bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra‐articular morphine and bupivacaine analgesia after arthroscopic knee surgery
Authors: Haynes T. K. , Appadurai I. R. , Power I. , Rosen M. , Grant A. 
Published: February 2007

SummaryWe assessed the effectiveness of intra‐articular solutions of morphine, bupivacaine with adrenaline and a combination of both, compared with placebo in facilitating mobilisation and reducing postoperative pain and analgesic requirements for 24 h after operation. Forty patients undergoing arthroscopic knee surgery were studied in a double‐blind, randomised, controlled trial. All treatments proved more effective than placebo in facilitating earlier mobilisation and in decreasing postoperative pain as measured by visual analogue scale. Morphine alone provided the best analgesia and significantly decreased analgesic consumption for 24 h after surgery. We conclude that 1 mg of intra‐articular morphine provides effective pain relief following arthroscopic knee surgery and that the addition of bupivacaine is of no benefit.
Postoperative pain relief in children
Authors: Ryhänen P. , Adamski J. , Puhakka K. , Leppäluoto J. , Vuolteenaho O. , Ryhänen J. 
Published: February 2007

SummaryTwo hundred and fifty children undergoing herniotomy or orchidopexy under general anaesthesia were randomly allocated to receive pre‐operatively either diclofenac sodium 1 mg.kg‐1 given intramuscularly or a caudal injection of bupivacaine 0.25% 1 ml.kg‐1 with or without adrenaline or no analgesia. Plasma diclofenac and beta‐endorphin concentrations were determined in eight and 21 patients respectively. Postoperative pain was assessed by ward nurses who were blinded to the group allocation. Comparison with the control group showed diclofenac to be an effective analgesic. Caudal bupivacaine provided more pain‐free children during the early postoperative hours, but later the need for pethidine as rescue analgesic was lower among the children who had received intramuscular diclofenac. Caudal analgesia abolished the stress‐induced increase in plasma beta‐endorphin level which was found in the children given diclofenac and in those who served as controls. Total plasma clearance of intramuscular diclofenac sodium appears to be higher in children than in adults. A single intramuscular dose of diclofenac significantly reduces the need for an opioid analgesic in children after inguinal herniotomy or orchidopexy, and owing to its long duration of action, it offers an alternative or complementary method of pain relief to caudal analgesia.
The use of a visual aid to check anaesthetic machines
Authors: GROVES J. , EDWARDS N. , CARR B. 
Published: February 2007

SummaryWe asked 20 anaesthetists and seven operating department assistants to check three anaesthetic machines‘doctored’to contain errors of varying seriousness, and recorded their performances. Two weeks later we asked the same group to repeat the test. On the second occasion they followed a visual aid and filled in a questionnaire about the test. Participants showed a significant improvement in the rate of fault detection when using the aid (p < 0.05). The visual aid was most useful at increasing the detection rate of machine leaks. Of the participants, 60% considered that the visual aid was helpful and 74% thought that such an aid should be available in our theatre complex. Sixty‐six percent of those questioned felt that a formal check list would be of use.
Cuffed nasopharyngeal tube as‘dedicated airway’in difficult intubation
Authors: RALSTON S. J. , CHARTERS P. 
Published: February 2007

SummaryA cuffed nasopharyngeal airway was used in five cases of difficult intubation, initially to maintain anaesthesia, and subsequently to act as a landmark for the passage of a fibreoptic laryngoscope loaded with a tracheal tube. In all cases, airway patency was well preserved with the device and there were no significant problems with its use. The notion of a‘dedicated airway’for difficult intubation cases is developed. A trouble‐free airway will permit time to consider solutions for difficult cases and time for the novice to learn fibreoptic laryngoscopy technique.
The Sparklet carbon dioxide Resuscitator
Authors: WRIGLEY M. , NANDI P. 
Published: February 2007

SummaryThe use of carbon dioxide in resuscitation was advocated in the 1920s and 1930s. A device, the Sparklet Resuscitator, was marketed to allow the administration of carbon dioxide gas. This piece of equipment is described and the indications for its use in resuscitation reviewed. The use of carbon dioxide appeared to have a degree of support and success as a‘universal’aid to resuscitation.
Routine pre‐oxygenation using a Hudson mask A comparison with a conventional pre‐oxygenation technique
Authors: Hett D. A. , Geraghty I. F. , Radford R. , House J. R. 
Published: February 2007

