bluuebunny/crossref_metadata_2025 huggingface dataset:
pH‐adjustment and discomfort caused by the intradermal injection of lignocaine
Authors: Martin A. J.
Published: February 2007

One hundred adult day‐case patients who required intravenous access had cannulae inserted using local anaesthesia with 1% lignocaine, 1% lignocaine with adrenaline or the corresponding pH‐adjusted solutions. The local anaesthetic solutions were modified by the addition of 1 ml 8.4% sodium bicarbonate to 10 ml lignocaine. Pain scores at different stages of cannulation were noted and showed a significant reduction after use of pH‐adjusted solutions (p < 0.02 for the plain lignocaine, and < 0.001 for the lignocaine with adrenaline). Modification of the pH of lignocaine solutions by the addition of sodium bicarbonate is a simple method significantly to reduce the discomfort caused by the infiltration of the local anaesthetic.
Induction agents for day‐case anaesthesia A double‐blind comparison of propofol and midazolam antagonised by flumazenil
Authors: NORTON A. C. , DUNDAS C. R.
Published: February 2007

Early postoperative recovery was studied using sedation scoring, measurement of flicker fusion frequency and completion of Trieger test figures in 60 male patients who presented for vasectomy under general anaesthesia as day patients. Anaesthesia was induced in groups I and 2 (20 patients each) with mean (SD) doses of 0.16 (0.04) mg/kg or 0.16 (0.03) mg/kg midazolam respectively; group 2 received flumazenil 0.55 (0.19) mg after completion of surgery. The remaining 20 patients (group 3) received propofol 1.50 (0.24) mg/kg. Anaesthesia was maintained with isoflurane vaporized in 33% oxygen and nitrous oxide in all patients. Flumazenil tended to improve tests of recovery after midazolam anaesthesia, but early recovery after propofol anaesthesia was associated with better psychomotor test results and less impairment of mental state as judged by sedation and amnesia scoring.
Arterial to end‐tidal carbon dioxide tensio difference during laparoscopy Magnitude and effect of anaesthetic technique
Authors: BRAMPTON W. J. , WATSON R. J.
Published: February 2007

The relationship between arterial carbon dioxide tension and end‐tidal carbon dioxide tension was studied in 25 patients during laparoscopy. Thirteen patients received general anaesthesia and 12 epidural anaesthesia. The overall mean difference between arterial and end‐tidal carbon dioxide tensions was 0.44 kPa (95% confidence intervals 0.28–0.60 kPa) which was significantly less than that reported in studies during other procedures. The reasons for this difference are probably associated with the physiological changes induced by CO2 pneumoperitoneum and steep Trendelenburg positioning. The choice of anaesthetic technique did not affect the arterial to end‐tidal carbon dioxide tension difference significantly (p > 0.9).
Retroperitoneal fibrosis after multiple coeliac plexus blocks
Authors: PATEMAN J. , WILLIAMS M. P. , FILSHIE J.
Published: February 2007

Retroperitoneal fibrosis is described as a complication of multiple coeliac plexus blocks for chronic pancreatitis.
A comparison of three methods of axillary brachial plexus anaesthesia
Authors: BARANOWSKI A. P. , PITHER C. E.
Published: February 2007

One hundred patients scheduled for elective outpatient hand surgery had blockade of the axillary brachial plexus by one of three techniques; insertion of a catheter into the brachial plexus sheath (n = 25), use of paraesthesia (n = 50) or use of the nerve stimulator (n = 25) to localise the plexus. Only two patients required general anaesthesia for the planned surgery. Assessment of the dermatomes blocked did not demonstrate a statistical difference between the success rates of the three groups. The more nerves detected in the paraesthesia and the nerve stimulator groups before injection of local anaesthetic the higher the success rate of the block. We advocate use of the nerve stimulator technique in view of the possible risk of neurological damage associated with paraesthesia and the technical difficulties with the catheter technique, for routine brachial plexus blockade.
Forty‐eight single‐shot epidural injections on the same patient
Authors: KATSAROS G. A. , HANDJIS G. P. , ANASTASIADES J.
Published: February 2007

A patient is described who has received 48 single‐shot epidurals with plain lignocaine. No complications were encountered at any time. Nuclear magnetic resonance imaging confirmed that no dural damage had occurred.
Anaesthesia for the treatment of a giant cerebral aneurysm under hypothermic circulatory arrest
Authors: THOMAS A. N. , ANDERTON J. M. , HARPER N. J. N.
Published: February 2007

The anaesthetic management of a patient whose giant cerebral aneurysm was clipped is described. Profound hypothermia and thiopentone were used to provide cerebral protection during circulatory arrest. Atracurium was used to provide muscle relaxation; the level of neuromuscular block and plasma concentrations of atracurium and laudanosine were measured.
Management of low cardiac output syndrome after cardiac surgery using enoximone
Authors: WHITE D. A. , LATIMER R. D. , ODURO A.
Published: February 2007

This case report describes the use of enoximone, a potent phosphodiesterase F‐IV inhibitor with inotropic and vasodilator actions, to treat low output syndrome after cardiac surgery. The reduced cardiac output was unresponsive to a combination of inotropic drugs and intra‐aortic balloon counterpulsation was contraindicated. Cardiac output was increased dramatically by enoximone, but systemic vascular resistance and perfusion pressure remained low until the addition of metaraminol.
Clinical evaluation of double‐burst stimulation Its relationship to train‐of‐four stimulation
Authors: GILL S. S. , DONATI F. , BEVAN D. R.
Published: February 2007

