bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular effects of spinal subarachnoid anaesthesia
Authors: BARKER I. , ALDERSON J. , LYDON M. , FRANKS C. I. 
Published: July 2010

SummarySpinal anaesthesia using 1.2 ml of hyperbaric cinchocaine was found to abolish the autonomic hyper‐reflexic cardiovascular responses to bladder distension and produced little alteration in cardiovascular measurements.
Warming blood before transfusion
Authors: MARKS R. J. , MINTY B. D. , WHITE D. C. 
Published: July 2010

SummaryThe practice of warming blood for transfusion by immersion in a water bath has been studied. Blood, 3 days after collection, with CPD‐adenine anticoagulant, was warmed at 25°C, 37°C and 45°C for up to 2 hours. The procedure was repeated after 2 and 4 weeks' storage at 4°C. Only trivial biochemical and morphological changes resulted from warming. Within these limits, immersion warming of blood appears to be a reasonable alternative to using a blood‐warming coil. Other aspects of immersion warming are discussed.
H2 antagonists and bupivacaine clearance
Authors: O'SULLIVAN G. M. , SMITH M. , MORGAN B. , BRIGHOUSE D. , REYNOLDS F. 
Published: July 2010

SummaryThe effect of the H2 receptor antagonists cimetidine and ranitidine on bupivacaine clearance was assessed in women scheduled to undergo elective Caesarean section under epidural anaesthesia. Thirty‐six women were randomly allocated to receive either no medication, cimetidine 400 mg or ranitidine 150 mg on the night prior to and on the morning of surgery. No significant difference was found between the peak bupivacaine levels: the mean (SD) values were 0.74 (0.17) μg/ml, 0.81 (0.38) μg/ml and 0.70 (0.24) μg/ml in the control, cimetidine and ranitidine groups, respectively. Similarly, the H2 receptor antagonists did not alter the plasma bupivacaine against time curves, half‐life or bupivacaine clearance in the three groups studied.
A single dose epidural technique for Caesarean section
Authors: LAISHLEY R. S. , MORGAN B. M. 
Published: July 2010

SummaryAn epidural technique based on a fractionated injection through a Tuohy needle of 20 ml over 10 minutes, was investigated in 40 mothers who underwent elective Caesarean section. Mothers were randomised to receive either 0.5% bupivacaine plain or 0.5% bupivacaine with adrenaline 1:200 000. After a 2‐ml test dose, the remaining 18 ml was injected over 5 minutes. The use of adrenaline did not significantly alter the onset or duration, but improved the efficacy of the epidural block. Mean time to onset of adequate surgical anaesthesia was 20 minutes. Only 10 patients required more than the initial 100 mg of bupivacaine. Epidural anaesthesia was supplemented in eight patients with nitrous oxide and/or intravenous opioids.
A comparison of midazolam and temazepam for premedication of day case patients
Authors: NIGHTINGALE J. J. , NORMAN J. 
Published: July 2010

SummaryOne hundred patients who underwent day case surgery took part in a randomised double‐blind comparison between midazolam 15 mg and temazepam 20 mg orally as premedicants. Postoperative recovery was studied using tests of psychomotor function. Midazolam produced a similar degree of anxiolysis to temazepam and a greater incidence of drowsiness. Recovery was similar after either premedicant and psychomotor function was still depressed 4 hours postoperatively (p < 0.001). Nearly 90% of patients felt that they had benefitted from either premedicant. We conclude that midazolam is a suitable drug for premedication in day case surgery.
AIDS in ICUs: outcome
Authors: Deam R. , Kimberley A. P. S. , Anderson M. , Soni N. 
Published: July 2010

SummaryThe admission of patients with acquired immune deficiency syndrome (AIDS) to intensive care units in the United Kingdom was surveyed in January 1986. Ninety‐three intensive care units completed the questionnaire. Thirty‐two patients had been admitted to 12 units up to that time. Twenty‐five (78%) of these patients had received artificial ventilation of the lungs. The commonest cause of respiratory failure on admission was Pneumocystis carinii pneumonia; this occurred in 27 patients, seven of whom also had pulmonary cytomegalovirus infection. Four patients had Kaposi's sarcoma and three of these patients also had Pneumocystis carinii pneumonia. The overall mortality was 72%; twenty (80%) of the patients who required artificial ventilation, died. Ten patients survived to leave the intensive care unit, but one patient died of respiratory failure prior to discharge home.
Use of negative pressure ventilation to facilitate the return of spontaneous ventilation
Authors: SIMONDS A. K. , SAWICKA E. H. , CARROLL N. , BRANTHWAITE M. A. 
Published: July 2010

