bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dermal patch anaesthesia for venous cannulation with 10% lignocaine gel containing glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter
Authors: Kano T. , Nakamura M. , Hashiguchi A. , Morioka T. , Mishima M. , Nakano M. 
Published: February 2007

SummaryThe clinical efficacy of transdermal 10% lignocaine gel mixture containing 3% w/w glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter was evaluated at venous cannulation in 17 paediatric (6–11 years) and 17 adult (29–65 years) patients. After about 60 min of occlusive application, the mean (SD) pinprick pain score was 0.7 (0.7) in the paediatric group, compared with 1.4 (1.3) in the adults (p < 0.05). Twenty‐five patients (14 children and 11 adults) who had a pinprick score of 0 or 1 underwent venous cannulation without intradermal local anaesthetic. The mean (SD) pain scores at venepuncture showed no significant differences between children and adults.
Does the laryngeal mask airway compromise cricoid pressure?
Authors: STRANG T. I. 
Published: February 2007

SummaryThe laryngeal mask airway was inserted in 10 cadavers. At postmortem the chest was opened and an infusion set primed with a dilute barium solution was inserted into the oesophagus and ligated in place. A cricoid force of 43 N was then applied and the infusion set was positioned so that when the clamp was opened it generated a pressure of 7.8 kPa within the oesophagus. The cricoid pressure was able to stop the flow of fluid into the oesophagus. This demonstrates that cricoid pressure is effective in preventing reflux at intragastric pressures which are encountered clinically and the presence of the laryngeal mask airway does not compromise this.
Patient controlled analgesia—assessment of machine feedback to patients
Authors: Johnson T. W. , Luscombe F. E. 
Published: February 2007

SummaryThe effect of varying patient‐controlled analgesia machine feedback was studied in two groups of patients following a standard surgical procedure using patient controlled analgesia with morphine to control postoperative pain. Analgesic demands, morphine consumption, pain scores and side effects were compared and comments from the patients were noted. There was no significant difference between those whose machines signalled only successful demands compared with those who had every demand acknowledged. The patients in the former group appreciated the extra input and the nursing staff found this machine configuration to be less disturbing to the ward. There was no evidence of a clinically useful placebo effect in the latter group.
Pre‐oxygenation: the Hudson mask as an alternative technique
Authors: Ooi R. , Pattison J. , Joshi P. , Chung R. , Soni N. 
Published: February 2007

SummaryThe use of a simple oxygen facemask (Hudson) with high oxygen inflow (48 l.min−1) was investigated as a technique for pre‐oxygenation, comparing it with the Magill system (oxygen flow: 100 ml.kg−1.min−1). One hundred and thirty‐eight patients scheduled for elective gynaecological and orthopaedic surgery were studied: group 1. Hudson mask and group 2, Magill system (Asa 1–2, n = 107); group 3, Hudson mask and group 4, Magill system (Asa 3, n = 30). Pre‐oxygenation was assessed by measuring the times to 97%, 95% and 93% arterial desaturation (finger pulse oximetry) following 3 min of pre‐oxygenation. The times taken to achieve these end‐points in all the study groups suggest that the Hudson mask offers an alternative technique for pre‐oxygenation.
Thoracic electrical bioimpedance measurement of cardiac output and cardiovascular responses to the induction of anaesthesia and to laryngoscopy and intubation
Authors: SANDERS D. J. , JEWKES C. F. , SEAR J. W. , VERHOEFF F. , FOËX P. 
Published: February 2007