SummaryTwo techniques of pre‐oxygenation were studied by continuous analysis of respired gases using a mass spectrometer in 10 healthy volunteers. The first was a conventional technique as commonly used in anaesthesia with a Bain system and tightly‐fitting anaesthetic facemask and an oxygen flow of 8 l.min‐1. The second technique also used a Bain system with an oxygen flow of ‐8 l.min‐1, but with a Hudson mask attached. The mean fractional end‐tidal oxygen concentrations after 3 min were 0.812 and 0.46 respectively for each of the pre‐oxygenation techniques against 0.16 for subjects breathing air. This represents a considerable increase in pulmonary oxygen reserve for both techniques. The second technique is not an alternative to conventional pre‐oxygenation for emergency anaesthesia, but is a useful and simple method that is acceptable to both patient and anaesthetist in routine cases.
Patients’desire for information about anaesthesia: Australian attitudes
Authors: Farnill D. , Inglis S. 
Published: February 2007

SummaryPatients in a medium‐sized Australian suburban general hospital were asked to complete a pre‐operative questionnaire concerning their desire for information about their impending anaesthesia. The results are compared with those of Canadian and Scottish studies published recently. The Australian patients had a higher preference for information about complications, although some patients, mainly elderly, did not want to know about unpleasant aspects of peri‐operative procedures or potential complications. As in the other countries, patients under the age of 50 years had a greater desire for information than those who were older (p < 0.05). All national groups accorded highest priority to meeting the anaesthetist before surgery. The results are discussed in relationship to the requirements for informed consent.
The influence of nasal obstruction and its relief on oxygen saturation during sleep and the early postoperative period
Authors: Serpell M. G. , Padgham N. , McQueen F. , Block R. , Thomson M. 
Published: February 2007

SummaryNasal obstruction causes abnormal breathing patterns during sleep which often result in hypoxaemia. We studied the effect of nasal obstruction on arterial oxygen saturation in 20 healthy patients undergoing elective surgery which required bilateral nasal packing. Ten patients were subject to complete nasal obstruction while the remaining half had the obstruction relieved by the insertion of nasal cannulae. We found that nasal obstruction did not have any detrimental effect on the already low incidence of oxygen desaturation. There was no effect of the cannulae on the degree or frequency of hypoxaemia, although they did appear to improve the quality of sleep during the first postoperative night. They were more comfortable by day than simple packing alone and no adverse effects were observed.
Risk factors for postoperative nausea and vomiting
Authors: KENNY G. N. C. 
Published: February 2007

SummaryAlthough the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. The inhalational agents are variably associated with postoperative nausea and vomiting, and nitrous oxide is particularly emetogenic. Older inhalational anaesthetics, such as cyclopropane, are associated with a high incidence, while the currently used agents, isoflurane, enflurane and halothane, cause less, but still significant postoperative nausea and vomiting. Intravenous anaesthetics are also associated with differing degrees of emesis, though the newer agent, propofol, may be less emetogenic than the older anaesthetics. Opioids, used extensively throughout surgery, are further strong emetogens. Patient factors are also important — postoperative nausea and vomiting is three times more prevalent in adult females than in males, and children are around twice as susceptible as adults. Furthermore, a previous history of postoperative nausea and vomiting or motion sickness is a known risk factor. Superimposed on this is the type of surgery — abdominal and gynaecological surgery are particularly emetogenic, and the incidence of postoperative nausea and vomiting following strabismus surgery is high. Increased quality of healthcare, and a growing awareness of the importance of patient satisfaction, are providing new incentives to ensure that postoperative nausea and vomiting is dealt with adequately.
Single dose intravenous ondansetron for the 24‐hour treatment of postoperative nausea and vomiting
Authors: CLAYBON L. 
Published: February 2007

