bluuebunny/crossref_metadata_2025_split huggingface dataset:
Harold King
Authors: GRAY T. C. 
Published: February 2007

SummaryHarold King was an analytical chemist of distinction, who worked with Sir Henry Dale and his colleagues in the Medical Research Institute, later the Medical Research Council. He helped to quash the theory that the anaesthetic action of ether was attributable to its impurities. Interest in alkaloids led to the elucidation of the structure of hyoscine, the synthesis of muscarine and the first isolation of crystalline tubocurarine for which he proposed a structural formula, work which influenced Bovet in the synthesis of gallamine. He proposed the synthesis of the homologous series of methonium compounds which included relaxant and hypotensive drugs. His collaboration with Rosenheim was outstanding and opened the way for synthesis of cholesterol and the steroids. He was always encouraging clinicians, and gave a sample of tubocurarine to Ranyard West who was the first to inject d‐tubocurarine into a human patient.
The first 24 hours after surgery
Authors: GAMIL M. , FANNING A. 
Published: February 2007

SummaryThe first 24 hours of the postoperative course of 2153 consecutive patients who had operations at the Nottingham Hospitals were studied in detail. Five per cent of patients had serious complications during this period; 15% of those having major operations, 1.8% having intermediate operations and 1.4% having minor operations. Thus, a significant number of patients were in an unstable condition for many hours after they were discharged from the main theatre recovery areas to the surgical wards. In 17 out of 23 patients who died and six out of six patients who suffered severe disability as a result of their surgery, the final outcome was a direct result of a sequence of events which began with an initial deterioration within 24 hours of surgery. We considered that, for at least 10 of these 29 patients, the outcome might have been different had more sophisticated postoperative facilities been available. In the light of this study we have identified the operations for which high dependency facilities are most likely to be required.
Intra‐arterial blood sampling for clotting studies
Authors: LEW J. K. L. , HUTCHINSON R. , LIN E. S. 
Published: February 2007

SummaryProthrombin time and activated partial thromboplastin time were measured in two groups of 30 patients each. Blood sampled from an arterial line after various discard volumes and from a central venous line were compared with direct venipuncture control samples. The arterial line flushing solution contained 1 unit of heparin per ml in group 1 and 2 units per ml in group 2. Our results confirmed that clotting studies carried out on blood samples from an arterial line or central venous line correlate well with those obtained from a venipuncture sample. The only exception was activated partial thromboplastin time in group 2 patients when the discard volume from the arterial line is only 2.5 ml above the deadspace volume of the connecting line. At least 5 ml of discard volume must be withdrawn before sampling, to obtain reliable results.
An assessment of the Cerebrotrac 2500 for continuous monitoring of cerebral function in the intensive care unit
Authors: SHEARER E. S. , O'SULLIVAN E. P. , HUNTER J. M. 
Published: February 2007

SummaryExperience of the use of the Cerebrotrac 2500 EEG monitor in 17 patients subjected to artificial ventilation in an intensive care unit is reported; seven were receiving continuous sedation with morphine, midazolam and propofol singly or in combination and 10 received both sedation and the neuromuscular blocking agent, atracurium. The processed EEG patterns could not be precisely correlated with a standard clinical scoring system but were useful in determining the adequacy of sedation, particularly when a muscle relaxant was used. The monitor also shows considerable promise in the management of the paralysed patient with widespread convulsive activity in whom ischaemic brain damage may be occurring from epileptiform activity in the absence of any clinical manifestation. The ability to detect cerebral irritability or isolated epileptiform discharges using this apparatus is, however, questionable. The equipment was easy to use and robust; the running costs were 9.5p per hour.
The Extensometer
Authors: BRIMACOMBE J. R. , MACFIE A. G. , McCRIRRICK A. 
Published: February 2007

SummaryThe Extensometer is a new device capable of continuous accurate measurement of length over convex surfaces with a rapid response rate. This makes it a powerful research tool and a useful clinical instrument, particularly in the field of respiratory monitoring. This paper describes the principles behind the device. The linearity of its response was demonstrated in laboratory tests and its ability to quantify abdominal and chest wall movement was assessed in anaesthetised patients. Potential applications in the field of ventilatory pattern analysis and respiratory monitoring in anaesthesia and intensive care are discussed.
The Alton Dean pressure infusor: an evaluation
Authors: LALOR J. M. , ORTIZ J. C. G. , HOLDCROFT A. 
Published: February 2007