SummaryNoninvasive methods of determining cardiac output (by thoracic electrical bioimpedance) and arterial pressure (by intermittent oscillometry) were used to record minute‐by‐minute changes in heart rate, mean arterial pressure, stroke volume, cardiac output and systemic vascular resistance following induction of general anaesthesia and laryngoscopy and intubation in 60 healthy female patients who were either unpremedicated, or premedicated with temazepam or papaveretum‐hyoscine. Anaesthesia was induced with a sleep dose (3–5 mg.kg−1) of thiopentone and maintained with 70% nitrous oxide in oxygen with 0.5–1% enflurane. Tracheal intubation was facilitated by administration of vecuronium 0.1 mg.kg−1. Mean arterial pressure and cardiac output decreased maximally 5 min after induction in all premedication groups by mean estimates of 21–25% and 14–22% respectively. Heart rate increased initially one minute after induction, but decreased to less than the baseline value 5 min after induction. Systemic vascular resistance was unchanged. The stimulus of laryngoscopy and tracheal intubation was accompanied by a significant pressor response and tachycardia one minute after intubation (with mean increases in mean arterial pressure and heart rate of 29–34% and 22–33% respectively). The increase in mean arterial pressure was secondary to an increase in systemic vascular resistance (36–57%), and was accompanied by a decrease in stroke volume (– 25 to –31%). These changes were significant in all three groups. Cardiac output decreased only in unpremedicated patients. There were wide variations in the different haemodynamic indices. The 5th and 95th centiles for the decreases in mean arterial pressure and cardiac output during induction were –17 to –26, –21 to –33, and –21 to –35mmHg, and –0.7 to –2.0, –0.7 to –2.3, and –0.2 to –1.31.min−1 respectively in unpremedicated patients and those premedicated with papaveretum‐hyoscine, or temazepam. Corresponding values for increases in mean arterial pressure and systemic vascular resistance, and decreases in stroke volume following laryngoscopy and intubation, were 16 to 33, 16 to 31.5, and 15 to 31 mmHg; 5.0 to 8.6, 3.5 to 10.2, and 4.3 to 7.8 mmffg.min.−1; and –19 to –31, –11 to –32.5, and –9 to –21 ml respectively.
The pre‐operative anaesthetic visit
Authors: Nightingale J. J. , Lack J. A. , Stubbing J. F. , Reed J. 
Published: February 2007

SummaryOne hundred and thirty‐two patients staying in hospital more than 24 h were visited pre‐ and postoperatively. Patients were asked a standard set of questions, and 39% could not remember accurately what they were asked. This has important medicolegal implications. In 15% of patients, information that significantly altered subsequent anaesthetic management was discovered, but in less than 3% would ignorance of the patient's condition have required postponement of the surgery. We conclude that the major reason for a pre‐operative visit by an anaesthetist is that patients appreciate it, rather than it being medically necessary.
Cardiovascular effects of forces applied during laryngoscopy
Authors: BUCX M. J. L. , VAN GEEL R. T. M. , SCHECK P. A. E. , STIJNEN T. 
Published: February 2007

SummaryThe relationship between the forces applied during laryngoscopy and cardiovascular changes were studied in patients undergoing laryngoscopy with or without intubation. This enabled us to differentiate between the cardiovascular effects of laryngoscopy and the effects of tracheal intubation. The forces applied during laryngoscopy were only weakly related to the cardiovascular changes, whereas tracheal intubation had a major influence. The many difficulties encountered in interpreting results from these studies are discussed. It is concluded that tracheal intubation causes more cardiovascular changes than laryngoscopy in routine uncomplicated procedures.
Effect of extradural anaesthesia on the ventilatory response to hypoxaemia
Authors: SAKURA S. , SAITO Y. , KOSAKA Y. 
Published: February 2007

SummaryThe eflect of lumbar or thoracic extradurul anaesthesia on the ventilatory response to progressive isocapnic hypoxaemia was studied in two groups of 10 unpremeditated patients. The ventilatory measurements were taken twice, before and 20 min after the administration of 10 ml of lignocaine 2%. Lumbar extradural anaesthesia did not change the slope of the hypoxic response curve, but it significantly increased minute ventilation by 27% at an arterial oxygen saturation of 90%. Thoracic extradural anaesthesia was not associated with any changes in either index. We conclude that neither lumbar nor thoracic extradural anaesthesia impairs the ventilatory response to progressive isocapnic hypoxaemia.
Sedation with propofol during surgery under local blockade
Authors: SKIPSEY I. G. , COLVIN J. R. , MACKENZIE N. , KENNY G. N. C. 
Published: February 2007

SummaryThe ability of a target‐controlled propofol infusion system to provide sedation for 40 patients undergoing surgery under regional blockade was assessed. Eighty‐eight per cent of the total infusion time was at the desired sedation level with little oversedation. This was achieved with a median blood propofol concentration of 0.93 μg.ml−1. The pharmacokinetic algorithm performed as well when used for sedation as for total intravenous anaesthesia. The predicted and measured blood propofol concentrations showed a bias of—12% and a precision of 34%.
The minilink breathing system: resistance and suitability for spontaneous ventilation
Authors: O'MEARA M. E. , BHATT S. B. , BREEN D. , BENNETT N. R. 
Published: February 2007

