bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acetylcholinesterase ‐ a specific marker for cerebrospinal fluid
Authors: VANNER R. G. 
Published: July 2010

SummaryAn oedematous pre‐eclamptic patient received lumbar epidural analgesia during labour. Clear fluid leaked from the skin puncture site for 4 days. The fluid was analysed using protein electrophoresis for cholinesterase enzymes and was found not to contain the cerebrospinal fluid specific form of the enzyme, acetylcholinesterase. The sensitivity of this test was explored using serial dilutions of cerebrospinal fluid. It is now possible to say that the leaking fluid did not contain cerebrospinal fluid.
Inspiratory muscle effort during nasal intermittent positive pressure ventilation in patients with chronic obstructive airways disease
Authors: ELLIOTT M. W. , MULVEY D. A. , MOXHAM J. , GREEN M. , BRANTHWAITE M. A. 
Published: July 2010

SummaryEffective intermittent positive pressure ventilation can be achieved noninvasively using a nasal mask, but patient comfort may be compromised and respiratory effort increased unless the trigger threshold is low and the response time of the ventilator short. The effect of nasal ventilation upon inspiratory muscle effort and the functional characteristics of the trigger of a purpose‐built ventilator were evaluated in five patients with chronic obstructive airways disease. A measure of inspiratory muscle effort, the average pressure time integral per minute, decreased by at least 80% in four patients and by 50% in one. Only two patients had significant numbers of triggered breaths (17% and 47% of total) during I h of ventilation with settings as used at home. Therefore trigger function was evaluated when the patients were made to trigger the ventilator by slowing the control rate. A high resting end‐expiratory intrathoracic pressure decreased the effective trigger sensitivity so that a mean (SD) change in oesophageal pressure of 14.8 (4.8) cmH2O was required to lower mask pressure by 2.4 (0.3) cmH2O and activate the trigger. Even under these conditions of lowest trigger sensitivity inspiratory muscle effort was not increased compared to spontaneous ventilation.
Growth of micro‐organisms in solutions of intravenous anaesthetic agents
Authors: BERRY C. B. , GILLESPIE T. , HOOD J. , SCOTT N. B. 
Published: July 2010

SummaryThis controlled bench study compared the growth of bacteria and yeast in solutions of commonly used intravenous anaesthetic agents at room and body temperatures. Drugs presented in aqueous emulsions support both bacterial and fungal growth. Five out of the six solutions supported the growth of yeast. The one exception was chlormethiazole. Which is both fungicidal and bactericidal. Solutions of drugs which will support growth of micro‐organisms should be used with great care and they should not be stored or infused over prolonged periods.
Development of a subdural motor blockade
Authors: ASATO F. , NAKATANI K. , MATAYOSHI Y. , KATEKAWA Y. , CHINEN K. 
Published: July 2010

SummaryWe report an unusual development of motor blockade following the subdural injection of local anaesthetic during attempted continuous lumbar epidural anaesthesia. Four characteristic features of subdural block, extensive spread, segmental distribution, delayed onset, and short duration of motor blockade were all features of the case. The patient had gradual development of complete motor blockade in the left upper extremity, incomplete in the right upper extremity, but absence of motor blockade in the lower extremities. The duration of complete motor blockade was 10 min in the hand and 35 min in the arm. The spread of contrast medium in the subdural space revealed the extent and degree of motor blockade.
Anaphylactoid reaction following local anaesthesia for epidural block
Authors: THOMAS A. D , CAUNT J. A. 
Published: July 2010

SummaryA potentially serious complication of epidural bupivacaine used for a repeat, elective Caesarean section is presented. The main features of this reaction were erythema, itching, generalised and pulmonary oedema. In addition, pulmonary oedema was subsequently noted in the baby. An immunological hypersensitivity to bupivacaine or lignocaine is the likely cause.
Anaesthetic log books
Authors: Strang T. I. 
Published: July 2010

SummarySince 1989, the Royal College of Anaesthetists has encouraged trainees to keep log books, although there is little information about the benefits of this practice as a part of anaesthetic training. A postal survey of all grades of trainee anaesthetist in the North West Region of England was conducted to obtain information about the present use of log books. The survey showed that log books are only used diligently by the more junior grades of anaesthetic staff. Although the practice of keeping a log resulted in an increased ability of the trainee to describe his clinical experience, the subsequent exploitation of this information to monitor or correct deficiences in training was disappointingly low.
Estimation of the correct length of tracheal tubes in adults
Authors: Patel N. , Mahajan R. P. , Ellis F. R. 
Published: July 2010

