bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electromyography in anaesthesia A comparison between two methods
Authors: PUGH N. D. , KAY B. , HEALY T. E. J. 
Published: February 2007

SummaryTwo instruments measuring evoked compound muscle action potentials (EMG) produced by train of four stimulation of the ulnar nerve were compared. The neuromuscular transmission section of a Datex Anaesthesia and Brain Monitor (ABM), which utilises an integration technique to measure the EMG, and the Medelec MS6, by which amplitude of the EMG was recorded and measured were attached to the same electrodes placed over adductor pollicis. Eight patients scheduled for surgery requiring non‐depolarising neuromuscular blockade were studied. The changes in neuromuscular transmission measured by the two methods correlated well, with no statistically significant difference in results. The ABM provides a simple and accurate automatic measurement of evoked EMG for use in the study of neuromuscular transmission.
Premedication by controlled‐release morphine
Authors: Kay B. , Healy T.E.J. 
Published: February 2007

SummaryIn a double‐blind investigation the effect of oral controlled‐release morphine (MST 30 mg) on pre‐operative anxiety was assessed in 50 patients undergoing cholecystectomy. The effects on anaesthetic requirements and recovery, and postoperative pain were also studied. The patients who received morphine treatment were more sedated than those who received the placebo: however there was no significant difference in the anxiety scores for both groups of patients. During anaesthesia there were no significant differences between the groups, although the group of patients who received morphine required less anaesthetic supplement, and appeared to recover more slowly than the placebo group. One hour postoperatively, the morphine group had significantly less pain and were more sedated than the placebo group: the time to the administration of a postoperative analgesic was also significantly longer in the morphine group than the placebo group.
Enflurane as an analgesic in labour
Authors: McGUINNESS Carol , ROSEN M. 
Published: February 2007

SummaryA comparison of the analgesic efficacy of enfrurane 1% in air with Entonox (50% nitrous oxide in oxygen) was performed in 20 consenting women during the first stage of labour. The two drugs were given in a random sequence to each woman, who also acted as her own control. Pain scores were significantly lower with enfrurane than Entonox, although drowsiness scores were higher. No untoward effects were reported with either agent. The use of enflurane as an analgesic in the first stage of labour warrants further investigation.
Percutaneous arterial cannulation in children
Authors: MARSHALL A. G. , ERWIN D. C. , WYSE R. K. H. , HATCH D. J. 
Published: February 2007

SummaryFor percutaneous arterial monitoring in children, the Medicut (polypropylene) is an appropriate choice of cannula. Morbidity associated with its use is low. We studied blood flow and clinical signs relating to 70 arterial cannulations in 62 patients. In the few patients exhibiting flow disturbances either whilst the cannula was in situ or following decannulation, we observed no associated clinical signs of vascular insufficiency of the forearm, wrist or digits. Also, most patients showed normal, antegrade blood flow past the cannula in situ and following decannulation. Eight patients showed retrograde flow which, in six cases, spontaneously reverted to normal whilst the child was still in hospital. The results of this study increased our conjidence in the appropriateness, safety and ease of use of these polypropylene cannulae in children where peripheral arterial vessel diameters are small.
Forum
Authors: Heath Margaret L. 
Published: February 2007

SummarySerious accidents in which the possibility of equipment‐related hazards are raised have been reported to the Scientific and Technical Branch of the Department of Health and Social Security. The author has examined anonymous summaries of 23 such reports of events which occurred over a 5‐year period. The principle cause of catastrophe in seventeen of the incidents was user error involving disconnexion or misconnexion. Faulty systems of equipment management combined in some cases with inadequate pre‐anaesthetic checking of apparatus were responsible for the other instances. Appropriate systems of equipment management and checking together with meticulous basic clinical monitoring are recommended as the best safeguards in anaesthetic practice.
Nausea and vomiting during spinal anaesthesia
Authors: SPELINA K. R. , GERBER H. R. , PAGELS I. L. 
Published: February 2007

SummaryA randomised, double‐blind investigation was undertaken into the value of metoclopramide and domperidone as anti‐emetics in orthopaedic patients who received spinal anaesthesia. Seventy‐seven patients were divided into three statistically comparable groups: Group I received 10 mg metoclopramide, Group II 10 mg domperidone, and Group III NaCl as placebo. These substances were given intravenously before the spinal puncture. There was a comparable decrease in mean arterial blood pressure (MAP), level of sensory block and dose of tetracaine in all three groups. The patients who were nauseated and/or vomited showed a greater decrease in MA P. The incidence of nausea and/or vomiting in the metoclopramide and the placebo group were similar, 20% and 15% respectively, whereas this complication was apparent in 35% of patients who received domperidone. We conclude that metoclopramide and domperidone in the dosages used are ineffective in alleviating nausea and vomiting after spinal anaesthesia.
Continuous sciatic nerve block
Authors: SMITH B. E. , FISCHER H. B. J. , SCOTT P. V. 
Published: February 2007

