bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma concentrations of lignocaine after thoracic paravertebral blockade in infants and children
Authors: LÖNNQVIST P.A. 
Published: July 2010

SummaryPlasma concentrations of lignocaine were determined in six ASA I children treated with thoracic paravertebral blockade. Peak concentrations ranged between 1.7 and 3.0 μg.ml−1 after a bolus injection of lignocaine 0.5 ml.kg−1 (lignocaine 10 mg.ml−1 with adrenaline 5 μg.ml−1) and peak plasma concentrations were reached 15–30 min after injection. Two hours after the initial bolus a continuous infusion of the same lignocaine solution was started (0.25 ml.kg−1.h−1). Steady state levels of lignocaine were reached 8–10 h after the start of the infusion and ranged from 2.1–3.2 μg.ml−1. This regimen for paravertebral block in children resulted in moderate plasma concentrations of lignocaine, well below those which might result in side effects or systemic toxicity.
An ethnic comparison of the sympathetic response to tracheal intubation
Authors: HOUGHTON I. T. , LOW J. M. , LAU J. T. F. , OH T. E. 
Published: July 2010

SummaryThe sympathetic response to orotracheal intubation was examined in five Europeans, 15 Chinese, and seven Nepalese male patients. Plasma adrenaline and noradrenaline concentrations were assayed using high performance liquid chromatography with colometric detection. There was a significant rise in noradrenaline concentrations following intubation in the Chinese and the concentrations decreased over 5 min. Similar increases were seen in the Europeans and Nepalese. The mean plasma catecholamine concentrations were comparable, which suggests that there are no ethnic differences in the groups studied. A wide inter individual variation of catecholamine concentrations was found.
The intraosseous route for induction of anaesthesia
Authors: SELBY I. R. , JAMES M. R. 
Published: July 2010

SummaryA 6‐week‐old baby, who had sustained a head injury, resulting in a fractured skull and scalp haematoma, was successfully resuscitated and anaesthetised with colloid, blood, midazolam, suxamethonium and atracurium via the intraosseous route.
Combined continuous spinal‐epidural anaesthesia with a single interspace, double‐catheter technique
Authors: Vercauteren M. P. , Geernaert K. , Vandeput D. M. , Adriaensen H. 
Published: July 2010

SummaryA double catheter, single interspace combined spinal‐epidural anaesthetic was performed in 12 ASA grade 3 patients. The technique failed in one patient in whom the intrathecal catheter could not be inserted satisfactorily. In another patient, the epidural catheter was accidentally placed intrathecally. The maximum height of the block obtained with hyperbaric lignocaine or bupivacaine was below T10 in all patients and there were no adverse cardiovascular changes. As opposed to a classical combined spinal‐epidural block, this technique is most suitable for very debilitated patients. The advantages are the ability to titrate the intrathecal dose of the local anaesthetic to achieve the desired dermatomal level and to test the correct position of the epidural catheter before injecting drugs intrathecally.
Elderly patients' preferences concerning life‐support treatment
Authors: HEAP M. J. , MUNGLANI R. , KLINCK J. R. , Males A. G. 
Published: July 2010

SummaryThe preferences of 118 elderly patients, aged from 70 to 97 years, concerning the institution of artificial ventilation in the event of an overwhelming illness, were investigated using a questionnaire. Most patients wanted treatment if the outcome was likely to be good, but in approximately half, the desire for treatment declined as anticipated quality of life or chances of recovery fell. Forty percent wanted to make the decision about institution of artificial ventilation themselves if mentally competent and 24% wanted to use some form of advance directive if mentally incompetent.
Concealed Wolff‐Parkinson‐White syndrome detected during spinal anaesthesia
Authors: NISHIKAWA K. , MIZOGUCHI M. , YUKIOKA H. , ASADA A. , FUJIMORI M. 
Published: July 2010

SummaryWe report a case of concealed Wolff‐Parkinson‐White syndrome detected for the first time during spinal anaesthesia in an adult male. Episodes of tachy'arrhythmia with a heart rate of approximately 115 beat.min−1, wide QRS complexes and negative T waves which lasted 30–60 s, but were unassociated with hypotension, occurred three times after spinal anaesthesia. Postoperative Holler ECG monitoring showed the frequent occurrence of supraventricular premature contractions and paroxysmal supraventricular tachycardias with the same electrophysiological characteristics as those noted during spinal anaesthesia. The patient was diagnosed as having concealed Wolff‐Parkinson‐White syndrome. Since this condition is asymptomatic and undetectable by routine pre‐operative screening it is likely that other unsuspected cases will arise. When episodes of tachyarrhythmia occur unexpectedly during anaesthesia, as was the case in this patient, postoperative examination including Holler ECG monitoring will be necessary to determine the nature and severity of the tachyarrhythmia.
A modified sensor for pulse oximetry in children
Authors: HOWELL S. J. , BLOGG C. E. , ASHBY M. W. 
Published: July 2010