SummaryNegative pressure ventilation was used to facilitate the return of spontaneous ventilation in 10 patients with severe, chronic respiratory disability. All patients had required tracheal intubation and intermittent positive pressure ventilation, and conventional weaning techniques had failed. Details of the method are described. It permits extubation before spontaneous ventilation can be sustained indefinitely and thus assists the return of normal speech, sleep pattern and nutrition. The lack of flexible control of ventilatory variables and absence of access to the trachea for sputum clearance limit its widespread application.
Spinal haematoma following epidural analgesia
Authors: GUSTAFSSON H. , RUTBERG H. , BENGTSSON M. 
Published: July 2010

SummaryA patient who developed an epidural haematoma with multifactorial aetiology (bleeding diathesis, ankylosing spondylitis, chronic alcoholism and acute pancreatitis) after epidural analgesia for pain relief is described. Our conclusion is that adequate laboratory screening of blood coagulation, including platelet count, should be carried out in this category of patient before attempted epidural blockade, the risks of which must be weighed against the benefits. The block should be allowed to wear off intermittently and repeated neurological assessment performed if an epidural catheter is used for repeated injections or for a continuous infusion of local anaesthetic. Neuroradiological examination should be carried out promptly if an epidural haematoma is suspected and surgical decompression performed without delay if the diagnosis is confirmed.
Identification of autonomic dysfunction with a pulse oximeter
Authors: BROOME I. J. , MASON R. A. 
Published: July 2010

SummaryChart recordings of the pulse oximeter waveform were taken during the performance of a standard Valsaha manoeuvre, in one subject with and another without autonomic dysfunction. They demonstrate that certain types of pulse oximeter may be used for the rapid pre‐operative identification of patients who have an autonomic neuropathy in which the cardiovascular responses to stress are impaired.
The effect of tracheal intubation and surgical stimulation on median nerve somatosensory evoked potentials during anaesthesia
Authors: SEBEL P. S. , WITHINGTON P. S. , RUTHERFOORD C. F. , MARKHAM K. 
Published: July 2010

SummaryThis study was designed to determine whether alterations in the median nerve somatosensory evoked potentials occur during the stimuli of tracheal intubation and skin incision. Twenty‐two patients scheduled for elective surgery and who required tracheal intubation were studied. Median nerve somatosensory evoked potentials were recorded, analysed and stored approximately every 40 seconds. Anaesthesia was induced with thiopentone and vecuronium used for neuromuscular blockade; the trachea was intubated 2 minutes after induction. Fentanyl 1.5 μ/kg was administered subsequently. Evoked potential monitoring was continued until at least 2 minutes after surgical incision. Induction of anaesthesia was associated with an increase in evoked potential latency of 0.8 msec and reduction in amplitude of 1.7 μV. Small, statistically insignificant changes occurred between induction of anaesthesia and tracheal intubation. Surgical incision was accompanied by a statistically significant mean decrease in evoked potential latency of 0.5 msec and a statistically significant increase in evoked potential amplitude of 0.6 μV. The fact that surgical stimulation produced an activating effect on evoked potentials suggests that they may be used as a measure of the neurophysiological effects of anaesthesia.
A boy with an anterior mediastinal mass
Authors: JOHN R. E. , NARANG V. P. S. 
Published: July 2010

SummaryA 12‐year‐old boy presented for biopsy of a large mediastinal mass. General anaesthesia precipitated immediate severe airway obstruction. This was overcome by the insertion of two microlaryngeal tubes, one into each main bronchus. The anaesthetic management of patients with an anterior mediastinal mass is discussed and the importance of pre‐operative assessment stressed.
An unexpected functional cause of upper airway obstruction
Authors: MICHELSEN L. G. , VANDERSPEK A. F. L. 
Published: July 2010

SummaryA case of acute respiratory obstruction in the immediate postoperative period is described in it young woman who emerged front general anaesthesia after a Caesarean section for fetal distress. She had a pregnancy complicated by disabling polyhydramnios and anxiously anticipated the birth of a child with a diaphragmatic hernia, diagnosed antenatally. The cause of the airway obstruction was functional in nature as confirmed by flexible fibreoptic laryngoscopy. The diagnosis, paradoxical vocal cord motion, has to be considered as an infrequent cause of postoperative airway obstruction; its recognition and treatment are discussed. The patient did not have a history which might have indicated its possible occurrence. It is suggested that paradoxical vocal cord movement in a more mild form may be overlooked as cause for postoperative stridor and airway obstruction.
Evaluation of a multigas anaesthetic monitor: the Datex Capnomac
Authors: McPEAK H. , PALAYIWA E. , MADGWICK R. , SYKES M. K. 
Published: July 2010

