bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous fluids in minor gynaecological surgery. Their effect on postoperative morbidity
Authors: Spencer E. M. 
Published: July 2010

SummaryPostoperative morbidity was assessed in 100 patients who underwent minor gynaecological procedures. Fifty patients received intra‐operative crystalloid (1000 ml compound sodium lactate solution) and the remaining fifty none. Identical short‐acting intravenous anaesthetic techniques were used in both groups. There was no statistically significant difference between the groups in symptoms of nausea, vomiting, headache, and drowsiness within the first 6 hours after operation. Patients who received intra‐operative fluids exhibited a decreased incidence of dizziness within the first 6 hours and a decreased incidence of nausea when questioned at 3 days compared with those who did not receive any fluid; the difference was statistically significant.
Anxiety and informed consent
Authors: ANTROBUS J. H. L. 
Published: July 2010

SummaryForty‐three consecutive patients were interviewed on the eve of elective gynaecological surgery to determine the effect of anxiety on the granting of informed consent to participate in an hypothetical study. Anxiety was assessed using the Spielberger state‐trait anxiety inventory and 10‐cm linear analogue scale. A standardised explanation of an hypothetical premedication study was given and the patients' consent requested. Results were grouped for those who granted (n = 33) and those who withheld (n = 10) consent: anxiety scores for the latter were significantly higher (p < 0.01). It is concluded that patients with high pre‐operative anxiety levels are more likely to withhold consent for inclusion in premedication studies than are those who are less anxious. Seeking informed consent would introduce bias into studies of anxiolytic premedication.
Intranasal sufentanil for pre‐operative sedation
Authors: VERCAUTEREN M. , BOECKX E. , HANEGREEFS G. , NOORDUIN H. , VANDEN BUSSCHE G. 
Published: July 2010

SummarySufentanil, a short‐acting and potent narcotic agent, was studied as a premedicant administered by the nasal route. A total dose of 5 μg appeared to be too low, while either 10 or 20 μg was very effective in producing sedation. Side effects were minor. There appeared to be no differences between nose drops and spray. In a further study, sufentanil nose drops were compared with saline (0.9% in a double‐blind fashion. Sedation of rapid onset but of limited duration was observed in the majority of patients who received sufentanil.
Benzodiazepine intoxication treated with flumazenil (Anexate, RO 15–1788)
Authors: KNUDSEN L. , LONKA L. , SØRENSEN B. H. , KIRKEGAARD L. , JENSEN O. V. , JENSEN S. 
Published: July 2010

SummaryThe efficacy and safety of flumazenil were assessed in comparison to placebo in a double‐blind randomised study of 31 adults intoxicated with benzodiazepines. The criteria of efficacy were the degree of sedation, and orientation in time and space. Patients who received flumazenil awoke within minutes but central depression returned partly one hour later, which reflects the short elimination half‐life of the drug. Side effects were few and the results indicate that flumazenil is effective in the primary management of benzodiazepine overdose and in states where benzodiazepines have been taken with other drugs.
A comparison of rectal diclofenac with intramuscular papaveretum or placebo for pain relief following tonsillectomy
Authors: BONE M. E. , FELL D. 
Published: July 2010

SummaryA controlled investigation was conducted to compare the effectiveness of diclofenac and papaveretum in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 3 and 13 years of age were randomly allocated to receive rectal diclofenac 2 mg/kg, intramuscular papaveretum 0.2 mg/kg or no medication immediately after induction of anaesthesia. Pain and appearance were assessed 1, 3 and 6 hours postoperatively, and the following morning. The assessments were double‐blind and performed by the same observer. No significant differences in postoperative pain were found between the groups at any time. The use of diclofenac was associated with a significantly more rapid return to calm wakefulness and had significantly less effect upon respiratory rate. Consumption of paracetamol on the day of operation was significantly less in the diclofenac group. Diclofenac may offer advantages compared to papaveretum with regard to safety and convenience for use in the treatment of pain after tonsillectomy in children.
Nalbuphine combined with midazolam for outpatient sedation
Authors: SURY M. R. J. , COLE P. V. 
Published: July 2010

