bluuebunny/crossref_metadata_2025_split huggingface dataset:
The present status of blood filtration
Authors: DERRINGTON M. CLARE 
Published: July 2010

SummaryThe history of the development of blood transfusion and blood filtration is outlined. Clinical and experimental evidence for the efficacy of microfiltration in both small and large volume transfusions is evaluated. Though microfilters do remove the micro‐aggregates from stored blood, the results of clinical studies suggest that both the debris from septic processes in the body and the formation of micro‐aggregates in the blood stream triggered by processes such as complement activation play a far more important role in the pathogenesis of adult respiratory distress syndrome. If this is so the enhancement of the reticulo‐endothelial system by fibronectin therapy may be indicated. It also follows that the use of microfilters is probably an unnecessary expense and, where exsanguination is a risk, may be positively dangerous. Microfilters have been found useful in the preparation of granulocyte‐free transfusions after centrifugation of the blood, but their routine use for transfusions, small or large, remains to be justified.
Systemic absorption of lignocaine ointment from tracheal tubes
Authors: Sellers W. F. S. , Dye Anne 
Published: July 2010

SummaryArterial plasma concentrations of lignocaine were studied in fifreen adult patients following insertion of a tracheal tube whose cuff area was smeared with 5% lignocaine ointment. Twelve patients had 2 ml of ointment (114 mg) and samples were taken every 5 minutes until 30 minutes and in eight of the 12 patients at 40, 50 and 60 minutes after insertion and inpation of the tracheal tube and cuff. Three patients had 1 ml of ointment on the tube and were studied over 60 minutes. Plasma concentrations were determined using gas liquid chromatography. In the 2 ml lignocaine group mean plasma lignocaine levels were 1.9 (SD 0.9) μg/ml at 10 minutes, 2.3 (SD 0.8) μg/ml at 20 minutes, 2.3 (SD 0.8) μg/ml at 30 minutes and 1.7 (SD 1.0) μg/ml at 60 minutes. After 1 ml of lignocaine, levels were 1.2 (SD 0.1) μg/ml at 10 minutes, 1.1 (SD 0.7) μg/ml at 20 minutes, 0.8 (SD 0.3) μg/ml at 30 minutes and 0.75 (SD 0.1) μg/ml at 60 minutes.
Failure of magnesium sulphate to prevent suxamethonium induced muscle pains
Authors: Chestnutt W.N. , Dundee J.W. 
Published: July 2010

SummaryIn fit unpremedicated patients undergoing minor operations and who were ambulant on the afternoon of the operations, pretreatment with magnesium sulphate given intravenously did not reduce the incidence of suxamethonium induced myalgia below that in a similar series who received no prophylactic therapy. The injection of magnesium in conscious patients is followed by unpleasant side effects.
Self‐administered nalbuphine, morphine and pethidine
Authors: BAHAR M. , ROSEN M. , VICKERS M. D. 
Published: July 2010

SummaryIn a double‐blind clinical trial of 48 patients, nalbuphine, morphine, and pethidine were compared by on‐demand intravenous analgesia during the first 24 hours after cholecystectomy. Overall pain relief (visual analogue score) was recorded by the patients as 50 (SEM 4) for nalbuphine, 44 (SEM 4) for morphine and 53 (SEM 5) for pethidine. These scores were not significantly dfferent. The mean demand for each drug over the 24‐hour period was 70 (SEM 12) mg for nalbuphine, 46 (SEM 6) mg for morphine and 614 (SEM 49) mg for pethidine. Pain on movement, either during deep breathing or turning, was found to be less well controlled after nalbuphine (70, SEM 2), and pethidine (67 SEM 7) than after morphine (52, SEM 5; p < 0.01). The incidence of side effects was similar with each drug. Nalbuphine is a useful postoperative analgesic, as effective as pethidine. Nalbuphine 15 mg is apparently equipotent with morphine 10 mg or pethidine 120 mg by this mode of administration.
The ‘Permox’ oxygen concentrator
Authors: CARTER J. A. , BASKETT P. J. F. , SIMPSON P. J. 
Published: July 2010

SummaryThe performance of the ‘Permox’ oxygen concentrator has been investigated in detail with particular reference to its possible use as an alternative to conventional oxygen supplies both in the emergency situation, in the event of failure of pipeline or cylinder systems or when these are unavailable. The stability and concentrations of oxygen produced at various flows provided a viable alternative supply of oxygen, and the portability and reliability of this particular apparatus made it suitable for use in the many situations considered.
A Venturi connector for tracheal tubes
Authors: CONACHER I. D. 
Published: July 2010