SummaryThe Portex infant breathing/ventilation systems with 8.5 mm and 15 mm internal diameter connectors were compared with a standard T‐piece which had a 15 mm connector and 22 mm internal diameter tubing. The differential pressures across each system were measured at constant fresh gas flows up to 30 l.min−1 dry air. Resistance was calculated at flows compatible with quiet respiration and peak inspiratory flow. Flow resistance of the 3.0 mm internal diameter tracheal tube in conjunction with the minilink breathing systems were similar to those previously reported for tracheal tubes alone. However, the minilink breathing system assumed a greater influence on resistance when tracheal tubes of larger internal diameter were used. It added considerably more resistance than the standard tubing. This may have a deleterious effect during spontaneous ventilation in older children.
Interaction of H2‐receptor antagonists and benzodiazepine sedation
Authors: SANDERS L. D. , WHITEHEAD C. , GILDERSLEVE C. D. , ROSEN M. , ROBINSON J. O. 
Published: February 2007

SummaryH2‐receptor antagonists differentially inhibit cytochrome P450 and this may affect the rate at which benzodiazepines are metabolised. However, it is not known whether this delayed clearance results in prolonged psychomotor impairment. In a randomised double‐blind trial 28 healthy volunteers received two single doses of midazolam (0.07 mg.kg−1) at an interval of one week during which they took cimetidine 400 mg, ranitidine 150 mg or placebo, each twice daily. Recovery from the benzodiazepine was monitored on each occasion over a 12 h period using a battery of psychometric tests. There was wide individual variation in performance; however, an overall measure of impairment indicated a significant difference at 2.5 h (p < 0.05), the cimetidine group having a high impairment score. This decrement appeared to be in cognitive and psychomotor functions and was not reflected in the subjective assessment.
Topical nitroglycerine prevents the pressor response to tracheal intubation and sternotomy in patients undergoing coronary artery bypass graft surgery
Authors: MAHAJAN R. P. , RAMACHANDRAN R. , SAXENA N. 
Published: February 2007

SummaryThirty adult patients who underwent coronary artery bypass graft surgery were allocated randomly to one of two equal groups to receive either 2% nitroglycerine, or a placebo ointment, applied topically over an area of 5 cm by 10 cm, in a double‐blind manner, 1 h before induction of anaesthesia. Premedication consisted of oral diazepam 5–10 mg, intramuscular morphine 0.2 mg.kg−1 and promcthazine 0.4 mg.kg−1. Anaesthesia was induced with morphine 0.15–0.2 mg.kg−1 and thiopentone 3–5 mg.kg−1. Laryngoscopy and tracheal intubation were facilitated by suxamethonium 1.5 mg.kg−1, and pancuronium 0.1 mg.kg−1 was used for subsequent muscle relaxation. Anaesthesia was maintained with 0.5% halothane and 40% oxygen in nitrous oxide. A significant increase in blood pressure occurred during and after laryngoscopy and tracheal intubation, and following midline sternotomy in the control group. These changes were absent in patients pretreated with topical nitroglycerine. The nitroglycerine group also maintained a lower rate‐pressure product than the control group. We conclude that topical nitroglycerine is a simple and useful pretreatment to prevent the pressor response to tracheal intubation and midline sternotomy in patients undergoing coronary artery bypass graft surgery.
Leg elevation and wrapping in the prevention of hypotension following spinal anaesthesia for elective Caesarean section
Authors: ROUT C. C. , ROCKE D. A. , GOUWS E. 
Published: February 2007

SummaryNinety‐seven parturients undergoing elective Caesarean section were allocated randomly to have their legs elevated to approximately 30° on pillows or elevated and wrapped with elasticated Esmarch bandages or neither (controls) following spinal anaesthesia. All patients received intravenous crystalloid (20 ml.kg−1 over 20 min) prior to spinal injection and were placed in the left lateral tilt position. Significant hypotension was treated with intravenous ephedrine in 5 mg bolus doses. Leg wrapping resulted in a significant reduction in the incidence ofpostspinal hypotension in comparison to the control group (18% compared to 53%, p = 0.004). This represents a five‐fold reduction in the likelihood ofpostspinal hypotension (odds ratio 5.3, 95% CI 1.7–16.3). Leg elevation alone did not significantly reduce the incidence of hypotension (39%). There was no significant difference in the time of onset of hypotension between the groups. For those patients requiring ephedrine, there was no significant difference in mean dose requirements between the groups. The use of leg compression immediately postspinal provides a simple means of reducing the accompanying hypotension and should be used more widely.
Ventilatory effects of pneumoperitoneum monitored with continuous spirometry
Authors: BARDOCZKY G. I. , ENGELMAN E. , LEVARLET M. , SIMON P. 
Published: February 2007