SummaryPostoperative nausea and vomiting is a major concern for patients undergoing outpatient surgery under general anaesthesia, and may complicate and delay discharge from hospital. This paper evaluates the safety and efficacy of ondansetron, a 5‐HT3 receptor antagonist, in the treatment of postoperative nausea and vomiting. One thousand patients in 30 centres in the United States who received general anaesthesia and developed postoperative nausea and vomiting were studied. In a randomised, double‐blind, stratified and parallel designed protocol, patients received either ondansetron 1, 4, 8mg or placebo for nausea or vomiting occurring within 2 h of entry into the Post Anaesthesia Care Unit. Subsequent episodes of vomiting, nausea scores, laboratory and clinical safety data and adverse events were evaluated during the 24‐h study period. In a separate study, pharmacokinetic data were compared for intramuscularly and intravenously administered ondansetron. Each dose of ondansetron was significantly better than placebo in reducing nausea from control values during the initial 2‐h study period, and in preventing further emesis over 24 h. There were no significant differences in the incidence of adverse events, changes in laboratory values or measures of vital signs in the ondansetron groups compared to the placebo group. Dose comparisons between the three treatment groups showed that ondansetron 4 mg is the optimal dose to treat postoperative nausea and vomiting. Ondansetron is a well tolerated, efficacious antiemetic which has a similar side effect profile to placebo. Intramuscular administration has the same systemic availability as intravenous administration. Ondansetron 4mg appears to be the optimal dose for the treatment of postoperative nausea and vomiting in patients with or without a positive history.
The effect on laryngoscopy of different cervical spine immobilization techniques
Authors: HEATH K. J. 
Published: February 2007

SummaryFifty patients underwent laryngoscopy with two different cervical spine immobilisation techniques. First the cervical spine was immobilised in a rigid collar with tape across the forehead and sandbags on either side of the neck, then with an assistant providing manual in‐line immobilisation. Finally, patients underwent laryngoscopy in the routine intubating position. In 56% of patients the view of the larynx improved by one grade and in 10% the view improved by two grades when manual immobilisation was substituted for the collar, tape and sandbags (p < 0.0001). There was a poor view on laryngoscopy (grade 3 or 4) in 64% of patients when immobilised in a collar, tape and sandbags compared to 22% of patients undergoing in‐line manual immobilisation (p < 0.001). Mouth opening was significantly reduced when patients were wearing cervical collars and this was the main factor contributing to the increased difficulty of laryngoscopy in this particular form of cervical spine immobilisation. It is recommended that manual in‐line immobilisation should be the method of choice for cervical spine stabilisation during tracheal intubation.
Acid aspiration prophylaxis in elective biliary surgery A comparison of omeprazole and famotidine using manually aided gastric aspiration
Authors: Vila P. , Espachs P. , Echevarria V. , Garcia M. , Rincón R. , Vidal F. 
Published: February 2007

SummaryWe have compared the effects of single oral doses of omeprazole 40 mg, famotidine 40 mg or placebo on gastric secretion in 45 non‐obese patients the night before elective biliary surgery. After stable anaesthesia had been established, a Salem orogastric tube was introduced and gastric contents were aspirated by a blinded observer. The volume and pH were noted. After the abdomen was opened aspiration was repeated but on this occasion with the surgeon's manual assistance. We found that the initial aspirate volume underestimated total gastric volume by an average (SD) of 7.1 (6.6) ml. Famotidine, but not omeprazole, produced a significant decrease in gastric volume and acidity. Patients were considered to be at risk if pH < 2.5 and volume > 0.4ml.kg‐1. Three patients in the omeprazole group, three in the placebo group and none in the famotidine group came into this category. We conclude that a single oral dose of omeprazole 40 mg given the night before surgery does not afford adequate prophylaxis for acid aspiration syndrome.
A multilumen catheter guide for difficult airway management
Authors: DHARA S. S. 
Published: February 2007

SummaryA multilumen catheter guide (jet stylet) with an adapter has been used for various manoeuvres in the upper airway. With the split length, procedures such as change of tracheal tube from oral to nasal or nasal to oral position, are possible while the patient's lungs are ventilated by means of high frequency jet ventilation. During high frequency jet ventilation for longer periods of time, for example for microlaryngeal surgery, the central channel of the catheter is used as a conduit for jet delivery, whilst the other channels are used for continuous monitoring of airway pressure and concentration of carbon dioxide in the upper airway.
Parents in the anaesthetic room—parents’and anaesthetists’views
Authors: McEwen A. W. , Caldicott L. D. , Barker I. 
Published: February 2007