SummaryAn automatically pressurised infusor system, the Alton Dean infusor, has been compared with two types (cloth and plastic) of commonly used pneumatically pressurised bags. All the infusors had reasonably accurate pressure gauges but pressure could only be consistently maintained with the cloth infusors or with the Alton Dean infusors when connected to a compressed air supply. Sequential fast infusions were possible with all infusors, but simultaneous infusions could be limited in number when the pressure infusor was connected directly to pipeline gas. One of the Alton Dean pressure infusors tested had a leak in the pressurisation system, and the pressure adjustment valves were difficult to manipulate. These may require modification.
The role of the teaching hospital
Authors: Mulholland D. , Weir P. S. 
Published: February 2007

SummaryAll trainee anaesthetists on the Northern Ireland training scheme were surveyed about the techniques they use when anaesthetising elective paediatric cases. We compared the practice of doctors with specialist paediatric training to that of others and discovered that trainees with specialist training were more likely (p < 0.05) to admit parents during induction, but were less likely (p < 0.05) to visit their patients pre‐operatively and routinely to use suxamethonium. Other general findings were confusion over the re‐use of halothane and extensive involvement of trainee anaesthetists in neonatal resuscitation.
Dose‐response relationship and time course of action of Org 9426
Authors: LAMBALK L. M. , DE WIT A. P. M. , WIERDA J. M. K. H. , HENNIS P. J. , AGOSTON S. 
Published: February 2007

SummaryThe dose‐response relationship of Org 9426, its time course of action and the reversibility of the residual block by neostigmine have been investigated in 100 patients undergoing various anaesthetic techniques. The dose‐response was measured immediately following induction of anaesthesia. Doses of Org 9426, required for 50% and 90% depression of the twitch height, were 202 and 328 μg.kg−1, respectively. The clinical duration of the maintenance doses, 150 μg.kg−1, ranged from 9.5 to 13.4 min and from 12.8 to 18.9 min for the first and fifth maintenance doses, respectively. Spontaneous recovery indices (25%‐75%) were between 9.5 and 16.7 min; neostigmine methylsulphate administered at 25% recovery of the twitch height promptly reversed the residual block. No side effects were observed. The extent of the influence of the anaesthetic on the time course of Org 9426 appears to be fractional considering the variation of the time course within the separate groups.
Pain following thoracotomy
Authors: COE A. , SARGINSON R. , SMITH M. W. , DONNELLY R. J. , RUSSELL G. N. 
Published: February 2007

SummaryFifty‐eight patients scheduled for elective thoracotomy were randomly allocated to receive fentanyl by either the thoracic or the lumbar epidural route for postoperative analgesia. The infusion rate was adjusted to optimise analgesia. Dose adjustment, pain assessment and the incidence of side effects were monitored by a blinded observer at set times over the 24 hour study period. Similar pain scores were obtained in both groups at all assessment times. In addition, there was no significant difference in dose requirements or incidence of side effects between the two groups. There appears little justification for the use of the generally less familiar, and potentially more dangerous, thoracic approach when fentanyl alone is infused into the epidural space following thoracotomy.
Sensitivity to curare in patients with upper and lower motor neurone dysfunction
Authors: Fiacchino F. , Gemma M. , Bricchi M. , Giombini S. , Regi B. 
Published: February 2007

SummarySensitivity to the action of nondepolarising relaxants was compared in muscles of upper and lower limbs in four syringomyelic patients undergoing elective neurosurgical procedures. It was observed that muscles with signs of lower motor neurone dysfunction are supersensitive to the action of nondepolarising relaxants. Terminal sprouting of motor axons and the occurrence of newly formed neuromuscular junctions may be responsible for a low synaptic efficacy and may explain the high sensitivity to factors that reduce the safety margin of neuromuscular transmission.
Predicting difficult intubation
Authors: FRERK C. M. 
Published: February 2007