SummaryEstimation of the correct length of a tracheal tube is extremely important and should be tailored to the needs of the individual patient. One hundred and eight patients who required tracheal intubation during anaesthesia were studied. The predicted length was estimated in each patient before induction of anaesthesia. The upper end of the cuff was aligned externally with the cricoid cartilage, while the more proximal part of the tube lay alongside the neck to the angle of the mandible. The tube was then curved fowards towards the upper incisor teeth, and the length at the teeth or gums was noted. The anaesthetist, who was unaware of the predicted length, intubated the trachea after induction of anaesthesia. The length of tube inserted was standardised in relation to the vocal cords, and the actual length of tube inserted was recorded. The estimated length was within 1.0 cm and 1.5 cm of the actual length in 91% and 97% of patients respectively.
A review of 2000 consecutive ICU admissions
Authors: COHEN A. , BODENHAM A. , WEBSTER N. 
Published: July 2010

SummaryThe working practices and outcomes from UK intensive care units are poorly documented to date. We have reviewed 2000 consecutive admissions to one intensive care unit in a tertiary referral centre with initially six, then eight beds. The study was a retrospective review of contemporaneous data collection within the period 1986–1990. Demographic details, referral source, admission time, admission diagnosis, APACHE II score, therapeutic interventions, and outcome were recorded. A high overall mortality in the intensive care unit (23%), proportional to APACHE II scoring on admission, was demonstrated. This reflects the referral of many patients who have, or who develop, multiple organ failure. Mortality was significantly higher in patients over the age of 40 years. A total of 69.5% of patients were admitted outside the hours 0800–1800 h on Monday to Friday and admissions peaked between 1200 and 2100 h, demonstrating the need for senior out‐of‐hours cover. These figures may be used to compare future mortality and work practices in this and other units. The report illustrates some of the advantages and disadvantages of one method of data collection. As it represents one unit only, care must be taken in extrapolating results to others. The liming of admissions suggests that a review of medical staffing practices would be useful.
Propofol and fentanyl act additively for induction of anaesthesia
Authors: BEN‐SHLOMO I. , FINGER J. , BAR‐AV E. , PERL A. Z. , ETCHIN A. , TVERSKOY M. 
Published: July 2010

SummaryThe induction dose‐response of propofol was compared with the dose‐response of its combination with fentanyl and with that of fentanyl alone in three groups of 60 women undergoing minor gynaecological surgery. Dose‐response curves were determined for each group using bootstrap and isobolographic analyses. Propofol was found to act additively with fentanyl for induction of anaesthesia. Twenty‐three percent of the ED50of fentanyl was required in combination with 75% of the ED50for propofol to achieve the ED50of the combination. This indicates that, for induction of anaesthesia, propofol and fentanyl are not synergistic.
Blood loss following tonsillectomy in children
Authors: THIAGARAJAN J. , BATES S. , HITCHCOCK M. , MORGAN‐HUGHES J. 
Published: July 2010

SummaryOne hundred and ninety‐eight children, aged 3 to 12 years, who were scheduled for tonsillectomy were randomly allocated to receive either diclofenac 1.0 mg.kg−1 or papaveretum 0.2 mg.kg−1 by intramuscular injection after induction of anaesthesia. There were no significant differences between the treatment groups in operating theatre blood loss, the frequency of bleeding on the ward, or the need for operative haemostasis. However, the incidence of above average bleeding in the recovery room was significantly higher in the diclofenac group (p < 0.05). Similarly, marked restlessness in the recovery room was more frequent in the diclofenac group (p < 0.01). In both treatment groups there was an association between bleeding and restlessness during recovery so the increased bleeding in the diclofenac group may not be a direct effect.
Audit of pre‐operative starvation
Authors: Maclean A. R. , Renwick C. 
Published: July 2010

SummaryAn audit of pre‐operative starvation at Huddersfield Royal Infirmary has been undertaken. It shows that both adults and children are starved for significantly longer than the hospital's official starvation policy requires. The mean starvation time for children was almost 10 h, which is longer than the 8 h required before hypoglycaemia becomes a risk. A review of the literature suggests that only 3 h of fluid withdrawal is necessary. Possible ways to improve pre‐operative starvation regimens are discussed.
The Bicore pulmonary monitor
Authors: PETROS A. J. , LAMOND C. T. , BENNETT D. 
Published: July 2010

