bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylaxis against acid aspiration syndrome
Authors: GALLAGHER E. G. , WHITE M. , WARD S. , COTTRELL J. , MANN S. G. 
Published: July 2010

SummaryWe have compared famotidine 40 mg, ranitidine 300 mg and placebo given in a single oral dose at 2200 hours as the sole means of prophylaxis in 286 patients who underwent elective surgery the following day. Standardised premedication was administered and anaesthesia induced. Gastric contents were aspirated by nasogastric suction and the pH and volume measured. Median values of pH after famotidine, ranitidine and placebo were 6.17, 6.74 and 2.45 respectively; median aspirate volumes were 8, 8 and 10 ml respectively. The proportions of patients considered ‘not at risk’ (pH > 2.5) were 90% after famotidine, 91% after ranitidine and 52% after placebo. We conclude that the administration of a potent H2‐antagonist in a single oral dose at night offers a convenient routine means of providing extensive prophylactic cover in patients scheduled to undergo elective surgery the following day.
Alkalinised bupivacaine and adrenaline for epidural Caesarean section
Authors: TACKLEY R. M. , COE A. J. 
Published: July 2010

SummaryTwenty‐four mothers received either 0.5% bupivacaine (group 1, n = 14), or alkalinised 0.5% bupivacaine and 1 in 200 000 adrenaline (group 2, n = 10), as an epidural local anaesthetic for elective lower segment Caesarean section in a randomised, double blind study. The two groups were prepared for surgery according to an identical technique. Onset of analgesia to pinprick was significantly faster in group 2 (p < 0.02). Group 1 required additional analgesia during surgery significantly more often than those in group 2 (p = 0.04). Significantly more patients in group 2 were ready for surgery by the time limit for the study (45 minutes, p = 0.002). Onset of motor blockade was significantly faster in group 2 (p = 0.01). There were no significant differences between the two groups with regard to duration of surgery, or Apgar scores at 1 and 5 minutes. Alkalinised 0.5% bupivacaine and adrenaline was superior to 0.5% bupivacaine for epidural Caesarean section.
Dependence of the output of a halothane vaporizer on thymol concentration
Authors: GRAY W.M. 
Published: July 2010

SummaryThe effect of thymol accumulation inside a Fluotec 3 vaporizer on the concentration of halothane delivered by the vaporizer was investigated. The vaporizer output was reduced progressively as the thymol concentration increased, but the reduction was less than that predicted by Raoult 's Law. A reduction of 5% in output required an increase in thymol concentration of a factor of 650 compared to the concentration in fresh halothane, while a reduction of 10% required a 1100‐fold increase in thymol concentration. The equilibration of the thymol from the wicks throughout the vaporizing chamber was very slow after the vaporizer was drained and filled with fresh halothane; the half‐time was 2.7 days.
Transverse myelitis following general anaesthesia
Authors: GUTOWSKI N. J. , DAVIES A. O. 
Published: July 2010

SummaryA 47‐year‐old woman developed a complete transverse myelitis 2 weeks after an uncomplicated general anaesthetic for total abdominal hysterectomy and bilateral salpingo‐oophrectomy. If spinal or epidural anaesthesia had been used, a causal relationship might have been assumed. This case emphasises the danger of attributing all cases of transverse myelitis which have a close temporal relationship to spinal or epidural anaesthesia, to the anaesthetic technique itself.
Prospective survey of the use of the laryngeal mask airway in 2359 patients
Authors: Verghese C. , Smith T. G. C. , Young E. 
Published: July 2010

SummaryPatients undergoing anaesthesia in which the laryngeal mask airway was used were prospectively audited over a 6‐month period. A simple record sheet was completed at the time of anaesthetic administration and 2359 completed forms were analysed to assess problems encountered with its use. It was used successfully in 2350 patients (99.61%); of these, 1399 patients (59%) breathed spontaneously through the airway and 960 patients (41%) underwent intermittent positive pressure ventilation of the lungs. Two patients (0.08%) were reported to have regurgitated during the use of the laryngeal mask airway, but no serious sequelae associated with its use were encountered.
Incidence and magnitude of hypoxaemia with ketamine in a rural African hospital
Authors: Pederson L. , Benumof J. 
Published: July 2010