SummaryEighteen healthy volunteers were studied in a double‐blind trial to determine which dose of nalbuphine (0.05, 0.1 or 0.2 mg/kg) may be combined with midazolam 0.05 mg/kg to provide a safe outpatient intravenous sedative technique. The ventilatory response to carbon dioxide and end tidal Pco2 were measured before and after the drugs were administered. A mild degree of respiratory depression occurred, which was maximal at 3–30 minutes after injection. This was not related to dose except that nalbuphine 0.05 mg/kg resulted in the slowest respiratory rates. The implications of these findings for clinical practice are discussed.
Free radicals
Authors: ROYSTON D. 
Published: July 2010

SummaryFree radical species are ubiquitous in plant and animal life. This article describes briefly the formation of certain oxygen‐centred free radicals which are essential for aerobic metabolism and host defences in humans. The mechanism of cytotoxicity of excess or inappropriate free radical production is described. The potential relevance of free radical tissue injury to the anaesthetist is illustrated using oxygen toxicity, adult respiratory distress syndrome and halothane hepatitis as examples.
Silent regurgitation in day case gynaecological patients
Authors: Miller C. D. , Anderson W. G. 
Published: July 2010

SummaryThe effect of metoclopramide premedication on the incidence of gastric regurgitation and postoperative nausea and vomiting was studied in 101 women during gynaecological procedures performed under mask anaesthesia. All patients were premedicated orally with carmine red and temazepam. A treatment group of 48 women also received oral metoclopramide. Anaesthesia was standardised in both groups. None of the women regurgitated gastric contents. Pharyngeal pH was measured in the last 68 patients and found to be > 5 in all instances. Postoperative nausea and vomiting were significantly less frequent in the treatment group.
Critical incident reporting in an anaesthetic department quality assurance programme
Authors: SHORT T. G. , O'REGAN A. , LEW J. , OH T. E. 
Published: July 2010

SummaryThe critical incident technique was introduced as an additional form of quality assurance to an anaesthetic department of a major Hong Kong teaching hospital. In one year, 125 critical incidents were reported from over 16000 anaesthetics. The most common incidents reported concerned the airway, breathing systems, and drug administration, with inadequate checking of equipment a frequent associated factor. Human error was a factor in 80% of incidents. Critical incidents were reported for the time during which the patient was under the anaesthetist's care. The majority occurred at induction or during anaesthesia, and were reported for all surgical subspecialties. Half of the incidents were detected by the anaesthetist and one third by monitoring equipment. Although there were improvements in anaesthetic care as a consequence of increased vigilance, critical incidents still occurred. Critical incident reporting highlighted problems not otherwise covered by case and peer reviews, and complemented our quality assurance programme.
An evaluation of gastric emptying times in pregnancy and the puerperium
Authors: Whitehead E. M. , Smith M. , Dean Y. , O'Sullivan G. 
Published: July 2010

SummaryIn a controlled study, gastric emptying was measured during the three trimesters of pregnancy and after delivery, using an indirect paracetamol absorption technique. The peak plasma paracetamol concentration, time to reach the peak, and the area under the plasma paracetamol concentration‐time curve, were determined. As compared to nonpregnant controls, there were no significant differences in the gastric emptying times of women in the three trimesters of pregnancy and of mothers from 18 h after delivery onwards. Gastric emptying was significantly delayed in mothers within 2 h after delivery (p < 0.01); median (range) values of peak paracetamol concentration, time to reach the peak and the area under the paracetamol concentration‐time curve for this group were 12.5 (0.2–30.5) mg.l−1, 120 (30–120) min and 3.8 (0.1–16.6) mg.l−1.h respectively, and 20.8 (8.6–64.5) mg.l−1, 40 (10–120) min and 13.5 (5.5–28.8) mg.l−1.h respectively, for the nonpregnant control group (p < 0.01). Repeated measurements of gastric emptying in these women on the second postpartum day showed no significant delay.
Current practice of epidural analgesia during normal labour
Authors: Davies M. W. , Harrison J. C. , Ryan T. D. R. 
Published: July 2010

SummaryA postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24‐h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivicaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top‐ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top‐up, whereas 0.25% was most often used during the first stage of labour. Midwife top‐ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top‐ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.
Skin necrosis following continuous positive airway pressure with a face mask
Authors: SMURTHWAITE G. J. , FORD P. 
Published: July 2010