SummaryTwo pre‐operative tests for the prediction of difficult intubation are assessed. A modified Mallampati test and a measurement of thyromental distance were performed at the pre‐operative visit of 244 patients whose tracheas were subsequently intubated under general anaesthesia. Patients in whom the posterior pharyngeal wall could not be visualised below the soft palate, who also had a distance of less than 7 cm between the prominence of the thyroid cartilage and the bony point of the chin proved significantly more likely to present difficulty with intubation. The performance of these two simple tests on all patients before operation should allow the majority of cases of difficult intubation to be anticipated.
Guided isoflurane injection in a totally closed circuit
Authors: El‐Attar A. M. 
Published: February 2007

SummaryTwenty‐six patients undergoing middle ear surgery were anaesthetised using a completely closed circuit into which liquid isoflurane was injected using a syringe pump. The injection rate was guided by a table of calculated rates of isoflurane uptake, utilising the square root of time principle, at succeeding time intervals in different weight groups. A constant alveolar concentration of 1.3 MAC was aimed for. The injection rate was changed to that for the higher or lower weight group appropriate to the time interval whenever clinical signs indicated inappropriate depth of anaesthesia. A mean of10.3 ml liquid isoflurane was used to maintain anaesthesia for a mean of 82.3 minutes. Blood pressure was maintained at 75% of the pre‐operative value. Mean arterial blood gas data and changes in plasma catecholamine levels were within the normal range. The mean recovery time was 10.5 minutes. Syringe pump delivery of liquid isoflurane avoided fluctuations that result from bolus injections of unit dose. The implemented injection rate table, working as a therapeutic window, guided redosing, reduced calculation time and served as a record. The technique is safe, economic and adaptable to variations in uptake and response to inhalational anaesthetics.
Oral fluids prior to day surgery
Authors: Goodwin A. P. L. , Rowe W. L. , Ogg T. W. , Samaan A. 
Published: February 2007

SummaryOne hundred day surgical patients undergoing first trimester termination of pregnancy were randomly allocated to receive either 150 ml of clear fluid 1.5–2 hours before anaesthesia or to remain fasted from midnight the night before. Patients were anaesthetised using a total intravenous technique which consisted of propofol and alfentanil. No adverse intra‐operative events were noted in either group. There were no significant differences in immediate recovery time, or pain, nausea and headache scores at 30 or 120 minutes following recovery. The fasted group had less pain (p < 0.05) at 60 minutes after recovery than the fluid group, although the mean pain scores in both groups were low. Eighty two per cent of the patients returned questionnaires about pain, nausea and headache scores on arriving home, and at 12 and 24 hours after surgery. There were no significant differences between the two groups. In conclusion, pain, nausea and headache scores are low following total intravenous anaesthesia with propofol and alfentanil for termination of pregnancy and these were unaffected by the administration of 150 ml of clear fluid given approximately 1.5 hours pre‐operatively.
Addition of fentanyl to prilocaine for intravenous regional anaesthesia
Authors: ARMSTRONG P. , POWER I. , WILDSMITH J. A. W. 
Published: February 2007

SummaryFifteen volunteers underwent intravenous regional anaesthesia on two occasions using 40 ml 0.5% prilocaine, to which had been added either 2 ml 0.9% saline or 0.1 mg fentanyl (resultant concentration 2.5 μg/ml). There was no difference in the rate of onset of blockade of cold sensation from an ethyl chloride spray, or to sharp and touch pinprick sensation in either group. There was an increase in the incidence of nausea after tourniquet release in the fentanyl group. It is concluded that the addition of fentanyl 2.5 μg/ml to prilocaine 0.5% confers no benefit in intravenous regional anaesthesia.
Vasovagal asystole during spinal anaesthesia
Authors: McCONACHIE I. 
Published: February 2007

SummaryA patient in whom vasovagal asystole was induced by the performance of a spinal anaesthetic in the upright position is described. This illustrates the importance of routine monitoring of the electrocardiograph during regional anaesthesia. The risk of vasovagal syncope may be increased by the use of the sitting position and by the omission of anxiolytic premedication.
Intubation guide marks for correct tube placement A clinical study
Authors: Mehta S. , Mehta S. 
Published: February 2007