SummaryThe incidence of hypoxaemia with ketumine anaesthesia in unpremedicated, spontaneously breathing patients without oxygen supplementation at high altitudes has never been investigated. Twenty‐three consenting patients received ketamine (2 mg.kg−1 intravenously in adults or 8 mg.kg−1 intramuscularly in children supplemented with 0.5 mg.kg−1 intravenously when clinically indicated) as the sole anaesthetic agent in a small, rural hospital in central Kenya (altitude 6000 ft; Pio2 127 mmHg). Oxygen saturation (Spo2) was measured with pulse oximetry. The Spo2 values were grouped in time epochs of pre‐induction, postinduction but presurgery, every 1–2 min after start of surgery, and at the end of the case. The mean Spo2 values reached 90.8% during the first min following start of surgery and this was significantly different from pre‐induction levels (p < 0.01). In four patients (17%) Spo2 decreased to 90% or less, in two patients (9%) Spo2 decreased to 85% or less, and in two patients (9%) Spo2 decreased to 75% or less. Mean values returned to near baseline by the end of the surgery. It is concluded that ketamine anaesthesia is acceptable in this setting if monitored by vigilant personnel who are capable of providing supplemental oxygen (if available) and manual support of the airway (i.e. jaw thrust) if airway obstruction occurs.
Effects of omeprazole, with and without metoclopramide, in elective obstetric anaesthesia
Authors: ORR D. A. , BILL K. M. , GILLON K. R. W. , WILSON C. M. , FOGARTY D. J. , MOORE J. 
Published: July 2010

SummaryWe report the results of a study comparing two dose regimens of the gastric antisecretory agent, omeprazole, used as prophylaxis against pulmonary aspiration of gastric contents during general anaesthesia for elective Caesarean section. Since antisecretory agents do not clear stomach contents already present at the start of treatment, two groups of patients who had received both omeprazole and a prokinetic drug, metoclopramide, were also studied. Thirty patients received oral omeprazole 40 mg on the evening before and on the morning of the operation (group 1), 33 received oral omeprazole 80 mg on the morning of the operation (group 2), and 15 (group 3) and 16 (group 4) patients respectively received the oral omeprazole doses stated above and in addition metoclopramide 10 mg given intramuscularly at least 20 min before induction of anaesthesia. Gastric aspirate pH and volume were measured at induction of anaesthesia and on completion of surgery. At induction of anaesthesia, treatment was judged successful (pH ≥2.5 and volume < 25 ml) in 87%, 73%, 100% and 81% of patients in groups 1–4 respectively. The corresponding results on completion of surgery were 100%, 88%, 100% and 100%. While omeprazole is useful as prophylaxis against pulmonary aspiration during general anaesthesia for elective Caesarean section, the addition of a prokinetic agent seems to be necessary la maximise its effects.
Epidural anaesthesia through caudal catheters for inguinal herniotomies in awake ex‐premature babies
Authors: PEUTRELL J. M. , HUGHES D. G. 
Published: July 2010

SummaryEx‐premature babies are at risk of apnoea after surgery. Regional anaesthesia has been used as an alternative to general anaesthesia for some surgical procedures in the belief that it may be safer. However, single dose caudal epidural and subarachnoid anaesthetics have a duration of action which may be insufficient for some operations. The level and duration of anaesthesia can be extended ij local anaesthetic is given through an epidural catheter. In addition, the dose needed to provide adequate anaesthesia may be lower because the local anaesthetic is given at an appropriate segmental level. We report our experience of caudal epidural anaesthesia in nine, awake ex‐premature babies who were having inguinal herniotomies. The anaesthesia was excellent in six babies. Two babies cried briefly with peritoneal or spermatic cord traction. One other baby needed supplementation with nitrous oxide in oxygen in order to complete the surgery. The majority of babies slept throughout surgery. There were no reported postoperative complications.
Coeliac plexus block with bupivacaine reduces intestinal dysfunction in neurosurgical ICU patients
Authors: Weinstabl C. , Forges P. , Plainer B. , Werba A. , Spiss C. K. , Seitz H. 
Published: July 2010