SummaryIn this study parents’and anaesthetists’views were compared, by means of a questionnaire, to assess the benefit of parental presence at induction. One hundred and ninety four unpremedicated children aged 1–16 years underwent daycase surgery. One hundred and eighty four parents accompanied their child and felt that their child benefited from this. Anaesthetists rated only 72% of parents as being helpful. Parents who had undergone anaesthesia in the past were less likely, 60% compared with 79% (p < 0.01), to consider themselves as upset than parents who had not. Thirty one percent (44/140) of anaesthetists, compared with 43% (60/140) of parents, felt the child was upset at induction (p < 0.01). Parents judging themselves to be upset at induction were significantly more likely to consider their child as upset (p < 0.01). Most parents feel that they are of help in the anaesthetic room regardless of whether or not they find it an upsetting experience. Ninety eight per cent would want to accompany their child in the future and we believe this should be allowed unless there are overriding considerations.
A new technique for fibreoptic intubation in children
Authors: HASAN M. A. , BLACK A. E. 
Published: February 2007

SummaryWe describe a technique involving the use of a laryngeal mask airway, fibreoptic bronchoscope and a guide wire to manage the intubation of a child who was known to be a difficult intubation. The technique is simple, atraumatic, permits the use of an adult bronchoscope for infants and children, and allows control of the airway and ventilation throughout the period of intubation.
Effect of ketorolac, ketoprofen and nefopam on platelet function
Authors: DORDONI P. L. , VENTURA M. DELLA , STEFANELLI A. , IANNACE E. , PAPARELLA P. , ROCCA B. , ACCORRA F. 
Published: February 2007

SummaryKetorolac, ketoprofen and nefopam are often used in the treatment of postoperative pain. While nefopam is a non‐narcotic, non‐opioid central analgesic agent, ketorolac and ketoprofen are non‐steroidal anti‐inflammatory drugs, which, due to their prostaglandin‐synthetase inhibiting activity, have antiplatelet effects. In this study we investigated the effect of ketorolac, ketoprofen and nefopam on platelet function by performing bleeding time and in vitro platelet aggregation in 30 healthy volunteers (10 for each treatment) before and 3h after drug administration. Nefopam did not affect bleeding time and platelet aggregation, while ketorolac and ketoprofen significantly prolonged bleeding time without significantly inhibiting platelet aggregation in response to adenosine diphosphate. The prolongation of bleeding time observed after ketorolac and ketoprofen may have clinical relevance and suggests that nefopam could be more safely administered for the treatment of postoperative pain, especially in patients with haemostatic defects or after high bleeding risk surgery.
Scapular and proximal humeral head fractures
Authors: KAM A. C. A. , KAM P. C. A. 
Published: February 2007

SummaryWe report a patient who sustained fractures of the scapula and proximal humeral head as a result of cardioversion during cardiopulmonary resuscitation. It is postulated that the fractures were the result of tetanic muscular contractions involving the proximal humeral heads and the shoulder girdles. This appears to be a previously unreported injury.
Low dose bupivacaine/fentanyl epidural infusions in labour and mode of delivery
Authors: Stoddart A. P. , Nicholson K. E. A. , Popham P. A. 
Published: February 2007

SummaryThe aim of this study was to determine the effect on the instrumental delivery rate of two different concentrations of bupivacaine combined with fentanyl in epidural infusions during labour. Only primiparous women in whom a spontaneous vaginal delivery was anticipated, were included in the study. Those women receiving a higher concentration of bupivacaine and therefore a greater amount of local anaesthetic agent during labour were significantly more likely to have an instrumental delivery with Kielland's rotational forceps (p < 0.01). Those women receiving a lower concentration and smaller amount of bupivacaine were significantly more likely to have an instrumental delivery with Neville‐Barnes forceps (p < 0.05). This provides evidence to support the theory that epidural analgesia may contribute to inadequate rotation of the presenting fetal part due to weakened pelvic floor muscles and that this is more likely to occur when higher concentrations of bupivacaine are used and a greater degree of motor block occurs.
A changing role for intensive therapy: is there a case for high dependency care?
Authors: KILPATRICK A. , RIDLEY S. , PLENDERLEITH L. 
Published: February 2007