Double‐burst stimulation was compared with train‐of‐four stimulation in 23 adult patients receiving atracurium. Train‐of‐four was interrupted in 11 subjects every 2 minutes by one double‐burst stimulation, and re‐applied 6–30 seconds later; the height of the first double‐burst response, compared with its control, was depressed slightly more than T1. The relationship between double‐burst stimulation ratio and train‐of‐four ratio was indistinguishable from the line of identity. The train‐of‐four response, if repeated more than 12 seconds after double‐burst stimulation, was not depressed compared with pre double‐burst stimulation values. Fifteen anaesthetists were asked to detect fade manually in the second part of the study, while train‐of‐four was recorded on the opposite arm. One hundred and fourteen determinations were made in 12 patients. Fade was detected manually more often with double‐burst stimulation than with TOF.
Impairment of left ventricular diastolic function during coronary artery bypass grafting
Authors: WEHLAGE D. R. , BÖHRER H. , RUFFMANN K.
Published: February 2007

Twelve patients were studied by transoesophageal Doppler echocardiography to determine diastolic function during coronary artery bypass grafting. Haemodynamic and Doppler‐derived variables were measured after induction of anaesthesia and after closure of the sternum. Early diastolic filling of the left ventricle decreased from 55% to 35% during surgery. The contribution of atrial contraction to left ventricular filling increased from 41% to 62% (p < 0.001). We conclude that coronary artery bypass grafting results in impairment of diastolic function during the operation.
Respiratory tract infection and anaesthesia Haemophilus influenzae pneumonia that developed under anaesthesia
Authors: CAMPBELL N. N.
Published: February 2007

A 2‐year‐old boy with symptoms of a minor upper respiratory tract infection developed Haemophilus influenzae pneumonia that presented as hypoxaemia under anaesthesia for minor emergency surgery. The patient required 72 hours of mechanical ventilation in an intensive care unit after the anaesthetic and thereafter made an uneventful recovery. The value of pre‐operative chest radiology and the possible contributory effect of anaesthesia are discussed.
Response to suxamethonium in a myasthenic patient during remission
Authors: ABEL M. , EISENKRAFT J. B. , PATEL N.
Published: February 2007

A cumulative dose followed by an infusion was used to determine the dose response to suxamethonium in a patient with diagnosed my asthenia gravis who was in true remission (asymptomatic while receiving no therapy). The ED50 and ED90 values for suxamethonium were 0.08mg/kg and 0.20mg/kg, and an infusion rate of 3.2 mg/kg/hour was required to maintain a 90–95% depression of the single twitch response as monitored by integrated electromyography. These values are within the range for normal patients, and we conclude that myasthenic patients during a true remission may not demonstrate resistance to suxamethonium.
Minimum oxygen requirements during anaesthesia with the Triservice anaesthetic apparatus A study of drawover anaesthesia in the young adult
Authors: Tighe S.Q.M. , Turner G.A. , Merrill S.B. , Pethybridge R.J.
Published: February 2007

Thirty‐six servicemen were anaesthetised using the Triservice anaesthetic apparatus. They were allocated randomly into one of two groups, to breathe spontaneously or to receive artificial ventilation, and into subgroups who were given air alone, or air supplemented with 1 or 4 litres/minute of oxygen. A further 12 subjects were studied subsequently using 0.5 litres/minute of added oxygen. Intra‐operative blood gases were compared with those of awake premedicated controls. Artificial ventilation was associated with an unchanged arterial oxygen tension with air alone; in the other subgroups arterial oxygen tension was higher than with spontaneous respiration when related to inspired oxygen fraction (p < 0.05). Air anaesthesia caused significant hypoxaemia with spontaneous ventilation (p < 0.05), and 50% of the subjects required assisted ventilation. There was also a significant respiratory acidosis (p < 0.05). Intermittent positive pressure ventilation is the method of choice for field anaesthesia when oxygen is unavailable. Spontaneous respiration must be supplemented with at least 0.5 litres/minute of oxygen.
Factors that influence the induction dose of propofol
Authors: McCleane G. J. , Fogarty D. F. , Watters C. H.
Published: February 2007

Factors that influence the induction of anaesthesia with propofol were investigated in a prospective study of 1000 patients. Pre‐operative albumin and urea concentrations correlated with the minimum induction dose of propofol, but less strong correlations were found with haemoglobin, globulin and total protein concentrations. Age was an important influence on the induction dose of propofol (r = 0.34) which was also closely related to ASA grade. Induction of anaesthesia with propofol is dependant on a number of variables, and this study suggests that pre‐operative albumin and urea concentrations are important.
Lumbar epidural diamorphine following thoracic surgery
Authors: PATRICK J. A. , MEYER‐WITTING M. , REYNOLDS F.
Published: February 2007

Twenty‐two patients received a single dose of diamorphine 5 mg through a lumbar epidural catheter before thoracic surgery. The patients were transferred after surgery to a high dependency unit where they were allocated randomly to receive either an infusion of epidural diamorphine at a rate of 1 mg/hour (group 1) or bolus doses of epidural diamorphine 5 mg on demand (group 2). There was no statistically significant difference between the groups in visual analogue pain scores in the first 18 postoperative hours. Arterial carbon dioxide tension was elevated in both groups and was consistently higher in group 1 than in group 2, with a statistically significant intergroup difference 12 hours after operation. Respiratory rate was not a useful index of respiratory depression. The commonest nonrespiratory side effect was urinary retention, but the incidences of this and other minor side effects were similar in the two groups.
Incremental spinal anaesthesia using a 32‐gauge catheter
Authors: KESTIN I. G. , GOODMAN N. W.
Published: February 2007