SummaryAn attachment for tracheal tubes is described. It functions as a holder for a choice of needles used to conduct a Venturi jet powered from a high‐pressure gas system of the kind used for bronchoscopic ventilation. It is suggested as a potentially useful device for some unusual clinical situations, two of which are illustrated.
Parenteral aspirin for pain relief in day‐case dental anaesthesia. A randomised double blind placebo controlled trial
Authors: Foster J. M. G. , Cashman J. N. , Jones R. M. 
Published: July 2010

SummaryForty patients undergoing day‐case anaesthesia for surgical extraction of third molar teeth received either lysine acetylsalicylate 1.8 g in 10 ml of saline intravenously or a placebo injection of 10 ml of saline intravenously just prior to induction of anaesthesia. Lysine acetylsalicylate was associated with a significantly more satisfactory postoperative recovery overall. However, there was no significant difference in mean pain scores between the two treatment groups at 1, 6, 12 or 24 hours following administration. Both treatment groups self administered additional oral analgesics to the same extent during the first 24 hours following surgery.
Postoperative pain relief with naloxone, Severe respiratory depression and pain after high dose buprenorphine
Authors: Schmidt J.F. , Chræmmer‐Jørgensen B. , Pedersen J.E. , Risbo A. 
Published: July 2010

SummaryBuprenorphine 30 and 40 μg/kg was given as the sole intravenous analgesic in balanced anaesthesia to 12 patients undergoing cholecystectomy. Significant and severe respiratory depression was found 15 minutes after pre‐operative loading with buprenorphine. In the immediate postoperative period six patients were in pain. They were treated with naloxone 0.08–0.4 mg leading to a long lasting period of pain relief (median 22 hours).
Changes in memory following general or spinal anaesthesia for hip arthroplasty
Authors: HUGHES D. , BOWES J.B. , BROWN M. W. 
Published: July 2010

SummaryPatients scheduled for hip arthroplasty were anaesthetised using either general or spinal anaesthesia. Each patient's memory was tested for both recall and recognition by using lists of 10 words each of a different category. This testing for memory extended from the pre‐operative visit to one week after operation. Memory was not tested on the day of operation. There was little overall change of memory after either spinal or general anaesthesia although there was an inexplicable but significant decrease in the ability to recognise words after spinal anaesthesia.
A comparison of two pulse oximeters
Authors: RIDLEY S. A. 
Published: July 2010

SummaryThe accuracy of the Ohmeda Biox 3700 and the Nellcor N100E was assessed in 25 cyanosed children. The readings obtained front the two puise oximeters were compared with arterial blood measurements using a Radiometer OSM‐2 co‐oximeter. Both pulse oximeters differed significantly from the co‐oximeter measurements and in these patients the error of both machines exceeded the manufacturers' claims. However, the machines appeared to reflect changes in saturation accurately in the same patient.
Reducing the risks of laryngoscopy in anaesthetised infants
Authors: Ledbetter J. L. , Rasch D. K. , Pollard T. G. , Helsel P. , Smith R. B. 
Published: July 2010

SummaryWe have evaluated the use of oxygen insufflation during laryngoscopy with an OxyscopeTM laryngoscope blade compared to conventional laryngoscopy for maintenance of transcutaneous Po2 during intubation of anaesthetised, spontaneously breathing infants. Twenty healthy children aged between 1 and 24 months were anaesthetised with halothane in oxygen. Laryngoscopy and intubation were performed in a double‐blind fashion using a Miller No. 1 OxyscopeTM blade either with or without oxygen insufflation. Transcutaneous oxygen tension, arterial pressure and heart rate were measured before and after laryngoscopy, and duration of laryngoscopy was recorded. Transcutaneous oxygen tension decreased by 7.1% (SD 6.1%) when oxygen insufflation was used, compared to 33.0% (SD 15.1%) without oxygen insufflation (p < 0.0001). There were no significant differences in mean duration of laryngoscopy or patient age. We conclude that oxygen insufflation during laryngoscopy and intubation of spontaneously breathing, anaesthetised infants effectively minimises the decrease in transcutaneous oxygen tension from pre‐laryngoscopy levels, and makes instrumentation of the airway safer.
Bladder temperature as an estimate of body temperature during cardiopulmonary bypass
Authors: BONE M. E. , FENECK R. O. 
Published: July 2010

