flows of 5–15 l.min−1 maintained the cuff pressure above 10 cmH2O. We conclude that this valve prevents excessive tracheal cuff pressure while maintaining the airway seal.
Infusion nomograms
Authors: SHERRY E. , BURTON G. W. , WILKINS D. G.
Published: February 2007

Seven infusion nomograms are presented for the rapid and accurate composition of continuous infusions. The construction of these nomograms is described.
Extradural air as a cause of paraplegia following lumbar analgesia
Authors: NAY P. G. , MILASZKIEWICZ R. , JOTHILINGAM S.
Published: February 2007

A 52‐year‐old woman with chronic back pain presented for lumbar extradural analgesia. The ‘loss of resistance to air’ technique was used to locate the extradural space. Prolonged paraesthesia and paresis of the left leg occurred following the procedure. Urgent lumbar computed tomography scan revealed nerve root displacement due to extradural air.
Local anaesthesia for eye surgery without a facial nerve block
Authors: Sanchez‐Capuchino A. , Meadows D. , Morgan L.
Published: February 2007

Traditionally, local anaesthesia for cataract surgery requires retrobulbar blockade to be supplemented with a facial nerve block in order to prevent blepharospasm. In this study retrobulbar block using a larger volume of local anaesthetic without facial nerve block is compared with the combined technique in 50 patients. The adequacy of the two techniques was assessed by the surgeon according to eye motility (in four different planes). lid motility and eye softness and an overall surgical assessment was made at the end of the procedure. Blepharospasm did not occur. The operating conditions were equally good in both groups (p > 0.05). These results suggest that good operating conditions for cataract operations can be provided by retrobulbar block alone without supplementary facial nerve block.
Anaesthesia for gynaecological laparoscopy—a comparison between the laryngeal mask airway and tracheal intubation
Authors: Swann D. G. , Spens H. , Edwards S. A. , Chestnut R. J.
Published: February 2007

In a single‐blind, randomised, controlled study, we compared two anaesthetic techniques in 60 patients undergoing gynaecological laparoscopy. In the first group, ventilation was controlled, after paralysis and tracheal intubation. In the second group, a laryngeal mask airway was inserted and spontaneous or assisted ventilation allowed. There were no clinically significant differences in the intra‐operative conditions of the two groups, although the procedure was quicker in the second group. The only significant difference in morbidity was a greater incidence of nausea and vomiting in the second group in the first 4 h after operation. We conclude that use of the laryngeal mask airway is an acceptable technique for elective gynaecological laparoscopy, in patients who are at low risk of regurgitation.
Deaths associated with dentistry and dental disease 1980–1989
Authors: Coplans M. P. , Curson I.
Published: February 2007

A study of deaths associated with dentistry and dental disease in England and Wales between 1980 and 1989 has been undertaken. There were fewer deaths associated with dentistry than in the previous decade. Whilst most of the deaths are still associated with general anaesthesia, the total number has decreased, as has the percentage of deaths in which general anaesthesia was thought to play a significant part. There were only four deaths involving an operator/anaesthetist compared with 13 in the previous decade and all four took place between 1980 and 1983. However, there were two deaths associated with sedation techniques, both of which occurred after 1984, whereas there had been none in the previous decade. On the information available, it is still not possible to establish the role of the patient's posture in these deaths.
A comparison between propofol and desflurane anaesthesia for minor gynaecological laparoscopic surgery
Authors: GRAHAM S. G. , AITKENHEAD A. R.
Published: February 2007

Fifty‐seven healthy female patients who underwent gynaecological laparoscopic surgery received either desflurane or propofol for induction and maintenance of anaesthesia. Inhalational induction was generally well tolerated, and consciousness was lost in approximately 2 min (mean end‐tidal concentrations of desflurane were 8.3% with 60% nitrous oxide, and 7.1% with oxygen). Recovery of consciousness and orientation were more rapid in patients in whom anaesthesia was maintained with desflurane than with propofol, but there were no differences in psychomotor function test scores at 30 min. The data suggest that desflurane provides controllable anaesthesia and rapid recovery of consciousness after laparoscopic surgery.
Peri‐operative nightmares in surgical patients
Authors: Brimacombe J.
Published: February 2007