SummaryA technique of continuous sciatic nerve block is described. The method was used to relieve pain from ischaemic gangrene of the foot for 2 days before below‐knee amputation and, combined with a continuous inguinal paravascular block, to provide regional anaesthesia both for the surgery and for the first 2 postoperative days.
Sacro‐iliitis in a heroin addict
Authors: GOMAR C. , LUIS M. , NALDA M. A. 
Published: February 2007

SummaryA case is presented of a pregnant heroin addict patient, with a septic sacro‐iliitis due to Staphylococcus aureus. The incidence of joint infections in heroin addicts and the difficulty of diagnosis is discussed with the potential risks of spinal or extradural anaesthesia when there is infection in joints close to the needle site. Caution is advised with patients addicted to heroin who have low, back pain and may have infectious sacro‐iliitis.
Diazepam premedication in children
Authors: FELL D. , GOUGH M. B. , NORTHAN A. A. , HENDERSON C. U. 
Published: February 2007

SummaryOral diazepam 0.25 mg/kg or 0.5 mg/kg was employed as premedication in one hundred and one children undergoing elective surgery. The drug failed to modify the rise in cardiorespiratory indices of pre‐anaesthetic anxiety compared with control values, and there was no difference between the two doses assessed by a sedation scoring system. 0.25 mg/kg diazepam produced less sedation in children under 5 years old, compared with those 5 years and older, whereas 0.5 mg/kg produced no difference between the older and younger age groups. The plasma levels of diazepam were greater postoperatively in the 0.5 mg/kg group. There was no relationship between plasma diazepam and recall at induction, and pre‐anaesthetic amnesia was not enhanced with the higher premedication dose.
Variations on a theme: splitting ratio
Authors: Leigh J.M. 
Published: February 2007

SummaryAn expression for the splitting ratio (bypass gas/gas through vaporizing compartment) is derived formally. The factors affecting volatile agent gaseous fraction and, more importantly, partial pressure are discussed in relation to changes in temperature and barometric pressure. Low‐boiling point, high saturated vapour pressure anaesthetics are more susceptible to the influence of barometric pressure variations.
A comparison of the induction characteristics of thiopentone and propofol (2, 6‐di‐isopropyl phenol)
Authors: FAHY LEONORA T. , van MOURIK G. A. , UTTING J. E. 
Published: February 2007

SummaryA study has been undertaken to compare the induction characteristics of the new intravenous anaesthetic agent 2,6 di‐isopropyl phenol, newly prepared in a lipid emulsion (propofol) with those of thiopentone. Despite a significantly higher incidence of pain on injection and spontaneous movement, the new agent was felt to perform comparably to thiopentone as an induction agent. Unfortunately, propofol caused decreases in blood pressure which were significantly greater than those seen after thiopentone. This feature may prove to be a considerable hurdle to the general acceptance of propofol.
Respiratory effects of epidural fentanyl
Authors: AHUJA B. R. , STRUNIN L. 
Published: February 2007

SummaryRespiratory, function following single bolus doses as well as continuous infusions of epidural fentanyl were studied in 21 patients. Respiratory rate decreased significantly and end‐tidal CO2 showed a non significant increase following single doses of epidural fentanyl (1.5 μg/kg). These changes occurred within minutes of injection, hut could not be attributed solely to rapid systemic absorption of fentanyl from the epidural space. Prior administration of parenteral morphine resulted in significantly higher end‐tidal CO2 concentrations and lower respiratory rates following epidural fentanyl. Continuous epidural fentanyl infusion (0.5 μg/kg/hour) started 60 minutes after the bolus dose had no effect on end‐tidal CO2 concentration or respiratory rate for up to 18 hours. Infusions were continued after the study terminated for up to 9 days, during which there was no clinically significant respiratory depression.
Paradoxical air embolism during neurosurgery
Authors: CLAYTON D. G. , EVANS P. , WILLIAMS C. , THURLOW A. C. 
Published: February 2007