SummaryA laboratory investigation was carried out to evaluate the performance of the Datex Capnomac multigas anaesthetic agent analyser, with particular emphasis on accuracy, response and delay times, zero and gain stability and interference from water vapour. The analysis of anaesthetic vapours was less accurate than the analysis of CO2, O2 and N2O, but acceptable for clinical use. The response to square wave changes in gas composition was accurate at frequencies up to 60 per minute for CO2 and 30 per minute for O2, but with N2O and the anaesthetic vapours there was a decrease in accuracy at frequencies above 20 breaths/minute. The instrument appeared to be unaffected by water vapour.
Continuous epidural infusion of 0.075% bupivacaine for pain relief in labour
Authors: HICKS J. A. , JENKINS J. G. , NEWTON M. C. , FINDLEY I. L. 
Published: July 2010

SummarySeventy‐three women who requested epidural analgesia during labour were randomly allocated in a prospective study to receive either a continuous epidural infusion of 0.075% bupivacaine at a rate of 12–18 ml/hour (38 mothers) or intermittent top‐ups of 0.5% bupivacaine (35 mothers). Both groups received an initial dose of 6–8 ml bupivacaine 0.5%. Patients were asked to score their pain using a 10‐cm linear scale prior to insertion of the epidural, 30 minutes after its insertion and hourly thereafter. The quality of analgesia in the continuous infusion group was significantly better than in the intermittent top‐up group (p < 0.025). There was no significant difference in the total dose of bupivacaine given to the two groups.
Plasma morphine concentrations after intramuscular injection into the deltoid or gluteal muscles
Authors: KIRKPATRICK T. , HENDERSON P. D. , NIMMO W. S. 
Published: July 2010

SummaryThe absorption of morphine 10 mg after intramuscular injection into the gluteal and deltoid muscles was investigated. Ten patients received the injection into the deltoid and 10 were given the injection into the upper outer quadrant of the buttock. Blood was taken at frequent intervals up to 2 hours after the injection for plasma morphine analysis by high performance liquid chromatography. Morphine concentrations were generally higher in the gluteal group although the mean peak concentrations (62.8 ng/ml in the gluteal group and 52.3 ng/ml in the deltoid group) were similar. Peak morphine concentrations varied from 22.5–99.3 ngjml in the gluteal group and 26.5–84.5 ng/ml in the deltoid group. The area under the concentration‐time curve was significantly greater in the gluteal group than in the deltoid group but this difference disappeared when allowance was made for differences in body weight of the two groups. We conclude that the absorption of morphine from the deltoid and gluteal sites is similar
Adriamycin cardiomyopathy
Authors: McQUILLAN P. J. , MORGAN B. A. , RAMWELL J. 
Published: July 2010

SummaryThe death under general anaesthesia of a child with Adriamycin cardiomyopathy is reported. The acute, subacute and chronic cardiotoxic effects of Adriamycin are discussed and the risk factors for chronic Adriamycin cardiomyopathy presented, with particular reference to cumulative dosage of Adriamycin. The insidious onset of impairment of cardiac function is stressed and suggestions for anaesthetic management outlined.
Ischaemic pain in Buerger's disease
Authors: SADDLER J. M. , CROSSE M. M. 
Published: July 2010

SummaryA female patient with Buerger's disease developed severe ischaemic pain in her left index finger which was refractory to several therapeutic measures. A silastic catheter inserted in the region of the, median nerve at the elbow was topped up intermittently with local anaesthetic for 6 weeks and effected excellent analgesia. The catheter was removed when the pain had abated, and the finger tip later amputated.
Tracheal tube cuff pressure
Authors: WILLIS B. A. , LATTO I.P. , DYSON A. 
Published: July 2010