SummaryThe Bicore CP‐100 pulmonary monitor offers the advantage of continuous pulmonary monitoring at the bedside. Using an easily placed oesophageal balloon catheter and a flow transducer within the ventilator system, intrathoracic pressures, airway pressures and airway flow can be measured, and from these the Bicore calculates 25 other respiratory variables. The monitor screen displays real time waveforms of airway pressure, airway flow, oesophageal pressure and inspired tidal volume, and with these data it should be possible to determine more accurately when patients can be weaned from mechanical ventilation. It should also be possible to assess objectively the onset of respiratory fatigue and failure so that intervention can take place at an earlier stage. To assess the ease of use and potential benefit, the Bicore was used to calculate the work of breathing while weaning eight patients from mechanical ventilation in a spontaneous breathing mode. The pressure support ranged from 20 cmH2O, 10 cmH2O and 5 cmH2O, to a continuous positive airway pressure of 5 cmH2O, all with a positive end‐expiratory pressure of 5 cmH2O, down to a single T‐circuit with no positive airway pressure or end‐expiratory pressure. The work of breathing while on a Veola Hamilton ventilator was found to be about the same, while receiving pressure support of 20 cmH2O compared to a continuous positive airway pressure of 5; the other forms of respiratory support increased the work of breathing significantly.
Anaesthesia and rheumatoid arthritis
Authors: SKUES M. A. , WELCHEW E. A. 
Published: July 2010

SummaryA review of the implications of rheumatoid arthritis on peri‐operative anaesthetic management is presented. Pre‐operative assessment should include a careful search for articular and systemic manifestations of the disease that may complicate intra‐operative care. Drug disposition may vary from the normal patient as a result of changes in serum protein binding, together with possible exaggeration of pharmacodynamic responses. Airway management presents one of the greatest challenges to the anaesthetist, and care in manipulation of the cervical spine is paramount.
Successful use of continuous veno‐venous haemofiltration to treat profound fluid retention in severe peripartum cardiomyopathy
Authors: BEARDS S. C. , FREEBAIRN R. C. , Lipman J. 
Published: July 2010

SummaryThe use of continuous veno‐venous haemofiltration after failure of conventional treatment in a patient with severe peripartum cardiomyapathy is described. Treatment with inotropes and diuretics failed to produce a diuresis despite the presence of severe fluid overload. Haemofiltration over a 9‐day period allowed removal of 171 of fluid with a concomitant improvement in haemodynamic function and a spontaneous diuresis.
Resistance to vecuronium
Authors: NORMAN J. 
Published: July 2010

SummaryA 19‐year‐old epileptic patient taking carbamazepine was anaesthetised for a sigmoid colectomy. Such patients are reported to show a resistance to the actions of competitive neuromuscular blocking drugs, and a conventional dose of vecuronium (0.1 mg.kg−1) produced relaxation for only 18 min. Subsequently she received vecuronium 6.7 mg.h' which kept the first twitch of the train‐of‐four response at 30% of the control value. Antagonism with neostigmine 1.25 mg produced a rapid and full recovery. The report illustrates the usefulness of monitoring neuromuscular transmission whenever there is an anticipation of an altered response.
A split laryngeal mask as an aid to training in fibreoptic tracheal intubation
Authors: DARLING J. R. , KEOHANE M. , MURRAY J. M. 
Published: July 2010

SummaryThirty patients were randomly allocated to one of two groups in order to compare the use of a split laryngeal mask airway with the Herman II airway as aids to training in fibreoptic laryngoscopy. In both groups anaesthesia was induced with propofol and maintained with isoflurane in N2O/O2 (Fio2= 0.5). The fibreoptic laryngoscope was guided towards the larynx using the split laryngeal mask airway in group 1 and the Herman airway in group 2. The tracheas of all patients were successfully intubated at the first attempt and no patient's peripheral oxygen saturation decreased below 92%. Two min after intubation mean heart rate was significantly greater in group J (101 beat.min−1) than in group 2 (84 beat.min−1) (P < 0.05). The split laryngeal mask is a useful aid to training in fibreoptic intubation and may allow better airway control than the Berman II intubating airway.
What changes drug metabolism in critically ill patients? Two preliminary studies in isolated human hepatocytes
Authors: PARK G. R. , PICHARD L. , TINEL M. , LARROQUE C. , ELSTON A. , DOMERQUE J. , DEXIONNE B. , MAUREL P. 
Published: July 2010