SummaryBladder temperature measured by a thermistor‐tipped urinary catheter, was compared to oesophageal, nasopharyngeal, rectal and cutaneous temperatures in 33 patients during cardiopulmonary bypass. The bladder site was warmer than all other monitored sites in the pre‐bypass period and showed least variation in temperature. The rate of change of bladder temperature during cooling and rewarming on bypass was significantly (p < 0.01) lower than for oesophageal and nasopharyngeal temperatures, but was greater than or similar to the rate of change of rectal and cutaneous temperatures. This method of temperature measurement was found to be satisfactory during major surgery and also during the postoperative period in the intensive care unit.
Patient‐controlled analgesia with a mixture of pethidine and doxapram hydrochloride
Authors: CLYBURN P. A. , ROSEN M. 
Published: July 2010

SummaryTwenty‐four patients who underwent elective cholecystectomy received double‐blind increments of either pethidine 30 mg or a mixture of pethidine 30 mg and doxapram 45 mg delivered on a patient‐controlled basis. A loading dose of doxapram 100 mg or saline was administered. There was no difference in respiratory depression as indicated by respiratory frequency and end tidal carbon dioxide concentration. The incidence of respiratory apnoea was similar in the two groups but apnoea was of shorter duration in patients who received doxapram, although the difference was not significant. Patients who received doxapram assessed overall pain as worse on a linear analogue scale (p < 0.05) but demanded similar amounts of pethidine. There was no difference in pain on movement.
Pain‐free injection in infants
Authors: HOPKINS C. S. , BUCKLEY C. J. , BUSH G. H. 
Published: July 2010

SummaryA randomised, placebo‐controlled, double‐blind study was undertaken in 111 children between the ages of 1 and 5 years to assess the efficacy of EMLA 5% cream in the alleviation of venepuncture pain at intravenous induction of general anaesthesia using 27‐gauge needles. Pain assessment was made by an operating department assistant using both verbal rating scale and visual analogue scale methods. Seventy‐five children, of whom 24 were premedicated, were treated with EMLA cream and 36 with placebo, 14 of whom were premedicated. Significantly lower pain scores were recorded in the children treated with EMLA cream (verbal rating scale: premedicated p < 0.05, unpremedicated p < 0.001; visual analogue scale: premedicated p < 0.0005, unpremedicated p < 0.0002). No variation in analgesia was found for application times between 30 and 300 minutes and there were no serious side effects.
Myocardial infarction in the third trimester of pregnancy
Authors: BEMBRIDGE M. , LYONS G. 
Published: July 2010

SummaryA 30‐year‐old woman developed severe chest pain while out shopping and was admitted to the delivery suite. She was 38 weeks pregnant with her second child. A diagnosis of myocardial infarction was made and cardiac arrest occurred shortly afterwards. She went into spontaneous labour 30 hours later and was delivered vaginally. This report reviews myocardial infarction in pregnancy and considers the clinical management of this patient.
Measurement of FEV1 and FVC
Authors: HOSIE H. E. , NIMMO W. S. 
Published: July 2010

SummaryThe performance of a pocket spirometer was compared with that of the Vitalograph to assess the extent of agreement between the instruments and the repeatability of measurements with each instrument. Both instruments showed a similar leval of accuracy when measurements were repeated and in the estimation of forced vital capacity, but there was a mean difference of 201 ml in measurements of forced expiratory volume in one second, for which the Vitalograph gave the larger reading.
Alfentanil infusion in the elderly
Authors: LEMMENS H. J. M. , BOVILL J. G. , BURM A. G. L. , HENNIS P. J. 
Published: July 2010

SummaryThe use of a computer‐assisted infusion of alfentanil, combined with 66% nitrous oxide in oxygen, for induction and maintenance of anaesthesia was evaluated in IS elderly patients. The target alfentanil concentration for induction was varied between 300 and 475 ng/ml, to be achieved in 2 minutes. During maintenance, the alfentanil concentration was increased or decreased according to each patient's responses. Arterial blood samples were taken for measurement of alfentanil concentration. There were high incidences of muscle rigidity, bradycardia and hypotension during induction. Hypotension was dose‐ and concentration‐dependent. Signs of light anaesthesia during maintenance were controlled rapidly by increasing the target plasma concentration. Nine patients required naloxone at the end of surgery. Ventilatory depression recurred in three of these. The use of published alfentanil pharmacokinetic data from elderly patients to predict plasma concentrations during prolonged infusion resulted in significant prediction errors, notably in the higher concentration range.
An analysis of critical incidents in a teaching department for quality assurance A survey of mishaps during anaesthesia
Authors: Kumar V. , Barcellos W.A. , Mehta M.P. , Carter J.G. 
Published: July 2010