SummaryThe tracheas of 140 adult patients were intubated with either TFX or Portex tracheal tubes. Guide marks were printed at variable distances proximal to the tube cuffs, and during intubation the guide mark was positioned at the level of the vocal cords. The distance between the bevel end of the tube and the carina was determined with a fibreoptic bronchoscope. The mean distance between the tip of the tracheal tube and the carina varied between 3.7 and 4.1 cm with the head in the neutral position. The tip of the tracheal tube approaches the carina by a mean distance of 0.5 cm when the head is moved from the extended position to the neutral position. It is recommended that a guide mark be placed 2.5 cm from the proximal end of the cuff in tubes used for adult males and 2.25 cm in tubes used for adult females. The use of guide marks is a simple, safe and reliable method for correct tracheal tube placement.
Patient‐controlled on‐demand epidural fentanyl
Authors: WELCHEW E. A. , BREEN D. P. 
Published: February 2007

SummaryA prospective, open, clinical trial is described in which 20 patients having upper abdominal surgery were randomly allocated to receive fentanyl for postoperative analgesia by patient‐controlled demand analgesic computer by either the epidural or intravenous route. Hourly pain, sedation and nausea scores were very similar in the two groups during the first 24 hours after surgery. What few differences there were favoured the epidural group. There was a highly significant difference in fentanyl consumption between the two groups, with the intravenous group demanding consistently more than twice as much as the epidural group.
Serum bupivacaine concentrations following wound infiltration in children undergoing inguinal herniotomy
Authors: Mobley K.A. , Wandless J.G. , Fell D. , McBurney A. 
Published: February 2007

SummarySerum bupivacaine concentrations were measured in 12 children who underwent elective herniotomy and who received analgesia in the form of wound infiltration. Mean (SD) peak concentration was 0.36 (0.14) μg/ml and time to peak concentration was 14.6 (7.2) minutes after infiltration of 1.25 μg/kg of bupivacaine. These concentrations are lower than those associated with other local anaesthetic blocks and well below potentially toxic levels. Wound infiltration provides a simple, effective and safe method of providing postoperative analgesia for hernia repair in children.
The ‘cuff‐leak’ test for extubation
Authors: Fisher M. McD. , Raper R. F. 
Published: February 2007

SummaryThe ‘cuff‐leak’ test, which involves demonstrating a leak around a tracheal tube with the cuff deflated, has been advocated to determine the safety of extubation in patients with upper airway obstruction. In 62 such patients we were able safely to extubate all patients with a cuff leak. Two patients extubated without cuff leak required reintubation and in five patients who repeatedly failed the test, tracheostomy was performed. Subsequently, we extubated 10 patients who were stable on spontaneous ventilation and did not have cuff leak; three later required tracheostomy and seven were uneventfully extubated. While the presence of cuff leak demonstrates that extubation is likely to be successful, a failed cuff‐leak test does not preclude uneventful extubation and if used as a criterion for extubation may lead to unnecessarily prolonged intubation or to unnecessary tracheostomy.
Initial evaluation of an intracorporeal oxygenation device
Authors: COCKROFT S. , KUO J. , COLVIN M. P. , LEWIS C. T. , INNIS R. F. , WITHINGTON P. S. 
Published: February 2007

SummaryWe describe a recently developed intracorporeal gas transfer device, its potential applications and hazards. To date, patients with potentially reversible respiratory failure have been treated with controlled oxygen therapy and positive pressure ventilation, but this treatment may itself contribute to lung parenchymal damage from barotrauma and oxygen toxicity. Total or partial extracorporeal gas exchange can be used to reduce these risks, but this treatment is complex and has significant morbidity and mortality. This gas exchange device has been designed to provide partial gas transfer with simplicity of insertion and use. The oxygenator lies in the vena cava to provide prepulmonary gas exchange. In preliminary studies with three calves we have shown that the device increases both mean mixed venous and arterial oxygen content and reduces mean arterial carbon dioxide tension.
Pipecuronium versus high dose vecuronium
Authors: HARROP‐GRIFFITHS W. , PLATT M. , HIRSCH N. , FELDMAN S. 
Published: February 2007