SummaryThis observational study examined whether specific characteristics of 1168 patients admitted to a general intensive therapy unit had changed over 4 years. The patients’age, diagnosis, severity of illness on admission (APACHE score), duration of management and outcome were recorded prospectively. The risk of hospital mortality was calculated using the APACHE score modified by the appropriate coefficient for presenting diagnosis. The numbers of admissions increased over the study period from 240 patients in the first year to 344 in the last year. The pattern of diagnoses varied significantly with an increasing proportion of patients being admitted for postoperative observation in later years. There was a significant reduction in duration of admission with 70% of patients being admitted for ≤ 3 days in 1988–89 while a similar proportion were admitted for a week in 1985–86. Approximately 40% of patients in each year were admitted with a risk of hospital mortality of ≤ 10%; such patients received only a short period of intensive care and had a low mortality in the intensive therapy unit. A group of patients with a low predicted (and actual) mortality rate was identified; such patients may be more appropriately managed on a high dependency unit.
Emergency intubation through the laryngeal mask airway The effective application of cricoid pressure
Authors: SWAYNE P. , GREENSLADE G. L. 
Published: February 2007

SummaryA patient with Kugelberg‐Welander disease presented as an unexpected difficult intubation. Tracheal intubation was achieved through the laryngeal mask airway, while regurgitation was prevented with continuous cricoid pressure. Regurgitation occurred after cricoid pressure was released.
Arterial oxygenation and mean arterial blood pressure in patients undergoing total hip replacement: cemented versus uncemented components
Authors: NOLAN J. P. 
Published: February 2007

SummaryArterial oxygen tension and mean arterial blood pressure were measured during total hip replacement with either cemented n = 10) or uncemented components (n = 10). All surgery was performed under general anaesthesia. Compared with baseline values, mean arterial oxygen tension decreased by 16% (p < 0.05) and mean arterial pressure increased by 23% (p < 0.05) and 20% (p < 0.05) after insertion of cemented acetabular and femoral components, respectively. In the uncemented group, arterial oxygen tension and mean arterial pressure remained unchanged after insertion of both components. This implies that for some patients, particularly those with cardiovascular or respiratory disease, the risk of significant immediate complications may be lower with the insertion of uncemented, rather than cemented, components.
End‐tidal carbon dioxide tension during laparoscopic cholecystectomy
Authors: BARAKA A. , JABBOUR S. , HAMMOUD R. , AOUAD M. , NAJJAR F. , KHOURY G. , SIBAI A. 
Published: February 2007

SummaryAn investigation of end‐tidal carbon dioxide tension changes was carried out in 19 healthy adult patients undergoing laparoscopic cholecystectomy. Following induction of anaesthesia, and throughout surgery, the end‐tidal carbon dioxide tension was continuously monitored by capnography. The value following carbon dioxide insufflation increased with time to reach a maximum value after 40 min. Correlation of the individual maximum end‐tidal carbon dioxide tension during laparoscopy with the corresponding baseline value prior to carbon dioxide insufflation showed a positive linear relationship (correlation coefficient 0.86). The correlation showed that an end‐tidal carbon dioxide tension of 5.32 kPa (40 mmHg) can be achieved during laparoscopy when the baseline value is adjusted to around 4.0 kPa (30 mmHg).
Suxamethonium apnoea and the isolated leg
Authors: MITCHELL J. B. , HARROP‐GRIFFITHS W. 
Published: February 2007

SummaryThe anaesthetic management of a patient with an unsuspected homozygous atypical pseudocholinesterase genotype is described. Suxamethonium was administered after an arterial tourniquet had been applied to the patient's right leg. After release of the tourniquet and termination of the anaesthetic it was noted that the patient was able to move his right leg but no other part of his body. This observation was confirmed by the use of a peripheral nerve stimulator and by the patient's own recollections. It is suggested that this occurrence shows that the slow offset of neuromuscular block in patients with atypical pseudocholinesterases who have received suxamethonium is caused by long lasting effects at the neuromuscular junction rather than the continuing presence of suxamethonium in the plasma.