SummaryA 60‐year‐old woman with respiratory.failure required ventilatory support using a continuous positive airway pressure face mask. She developed extensive necrosis of the skin of the bridge of the nose. A number of precipitating factors are discussed and suggestions made to minimise the risk qf this complication.
Cardiac arrest under anaesthesia in a child with previously undiagnosed Jervell and Lange‐Nielsen syndrome
Authors: HOLLAND J. J. 
Published: July 2010

SummaryA 7‐year‐old Sikh boy with a history of syncopal attacks and congenital deafness was admitted for elective adenoidectomy and examination of his ears under general anaesthesia. Immediately after induction of anaesthesia an Ecg demonstrated T wave inversion in the CM 5 lead. The child subsequently developed multifocal ventricular extrasystoles and later, ventricular fibrillation. Deftbrillation was achieved using two 50 J DC shocks. A 12‐lead ECG performed later demonstrated a prolonged Q‐Tc interval (0.52s). The child was diagnosed as having the Jervell and Lange‐Nielsen syndrome.
A comparison of the effect of isoflurane and propofol on arterial carbon dioxide tensions following intracranial surgery
Authors: WILSON R. , BERRIDGE J. , MOSS E. , POWELL D. 
Published: July 2010

SummaryThirty‐four adult patients undergoing elective craniotomy were randomly allocated to receive either isoflurane or propofol to supplement nitrous oxide and fentanyl for maintenance of anaesthesia. Arterial blood gases were measured pre‐operatively before premedication and at 5, 15, 30 and 60 min after tracheal extubation. The arterial carbon dioxide tension was higher than the pre‐operative value 5 min after tracheal extubation in both groups (p < 0.01), but there was no difference between the two groups at any time. It is concluded that the degree of postoperative respiratory depression after intracranial surgery is short‐lived and minimal following maintenance of anaesthesia with either propofol or isoflurane.
Subcutaneous emphysema, pneumomediastinum and pneumothorax complicating laparoscopic vagotomy
Authors: CHUI P. T. , GIN T. , CHUNG S. C. S. 
Published: July 2010

SummaryTwo patients developed subcutaneous emphysema and pneumomediastinum during laparoscopic vagotomy. One of the patients also had a pneumothorax which produced a sudden increase in end‐tidal carbon dioxide concentration preceding arterial oxygen desaturation. The pneumothorax was drained with an intercostal cannula. The patient required a twofold increase in minute ventilation to maintain normocarbia, probably because of the additional absorption of carbon dioxide through the pleural cavity. Despite the presence of a peritoneopleural communication, surgery was successfully completed. We believe that gas under tension in the peritoneal cavity dissected along tissue planes around the oesophagus opened up during surgery. Thus pneumomediastinum, subcutaneous emphysema and pneumothorax are definite risks associated with this new procedure.
Haemodynamic responses to surgery in brain‐dead organ donors
Authors: PENNEFATHER S. H. , DARK J. H. , BULLOCK R. E. 
Published: July 2010

SummaryIn a prospective study we documented the haemodynamic response to surgery in 14 brain‐dead organ donors. The haemodynamic responses to the first 30 min of surgery were predominantly due to alterations in vascular resistance. The mean systemic vascular resistance increased significantly (p = < 0.01) from 936 to 1217 dyn.s.cm−5 after 6 min, then decreased significantly (p = < 0.001) to 642 dyn.s.cm−5 after 30 min of surgery. In two patients, the decrease in systemic vascular resistance was associated with haemodynamic decompensation. The left cardiac work index increased significantly (p = < 0.05) during surgery. We conclude that retrieval surgery causes significant haemodynamic effects. The early effects are predictable and may jeopardise organ perfusion. We advance arguments that organ preservation may be compromised by the use of inotropic agents. When practical, we suggest that a pulmonary artery catheter should be used during retrieval surgery in multi‐organ donors to facilitate a reduction in the use of inotropic drugs.
True patient‐controlled sedation
Authors: COOK L. B. , LOCKWOOD G. G. , MOORE C. M. , WHITWAM J. G. 
Published: July 2010