SummaryCoeliac plexus block, an established method of treatment for pain associated with pancreatitis and cancer, was used in neurosurgical patients with gastrointestinal dysfunction. The study was performed in 16 patients whose gastric reflux volume exceeded 600 ml per day for 3 consecutive days. Patients were allocated to a block group (n = 8) or a control group (n = 8). Coeliac plexus block was accomplished with a modified Moore technique using 50 ml bupivacaine 0.25%. In the block group, gastric reflux volumes for 3 days preceding coeliac plexus block and 3 consecutive days following coeliac plexus block were analysed. In the control group, gastric reflux volumes were observed over a period of 6 days. Mean (Sem) gastric reflux volume decreased significantly following coeliac plexus block from 770 (50) ml to 60 (30) ml (p > 0.01). In the control group, gastric reflux remained unchanged over the corresponding periods (730 (60) ml c.f. 670 (50) ml). The response of gastric reflux volume to coeliac plexus block suggests that the mechanism is related to inhibition of sympathetic activity in patients whose sympathetic drive is increased due to the underlying neurological disease, and possibly due to sedation withdrawal symptoms.
Personality traits as predictors of anxiety prior to Caesarean section under regional anaesthesia
Authors: THORP J. M. , KENNEDY B. W. , MILLAR K. , FITCH W. 
Published: July 2010

SummaryOne hundred and fifteen patients scheduled for elective Caesarean section under regional anaesthesia were questioned to determine their personality profiles and anxiety state. Positive correlations were found between neuroticism and anxiety scores (p < 0.05). Patients with tendencies towards both neuroticism and introversion had higher pre‐operative anxiety scores than other personality types (p = 0.015). In general, previous experience did not reduce pre‐operative anxiety and personality appeared to be a better predictor of anxiety prior to Caesarean section under regional anaesthesia. Some personality types might benefit from additional support to improve their ability to cope with this stressful event.
Eltanolone for induction of anaesthesia and to supplement nitrous oxide for minor gynaecological surgery
Authors: RAJAH A. , POWELL H. , MORGAN M. 
Published: July 2010

SummaryWe have used eltanolone to induce anaesthesia and by intermittent injection to supplement nitrous oxide during maintenance in 50 patients undergoing minor gynaecological surgery; opioids were not used. Induction of anaesthesia was remarkably trouble free and achieved with a single dose of 0.5 mg.kg−1 in 90% of patients. Pain on injection was not a feature. Satisfactory anaesthesia was achieved in 84% of patients; eight required addition ofisoflurane. There were minimal cardiovascular changes and apnoea on induction occurred in only one patient. Recovery times were acceptable.
Left ventricular performance and cerebral haemodynamics during xenon anaesthesia
Authors: LUTTROPP H. H. , ROMNER B. , PERHAG L. , ESKILSSON J. , FREDRIKSEN S. , WERNER O. 
Published: July 2010

SummaryThe effects of xenon anaesthesia on myocardial function and cerebral blood flow velocities were investigated with transoesophageal echocardiography and transcranial Doppler sonography. Seventeen ASA 1 patients undergoing open cholecystectomy (n = 16) or abdominal hysterectomy (n = 1) were studied. Anaesthesia with 65% xenon in oxygen was induced by ventilating the lungs through a circle system with minimal fresh gas flow. The echocardiographically obtained mean (SD) fractional area change in a short axis view of the left ventricle at the level of the papillary muscles was 65 (10)% (n = 14) before xenon. There was no significant change after 5, 10 and 15 min of xenon anaesthesia. Cerebral blood flow velocities were unchanged during the first 5 min of xenon anaesthesia, but were significantly increased in the left and right middle, and the right anterior, cerebral arteries after 15 and 30 min (n = 16) (p < 0.05). In conclusion, xenon anaesthesia had no adverse effect on myocardial function, but probably increased cerebral flood flow.
Bacterial growth in isoflurane vapour
Authors: SLADE J. M. 
Published: July 2010

SummaryPathogenic bacteria were grown on nutrient agar in a mixture of air and isoflurane vapour, and in air alone. The presence of isoflurane vapour in concentrations considerably in excess of those used either for anaesthesia or for sedation in intensive care had no effect either on the rate of bacterial growth or on the viability of colony forming units.
Exertional heat stroke induced by amphetamine analogues
Authors: WATSON J. D. , FERGUSON C. , HINDS C. J. , SKINNER R. , COAKLEY J. H. 
Published: July 2010

SummaryThere are increasing numbers of patients admitted to hospital as a result of ingesting amphetamine‐like drugs. The most severe cases exhibit hyperthermia, rhabdomyolysis, coagulopathy and renal failure. We describe six such patients with varying severity of intoxication, and have reviewed the recent literature with particular reference to the use of dantrolene. One of our patients died but the others all survived. There is little evidence that dantrolene influenced the outcome in patients reported to date. We believe that a controlled trial should be carried out in amphetamine‐related hyperthermia before the use of dantrolene becomes widespread.
Measurement of intercostal and pleural pressures by epidural catheter
Authors: KAWAMATA M. , OMOTE K. , NAMIKI A. , MIYABE M. 
Published: July 2010