SummaryThe metabolism of many drugs is abnormal in the critically ill patient. The causes of this are unknown, and investigation in patients is difficult. We therefore used isolated, cultured human hepatocytes to study the effects of hypoxia and induction on cytochrome P450 3 A, the cytochrome responsible for the metabolism of many drugs. When hepatocytes were exposed to 5% oxygen, the amount of 3 A produced, after induction with rifampicin, was five to 10 times less than the amount produced in 21% oxygen. In another study, we exposed isolated hepatocytes for 4 days to serum from five critically ill patients or from volunteers. At the end of this time, the functional ability of the hepatocytes to glucuronidate 14C progesterone was measured. Four of the five patients had a substance in their plasma that reduced the ability of the hepatocytes to glucuronidate progesterone. The nature of this substance and the reason that the serum from the fifth patient did not affect metabolism are unknown. This model is able to simulate the abnormalities which occur in critically ill patients. Further studies are needed to explain our observations and to identify the substances in the serum from critically ill patients that alter drug metabolism.
Air in the cavernous sinus following scalp vein cannulation
Authors: BROOK J. , MOSS E. 
Published: July 2010

SummaryA 7‐month‐old infant was found to have air in the cavernous sinus during a CT scan under general anaesthesia. An anterior scalp vein had been used to administer atracurium and contrast. The anatomy and precautions to prevent air embolism during scalp vein cannulation are discussed.
A simple central venous puncture detector
Authors: TRIPATHI M. , PANDEY M. B. 
Published: July 2010

SummaryDuring central venous cannulation, percutaneous venous puncture is performed blindly using a variety of surface landmarks on the body for different puncture sites. To avoid vessel transfixion and injury to adjacent structures, the earliest detection of venous puncture is essential. A simple central venous puncture detector is described, which not only efficiently detects entry of the needle into the vein but also prevents air embolism and blood spillage.
Sleeping positions adopted by pregnant women of more than 30 weeks gestation
Authors: Mills G. H. , Chaffe A. G. 
Published: July 2010

SummaryThe position adopted during sleep by 52 pregnant women and 31 age‐matched nonpregnant control subjects was studied. The pregnant group were all beyond the 30th week of gestation. In the pregnant group, 40 (77%) adopted a left tilt, 11 (21%) a right tilt and one (2%) was supine. In the control group, eight (26%) adopted a left tilt, 10 (32%) a right tilt, 12 (39%) were supine and one (3%) was prone. Closer analysis of the position adopted by the pregnant group showed: 33 adopted a full left 90° tilt, five a left 60° tilt, two a left 30° tilt, 11 adopted a full 90° right tilt and only one was supine. There was a significant difference between the sleeping positions of the pregnant and the control groups (p < 0.001). The majority of the pregnant group adopted a sleeping position that reduced the likelihood of aortocaval compression syndrome.
Brainstem auditory evoked response changes following electro‐acupuncture therapy in chronic pain patients
Authors: KUMAR A. , TANDON O. P. , DAM S. , TYAGI K. K. 
Published: July 2010

SummaryBrainstem auditory evoked responses were recorded in 17 patients with chronic pain who had been given electro‐acupuncture therapy. The absolute peak latencies of waves I to V, and interpeak latencies and amplitudes of waves I and V were analysed before electro‐acupuncture and compared with values obtained during electro‐acupuncture and 5 min after its termination after one, five and 10 sittings. At these sittings the intensity of pain was recorded with the help of a 100 mm visual analogue scale. Each patient had 10 sittings given on alternate days. The absolute peak latencies of waves I, II, and III were delayed significantly (p < 0.05) after 5 and 10 sittings and amplitudes of wave V decreased significantly (p < 0.05) after 5 and 10 sittings. Visual analogue scores also decreased significantly (p < 0.01) during these sittings. It was established that before and after 10 sittings of electro‐acupuncture, there was a significant positive correlation between visual analogue scores and the amplitude of wave V (p < 0.01). There was a negative correlation between visual analogue scores and absolute peak latencies of wave III at 1, 5 and 10 sittings, suggesting that there is a definite interaction between the electro‐acupuncture neural mechanism and the generators of brainstem auditory evoked responses in the lower brainstem.
A preliminary clinical evaluation of magnetic stimulation of the ulnar nerve for monitoring neuromuscular transmission
Authors: Iwasaki H. , Igarashi M. , Namiki A. 
Published: July 2010