SummaryA modified patient‐controlled analgesia pump provided doses ofpropofol 3 mg or midazolam 0.1 mg in 0.3 ml, over 5.4 s, with no lockout, during transvaginal oocyte retrieval. Alfentanil 0.2 mg was administered at three points during the procedure, and on request. Patients were randomly assigned to receive either propofol (25 patients) or midazolam (22 patients). The mean age, weight, duration of procedure and dose ofalfentanil were similar in both groups. Onset of sedation with propofol or midazolam took 70.6 (SD 22.4) and 106.3 (50.7) s respectively. Mean doses over the first 5 min were midazolam 2.7 (1.2) mg, and propofol 54 (18) mg. Thereafter requirements decreased: midazolam 0.065 (0.065) mg.min−1, propofol 2.1 (1.3) mg.min−1. All patients successfully completed the procedure; none required additional sedation. P‐deletion, reaction time, and critical flicker fusion tests revealed similar depression in both groups immediately postoperatively. After 30 min the p‐deletion and critical flicker fusion scores were still impaired in the midazolam, but not in the propofol, group.
Controlled ventilation with the Bain co‐axial system
Authors: SAVVA D. 
Published: July 2010

SummaryThe minute ventilation required to maintain either hypocapnia (Fe'co2= 4.0 kPa, group A, n = 36) or normocapnia (Fe'co2= 5.0 kPa, group B, n = 38) in 74 adult patients was determined for the Bain system with controlled ventilation at 10 breath.min−1 and fresh gas flow equal to minute ventilation. Males required a greater minute ventilation and fresh gas flow than females (p < 0.01) in each group (group A, males ∼90 ml.min−1.kg−1, females ∼ 80 ml.min−1.kg−1; group B, males ∼ 75 ml.min−1.kg−1; females ∼ 65 ml.min−1.kg−1). Where capnography is not available, it may be safer to ventilate patients' lungs using the minute volume and fresh gas flow requirements established in group A patients. The administration of 5% carbon dioxide in oxygen for 2 min safely re‐established normocapnia and spontaneous respiration in hypocapnic patients when ventilated with the same minute volume, fresh gas flow and respiratory rate required during surgery. Only one patient required greater than 400 ml.min−1 of carbon dioxide to produce a 5% concentration. Maximum flow from the carbon dioxide flowmeter may be restricted to 400 ml.min−1 rather than the 500 ml.min−1 currently recommended.
A study of laryngeal mask inflation
Authors: O'KELLY S. W. , HEATH K. J. , LAWES E. G. 
Published: July 2010

SummaryLaryngeal mask airway cuff inflation pressures were measured when inflated with the same volume of gas firstly in free space and then in position in the pharynx. A large difference in these pressures was observed and this was related to pharyngeal mucosal perfusion pressure. This study shows that it may be easy to produce pressures on the pharyngeal mucosa in excess of the critical perfusion pressure and thus potentiate mucosal trauma. Furthermore, laryngeal mask cuff pressures were measured at intervals during anaesthesia and were found to rise by a significant amount if room air was used as the cuff inflating gas. This effect could, however, be reversed if inspired gas was used to inflate the mask cuff. We conclude that care must be taken when inflating the laryngeal mask cuff if postoperative morbidity is to be avoided and also that it may not be necessary to use as high a volume of inflating gas as has been recommended during spontaneous respiration.
Comparison of 2‐chloroprocaine and prilocaine for intravenous regional anaesthesia of the arm: a clinical study
Authors: Pitkänen M. , Kyttä J. , Rosenberg P. H. 
Published: July 2010

SummaryIn a double‐blind, randomised study of patients scheduled for minor hand surgery 0.5% 2‐chloroprocaine (n = 30) and 0.5% prilocaine (n = 30) in a volume of 40 ml were compared for intravenous regional anaesthesia. The onset of sensory and motor block and recovery of sensory block were determined, and the occurrence of side‐effects was noted. Twenty‐four patients in the 2‐chloroprocaine group and 17 in the prilocaine group developed complete sensory block by 15 min after injection (p < 0.05). Complete recovery of sensation was faster after prilocaine (7.1 min) than 2‐chloroprocaine (9.8 min) (p<0.01). Venous irritation and/or urticaria after tourniquet release was observed on 10 occasions in those receiving 2‐chloroprocaine and twice in those receiving prilocaine. An increase in heart rate of > 20% above control values occurred in three patients, all of whom had been given 2‐chloroprocaine. Clinically, local anaesthetic properties of 0.5% 2‐chloroprocaine and prilocaine were similar, but there were more side‐effects with the former drug.
Suxamethonium‐induced muscle pains are not related to cholinesterase activity
Authors: Ansermino J. M. , Burke M. A. , Upton P. M. , McVittie J. , Blogg C. E. 
Published: July 2010