Incremental spinal anaesthesia using a 32‐gauge intrathecal catheter was studied in 13 males scheduled for transurethral resection of the prostate or repair of inguinal hernia. The spinal technique failed in four patients. Dose‐response curves were obtained in the remaining nine patients using increments of 0.5% plain bupivacaine. The spinal block was extended safely and reliably without cardiovascular instability. No patient had any postoperative headache and all catheters were removed intact.
Echocardiographic assessment of the haemodynamic effects of propofol: a comparison with etomidate and thiopentone
Authors: GAUSS A. , HEINRICH H. , WILDER‐SMITH O. H. G.
Published: February 2007

The haemodynamic effects of propofol (2 mg/kg), etomidate (0.2 mg/kg) and thiopentone (4 mg/kg) were studied in 30 ASA 1 and 2 patients in whom anaesthesia had been induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg, vecuronium 0.1 mg/kg and atropine 10 μg/kg, and maintained with nitrous oxide in oxygen. Arterial pressure was measured directly and left ventricular diameters were determined by transoesophageal echocardiography. Systolic blood pressure after propofol and thiopentone and the end‐systolic quotient (systolic pressure/end‐systolic diameter), a measure of inotropy, decreased. Fractional shortening (end‐diastolic ‐ end‐systolic diameter/end‐diastolic diameter) decreased only in the thiopentone group. Diastolic blood pressure and end‐diastolic diameter (a measure of preload) did not change in any of the groups, and the etomidate group showed no changes in the haemodynamic variables measured. Propofol shows simultaneous negative inotropy and afterload reduction, while thiopentone is exclusively negatively inotropic.
Epidural blood patch for treatment of subarachnoid fistula in children
Authors: KUMAR V. , MAVES T. , BARCELLOS W.
Published: February 2007

A subarachnoid‐cutaneous fistula developed in two children after the placement of a catheter in the subarachnoid space for drainage of cerebrospinal fluid. The management of this iatrogenic complication with epidural blood patch is described.
Acute airway obstruction, hypertension and kyphoscoliosis
Authors: WRIGHT P. M. C. , ALEXANDER J. P.
Published: February 2007

An elderly woman developed acute respiratory obstruction after choking on a bolus of food. On rigid bronchoscopy no foreign body, or anatomical obstruction was seen, but airway obstruction recurred during emergence from general anaesthesia, and was thought to be functional in nature. A recurring airway obstruction followed, relieved by induction of anaesthesia and by sedation. This was subsequently demonstrated to be caused by a tortuous aorta which impinged intermittently on the anterior tracheal wall, as a result of kyphoscoliosis of the thoracic spine. We attribute the relief of airway obstruction by general anaesthesia to a reduction in arterial blood pressure.
Ketamine, midazolam and vecuronium infusion Anaesthesia for Down's syndrome and congenital heart disease
Authors: RILEY D. P. , McBRIDE L. J.
Published: February 2007

A ketamine, midazolam and vecuronium infusion was used for total intravenous anesthesia in a patient with Down's syndrome, a ventricular septal defect and pulmonary hypertension. A mixture of ketamine 200 mg, midazolam 5 mg and vecuronium 12 mg in 50 ml of normal saline was infused at 0.5 ml/kg/hour. This simple technique and ventilation with 100% oxygen maintained tissue oxygenation and cardiovascular stability.
Rhabdomyolysis and operating position
Authors: Targa L. , Droghetti L. , Caggese G. , Zatelli R. , Roccella P.
Published: February 2007

Rhabdomyolysis during routine surgery was studied in three groups of patients who had surgery, with limited trauma to muscle, in the lateral and supine positions, and prone on the spinal frame. A range of blood tests was performed (before surgery, and on the first, third and seventh day after operation). These showed that a creatine kinase increase in the 24 hours and the early appearance of myoglobin in the serum were the best indicators. Rhabdomyolysis was associated with the lateral position and long lasting surgery. No blood test before surgery was of any predictive value.
Introducing an acute pain service
Authors: CARTWRIGHT P. D. , HELFINGER R. G. , HOWELL J. J. , SIEPMANN K. K.
Published: February 2007

An acute pain service in a new district general hospital is described. We have reported the incidence of severe pain, common postoperative anaesthetic problems and patient satisfaction in relation to the analgesic technique. Over half the patients were treated by intermittent intramuscular injection of opioid, but increase in the use of continuous intravenous therapy and in particular patient‐controlled analgesia, was welcomed by both medical and nursing staff.
Cardiovascular effects of epidural local anaesthetics
Authors: KERKKAMP H. E. M. , GIELEN M.J.M.
Published: February 2007

The cardiovascular effects of 20 ml 0.75% bupivacaine with adrenaline 5 μg/ml injected epidurally were compared with those of 20 ml 0.75% ropivacaine with adrenaline. Cardiovascular measurements were performed with a transthoracic electrical bioimpedance monitor. The maximum mean arterial blood pressure decreased significantly from baseline values after both solutions, but the decrease after 20 minutes was more pronounced with bupivacaine (21 %) than with ropivacaine (9.6%). Stroke volume increased significantly in both groups (52% for bupivacaine and 29% for ropivacaine). Cardiac output increased significantly from baseline values 2 minutes after epidural administration; the mean of the maximum increase was 64% for bupivacaine and 53% for ropivacaine (NS). The mean of the maximum increase of the ejection fraction was 13% in the bupivacaine group and 9% in the ropivacaine group, but was only significantly different from baseline values following bupivacaine. There was no difference in the onset time or height of the sensory block between the groups. The cardiovascular changes can be ascribed to sympathetic blockade and to systemic absorption of the local anaesthetics and adrenaline.
Topical amethocaine in strabismus surgery
Authors: WATSON D. M.
Published: February 2007