SummarySeventy‐one adult patients (31 male, 40 female) who presented for surgery underwent orotracheal intubation with Portex Blue Line standard cuff disposable tubes (9‐mm for males, 8‐mm for females). The tracheal tube cuff was inflated by a trained assistant using a syringe and the initial cuff pressure measured; the minimum cuff pressure required to prevent respiratory gas leakage was also measured and the cuff pressure maintained above this pressure throughout the operation by means of the Cardiff Cuff Controller. Initial cuff pressure values averaged 11.9 k Pa for males and 13.5 k Pa for females compared with minimum cuff pressure values of 5.2 and 1.2 k Pa, respectively. The differences between initial and minimum pressures were statistically highly significant (p ≪ 0.001). It is concluded that the present method of inflation may lead to gross overinflation of tracheal tube cuffs and that cuff pressure monitoring may be performed simply by means of an electropneumatic controller. The difference in minimum cuff pressure between males and females suggests that the difference in tracheal size between the sexes is greater than the 9‐mm to 8‐mm difference in tracheal tube size.
Blood flow in the upper limb during brachial plexus anaesthesia
Authors: Cross G. D. , Porter J. M. 
Published: July 2010

SummaryChanges in finger blood flow, arm blood flow and cardiac output were measured using electrical impedance plethysmography in 20 patients after brachial plexus anaesthesia. The anaesthetic solution used in all patients was 1% lignocaine with adrenaline 1:200 000. Significant increases in cardiac output and blood flow to the unanaesthetised arm were observed immediately after anaesthesia had become effective. A highly significant increase in the blood flow to fingers of the blocked hand was observed throughout the period of anaesthesia but there was no overall increase in the blood flow to the arm. It is suggested that the adrenaline contained in the local anaesthetic solution increased the cardiac output and caused arterial vasoconstriction at the site of injection.
Enhanced brachial plexus blockade. Effect of pain and muscular exercises on the efficiency of brachial plexus blockade
Authors: Okasha A. S. , El‐Attar A. M. , Soliman H. L. 
Published: July 2010

SummaryThree groups each of 20 patients scheduled to undergo operations on hand or forearm, received supraclavicular brachial plexus blocks with 25 ml lignocaine 1.5%. Patients in the control group did not suffer from pain and were not asked to do muscular exercise. Patients with acute trauma of the upper limb formed the pain group and showed significantly decreased latency for onset of analgesia, partial and complete muscle paralysis. Patients in the muscle exercise group were free of pain and were asked to do muscular exercise for 5 minutes after injection of the lignocaine. Onset of analgesia, partial and complete muscle paralysis was significantly more rapid than in both control and pain groups. Changes in the duration of block were not significant. It is concluded that pain and muscular exercise enhance the onset of brachial plexus blockade.
Training nursing staff in airway management for resuscitation
Authors: MARTIN P. D. , CYNA A. M. , HUNTER W. A. H. , HENRY J. , RAMAYYA G. P. 
Published: July 2010

SummaryThe place of the larvngeal mask in emergency airway management by nonanaesthetists has yet to be established. We have compared the tidal volume achieved by nurses during hand ventilation using standard resuscitation equipment with a facemask, with or without a Guedel airway, and following placement of a laryngeal mask in the same patients. The tidal volumes measured while using the laryngeal mask were significantly greater (p < 0.01) than those measured during facemask ventilation.
Effects of halothane and isoflurane on beta‐endorphin release in children
Authors: GARCIA‐SANCHEZ M. J. , POLO A. , RERAN F. 
Published: July 2010

SummaryWe compared the effects of halothane and isoflurane with 50% nitrous oxide (seven children each) on plasma beta‐endorphin concentrations in a group of 14 children aged 1 to 6 years. The findings were compared for four periods of anaesthesia: basal, induction, maintenance and recovery. Beta‐endorphin release was most increased with isoflurane, especially during the maintenance period. Measurements of haemodynamic parameters (heart rate and blood pressure) showed diastolic blood pressure significantly lower after isoflurane anaesthesia. The findings suggest that the use of isoflurane for paediatric inhaled isoflurane anaesthesia leads to a more marked surgical stress adaptation effect than the use of halothane.
Use of EMLA cream for skin anaesthesia prior to epidural insertion in labour
Authors: Ralston S. J. , Head‐Rapson A. G. 
Published: July 2010

SummaryThe efficacy of the use of EMLA cream to provide skin anaesthesia prior to the insertion of 16 G Tuohy needles was assessed. Sixty women in labour were randomly allocated to receive either EMLA cream over the proposed epidural site for a minimum period of 5 min (mean 9.1 min), a skin bleb and subcutaneous injection oflignocaine 2% (1 ml), or a skin bleb with additional lignocaine 2% (2 ml) infiltrated into the supra and interspinous ligaments using a 23 G needle. Once the epidural catheter was sited, using a standard technique, 10 cm visual analogue pain scales were completed independently by the patient, by a blinded midwife and by the anaesthetist siting the epidural. Patients' perception of pain was not significantly different in any of the three groups, although the mean pain score was least in the group receiving full infiltration. The anaesthetists consistently underestimated the patients' perception of pain.
Neuromuscular effects of rocuronium bromide (Org 9426) during fentanyl and halothane anaesthesia
Authors: COOPER R. A. , MIRAKHUR R. K. , MADDINENI V. R. 
Published: July 2010