SummaryInspiratory and expiratory tidal volume, peak and plateau airway pressure, compliance of the respiratory system, pressure‐volume and flow‐volume loops were monitored continuously and recorded in seven women undergoing laparoscopy with carbon dioxide insufflation to an intra‐abdominal pressure of 1.6 kPa. All patients were anaesthetised using a total intravenous technique and a constant minute ventilation was maintained. Peak airway and plateau airway pressures increased by 50% and 81% respectively, whilst the compliance of the respiratory system decreased by 47% during the period of increased intra‐abdominal pressure. Following release of the pneumoperitoneum, peak and plateau pressures remained elevated by 37% and 27% respectively, and the compliance was 86% of the pre‐insufflation value. On‐line monitoring of respiratory volumes, pressures and compliance may be helpful during general anaesthesia for laparoscopic procedures to avoid the potential harmful effects of increased airway pressures occurring with increased intra‐abdominal pressure.
The Miller tracheal cuff pressure control valve
Authors: PAYNE K. A. , MILLER D. M. 
Published: February 2007

SummaryA constant pressure differential valve for the control of tracheal tube cuff pressure was tested under clinical conditions. Fifty‐one patients underwent controlled ventilation and 20 patients were allowed to breathe spontaneously. Nitrous oxide 66% with oxygen 33% and halothane were used via a circle system. With controlled respiration at afresh gas flow of 3–10 l.min −1, the expiratory cuff pressures of 10.1–16 cmH2sO and the inspiratory cuff pressures of 23.4–32.4 cmH2O were below venous and arterial mucosal capillary perfusion pressures respectively. Cuff pressures were unaltered with time. Methylene blue instilled into the larynx did not appear in the trachea. Fifty‐two control patients had the same incidence of sore throat (40%) and hoarseness (30%) at 24 h. With spontaneous ventilation, fresh gas flows of 5–15 l.min−1 maintained the cuff pressure above 10 cmH2O. We conclude that this valve prevents excessive tracheal cuff pressure while maintaining the airway seal.
Extradural air as a cause of paraplegia following lumbar analgesia
Authors: NAY P. G. , MILASZKIEWICZ R. , JOTHILINGAM S. 
Published: February 2007

SummaryA 52‐year‐old woman with chronic back pain presented for lumbar extradural analgesia. The ‘loss of resistance to air’ technique was used to locate the extradural space. Prolonged paraesthesia and paresis of the left leg occurred following the procedure. Urgent lumbar computed tomography scan revealed nerve root displacement due to extradural air.
Local anaesthesia for eye surgery without a facial nerve block
Authors: Sanchez‐Capuchino A. , Meadows D. , Morgan L. 
Published: February 2007

SummaryTraditionally, local anaesthesia for cataract surgery requires retrobulbar blockade to be supplemented with a facial nerve block in order to prevent blepharospasm. In this study retrobulbar block using a larger volume of local anaesthetic without facial nerve block is compared with the combined technique in 50 patients. The adequacy of the two techniques was assessed by the surgeon according to eye motility (in four different planes). lid motility and eye softness and an overall surgical assessment was made at the end of the procedure. Blepharospasm did not occur. The operating conditions were equally good in both groups (p > 0.05). These results suggest that good operating conditions for cataract operations can be provided by retrobulbar block alone without supplementary facial nerve block.
Anaesthesia for gynaecological laparoscopy—a comparison between the laryngeal mask airway and tracheal intubation
Authors: Swann D. G. , Spens H. , Edwards S. A. , Chestnut R. J. 
Published: February 2007

SummaryIn a single‐blind, randomised, controlled study, we compared two anaesthetic techniques in 60 patients undergoing gynaecological laparoscopy. In the first group, ventilation was controlled, after paralysis and tracheal intubation. In the second group, a laryngeal mask airway was inserted and spontaneous or assisted ventilation allowed. There were no clinically significant differences in the intra‐operative conditions of the two groups, although the procedure was quicker in the second group. The only significant difference in morbidity was a greater incidence of nausea and vomiting in the second group in the first 4 h after operation. We conclude that use of the laryngeal mask airway is an acceptable technique for elective gynaecological laparoscopy, in patients who are at low risk of regurgitation.
Deaths associated with dentistry and dental disease 1980–1989
Authors: Coplans M. P. , Curson I. 
Published: February 2007