A randomised study was performed to assess the effect of topical 1% amethocaine hydrochloride on postoperative analgesia requirements after strabismus surgery. Forty children scheduled for elective operation were allocated randomly to receive either topical amethocaine or normal saline. Postoperative analgesia was evaluated with the use of a four‐point assessment score and analgesic requirements. The topical amethocaine provided significantly better postoperative analgesia (p < 0.001) as measured by both the assessment score and the postoperative analgesia requirement.
Computer‐controlled anaesthesia in the management of bronchopleural fistula
Authors: DONNELLY J. A. , WEBSTER R. E.
Published: February 2007

The anaesthetic management of a bronchopleural fistula using a computer‐controlled propofol infusion system is described.
The effect of micropore filters on the aspiration test in epidural analgesia
Authors: CHARLTON G. A. , LAWES E. G.
Published: February 2007

Continuous epidural analgesia may be complicated by intravascular or subarachnoid injection of local analgesic, with disastrous consequences. One of the techniques described to prevent these complications is the aspiration test. It is the current standard of practice to employ a micropore bacterial filter for epidural infusions. We present an in vitro study of nine commercially available bacterial filters to determine whether or not the aspiration test could be reliably performed through them. Eight of the nine filters (except the Perifix, Braun) were found to be unreliable if air and liquid were both present in the system (air lock). The role of the aspiration test and the use of micropore filters in epidural analgesia are discussed, as are the implications and possible solutions in practice of this cause of failure of the test.
Lumbar regional anaesthesia and prophylactic anticoagulant therapy
Authors: WILLE‐JØRGENSEN P. , JØRGENSEN L. N. , RASMUSSEN L. S.
Published: February 2007

A survey has been carried out in all Danish anaesthetic departments (n = 80) regarding the attitude towards the use of epidural/spinal lumbar analgesia in patients who were receiving prophylactic anticoagulant therapy for the prevention of thromboembolism. About 60% of the departments used the techniques in patients receiving low‐dose heparin and no side effects had been experienced. Spinal and epidural anaesthesia were in general regarded as being contraindicated in patients fully anticoagulated with vitamin K antagonists. In the world literature, the attitude towards the combination is conflicting. No randomised trial has been performed and complications are almost entirely confined to patients fully anticoagulated with vitamin K antagonists. Only one case of an epidural haematoma has been recorded when subcutaneous low‐dose heparin was used as thromboprophylaxis.
Cardiovascular effects of intravenous clonidine
Authors: CARABINE U. A. , WRIGHT P. M. C. , HOWE J. P. , MOORE J.
Published: February 2007

The effect of clonidine on the pressor and heart rate response to tracheal intubation was studied in a placebo‐controlled, randomised, double‐blind trial. Thirty patients were pretreated with either clonidine 1.25 μg/kg, or clonidine 0.625 μg/kg or an equivalent volume of normal saline, given intravenously 15 minutes before induction of anaesthesia. The attenuation of the pressor response to intubation of both clonidine groups was statistically significant compared to the saline group. Neither dose of clonidine completely abolished the increase in either heart rate or blood pressure. There was no difference in attenuation between the clonidine treatments; this indicated that the lower dose may be the more appropriate.
Papaveretum infusions in infants under 6 months of age
Authors: Jones S. E. F. , Stokes M. A.
Published: February 2007

The effectiveness of a continuous low dose papaveretum infusion for the relief of postoperative pain was assessed in 29 infants aged 1–6 months nursed on the infant surgical ward following major abdominal surgery. Trained nursing staff were able to adjust the dosage within prescribed guidelines and satisfactory analgesia was obtained with a regimen which delivered up to 0.0375 mg/kg/hour, approximately half the dose recommended in children older than 12 months. There was one case of clinically significant respiratory depression.
Observations on deliberate dural puncture with a Tuohy needle: depth measurements
Authors: HOLLWAY T. E. , TELFORD R. J.
Published: February 2007

Observations were made during the use of a Tuohy needle to perform deliberate dural puncture for the insertion of lumbar drains to improve operating conditions for intracranial aneurysm surgery. The most striking finding was the distance from identification of the epidural space to penetration of the dura. We postulate that this was because of tenting of the dura by the blunt Tuohy needle. This was facilitated by the absence of a negative epidural space pressure because an open system was used, which allowed time for pressure equilibration. This minimised the reactive forces across the dura. Aspiration and rotation of the Tuohy needle revealed dural puncture in some cases.
Observations on deliberate dural puncture with a Tuohy needle: pressure measurements
Authors: TELFORD R. J. , HOLLWAY T. E.
Published: February 2007

Pressure recordings were made during passage of a Tuohy needle from the interspinous ligament to the subarachnoid space for lumbar drain insertion. Epidural space pressures were always positive. Negative pressures were seen only at the moment of entry into the subarachnoid space. These were artefactual and were caused by tenting of the dura by the blunt Tuohy needle. Use of a closed measurement system such as this facilitates the development of large transdural pressure gradients because of the inability of the epidural space pressure to equilibrate with atmospheric pressure. This may contribute to ease of dural puncture.
Possible inadvertent subdural block following attempted stellate ganglion blockade
Authors: BRUYNS T. , DEVULDER J. , VERMEULEN H. , DE COLVENAER L. , ROLLY G.
Published: February 2007