SummaryWe have investigated the possibility of using the pre‐operative measurement of cholinesterase activity to predict the postoperative development of myalgia following the administration of suxamethonium. Seventy‐seven patients presenting for elective extraction of wisdom teeth were entered in the study. All patients received a standard anaesthetic regimen, including suxamethonium to facilitate tracheal intubation, and standardised postoperative analgesia. Myalgia was assessed postoperatively and no correlation between muscle pains and cholinesterase activity was found.
A cost‐utility analysis of intensive therapy
Authors: RIDLEY S. , BIGGAM M. , STONE P. 
Published: July 2010

SummaryA questionnaire designed to assess changes in quality of life was sent to 56 survivors of critical illness one year after their admission to an intensive therapy unit. Forty‐one patients completed the questionnaire, and for the majority, quality of life remained unchanged (n = 25). However significant decreases in quality of life were found in those patients who previously enjoyed a good quality of life or were admitted with respiratory problems. Survivors also recorded significant decreases in five aspects of their perceived quality of life (ability to think and remember, seeing family, their contribution to society, activities outside work and income). As part of a previous study, the costs incurred by each of these patients had been measured so that changes in quality of life detected in this study could be combined to the individual costs and expressed as cost per quality adjusted life year. The cost of intensive therapy for a patient surviving for one year after acute respiratory or cardiovascular disease was £2600. The total hospital cost per quality adjusted life year was estimated at £7500, which places intensive therapy at the higher end of health programme costs. If the costs of nonsurvivors are included in the cost per quality adjusted life year calculation, the cost of intensive care increases considerably.
Cerebrospinal fluid cutaneous fistula An unusual complication of epidural anaesthesia
Authors: HOWES J. , LENZ R. 
Published: July 2010

SummaryWe describe two cases of cerebrospinal fluid‐cutaneous fistula following epidural anaesthesia used for postoperative pain relief. In each case spinal headache occurred only after removal of the catheters and both patients were treated successfully with autologous blood patches.
Flow characteristics of long spinal needles
Authors: PATEL M. , SAMSOON G. , SWAMI A. , MORGAN B. M. 
Published: July 2010

SummaryA 120 mm, 27‐gauge needle has recently been introduced for subarachnoid anaesthesia when using a single‐space, combined spinal‐extradural technique. The flow characteristics of this needle were compared with those of a 120 mm, 26‐gauge needle using a pressure monitor infusion pump. Surprisingly, the resistance to fluid flow of the 26‐gauge needle was twice that of the 27‐gauge needle. The results of this experiment were confirmed by the findings of a clinical study undertaken in 100 obstetric patients who required regional anaesthesia. The time taken from dural puncture to appearance of cerebrospinal fluid at the hub of the needle was on average three times greater with the 26‐gauge needle.
A comparative study of the incidence of sore throat with the laryngeal mask airway
Authors: Dingley J. , Whitehead M. J. , Wareham K. 
Published: July 2010

SummaryIn a prospective study of 150 patients randomly assigned to three groups, we have compared the incidence and duration of sore throat after a standard anaesthetic regimen using three different methods of airway management: facemask; laryngeal mask, and laryngeal mask with insertion aid. The insertion aid is currently being developed by Portex Ltd and is intended both to facilitate accurate placement of the laryngeal mask and to reduce trauma during insertion. All the patients were women undergoing short operative procedures requiring minimal postoperative analgesia. The incidence of sore throat was significantly less with a facemask (8%) than with the laryngeal mask when used without the insertion aid (28.5%) (p < 0.02). When using the insertion aid the incidence was 18% and this was not statistically different from the facemask. The presence of blood on the laryngeal mask (22%) was less likely when the insertion aid was used (4%) (p < 0.02).