SummaryA study of deaths associated with dentistry and dental disease in England and Wales between 1980 and 1989 has been undertaken. There were fewer deaths associated with dentistry than in the previous decade. Whilst most of the deaths are still associated with general anaesthesia, the total number has decreased, as has the percentage of deaths in which general anaesthesia was thought to play a significant part. There were only four deaths involving an operator/anaesthetist compared with 13 in the previous decade and all four took place between 1980 and 1983. However, there were two deaths associated with sedation techniques, both of which occurred after 1984, whereas there had been none in the previous decade. On the information available, it is still not possible to establish the role of the patient's posture in these deaths.
A comparison between propofol and desflurane anaesthesia for minor gynaecological laparoscopic surgery
Authors: GRAHAM S. G. , AITKENHEAD A. R. 
Published: February 2007

SummaryFifty‐seven healthy female patients who underwent gynaecological laparoscopic surgery received either desflurane or propofol for induction and maintenance of anaesthesia. Inhalational induction was generally well tolerated, and consciousness was lost in approximately 2 min (mean end‐tidal concentrations of desflurane were 8.3% with 60% nitrous oxide, and 7.1% with oxygen). Recovery of consciousness and orientation were more rapid in patients in whom anaesthesia was maintained with desflurane than with propofol, but there were no differences in psychomotor function test scores at 30 min. The data suggest that desflurane provides controllable anaesthesia and rapid recovery of consciousness after laparoscopic surgery.
Peri‐operative nightmares in surgical patients
Authors: Brimacombe J. 
Published: February 2007

SummaryA questionnaire was designed which made specific enquiries about peri‐operative nightmares and general enquiries regarding peri‐operative hallucinations, sleep disturbance and pain. The questionnaire was completed by four groups of patients. Groups 1 and 2 comprised patients who had undergone elective cardiac surgery and major noncardiac surgery respectively. Group 3 comprised patients undergoing day surgery. Group 4 consisted of 100 randomly selected patients who had undergone minor elective surgery to the upper or lower limbs during the preceding 2 years, half of whom had received regional and half general anaesthesia. Two hundred and seventy‐one completed questionnaires were analysed. In all, 18.5% of patients had experienced at least one nightmare during the postoperative week and and the highest incidence (27.9%) was found in group 1. Nightmares occurred most commonly on the fourth postoperative night and did not correlate with disturbed sleep, hallucinations or any other symptom recorded. Patients in group 1 reported the highest incidences of disturbed sleep (54.8%) and hallucinations (12.5%).
Orotracheal intubation in patients with potential cervical spine injuries
Authors: Nolan J.P. , Wilson M.E. 
Published: February 2007

SummaryThe conditions for emergency tracheal intubation of patients with cervical spine injury were simulated in 157 patients during induction of anaesthesia for routine surgery. The view of the larynx obtained during laryngoscopy with the head in the optimum intubating position was compared with that obtained when manual in‐line stabilisation of the cervical spine and cricoid pressure were used. During laryngoscopy with cervical stabilisation, the view of the larynx was reduced in 45% of patients, and in 22% of patients nothing was visible beyond the epiglottis. To assess the ease of intubation with the neck stabilised and with cricoid pressure applied, patients were randomised to either direct visual intubation (n = 79), or intubation aided by a gum elastic bougie (n = 78). The median time taken for visual intubation was 20 s, but in six patients intubation took over 45 s. In addition, five patients in this group could not be directly intubated. Using the gum elastic bougie all patients, including the failures from the visual group, were intubated within 45 s (median 25 s). We recommend the gum elastic bougie as an aid to intubating the patient with suspected cervical spine injury, particularly when the glottis is not immediately visible.
Cardiorespiratory arrest following combined spinal epidural anaesthesia for Caesarean section
Authors: MYINT Y. , BAILEY P. W. , MILNE B. R. 
Published: February 2007

SummaryA 31‐year‐old woman had an elective Caesarean section under combined spinal/epidural anaesthesia. At the end of the operation, diamorphine 2.5 mg in 5 ml of 0.25% bupivacaine plain was injected through the epidural catheter. Forty minutes after this, the patient had a Cardiorespiratory arrest in an ordinary postnatal ward.