SummaryPulse oximetry is a powerful tool for patient monitoring but there are practical problems with its application in small children. Standard probes may be too large to be used easily and dedicated paediatric probes may be awkward to apply. The authors describe a modification of the Nellcor ‘Oxiband’ probe which simplifies its use in children. The modified probe was compared in 27 children with the conventional ‘clothes‐peg’ type of device and found to under‐read by 1.5% with 95% confidence intervals of ±3.1%. This is comparable to the error of the ‘Oxiband’ probe in normal use of ±3% over the range of saturations 70–95%. It is concluded that the modified probe may safely be used in clinical practice.
A comparison of epidural diamorphine with intravenous patient‐controlled analgesia using the Baxter infusor following Caesarean section
Authors: Stoddart P. A. , Cooper A. , Russell R. , Reynolds F. 
Published: July 2010

SummaryIn a randomised study of analgesia following Caesarean section, we compared the efficacy and side effects of on‐demand epidural diamorphine 2.5 mg with intravenous patient‐controlled analgesia using diamorphine from the Baxter infusor system. Pain scores fell more rapidly in the epidural group, but by the fourth hour, and thereafter, both techniques had a similar analgesic effect. The patient‐controlled analgesia group used significantly more diamorphine (p < 0.001), median 62 mg (range 18–120 mg) compared to the epidural group, median 10 mg (range 2.5–20 mg), over a significantly longer time period (p < 0.001), median 54.25 h (range 38–68 h) compared to the epidural group, median 40.75 h (range 6–70 h). The frequency and severity of nausea, vomiting and pruritus were similar in the two groups, however the patient‐controlled analgesia group were more sedated during the first postoperative day. This reached statistical significance (p < 0.05) between 9–24 h. Overall satisfaction scores (0–100) were high, but the patient‐controlled analgesia group scored significantly higher: mean 85.5 (SD 12.2) compared to mean 77.0 (SD 11.7) in the epidural group.
The respiratory depressant effect of morphine
Authors: HOUGHTON I. T. , AUN C. S. T. , WONG Y. C. , CHAN K. , LAU J. T. F. , OH T. E. 
Published: July 2010

SummaryThe respiratory response to carbon dioxide was measured in 130 ASA 1 adult male patients from three ethnic groups, European, Nepalese, and Chinese, both before and after premedication with intramuscular morphine sulphate (200 μg.kg‐1 body weight). Satisfactory results were obtained from 125 patients. Overall, there was no ethnic difference in the effect of morphine on the respiratory response to carbon dioxide, but initially the Chinese group appeared to be more sensitive in their response to carbon dioxide than the Europeans and Nepalese. However, there was a significant correlation between respiratory response to carbon dioxide and pulse rate and on restricting analysis to those patients with a pulse rate equal to or less than 72 beat.min‐1, the ethnic difference in carbon dioxide response disappeared. It was concluded that there were no ethnic differences in the respiratory response to carbon dioxide before or after morphine in male Europeans, Nepalese and Chinese but that the respiratory response to carbon dioxide may be influenced by long term physical training.
Neutral head position for placement of internal jugular vein catheters
Authors: WILLEFORD K. L. , REITAN J. A. 
Published: July 2010

SummaryA new approach to the internal jugular vein is described which keeps the head and neck in the neutral position and uses bony and cartilaginous landmarks for guidelines. Venous puncture is made along an axial line drawn superiorly from the lateral edge of the bony depression caused by the insertion of the sternocleidomastoid muscle on the superior edge of the clavicle. This line, at the level of the cricoid cartilage, lies directly over the internal jugular vein. In 55 patients initially studied, the mean (SEM) number of puncture attempts to locate the vein was 1.4 (0.2) per patient, with an overall success rate of 98%. In 84%, the internal jugular vein was located exactly where predicted, the others were just lateral to the point. The complication rate (all short‐term) was 3.6%. Subsequently the internal jugular vein was cannulated successfully using the developed technique in 20 consecutive trauma patients with suspected cervical instability. An average of 1.2 (0.2) (range 1–3) attempts were made per patient to locate the vein and there were no complications. We propose this technique as a safe and reliable method of gaining central venous access in patients with possible cervical spine injury following trauma.
The intensity of postoperative shivering is unrelated to axillary temperature
Authors: CROSSLEY A. W. A. , MAHAJAN R. P. 
Published: July 2010