A case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex sympathetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered.
Nurse‐controlled intravenous analgesia
Authors: Murphy D. F. , Opie N. J.
Published: February 2007

Nurse‐controlled continuous intravenous opioid analgesia was evaluated prospectively in 60 patients after thoracotomy. The rate of opioid infusion was adjusted, and bolus doses were administered, as required to maintain patient comfort. The patients evaluated their pain using a visual analogue scale on 10 occasions during the first 48 hours after surgery. Pain scores remained consistently low throughout the period of measurement. Over the study period there was a 30‐fold difference between the least and greatest requirement for opioid to achieve adequate analgesia. No major side effects were encountered. The study indicates that nurse‐controlled intravenous analgesia can be successfully used for pain relief after thoracotomy.
Analgesic efficacy of controlled‐release dihydrocodeine
Authors: WOTHERSPOON H. A. , KENNY G. N. C. , McARDLE C. S.
Published: February 2007

A prospective, double‐blind, single‐dose placebo‐controlled four‐part crossover study of 12 healthy volunteers was carried out to compare the analgesic efficacy of controlled‐release dihydrocodeine tablets 60, 90 and 120 mg (DHC Continus tablets, Napp Laboratories) in cold‐induced pain. Subjects received each of the four treatments in a random order using a latin square design. On each of the four study days, the volunteers performed cold pressor tests, before dose and again at 4, 8 and 12 hours after dose. Subjects rated their pain continuously over a 120‐second period using a visual analogue scale. At 4 hours there was a significant reduction in pain in subjects who received 120 mg or 90 mg tablets compared with placebo, and in subjects who received 120 mg tablets compared with those who received 60 mg tablets. At 8 hours, 120 mg and 90 mg dihydrocodeine were still better than placebo. There was no significant difference in side effects between treatments.
Intra‐ocular pressure changes using the laryngeal mask airway and tracheal tube
Authors: HOLDEN R. , MORSMAN C. D. G. , BUTLER J. , CLARK G. S. , HUGHES D. S. , BACON P. J.
Published: February 2007

Intra‐ocular pressure was measured before and throughout airway establishment with either the laryngeal mask airway or tracheal tube. Similar measurements were made on removal of either airway and the amount of coughing noted in the first minute after removal. There was a significantly smaller increase in intra‐ocular pressure (p < 0.001) using the laryngeal mask airway, both on placement and removal, than with the tracheal tube. Postoperative coughing was significantly reduced using the laryngeal mask airway (p < 0.001). There was a significantly greater rise in heart rate using the tracheal tube (p < 0.01) probably related to an increased cardiovascular response. The laryngeal mask airway is recommended as an alternative to tracheal intubation in routine and emergency intra‐ocular surgery.
Protamine—the need to determine the dose
Authors: KEELER J. F. , SHAH M. V. , HANSBRO S. D.
Published: February 2007

A simple method of protamine titration using the Hemochron system was compared with an empirical dose protocol for reversal of heparinisation following cardiopulmonary bypass in 40 patients undergoing elective myocardial revascularisation. Protamine titration revealed a wide range for protamine requirement and resulted in a significant reduction in protamine dose compared with the empirical dose protocol (p < 0.01). Heparin reversal was assessed as adequate in all patients. The titration technique was easy and straightforward to use in the operating theatre.
A case of malignant hyperthermia?
Authors: BROEKEMA A. A. , BOERSMA G. A. , HENNIS P. J.
Published: February 2007

An acute episode of a malignant hyperthermia‐like syndrome is described which occurred after suxamethonium and isoflurane anaesthesia in a 41‐year‐old healthy male patient undergoing a minor elective hand operation. Dantrolene therapy rapidly reversed the life‐threatening signs. Laboratory results appeared to confirm the suspicion of malignant hyperthermia. However, the in vitro contracture test, which was carried out according to the standards of the European Malignant Hyperthermia Group, was equivocal.
A low‐flow to‐and‐fro system
Authors: KADIM M. Y. , LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

The insertion of a long deadspace tube between an anaesthetic breathing system and a ventilator produces only imperfect separation of the breathing system gas from the driving gas. This laboratory study has investigated different connecting tubes to establish the maximum tidal volume possible before ventilator gas contaminates the gas in a low‐flow to‐and‐fro system (fresh gas flow 1 litre/minute). A larger volume tube enables the use of larger tidal volumes, and plastic corrugated tubes are slightly better than black rubber corrugated tubes in this respect. The maximum tidal volume possible without contamination decreases as ventilatory rate increases, but the maximum minute volume is increased. A 22 mm plastic corrugated tube of internal volume 1.5 litres should be adequate for clinical use with the to‐and‐fro system described in this study at afresh gas flow of 1 litre/minute.
Evaluation of a small soda lime canister in a to‐and‐fro system
Authors: KADIM M. Y. , LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G.
Published: February 2007