A questionnaire was designed which made specific enquiries about peri‐operative nightmares and general enquiries regarding peri‐operative hallucinations, sleep disturbance and pain. The questionnaire was completed by four groups of patients. Groups 1 and 2 comprised patients who had undergone elective cardiac surgery and major noncardiac surgery respectively. Group 3 comprised patients undergoing day surgery. Group 4 consisted of 100 randomly selected patients who had undergone minor elective surgery to the upper or lower limbs during the preceding 2 years, half of whom had received regional and half general anaesthesia. Two hundred and seventy‐one completed questionnaires were analysed. In all, 18.5% of patients had experienced at least one nightmare during the postoperative week and and the highest incidence (27.9%) was found in group 1. Nightmares occurred most commonly on the fourth postoperative night and did not correlate with disturbed sleep, hallucinations or any other symptom recorded. Patients in group 1 reported the highest incidences of disturbed sleep (54.8%) and hallucinations (12.5%).
The use of propofol in a child with hepatitis A
Authors: SHAW A.
Published: February 2007

Propofol was used for the induction and maintenance of anaesthesia in a 4‐year‐old girl with hepatitis A and haematemesis. The anaesthetic was uneventful with no postoperative sequelae.
Orotracheal intubation in patients with potential cervical spine injuries
Authors: Nolan J.P. , Wilson M.E.
Published: February 2007

The conditions for emergency tracheal intubation of patients with cervical spine injury were simulated in 157 patients during induction of anaesthesia for routine surgery. The view of the larynx obtained during laryngoscopy with the head in the optimum intubating position was compared with that obtained when manual in‐line stabilisation of the cervical spine and cricoid pressure were used. During laryngoscopy with cervical stabilisation, the view of the larynx was reduced in 45% of patients, and in 22% of patients nothing was visible beyond the epiglottis. To assess the ease of intubation with the neck stabilised and with cricoid pressure applied, patients were randomised to either direct visual intubation (n = 79), or intubation aided by a gum elastic bougie (n = 78). The median time taken for visual intubation was 20 s, but in six patients intubation took over 45 s. In addition, five patients in this group could not be directly intubated. Using the gum elastic bougie all patients, including the failures from the visual group, were intubated within 45 s (median 25 s). We recommend the gum elastic bougie as an aid to intubating the patient with suspected cervical spine injury, particularly when the glottis is not immediately visible.
Cardiorespiratory arrest following combined spinal epidural anaesthesia for Caesarean section
Authors: MYINT Y. , BAILEY P. W. , MILNE B. R.
Published: February 2007

A 31‐year‐old woman had an elective Caesarean section under combined spinal/epidural anaesthesia. At the end of the operation, diamorphine 2.5 mg in 5 ml of 0.25% bupivacaine plain was injected through the epidural catheter. Forty minutes after this, the patient had a Cardiorespiratory arrest in an ordinary postnatal ward.
John Mervyn Nooth
Authors: Zuck D.
Published: February 2007

Further information about John Mervyn Nooth, his family and descendants, and surviving memorials in and near the city of Bath, has been obtained.
Pharyngeal teratoma
Authors: MORIARTY A. J. , McEWAN I. P.
Published: February 2007

A 30‐week newborn patient presented with acute respiratory obstruction due to a large pharyngeal teratoma. At taryngoscopy no view of the larynx was obtained, and a tracheal tube was unintentionally passed blindly into the oesophagus. This relieved the obstruction by anterior displacement of the mass.
A comparison of keyed and non‐keyed vaporizer filling modes and volatile agent wastage
Authors: UNCLES D. R.
Published: February 2007

Two hundred and forty bottles of enflurane were collected after their contents had been emptied into vaporizers equipped with keyed or non‐keyed filling ports. The volume of agent remaining, the residual volume, was measured. There was a greater (p < 0.001) residual volume in ‘empty’ bottles which had been used to fill keyed compared with non‐keyed enflurane vaporizers. Five hundred and fifty two bottles of isoflurane were also collected after they had been used to fill keyed vaporizers. There was no significant difference between the residual volume remaining in bottles of isoflurane and enflurane used to fill keyed fillers; however, the difference was statistically significant if the residual volume was expressed as a proportion to the volume of agent contained in the full bottle. The results show that volatile anaesthetic agent wastage is increased by the use of keyed fillers. Isoflurane wastage caused by utilisation of keyed fillers could be reduced by a factor of 2.5 by supplying isoflurane in 250 ml rather than 100 ml bottles.
Evaluation of three portable suction devices
Authors: SIMON E. J. , DAVIDSON J. A. H. , BOOM S. J.
Published: February 2007

Three portable suction devices were evaluated and compared with a wall‐mounted vacuum driven suction unit. The Repro‐med Res‐Q‐Vac, the Drager Sujector 2000 and the Laerdal suction unit were assessed by measuring the time taken to aspirate 140 ml of mock gastric contents. The respective times for each device, expressed as mean and (range) were 7.39 (4.3–10.4), 8.6 (7.8–9.4) and 11.4 (9.4–12.6) s. These compare favourably with the Ohmeda suction unit (7.27 (6.2–8.9)). Each type of device has advantages and disadvantages when factors such as size, power supply and portability are considered, and each will be the most suitable for a particular situation.
Propofol and Intralipid cause creaming of serum from critically ill patients
Authors: GEMPELER F. , ELSTON A. C. , THOMPSON S. P. , PARK G. R.
Published: February 2007