SummaryThe relationship between axillary temperature and postoperative shivering was examined in 302 patients who entered one recovery room in the Derbyshire Royal Infirmary over a one‐month period. No relationship was found between temperature and the occurrence of shivering, or between conscious level and the occurrence of shivering.
The relationship between oxygen delivery and uptake in the critically ill: is there a critical or optimal therapeutic value?
Authors: STELTZER H. , HIESMAYR M. , MAYER N. , KRAFFT P. , HAMMERLE A. F. 
Published: July 2010

SummaryIn order to identify a critical or an optimal therapeutic value for oxygen delivery and oxygen uptake, we analysed data from 40 publications concerning the relationship between oxygen delivery and consumption in patients with adult respiratory distress syndrome, trauma or during sepsis, and in nonseptic controls. According to the outcome, the patients were allocated to either group 1 (survivors) or group 2 (nonsurvivors). While oxygen delivery and uptake (mean, SEM) were significantly higher in patients with adult respiratory distress syndrome (636, SEM 31 ml.min‐1.m‐2and 155, SEM 5 ml.min‐1.m‐2), trauma (782, SEM 77 ml.min‐1.m‐2 and 167, SEM 10 ml.min‐1.m‐2) and sepsis (654, SEM 28 ml.min‐1.m‐2 and 163, SEM 5 ml.min‐1.m‐2) than in nonseptic controls (452, SEM 18 ml.min‐1.m‐2 and 126, SEM 3 ml.min‐1.m‐2, p < 0.05), there were no significant differences in these parameters between survivors and nonsurvivors. Although therapeutic manoeuvres were effective in increasing both oxygen delivery and consumption, these improvements were not parallelled by an increase in survival rate. The correlation between oxygen delivery and uptake is generally a result of the use of pooled data and therefore prone to mathematical coupling. This is true particularly for patients with adult respiratory distress syndrome and sepsis. Thus, our study failed to identify either an optimal or a critical value of oxygen delivery or oxygen consumption in critically ill patients.
Magnesium flux and cardiac surgery
Authors: Vyvyan H.A.L. , Mayne P. N. , Cutfield G. R. 
Published: July 2010

SummaryA prospective study of 128 adult cardiac surgical patients was undertaken in order to quantify net magnesium loss and its relationship to serum magnesium levels and postoperative problems, particularly arrhythmias. Peri‐operative magnesium flux on the first day was calculated from the administered magnesium (in cardioplegia solution and intravenous infusion) and urinary magnesium loss. Magnesium input ranged from 24 mmol to 40 mmol, resulting in a net magnesium gain in 94% of patients. Hypomagnesaemia, identified in 34% of patients pre‐operatively and 30% of patients postoperatively, had no significant correlation with the measured peri‐operative magnesium flux or the electrocardiograph corrected‐QT interval. Fifty‐three patients developed postoperative arrhythmias, but there was no significant correlation with the serum total magnesium concentration, or with the peri‐operative change in serum magnesium level, magnesium flux, or QT interval. The data suggest that serum total magnesium is not a useful measurement upon which to base preventive or therapeutic measures in cardiac surgical patients.
A new method of veno‐venous bypass during human orthotopic liver transplantation
Authors: SCHERER R. , GIEBLER R. , ERHARD J. , LANGE R. , GÜNNICKER M. , SCHMUTZLER M. , PAAR D. , KOX W. J. 
Published: July 2010