The main disadvantages of the to‐and‐fro system (the bulky canister and the progressive increase in apparatus deadspace) may be overcome by the use of a smaller canister. In this laboratory study, we have evaluated a 160 g canister in a low‐flow to‐and‐fro system (fresh gas flow 1 litre I minute). Two carbon dioxide productions of 150 and 200 ml/minute were simulated. The mean times to exhaustion, defined here as a 0.5 kPa rise in end‐tidal Pco2, were 112 and 79 minutes in the 150 and 200 ml/minute carbon dioxide groups respectively. Ventilation to normacapnia or hypocapnia did not affect the times to exhaustion. The soda lime absorbed 16 litres of carbon dioxide before exhaustion, and this was not affected by minute volume or carbon dioxide production. A small soda lime canister is suitable for carbon dioxide absorption in a low‐flow to‐and‐fro system for ventilated adults.
The effect of intravenous clonidine on the forearm circulation
Authors: CARABINE U. A. , WRIGHT P. M. C. , KEARNEY E. , HOWE J. P. , MOORE J.
Published: February 2007

The effect of two doses of clonidine on forearm blood flow was compared with an inert treatment using mercury strain gauge venous occlusive plethysmography. In the clonidine treated groups, forearm blood flow was unaffected in the resting state, but decreased sharply with tracheal intubation. In the saline group, blood flow increased with intubation. Forearm vascular resistance increased in the clonidine treated groups, but decreased in the saline group. These results suggest that clonidine has a peripheral action in anaesthetised normotensive individuals, and is not a purely centrally acting drug.
The effect of a priming epidural injection of adrenaline on epidural blockade with bupivacaine
Authors: BARANOWSKI A. P. , DEAN Y. , PITHER C. E.
Published: February 2007

Twenty‐four patients receiving epidural anaesthesia were studied to test the hypothesis that 1:200 000 adrenaline administered into the epidural space 5 minutes before 20 ml bupivacaine 0.5% would improve nerve block and delay systemic absorption of the local anaesthetic. Group A/B received 20 ml adrenaline 1:200000 5 minutes before 20 ml bupivacaine 0.5%, group S/BA 20 ml saline followed by 20 ml bupivacaine 0.5% with 100 pg adrenaline, and group S/B saline 20 ml followed by 20 ml plain bupivacaine 0.5%. Mean maximum plasma concentrations of bupivacaine tended to be lower in the adrenaline groups. A delay in the time to peak plasma concentration of bupivacaine was noted in the A/B group; this indicated that priming with adrenaline may be effective at delaying early systemic uptake of the local anaesthetic. In both adrenaline groups a more prolonged epidural block and increased efficacy were noted, although this was only significant for the duration of block at T6 (p = 0.023) and duration of motor block at Bromage level 1 (p = 0.016) in group A/B. There seems little clinical advantage in administering adrenaline 5 minutes before bupivacaine.
Serious complications with dextran‐70 despite hapten prophylaxis
Authors: BERG E. M. , FASTING S. , SELLEVOLD O.F.M.
Published: February 2007

Dextran is used clinically for plasma volume expansion, improvement of blood flow and thromboprophylaxis, but has been associated with untoward side effects. Immunoprophylaxis with dextran I (hapten), before the infusion of dextran‐70, has reduced the incidence of serious dextran‐induced anaphylactoid reactions. We report three cases of severe reactions occurring during anaesthesia in spite of immunoprophylaxis. One patient given dextran‐ 70 before Caesarean section had a mild reaction but gave birth to a child with serious brain damage. One patient with an extremely high titre of dextran‐reactive antibodies died from myocardial infarction and another patient recovered without sequelae. From our experience we conclude that dextran‐induced anaphylactoid reactions are still a serious problem despite immunoprophylaxis. Dextran‐70 should be avoided during pregnancy and should not be given during Caesarean section before delivery of the child. Even in the presence of immunological prophylaxis, vigilant observation of the patient is essential and resuscitation equipment must be available when starting a dextran infusion.
A ‘postspinal headache’ associated with incidental intracranial pathology
Authors: DUTTON D. A.
Published: February 2007

A 28‐year‐old woman developed symptoms of raised intracranial pressure associated with an obstructive hydrocephalus following a spinal anaesthetic administered for a Kiellands rotation forceps delivery. A diagnosis of an unverified pineal body tumour was made after computerised axial tomography scanning and the symptoms were effectively treated by the insertion of a ventriculo‐peritoneal shunt. This unusual case demonstrates the importance of careful history taking and neurological examination where symptoms of postspinal headache persist.
Variable apparatus deadspace
Authors: SCOTT P. V. , JONES R. P.
Published: February 2007

A variable apparatus deadspace was used to maintain normocapnia during artificial ventilation of the lungs in anaesthetised adults. End‐tidal carbon dioxide tension could be varied, if the need arose, within the range 4.0–5.2 kPa in both open and circle breathing systems when a fixed tidal volume of 12 ml.kg−1 and minute volume ventilation of 120 ml.kg−1.min−1 were employed.
Antireflux valves in intravenous opioid analgesia: are they necessary?
Authors: Turner G. A. , Murphy D. F.
Published: February 2007

A study was conducted in patients receiving intravenous opioid analgesia to determine the incidence and degree of retrograde flow along the parallel gravity‐driven infusion line. From 1187 hours of observations retrograde flow was found in 2.5% of the total time. In 70% of these cases this was equivalent to less than 1 mg of pethidine and in 96% this was equivalent to less than 5 mg of pethidine. The need for routine use of antireflux valves during intravenous opioid analgesia is therefore questioned.
Postoperative pain control
Authors: Semple P. , Jackson I. J. B.
Published: February 2007