SummaryThe neuromuscular effects of intravenous rocuronium bromide, 0.6 mg.kg−1 or 0.9 mg.kg−1, were studied in four groups of 10 patients during anaesthesia with or without halothane (0.5–0.75% inspired concentration). Neuromuscular block was monitored using mechanomyography and train‐of‐four stimulation. The mean times to onset of complete neuromuscular block were 58 and 59 s using the 0.6 mg.kg−1 dose in patients anaesthetised with fentanyl and halothane respectively. The times of 34 min and 33 min for 25% recovery of T1 (first response in the train of four), 54 min and 52 min for 90% recovery of T1, 55 min and 60 min for a train of four ratio of 0.7, and 13 and 13 min respectively for the recovery index (25–75% recovery of T1) were not significantly different in these groups. Complete block with the 0.9 mg.kg−1 dose occurred in 47 s and 44 s respectively in the fentanyl and halothane groups. T1 recovered to 25% in 51 min and 58 min, and to 90% in 77 min and 86 min respectively in the two groups. The recovery indices and the times to spontaneous recovery of the train of four ratio to 0.7 were 17 min and 19 min, and 83 min and 93 min respectively. All the parameters were significantly different between the 0.6 mg.kg−1 and 0.9 mg.kg−1 doses. Halothane in the concentrations used did not influence the neuromuscular effects. It is concluded that rocuronium is a rapidly acting non‐depolarising muscle relaxant with a duration of action similar to that of vecuronium and may be a useful alternative to suxamethonium for rapid tracheal intubation.
Can pre‐emptive lumbar epidural blockade reduce postoperative pain following lower abdominal surgery?
Authors: PRYLE B. J. , VANNER R. G. , ENRIQUEZ N. , REYNOLDS F. 
Published: July 2010

SummaryIn a double‐blind study, 36 patients who received a standard general anaesthetic for abdominal hysterectomy or myomectomy, received either 15 ml of bupivacaine 0.5% with adrenaline by lumbar epidural injection 15 min before surgery (group A) or the same dose at the end of surgery but before waking (group B). Pain was assessed for 24 h by cumulative morphine dose (self‐administered by patient‐controlled analgesia), visual analogue scale and verbal rating score. Patients were included for analysis if they were pain free on waking and for at least 2 h after. There was no significant difference (p > 0.05) between the two groups in morphine dose, visual analogue scale or verbal rating score at 6 and 24 h after waking. As expected, there was a significant difference in the mean time of first use of patient‐controlled analgesia (4.26 h in group A vs 5.06 h in group B, p < 0.05). Consequently, we compared the morphine dose, visual analogue scale and verbal rating score at 23 h in group A with those at 24 h in group B. Again there were no significant differences between the two groups. We were unable to demonstrate that epidural blockade had a significantly better effect on postoperative pain when administered before, rather than after, surgery.
Sumatriptan relieves and prevents peri‐operative migraine attacks
Authors: HANNINGTON‐KIFF J. G. 
Published: July 2010

SummaryThe novel use of sumatriptan as an adjunct to the management of general anaesthesia in patients with a historv of migraine is described. In two unpremedicated patients awaiting day surgery an acute pre‐operative attack of migraine was successfully terminated by the injection of sumatriptan, allowing surgery to proceed uneventfully under general anaesthesia without postoperative complications. Two other patients with a history of severe habitual vomiting after general anaesthesia, who also had a history of migraine, were each given a prophylactic injection of sumatriptan after induction of anaesthesia and for the first time emerged from general anaesthesia free of these distressing complications.
Association of Anaesthetist's checklist for anaesthetic machines
Authors: JACKSON I. J. B. , WILSON R. J. T. 
Published: July 2010

SummaryEight experienced anaesthetists performed a ‘cockpit drill’, following instructions in the Association of Anaesthetist's checklist, on an anaesthetic machine that had a significant leak (3 l.min−1 at a pressure of 16 kPa). Only one anaesthetist detected the leak and this was by audible means rather than by any of the protocol's set manoeuvres. We demonstrated that a leak of 3 l.min−1 from the flowmeter block resulted in an inspired oxygen concentration of 6% when the anaesthetic machine was used with a minute volume divider ventilator.