SummaryVeno‐venous bypass is commonly used during orthotopic liver transplantation, but there is some controversy as to whether it contributes to a better outcome. Low shunt flows frequently reduce the efficacy of portofemoro‐axillary systems and so a percutaneous cannulation technique for the subclavian and femoral vein with large bore catheters was developed in order to facilitate bypass management. This study reports the performance and complications of a portofemoro‐subclavian bypass system during the anhepatic phase of human orthotopic liver transplantation in 85 patients. A percutaneous cannulation technique and two 7 mm (subclavian and femoral) catheters, inserted pre‐operatively, were used in a pump driven portofemoro‐subclavian bypass system. Coagulation profiles, shunt flows, haemodynamic parameters, and peri‐operative complications associated with bypass were recorded for each patient. Percutaneous cannulation of the left femoral and subclavian vein was successful in 78 patients (91.8%). Mean femoro‐subclavian shunt flow was 1.45 1.min‐1 (SD 0.37), and mean portofemoro‐subclavian flow was 4.28 1.min‐1 (SD 1.03). Although oxygen delivery was not maintained at pre‐shunt levels (559.7 (SD 147) vs 506 (SD 107) ml.min‐1.m‐2, p < 0.05) renal perfusion pressure stayed above 50 mmHg (during shunt it was 56 (SD 9) mmHg). One intra‐operative air embolism was observed (1.2%), and in one patient a myocardial infarction occurred during the anhepatic phase; neither complication was considered to be related to the percutaneous cannulation technique. There were no bleeding complications. After operation, all chest X rays were normal and clinical examination revealed no adverse effects of portofemoro‐subclavian bypass. Percutaneous cannulation for portofemoro‐subclavian bypass using 7 mm catheters for the femoral and subclavian vein is a rapid, simple, effective, and safe method for management of adverse haemodynamic effects during the anhepatic phase of orthtopic liver transplantation.
Anaesthesia for Caesarean section in a patient receiving high dose amiodarone for fetal supraventricular tachycardia
Authors: FULGENCIO J. P. , HAMZA J. 
Published: July 2010

SummaryWe report the anaesthetic management of a Caesarean section in a woman treated with high dose amiodarone for fetal supraventricular tachycardia. Most of the interactions between anaesthesia and amiodarone therapy previously reported were observed during general anaesthesia. We therefore chose epidural anaesthesia using incremental doses of lignocaine 2% with adrenaline and fentanyl. This technique appeared to be safe, but since severe refractory vasodilatation with hypotension may occur, potent vasopressor agents should be immediately available.
Apparent massive tongue swelling A complication of orotracheal intubation on the Intensive Care Unit
Authors: HUEHNS T. Y. , YENTIS S. M. , CUMBERWORTH V. 
Published: July 2010

SummaryThe trachea of an 81‐year‐old woman was intubated with an orotracheal tube for emergency abdominal surgery and the tube was left in place for postoperative management on the Intensive Care Unit. After 36 h, she developed apparent massive tongue swelling. On closer examination, a normal sized tongue was found to be displaced by oedema of the floor of the mouth and submandibular space, secondary to purulent sialadenitis from right submandibular duct obstruction by the tracheal tube.
Laboratory assessment of a user‐assembled oxygen generation kit
Authors: BHIMSAN N. R. , ROUT C. C. , MURRAY W. B. 
Published: July 2010

SummaryA laboratory assessment was made of a user‐assembled oxygen generation kit designed for use in medical emergencies in the community. Twenty‐five kits were studied at five different water temperatures and the rate of oxygen generation and its concentration were measured. The apparatus produced a mean (SD) oxygen volume of 37 (1.98) I which was not affected by the starting water temperature. The mean (SD) rate of flow varied from 2.2 (0.04) l.min‐1 at 16°C to 10.3 (2.74) l.min‐1 at 40°C but the duration of flow varied inversely. Oxygenation concentrations ranging from 30–51% were produced at starting water temperatures from 22°C‐40°C, respectively.
Spinal anaesthesia for patients with previous lower limb amputations
Authors: Tessler M. J. , Kleiman S. J. 
Published: July 2010

SummaryPhantom limb pain has been reported as a transient phenomenon in patients with lower limb amputations during subsequent spinal anaesthesia. In order to determine its incidence and to define any predisposing factors we prospectively studied 23 spinal anaesthetics in 17 patients with previous lower limb amputation. Only one patient developed clinically significant phantom limb pain and we were unable to define any predisposing factors. Given the low incidence of recurrent phantom limb with spinal anaesthesia, its transient nature, and the fact that it can be treated if it occurs, we conclude that spinal anaesthesia is not contraindicated in patients with previous lower limb amputation.
A simple method for the maintenance of oxygen saturation following intravenous induction of anaesthesia with propofol
Authors: RUGGIER R. , BAILEY C. R. , GROUNDS R. M. , CLARKE J. T. 
Published: July 2010