SummaryThe evoked motor responses to magnetic and electrical peripheral nerve stimuli were quantitatively assessed after vecuronium in 15 women undergoing gynaecological surgery. Anaesthesia was induced with thiopentone and fentanyl and maintained with intermittent doses of fentanyl and 66% nitrous oxide in oxygen. After immobilisation of both forearms in splints, the ulnar nerves were stimulated supramaximally every 10 s with a magnetic stimulator (Magstim Model 200®) and an electric stimulator (Myotest®) on opposite sides. The adduction forces of both thumbs to magnetic and electric stimuli were measured simultaneously before and after 0.06 mg.kg‐1 of vecuronium. After vecuronium administration the twitch responses to magnetic stimulation decreased more slowly than those to electric stimulation. The difference in the evoked responses between the two types of stimulation was approximately 20% overall and was significant 2 min after vecuronium administration (p < 0.05). The rate of recovery of the evoked twich responses was more rapid with magnetic than electric stimulation. It is concluded that magnetic stimulation of peripheral nerve is a useful technique for evaluating residual neuromuscular blockade.
Effects of surgical stimulation on midlatency auditory evoked potentials during general anaesthesia with propofol/fentanyl, isoflurane/fentanyl and flunitrazepam/fentanyl
Authors: SCHWENDER D. , GOLLING W. , KLASING S. , FABER‐ZÜLLING E. , PÖPPEL E. , PETER K. 
Published: July 2010

SummaryDuring general anaesthesia, midlatency auditory evoked potentials are suppressed in a dose dependent manner by a number of general anaesthetics. The activating effects of surgical stimuli on midlatency auditory evoked potentials have been demonstrated during light inhalational anaesthesia, and indicate that midlatency auditory evoked potentials reflect the activity of the central nervous system and not only anaesthetic concentrations. We investigated the effect of surgical stimulation (skin incision, sternotoniy) on midlatency auditory evoked potentials under high dose opioid analgesia in 30 patients undergoing elective cardiac surgery. High dose opioid analgesia was maititained using fentanyl (1.2 mg.h−1) and combined with either propofol (4‐8 mg.kg−1.h−1) (group I, n = 10), isoflurane (0.6‐1.2 vol%) (group II, n = 10) or flunitrazepam (1.2 mg.h−1) (group III. n = 10). Midlatency auditory evoked potentials were recorded in the awake state, during general anaesthesia before skin incision, after skin incision and after sternotoniy. During general anaesthesia there were marked statistically significant increases in latencies and decreases in amplitudes of midlatency auditory evoked potentials in the propofol/fentanyl and isoflurane/fentanyl groups. In contrast, in the flunitrazepam/fentanyl group there were only small changes of midlatency auditory evoked potentials. The latencies of the early cortical potentials were similar to those in the awake state. After skin incision as well as after sternotomy no significant changes of midlatency auditory evoked potentials could be observed in any of the experimental groups. These results indicate that activation of the auditory pathway by surgical stimuli may be blocked when analgesia is provided by high dose fentanyl. Furthermore, midlatency auditory evoked potentials may be preserved during surgical analgesia as demonstrated in the flunitrazepam/fentanyl group, whereas they were suppressed during propofol/fentanyl and isoflurance/fentanyl. Propofol (4‐8 mg. kg−1.h−1) or isoflurane (0.6‐1.2 vol%) seem to be superior to flunitrazepam (1.2 mg.h−1) in their potency to suppress the auditory pathway during surgical analgesia with fentanyl.
Continuous measurement of systemic vascular resistance
Authors: O'DWYER J.P. , KING J. E. , WOOD C. E. , TAYLOR B.L. , SMITH G. B. 
Published: July 2010

SummaryWe have successfully linked a standard patient monitor system (Hewlett pakard M1166A‐A66) with the Boxter Edwards critical‐Care Swan Gan‐ Intellicath continuous cardiac output catheter and the Vigilance continuous cardiac output minior system to porduce continuous values of systemic vascular resistance. Six cases are presented in which marked changes in indexed systemic vascular resistance were observed as a result of clinical interventions. The continuous derivation of systemic vascular resistance has much potential as a diagnotic and research tool as well as allowing rapid ac curate assessment of the response of patients to therapy.