SummaryA prospective survey was conducted from April 1984–January 1985 and April 1985–January 1986 to study the frequency of critical incidents and factors associated with them. Eighty‐six mishaps were reported in the first period, the majority of which were because of human error (80.3%);the must common were the transmission of gases and vapours and errors in drug administration. Factors frequently associated with these mishaps were failure to perform a normal check and lack of familiarity with equipment or technique. An anaesthesia equipment checklist was incorporated in the survey during the second period and 43 mishaps were reported. This decrease in incidence may have resulted from the anaesthesia apparatus checklist, awareness of mishaps since they were discussed regularly at departmental meetings, and new anaesthesia machines (eight older machines were replaced during the first period and 11 at the beginning of the second).
Phaeochromocytoma—a presentation mimicking malignant hyperthermia
Authors: CROWLEY K. J. , CUNNINGHAM A. J. , CONROY B. , O'CONNELL P. R. , COLLINS P. G. 
Published: July 2010

SummaryA 52‐year‐old apparently healthy, normotensive woman who presented for elective cholecystectomy experienced intra‐operative hypertension and tachycardia, which were controlled by propranolol. Oesophageal temperature increased, there was a metabolic and respiratory acidosis with hypoxaemia, and malignant hyperthermia was diagnosed. Severe cardiogenic pulmonary oedema ensued, and was treated with intravenous glyceryl trinitrate. Ventricular fibrillation caused cardiac arrest, and this was treated successfully. Postoperatively a phaeochromocytoma was discovered, and removed at a subsequent operation. The case illustrates the similarities in presentation of malignant hyperthermia and phaeochromocytoma, and the possibility that misdiagnosis may exacerbate the crisis.
Transcutaneous electrical nerve stimulation after thoracotomy
Authors: STUBBING J. F. , JELLICOE J. A. 
Published: July 2010

SummaryForty patients scheduled to undergo thoracotomy were randomly allocated to receive either transcutaneous electrical nerve stimulation with intramuscular papaveretum (20 patients) or intramuscular papaveretum alone (20 patients) for postoperative pain relief. Total intramuscular analgesic requirements in the first 24 hours, time to satisfactory transfer to oral analgesia, antiemetic requirements and length of stay in hospital postoperatively were noted. Peak expiratory flow rate was compared pre‐and postoperatively in the two groups. Use of nerve stimulation did not significantly alter the requirements for analgesia although there was a reduction in postoperative nausea and vomiting in the nerve stimulation group. There was no difference between the two groups with respect to changes in peak expiratory flow rate.
Recurarisation following a suxamethonium–alcuronium sequence in patients with atypical cholinesterase
Authors: BARAKA A. , SIBAI A.‐N. , HAMED M. , DELLEH R. 
Published: July 2010

SummaryAlcuronium 10 mg was administered to maintain muscle relaxation in two patients before recovery from suxamethonium neuromuscular blockade to facilitate tracheal intubation. This sequence resulted in a markedly prolonged block which could not be antagonised adequately by neostigmine 0.05 mg/kg; initial antagonism was followed rapidly by prolonged recurarisation. Estimation of plasma cholinesterase activity revealed that the two patients were homozygous for the atypical and silent genes, respectively.
A cost‐benefit analysis of intensive therapy
Authors: RIDLEY S. , BIGGAM M. , STONE P. 
Published: July 2010

SummaryThe daily costs of 90 critically ill patients treated on an intensive therapy unit were calculated on an individual patient basis. Twenty‐one patients (23%) died on the intensive therapy unit and another 13 (15%) died within one year of discharge. The results demonstrate that there is wide variation in costs among the patients and the diagnoses. The mean daily cost of nonsurvivors was almost £300 greater than that of survivors (£816 (95% confidence interval =£649–982) versus £550 (£498–601)). Renal failure, sepsis and pneumonia proved to be some of the most expensive conditions to treat, and postoperative respiratory failure the cheapest. The cost of the first day of management was significantly related to the APACHE II score and individual costs on the first day may be predicted from admission APACHE II score. Patients who die in the intensive therapy unit continue to incur the same high level of expenditure throughout admission. The study could not provide conclusive answers concerning the trend in daily costs for survivors.
The effect of fentanyl administered epidurally by patient‐controlled analgesia, continuous infusion, or a combined technique of oxyhaemoglobin saturation after abdominal surgery
Authors: OWEN H. , KLUGER M. T. , ILSLEY A. H. , BALDWIN A. M. , FRONSKO R. R. L. , PLUMMER J. L. 
Published: July 2010