SummaryOne hundred unpremedicated fit adult patients having elective minor day‐stay surgery and general anaesthesia were randomly allocated to one of two groups. During 30 s of intravenous propofol administration (2.5 mg.kg‐1), study group patients (n = 50) were instructed to take three vital capacity breaths of room air, whilst control group patients (n = 50) were given no specific instructions. Pulse oximetry was continuously recorded over the next 5 min and the lowest oxygen saturation was noted. Pre‐induction oxygen saturation was the same for both groups, but the lowest median oxygen saturation in the study group patients was 94% versus 88% in the control group patients (p < 0.001). Oxygen saturation returned to the pre‐induction value significantly earlier in the study group patients compared with controls (97 s vs 135 s, p < 0.01). These results demonstrate that significant desaturation occurs in patients following intravenous induction of anaesthesia with propofol. This desaturation may be attenuated by asking patients to take three vital capacity breaths of room air during induction of anaesthesia.
Patient‐controlled epidural analgesia with sufentanil following Caesarean section: the effect of adrenaline and clonidine admixture
Authors: VERCAUTEREN M. P. , VANDEPUT D. M. , MEERT T. F. , ADRIAENSEN H. A. 
Published: July 2010

SummarySixty patients, scheduled for Caesarean section were randomly allocated to receive by the epidural route in a double‐blind fashion one of the following patient‐controlled analgesia mixtures for the relief of postoperative pain: sufentanil 2 μg.ml‐1 in 0.9% sodium chloride, sufentanil 2 μg.ml‐1+ adrenaline 2.5 μg.ml‐1, or sufentanil 2 μg.ml‐1+ clonidine 3 μg.ml‐1. Patient‐controlled analgesia settings were a basal infusion rate of 2.5 ml.h‐1, an incremental dose of 2.5 ml, a lockout interval of 10 min and a 1‐h limit of 10 ml. Whereas patient demographics and pain scores between the groups were not different, the 24‐h consumption of sufentanil was significantly lower in the groups receiving a combination (167.5 SD 45 and 139.1 SD 31.9 μg for the adrenaline and clonidine groups respectively) as compared to the plain sufentanil regimen (208.2 SD 38.9 μg). Although sufentanil requirements were the lowest in the clonidine admixture group, there were no differences with regard to sedation as compared to the plain sufentanil group. The quality of sleep appeared to be significantly better in the sufentanil/adrenaline group despite a significantly lower degree of sedation and higher incidence of pruritus. Treatment of pruritus with naloxone did not seem to influence the quality of analgesia.
Oral administration of midazolam as a premedicant for paediatric day‐case anaesthesia
Authors: McCLUSKEY A. , MEAKIN G. H. 
Published: July 2010

SummaryFifty‐four children aged 1–10 years, scheduled for day‐case anaesthesia were prescribed either oral midazolam 0.5 mg.kg‐1 or a placebo preparation 30‐60 min pre‐operatively on a double‐blind basis. On arrival at the induction room, anxiolysis was satisfactory in 23 out of 24 (96%) children who received midazolam compared with 12 out of 27 (44%) of those who received placebo (p < 0.001); at induction of anaesthesia these proportions were 21 out of 24 (88%) and nine out of 27 (33%) respectively (p < 0.001). The time to early recovery from anaesthesia was somewhat longer in children premedicated with midazolam compared with controls (28.2 vs 21.9 min) (p < 0.05). Similarly, the time to hospital discharge was longer in the midazolam group (244 vs 185 min) (p < 0.01). Analysis of behavioural questionnaires completed by parents 2 weeks after hospitalisation indicated that there were fewer postoperative behavioural disturbances in children premedicated with midazolam compared with controls (p < 0.05).
Paralytic ileus as a complication of atropine therapy following severe organophosphate poisoning
Authors: BEARDS S. C. , KRAUS P. , LIPMAN J. 
Published: July 2010

SummaryA 32‐year‐old man presented with symptoms of severe organophosphate poisoning and required an atropine infusion for 5 weeks. We believe the development of a paralytic ileus occurred as a rare feature of atropine toxicity when other signs were masked by the underlying condition. The onset of a paralytic ileus coincided with a spontaneous increase in red cell cholinesterase levels and may be an early sign of recovery from organophosphate poisoning.
Subdural block—further points
Authors: BELL G. T. , TAYLOR J. C. 
Published: July 2010

SummaryAn obstetric epidural performed for analgesia showed a changing pattern of neurological block. The original features suggestive of a subdural block were complicated when aspiration of cerebrospinal fluid from the catheter became possible. Subsequent management as a continuous subarachnoid catheter allowed delivery.