SummaryThe pressures in the intercostal and interpleural spaces were measured in 20 patients using an 18 gauge epidural catheter to confirm accurate catheter positioning for continuous intercostal and interpleural local anaesthetic blockade. In the intercostal space the mean (SD) pressure was negative (‐1.8 (0.3)) mmHg and positive (+ 2.1 (0.3)) mmHg at the end of inspiration and expiration respectively. In contrast, in the interpleural space although the pressure varied with the respiratory cycle it remained negative both at the end of inspiration (‐8.3 (1.0)) mmHg and expiration (‐2.1 (0.8)) mmHg. We conclude that measurement of intercostal and interpleural pressures with an epidural catheter is a straightforward procedure which may be helpful in confirming accurate catheter placement for continuous intercostal or interpleural local anaesthetic blockade.
A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery
Authors: Rodrigo M. R. C. , Tong C. K. A. 
Published: July 2010

SummaryThirty healthy Hong Kong Chinese patients between the ages of 15 and 31 years with bilaterally impacted lower third molar teeth, scheduled for surgical removal were studied. All the patients presented twice (for the right and left sides) and received, on separate occasions, patient or anaesthetist‐controlled midazolam sedation allocated using a randomised, crossover design. Both techniques provided reliable sedation with verbal contact maintained, minimal changes in respiratory and cardiovascular function, good operating conditions and a high degree of patient satisfaction. The majority of patients (67%) thought they could sedate themselves better on a subsequent visit and were confident that they could do this more satisfactorily than the anaesthetist. An almost equal number preferred patient (n = 12) or anaesthetist (n = 13) controlled sedation, with the remainder having no preference. The total dose of midazolam was very similar in the two groups, 5.3 (SD 2.4) mg and 5.0 (SD 1.1) mgfor patient and anaesthetist controlled sedation respectively.
A comparison of three types of tracheal tube for use in laryngeal mask assisted blind orotracheal intubation
Authors: Lim S. L. , Tay D. H. B. , Thomas E. 
Published: July 2010

SummaryLaryngeal mask assisted blind orotracheal intubation is a technique that is best mastered under controlled circumstances. The influence of the type of tracheal tube, and positioning of the head, on the success rate of this procedure was evaluated in 90 gynaecological patients presenting for elective procedures under general anaesthesia. After induction, a laryngeal mask was introduced and its position was confirmed. Up to three attempts at blind orotracheal intubation using one of three tracheal tubes (Argyle, Portex or Kendall Curity) passed through the laryngeal mask were permitted in each patient. The success rates after a single attempt at blind oral intubation were 3.3%, 70.0% and 30.0% respectively (p < 0.001 and p < 0.05 when Portex was compared to Argyle and Kendall Curity types). After a maximum of three attempts, success rates were 30.0% (Argyle), 93.3% (Portex) and 76.7% (Kendall Curity). The first attempt at tracheal intubation was performed in the 'sniffing the morning air position‘ and this was successful in 52% of successful intubations; the second attempt using extension at the atlanto‐occipital joint was successful in a further 35% of successful intubations; the third attempt used varying degrees of neck flexion and extension at the atlanto‐occipital joint and this permitted successful placement of the tracheal tube in the remaining 13% of patients in whom tracheal intubation was possible.
Emergency X ray‐guided nasotracheal intubation in a patient with a spinal epidural haematoma
Authors: KAWAGUCHI M. , SAKAMOTO T. , OHNISHI H. , KARASAWA J. 
Published: July 2010

SummaryA patient with a spinal epidural haematoma who developed tetraparesis and respiratory insufficiency is described. Nasotracheal intubation was successfully and rapidly undertaken with the aid of continuous fluoroscopy.
Failure of pain relief after surgery
Authors: OATES J. D. L. , SNOWDON S. L. , JAYSON D. W. H. 
Published: July 2010