SummaryThe aims of this study were to determine the effect of three different modes of epidural administration of fentanyl on oxyhaemoglobin saturation and pain control. Forty‐three patients undergoing elective abdominal surgery were randomly allocated to the following groups: (1) continuous infusion of fentanyl at a rate of 50 μg.h−1 with additional epidural boluses (25 μg.Ug) as required; (2) patient‐controlled analgesia using a 25 fig epidural bolus of fentanyl with a 15 min lockout period; (3) a combination of patient‐controlled analgesia and continuous infusion. Oxyhaemoglobin saturation was measured by continuous computerised pulse oximetry for 48 h after operation together with pain and sedation scores. In the first 24 h after surgery patients in the continuous infusion group spent a significantly greater proportion of time below oxygen saturations of 94% and 85% than those in the other two groups. On day 2 all oxygen saturation measurements were worse than during day 1, but differences between groups were not significant. Those patients receding patient‐controlled analgesia required significantly less fentanyl than patients in either of the other groups (p < 0.05). However, the mean pain and sedation scores did not differ significantly between the three treatment groups. There was no association between total fentanyl dose and oxygen saturation values. Overall, self‐administered fentanyl appeared to cause less oxyhaemoglobin desaturation than nurse‐administered analgesia without any loss of analgesic effect.
Histamine release by morphine and diamorphine in man
Authors: WITHINGTON D. E. , PATRICK J. A. , REYNOLDS F. 
Published: July 2010

SummaryIntravenous morphine and diamorphine are routinely used for postoperative analgesia but the relative histamine releasing abilities of these drugs have not been compared in man. Thirty‐eight patients were randomly allocated to receive morphine (0.16 mg.kg−1) or diamorphine (0.08 mg.kg−10) after abdominal surgery. Blood samples for histamine were taken before, and at timed intervals after, opioid administration and analysed by an isotopic radioenzymatic technique. Haemodynamic parameters and pain scores were recorded before and after analgesic administration, and a series of eight basophil histamine release studies was also performed. Significant histamine release (plasma concentration > 2 ng.ml−1or rise of > 700% baseline) occurred in 23.5% of the morphine group and 21.1% of the diamorphine group. Histamine was released earlier in those receiving diamorphine, but no significant change in haemodynamic parameters occurred, and no histamine release was demonstrated in the basophil histamine release studies. These findings suggest that morphine and diamorphine release histamine from mast cells rather than basophils.
Lignocaine spray applicators are a potential source of cross‐infection in the anaesthetic room
Authors: Williams O. A. , Wilcox M. H. , Nicol C. D. , Spencer R. C. , Reilly C. S. 
Published: July 2010

SummaryTen percent lignocaine spray is in widespread clinical use as a means of suppressing responses to tracheal intubation, ft is sprayed from a multidose container into the glottis and on to the vocal cords through an applicator nozzle, which may be used on successive patients. We have investigated the likelihood of the contamination of these nozzles, with patients' mouth flora. Spray applicators from four of the 20 cases investigated showed contamination with potential bacterial pathogens. We therefore recommend that lignocaine spray should not be applied to successive patients using the same applicator nozzle.
Combined infusions of morphine and ketamine for postoperative pain in elderly patients
Authors: EDWARDS N. D. , FLETCHER A. , COLE J. R. , PEACOCK J. E. 
Published: July 2010

SummaryThe value of using a combined infusion of morphine with a variable dose of ketamine for postoperative analgesia following upper abdominal surgery was assessed in a double‐blind randomised study of 40 elderly patients. Four groups of 10 patients received an infusion of morphine at J mg.h−1, either alone, or combined with ketamine at a rate of 5, 10 or 20 mg.h−1. The addition of ketamine to a continuous infusion of morphine did not significantly improve either analgesia or postoperative lung function. Increasing the dose of ketamine resulted in an increased incidence of postoperative dreaming (p < 0.01).
Subcutaneous emphysema in labour
Authors: JAYRAN‐NEJAD Y. 
Published: July 2010

SummarySpontaneous subcutaneous and mediastinal emphysema is a rare but potentially dangerous complication of labour. The condition was observed in an 18‐year‐old primigravida in the first stage of labour, who subsequently required Caesarean section which was performed under epidural anaesthesia.