A survey of postoperative analgesia in 195 anaesthetic departments in England and Wales was undertaken. The results showed that 64% of respondents were dissatisfied or very dissatisfied with the present situation. Large differences were demonstrated between what was regarded as the safest technique and what would form the ideal management of postoperative pain.
Double‐blind comparison of epidural diamorphine and intramuscular morphine after elective Caesarean section, with computerised analysis of continuous pulse oximetry
Authors: STEVENS J. D. , BRAITHWAITE P. , CORKE C. F. , MADEJ T. H. , WHEATLEY R. G.
Published: February 2007

A randomised, double‐blind comparison of the efficacy, duration of action and side effects of two analgesic regimens following elective epidural Caesarean section is described. Patients received epidural diamorphine 3 mg or intramuscular morphine 10 mg in the immediate postoperative period. Time to next analgesia was longer after epidural diamorphine (11.0 hours) compared to intramuscular morphine (6.5 hours) (p < 0.05). In addition, a greater number of patients in the diamorphine group had a pain score < 2.5 cm at 5 hours (p < 0.05). However, more patients in the diamorphine group required catheterisation and suffered emetic sequelae, whereas more patients in the morphine group were sedated at 8 hours. Ten patients in each group had continuous pulse oximetry performed overnight after administration of the trial medications. Neither group demonstrated evidence of hypoxia.
The haemodynamic effects of bronchoscopy Comparison of propofol and thiopentone with and without alfentanil pretreatment
Authors: HILL A. J. , FENECK R. O. , UNDERWOOD S. M. , DAVIS M. E. , MARSH A. , BROMLEY L.
Published: February 2007

The haemodynamic response to bronchoscopy under general anaesthesia was investigated. Forty patients were allocated at random to receive either thiopentone or propofol; half the patients in each group received in addition 18 μg/kg of alfentanil one minute before induction of anaesthesia. The heart rate, noninvasive blood pressure and Holter ECG was monitored in all patients. Significant increases in heart rate (p < 0.05), systolic and diastolic arterial pressures (p < 0.01) occurred in the thiopentone only group, following bronchoscopy. Systolic and diastolic arterial pressure decreased in patients receiving thiopentone plus alfentanil, following induction of anaesthesia and laryngoscopy (p < 0.05). No significant haemodynamic changes were seen in either of the groups which received propofol. ST segment changes on subsequent Holter analysis were seen in four patients, but there were no significant differences between the groups. Anaesthesia with propofol alone provides adequate haemodynamic stability for bronchoscopy and the addition of alfentanil is superfluous.
An unusual cause of obstructive emphysema
Authors: BUIST R. J.
Published: February 2007

A 6‐month‐old child presented with a history, physical signs and radiographic findings suggestive of the presence of a foreign body in the tracheobronchial tree. However, further investigation revealed extrinsic compression of the left main bronchus by a grossly enlarged left atrium. Treatment of the patient's heart failure resulted in resolution of the signs. Anomalous origin of the left coronary artery was found to be the cause.
A comparison of APACHE II and a clinical sickness score
Authors: SINCLAIR J. R , MAGEE P. T. , GOULD T. H. , COLLINS C. H.
Published: February 2007

The aim of this study was to compare the predictive power of a simple illness severity score (Clinical Sickness Score) to that of APACHE II in a District General Hospital intensive therapy unit. A prospective comparison was carried out on 97 consecutive adult patients whose severity of illness was scored one hour after admission using both the Clinical Sickness Score and APACHE II. Intensive Therapy Unit and hospital outcomes were recorded for each patient. The Clinical Sickness Score and APACHE II identified survivors and nonsurvivors with similar power (p < 0.001). There was a highly significant correlation between the two scoring systems for hospital survivors and nonsurvivors together (r = 0.5418, r2= 0.28, p = < 0.0001) and for hospital survivors alone (r = 0.6102, r2= 0.37, p = 0.0001). Correlation for hospital nonsurvivors was not significant (r = 0.1629, r2= 0.027, p = 0.3134). The positive predictive values of APACHE II were between 5% and 10% more sensitive than the Clinical Sickness Score for hospital outcome. Admission Clinical Sickness Score and APACHE II scores had similar predictive power in this study.
Propofol in short gynaecological procedures
Authors: SANDERS L. D. , CLYBURN P. A. , ROSEN M. , ROBINSON J. O.
Published: February 2007

Recovery was assessed over 48 hours after anaesthesia with propofol or thiopentone as sole anaesthetic agent in 36 unpremedicated gynaecological patients. Immediate recovery, as measured by the Steward scale, was shown to be quicker for the patients given propofol. At one hour postoperatively the thiopentone group showed impaired visual‐motor coordination on the aiming test (p < 0.01) and dexterity task (p < 0.05), and a slowing of reaction time (p < 0.01). Patients given propofol showed only an increase in reaction time (p < 0.05). By 2 hours the thiopentone group showed impairment only in the aiming task (p < 0.05). No further significant impairment was detected at 4, 24 or 48 hours. However, patients reported symptoms throughout the 48 hours indicative of residual drug effects. There was a substantial practice effect with some tests which may have obscured impairment. It can be argued therefore that the better recovery profile after propofol is still evident at 24 hours.
Anaesthesia for a patient with giant axonal neuropathy
Authors: MITCHELL A. , MOSKOVITS P. E.
Published: February 2007

Giant axonal neuropathy is a generalised disorder of cytoplasmic intermediate filaments which particularly involves the peripheral and central nervous systems. In this paper we describe a child with giant axonal neuropathy and discuss the anaesthetic management in the light of the pathology and physiology of the condition.
Resedation after bolus administration of midazolam to an infant and its reversal by flumazenil
Authors: COLLINS S. , CARTER J. A.
Published: February 2007