SummaryThree surveys of postoperative patients and surgical ward staff were conducted in an 840‐bed university hospital to ascertain the severity of pain after surgery and the reasons why patients in pain do not receive more of the analgesia prescribed for them. In the first survey, 206 inpatients were questioned within 24 h following operation, and 25.2% of patients experienced moderate pain wnust 9.2% experienced severe pain but received only 36% of their prescribed analgesics. In the second survey, 176 staff reported that the commonest reasons why patients in pain did not receive analgesics were that they did not request analgesia, were too sleepy or refused the dose. In the final survey, of 200 inpatients questioned, 88% had experienced pain since operation, 97% had been offered analgesics, 14% refused a dose. Twenty‐nine percent were moderately or very concerned about injections. The beliefs of both ward staff and patients could have contributed to this failure of pain relief.
A new colorimetric breath indicator (Colibri)
Authors: GEDEON A. , KRILL P. , MEBIUS C. 
Published: July 2010

SummaryColorimetric carbon dioxide indicators are designed for the verification of satisfactory tracheal tube placement. However, widespread use of the device in this and other applications is hampered by limitations in its performance characteristics. A new colorimetric breath indicator (Colibri) has been developed that overcomes major shortcomings of current technology. A simple method is described that can be used to evaluate the properties of colorimetric carbon dioxide indicators in a quantitative way.
Pre‐emptive analgesia form intravenous administration of opioids
Authors: WILSON R.J.T. , LEITH. S. , LACKSON I.J.B. , HUNTER D. 
Published: July 2010

SummaryForty patients undergoing total abdominal hysterectomy were randomly allocated to reveive either 40 μ. Kg−1 of alfentanil on induction of anaesthesia or 40 μ.kg−1 of alfentanil after the skin incision, Postoperative pain relief was provided with morphine from a patient‐controlled analgesia system. The amount of morphine consumed in the poperating theatre, while in recovery and for the first 24 h postoperatively was recorded. Pain scores were assed at 24 h using a visual analogue scale. There were no differences found between the two group for morophine consumption but the ‘pre‐emptive’ group had significantly higher pain scores at rest. We conclude that there is no clinically useful pre‐emptive analgesic effect with this dose of alfentanil and that therefore systemic opioid premedication in unlikely to decrease postoperative analgesic requirements throught the mechanism of pre‐emptive analgesia.
The effect of parenteral diclofenac and morphine on duration and height of blockade of continuous epidural infusion of bupivacaine 0.5%
Authors: SCOTT N. B. , FORBES D. W. , BINNING A. R. 
Published: July 2010

SummaryTwenty‐six patients undergoing abdominal hysterectomy (ASA 1‐2) were entered into a double‐blind randomised trail to determin: (a) whether diclofanac given intravenously could influence the effective duration of a continuous epidural infusion of bupivacine 0.5% and (b)0 whether morphine given intravenously altered the height of the regressing block. A block to T4 was established pre‐operatively and a continuous infusion of 0.5% bupivacaine 8 ml.h−1 ran for 14 h. Thirteen patients received 50 mg diclofenac intramuscularly before surgery repeated at 4 and 10h later and 13 patients received saline intramuscularly. the height of blockade and pain scores were measured hourly. Effectibe block duration was defined as regression to t10 or lower andlor a pain a score of 2 or more,. At this point 10 mg of morphine was given intravenously and the height of the block reassessed. Duration of blockade was not significantly prolonged (p>.05), but pain scores were significantly reduced with diclofenac (p<.01). Morphine did not alter blockade height. It is concluded that epidural bupivacaine and diclogenac act additively on postoperative pain.
The renin‐angiotensin system and angiotensin convertin enzyme (ACE) inhibitors.
Authors: KELLOW N. H. 
Published: July 2010

SummaryAnaesthetists wil encounter increasing numbers of patients who are receivng long‐term treatment with ACE inhibitors for hypertension, congestive heart fealure and prophylactically following myocardial infraction. Our understanding of the physiology and pharamacology of the renin‐angiotensin system has dramatically increased in the last decade, and has led to the discorvery of endogenous renin‐angiotensin systems which may be physiologicaly more important than the better understood circulating system. There are several reports of adverse interactions between anaesthesia and ACE inhibitors, manifestedas hyprotension and bradycardia which maybe delayed until the postoperative period. The mechanism behind them is not understood and, as yet, no published studies have attempted to address this issue. It is possible, however, that dehydration associatied with the pre‐operative fast may may play an important role. ACE inhibitors may, in the future, prove to be useful in the subspecialities of cardiac and vascular anaesthesia, where they might be used in an attempt to preserve cardiac funciton follwing periods of ischaemia and dardiopulmonary bypass, and to aviod renal damage following aortic cross‐clamping. Meanwhile. it would seem prudent to excerse caution when anaesthetishing patients tadking ACE inhibitors and to be fully prepared to treat the hypotension and brodycardia which may occur.