SummaryThe onset time and tendency to cumulation of pipecuronium and high‐dose vecuronium were compared during nitrous oxide anaesthesia supplemented with a propofol infusion. Pipecuronium 0.06 mg·kg−1 had a similar duration of action to vecuronium 0.2 mg·kg−1 (49 vs 43). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p < 0.01). Neither pipecuronium nor vecuronium showed marked cumulation.
Suprascapular nerve block
Authors: WASSEF M. R. 
Published: February 2007

SummaryA new approach for the management of frozen shoulder associated with reflex sympathetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified by its response to nerve stimulation. Three ml of 0.25% bupivacaine with 1:200 000 adrenaline was injected. The block was repeated twice weekly for a total of 2–4 treatments. Evaluation of the efficacy of the block was achieved by comparing subjective pain scores and passive range of movement before the first block and after the final one. Highly significant improvements were obtained. The choice of blockade of the suprascapular nerve is a new concept for the management of the frozen shoulder of reflex sympathetic dystrophy. This is based on the fact that the nerve contains a high proportion of sympathetic fibres supplying the shoulder joint. The new approach proved to be simple, highly successful, and reproducible.
Rapidly progressive laryngeal oedema associated with pregnancy‐aggravated hypertension
Authors: ROCKE D. A. , SCOONES G. P. 
Published: February 2007

SummaryWe report a patient with pregnancy‐aggravated hypertension who developed rapid progression of laryngeal oedema intra‐operatively and in whom airway obstruction occurred immediately following extubation. There were no pre‐operative signs to indicate potential airway problems.
Peripartum changes in gastric emptying
Authors: SANDHAR B. K. , ELLIOTT R. H. , WINDRAM I. , ROWBOTHAM D. J. 
Published: February 2007

SummaryApplied potential tomography was ilsed to measure changes in gastric emptying during the peripartum period. Gastric emptying was measured sequentially in each of 10 healthy patients at 37–40 weeks gestation, 2–3 days postpartum and after the 6‐week postnatal assessment (control),‘Aean (SD) times to 50% emptying were 15 (6.05), 11 (5.9) and 15 (5.5) min, respectively. There was no statistically signijicant change in gastric emptying as a result of pregnancy in this group of women. Retrospective power analysis (assuming α= 0.05 and β= 0.20) shows the study design was adequate to detect a difference of 8 min.
Combined epidural/spinal anaesthesia for Caesarean section
Authors: LYONS G. , MACDONALD R. , MIKL B. 
Published: February 2007

SummaryAn evaluation of a 30 gauge spinal needle in a combined epidural/spinal anaesthetic technique for Caesarean section revealed a 25% failure rate of the spinal element. In this unit, no more than 4% of spinal anaesthetics might be expected to fail. One of the reasons for the higher failure rate was that, when using the Tuohy needle as an introducer, the dura was not identified. This prompted us to compare the ‘hrough‐the‐ Tuohy’ or needle within needle approach for combined epidural/spinal anaesthesia, with a technique that involved siting the epidural and spinal sequentially in separate spaces. One hundred women requiring elective Caesarean section under spinal anaesthesia were randomised into single or double space groups. The technique failed in 16% of through‐the‐needle cases, and in 4% of sequential sitings. Combined spinal/epidural anaesthesia for Caesarean section is more successful if each procedure is performed using separate spaces.
Hoarseness after tracheal intubation
Authors: JONES M. W. , CATLING S. , EVANS E. , GREEN D. H. , GREEN J. R. 
Published: February 2007

SummaryThe reported incidence of hoarseness following short‐term tracheal intubation varies widely. It has been reported as being permanent in 3%. This suggests that an enormous problem exists considering the numbers of patients intubated daily in the United Kingdom. A prospective study of 235 adult patients undergoing general anaesthesia in a district general hospital included 167 patients whose tracheas were intubated. Of these 167, 54 (32%) complained of hoarseness postoperatively. All but five returned to normal within 7 days. The others were hoarse for 9, 10, 12, 54 and 99 days. Those who were hoarse for 54 and 99 days had vocal cord granulomata. Regression analyses showed that certain patient and anaesthetic factors had a significant effect on the hoarseness. This study confirms a low incidence of prolonged or permanent hoarseness following short‐term tracheal intubation.