The aim of this in‐vitro study was to investigate the incidence of propofol agglutination with serum from critically ill patients. Serum (400 μl) from 58 critically ill patients and 30 healthy volunteers was incubated with 10 μl of either propofol, Intralipid 10% or Intralipid 20%. Control incubations contained serum only. At 24 h, the serum was examined macroscopically and microscopically for agglutination. Agglutination was seen with Intralipid 20% in serum from all critically ill patients and 13.3% of volunteers. Serum from 91.4% of critically ill patients was agglutinated with Intralipid 10% and only 3.3% of the healthy volunteers. In comparison, propofol produced agglutination in 74.1% of critically ill patients and in none of the serum from healthy volunteers (p < 0.05 propofol versus Intralipid 10%, p < 0.0001 propofol versus Intralipid 20%). No correlation was seen between agglutination and age, sex, APACHE II score or plasma concentration of acute phase proteins. However, agglutination of propofol and Intralipid 10% was more frequent (p < 0.001) in serum from patients with pulmonary disease, than in patients with normal lungs. The clinical implications of these in‐vitro findings are unclear and need further investigation.
Predictable nitrous oxide uptake enables simple oxygen uptake monitoring during low flow anaesthesia
Authors: BENGTSON J. P. , BENGTSSON A. , STENQVIST O.
Published: February 2007

The uptake rate of oxygen and nitrous oxide were studied during low flow anaesthesia with enflurane or isoflurane in nitrous oxide with either spontaneous or controlled ventilation. The excess gas flow and composition were analysed. The nitrous oxide uptake rate was in agreement with Severinghaus’formula V̇N20 1000.t‐0.5. The composition of excess gas was predictable and the following formula for oxygen uptake could be derived: V̇O2=V̇fgO2 ‐0.45 (V̇fgN2O ‐(kg: 70.1000.t‐0.5)) where oxygen uptake rate (V̇O2, ml.min‐1) equals oxygen fresh gas flow (V̇fgO2) minus 0.45 times the difference between the fresh gas flow of nitrous oxide (V̇fgN2O), ml.min‐1 and estimated uptake of nitrous oxide. The equation assumes constant inspired gas concentrations of 30% oxygen and 65–70% nitrous oxide. The oxygen uptake rates calculated from this formula were in good agreement with measured uptake rates. Thus, continuous monitoring of oxygen uptake rates is possible by using only reliable flowmeters and analysis of inspried oxygen concentration.
Thyroid storm as a cause of loss of consciousness following anaesthesia for emergency Caesarean section
Authors: PUGH S. , LALWANI K. , AWAL A.
Published: February 2007

A previously undiagnosed thyrotoxic patient was anaesthetised for an emergency Caesarean section. The recovery period was complicated by an acute thyroid crisis resulting in loss of consciousness following an apparently normal recovery from general anaesthesia.
Studies in postoperative sequelae. Nausea and vomiting—still a problem
Authors: Quinn A. C. , Brown J. H. , Wallace P. G. , Asbury A. J.
Published: February 2007

We collected data on postoperative nausea and vomiting from 3850 patients aged 11–91 years. Thirty‐seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. Of the general anaesthetic patients reporting nausea, 72.2% were women, and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 74.0% were women and again the mean age was lower (p < 0.001). Of the local anaesthetic patients reporting nausea, 62.0% were women and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 68.1% were women and again the mean age was lower (p < 0.001). Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).
The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes
Authors: MURPHY P. J. , ERSKINE R. , LANGTON J. A.
Published: February 2007

This investigation studied the effect of two intravenous benzodiazepines and the specific reversal agent, flumazenil, on the sensitivity of upper airway reflexes. In a blinded, randomised, crossover study, we have investigated the effect of a single dose of diazepam (‘Diazemuls’) (0.2 mg.kg‐1) and midazolam (0.07 mg.kg‐1), both given intravenously on the sensitivity of upper airway reflexes in eight male volunteers. Reflex sensitivity was assessed by identification of reflex glottic closure in response to a threshold concentration of inhaled ammonia vapour. Both diazepam and midazolam produced significant depression of upper airway reflex sensitivity. This was maximum with both drugs within 10 min of administration, but baseline sensitivity was regained within 60 min. Flumazenil (300 μg) administered 10 min after midazolam, resulted in significant reversal of the upper airway reflex sensitivity depression.