A 4‐month‐old infant was sedated with bolus doses of midazolam, and after initial apparent complete arousal, became unresponsive and hypotonic. Administration of flumazenil enabled differentiation of a residual drug effect from an intracerebral event.
The laryngeal mask airway in children
Authors: Rowbottom S. J. , Simpson D. L. , Grubb D.
Published: February 2007

Clinical and fibreoptic assessment of the positioning of the laryngeal mask airway was performed in 100 children. Clinical observation indicated a patent airway in 98% and severe airway obstruction in 2% of cases. Perfect positioning, as judged by fibreoptic laryngoscopy, was found in 49% and the epiglottis was within the mask in 49%. Fibreoptic evidence of partial airway obstruction in 17%, was not detected clinically.
Colloid solutions in the critically ill
Authors: STOCKWELL M. A. , SCOTT A. , DAY A. , RILEY B. , SONI N.
Published: February 2007

All patients admitted to an Intensive Care Unit were assigned randomly to one of two groups, A and B. Group A received colloid volume replacement as 4.5% albumin whilst group B received a synthetic colloid, polygeline. This study describes the changes in serum albumin concentration in survivors and nonsurvivors in the two groups during their stay in the Intensive Care Unit. The incidences of renal failure and pulmonary oedema were also assessed. Serum albumin concentration decreased in all nonsurvivors. In survivors the serum albumin concentration decreased to a greater extent in the synthetic colloid group than in the albumin group. Despite the differences in serum albumin concentration there were no significant differences between the groups in the incidences of pulmonary oedema or renal failure.
Response to the Valsalva manoeuvre after spinal anaesthesia
Authors: MACFIE A. G. , BRIMACOMBE J.
Published: February 2007

The waveform from a Criticare 504 pulse oximeter was recorded during the performance of a standard Valsalva manoeuvre in 20 patients before and after spinal anaesthesia. The pulse oximeter waveform showed changes typical of the expected heart rate and pulse volume changes seen in each phase of the Valsalva manoeuvre. There were no significant changes in the typical pulse volume changes of the Valsalva manoeuvre after spinal anaesthesia, which achieved a sensory block ranging in upper extent from T3‐T12. There was, however, a significant delay in recovery of the pulse volume in phase 4 of the Valsalva manoeuvre after spinal anaesthesia from a mean (SD) of 3.1 (0.9) s to 6.2 (3.1) s (p < 0.05). There was also a significant reduction in reflex bradycardia seen in phase 4. However, this was found only at 5, 10 and 15 min after spinal anaesthesia and was not associated with a significant change in Valsalva ratio or maximum‐to‐minimum rate ratio. The study confirms that the normal response to a standard Valsalva manoeuvre is suppressed only mildly during spinal anaesthesia in normovolaemic fit patients.
The response times during anaesthesia of pulse oximeters measuring oxygen saturations during hypoxaemic events
Authors: BROOME I. J. , HARRIS R. W. , REILLY C. S.
Published: February 2007

Episodes of desaturation were recorded simultaneously by computer from two Ohmeda Biox 3700 pulse oximeters, one with an ear and one with a finger probe, on patients undergoing anaesthesia. Over a period of 6 months, 28 episodes of desaturation were detected. Analysis of the recordings showed the mean minimum saturations recorded for ear and finger probes were 86.3% and 83.5% respectively (p < 0.01). The mean delay for finger compared to ear pulse oximetry was 4.4 s (p < 0.01). Analysis at different saturation levels showed finger probe responses to be significantly slower than ear probe responses at saturations equal to and above 91% (p < 0.05). At saturation levels of 90% or less no significant difference in probe response times were found.
Effect of fentanyl on the circulatory responses to orotracheal fibreoptic intubation
Authors: SMITH J. E. , KING M. J. , YANNY H. F. , POTTINGER K. A. , POMIRSKA M. B.
Published: February 2007

The effectiveness of fentanyl in attenuating the pressor and heart rate response to orotracheal fibreoptic intubation under general anaesthesia was assessed in 60 healthy patients undergoing elective surgery. Patients were randomly assigned to receive either fibreoptic intubation with or without fentanyl 6μg.kg−1 or traditional Macintosh intubation with fentanyl 6μg.kg−1. A standardised general anaesthetic was administered which included temazepam premedication, thiopentone, atracurium, oxygen, nitrous oxide and isoflurane. The pressor response to fibreoptic intubation was suppressed in those patients who received fentanyl and was similar to that seen in the Macintosh‐fentanyl group of patients. The heart rate response to fibreoptic intubation was also significantly reduced in the patients who received fentanyl, but, in contrast, was still significantly greater than that in the Macintosh‐fentanyi group. Fentanyl 6μg.kg−1 appears to have a useful place in attenuating the cardiovascular effects of fibreoptic intubation under general anaesthesia.
Finger blood content, light transmission, and pulse oximetry errors
Authors: CRAFT T. M. , LAWSON R. A. , YOUNG J. D.
Published: February 2007

The changes in light emitting diode current necessary to maintain a constant level of light incident upon a photodetector were measured in 20 volunteers at the two wavelengths employed by pulse oximeters. Three states of finger blood content were assessed; exsanguinated, hyperaemic, and normal. The changes in light emitting diode current with changes in finger blood content were small and are not thought to represent a significant source of error in saturation as measured by pulse oximetry.