SummaryFour cases of air embolism which occurred during neurosurgical procedures in the sitting position are described, in whom the signs could be due to air in the coronary or cerebral arteries. It is suggested that, during venous air embolism in the sitting position, a significant number of patients are haemodynamically at risk from paradoxical air embolism, and that the serious consequences of venous air embolism in neurosurgery may be due to this.
Phaeochromocytoma removal and postoperative hypoglycaemia
Authors: MEEKE R. I. , O'KEEFFE J. D. , GAFFNEY J. D. 
Published: February 2007

SummaryA case of postoperative hypoglycaemia, following removal of a phaeochromocytoma is presented. The hypoglycaemia is due to a reactive rise in insulin and is augmented by alpha adrenoceptor blocking agents. Beta adrenoceptor blockers impair recovery, from this hypoglycaemia. Frequent monitoring of blood glucose and the administration of an appropriate solution of dextrose both during and after this operation is recommended.
Spinal anaesthesia for outpatient surgery
Authors: Flaatten H. , Raeder J. 
Published: February 2007

SummaryIn a prospective study of 51 young male outpatients given spinal anaesthesia through a 25‐gauge needle, we found a 37.2% incidence of postdural puncture headache. In addition, 54.9% complained of backache after surgery. Occurrence of headache significantly prolonged the sick‐Cave from work. General anaesthesia would be preferred by 31.4% of patients for a similar procedure in the future. These patients had a higher incidence of postoperative backache and pain during lumbar puncture. It is concluded that spinal anaesthesia is not a satisfactory technique for outpatient procedures in young men.
Controlled comparison of nalbuphine and morphine for post‐tonsillectomy pain
Authors: KRISHNAN A. , TOLHURST‐CLEAVER C. L. , KAY B. 
Published: February 2007

SummaryA controlled investigation was conducted to compare the effectiveness of morphine and nalbuphine in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 4 and 12 years old were randomly allocated to receive intramuscular morphine 0.2 mg/kg, nalbuphine 0.3 mg/kg or no medication approximately 5 minutes before the conclusion of surgery. Pain and restlessness were assessed 1 and 2 hours after injection, and side effects were recorded. The assessments were made double‐blind. Both nalbuphine and morphine decreased restlessness and pain 1 hour (p<0.01) and 2 hours (p<0.05) after surgery. No significant differences were found between the two groups of patients who received opioids. Both nalbuphine and morphine caused more drowsiness than placebo 2 hours after surgery (p < 0.001). Other side effects were uncommon. Nalbuphine may ofSer advantages compared with morphine in regard to safety and convenience of use for the treatment of post‐tonsillectomy pain in children.
Gas exchange in the partially atelectatic lung
Authors: FLETCHER R. , LARSSON A. 
Published: February 2007

SummaryAn 11‐month‐old girl was anaesthetised for resection of a coarctation of the aorta. The child took part in a research project in which functional residual capacity (FRO and alveolar deadspace were being monitored on‐line. Initial measurements during controlled ventilation showed an unexpectedly low Pao2 and an alveolar deadspace more than double the normal value. After manual hyperventilation and tracheal suction, FRC increased by 25% and Pao2 and the alveolar deadrpace fraction reverted towarak normal values for an infant. We therefore had strong grounds for suspecting atelectasis, although the shunt through the atelectatic lung was, in theory, too small to account for the increase in olveolar deadspace. We also noted that the shape of the expired CO2 trace was improved after hyperinflation, as was the time needed to wash out SF, (the tracer gas used to measure FRO from the lung. From these observations, we conclude that atelectasis may be associated with more widespread disturbances of gas exchange than is generally realized, perhaps because of distension of adjacent lung regions.
Controlled neck compression in neurosurgery
Authors: PFITZNER J. , McLEAN A. G. 
Published: February 2007

SummaryBilateral compression of the jugular veins to raise temporarily cerebral venous pressure, is a manoeuvre recommended frequently in the immediate management of venous air embolism during neurosurgery. One method of compressing the neck veins is to inflate a pneumatic cuff secured around the neck with adhesive tape. This method of neck vein compression had been assessed in upright anaesthetised sheep and found to be an easily controlled and efficient way to raise the cerebral venous pressure. Advantages, dangers and potential problems associated with the use of an inflatable cuff in the clinical situation are discussed.
Wolff‐Parkinson‐White syndrome
Authors: JACOBSON L. , TURNQUIST K. , MASLEY S. 
Published: February 2007

SummaryA patient with Wolff‐Parkinson‐White syndrome, susceptible to tachydysrhythmias, presented for eye surgery under general anaesthesia. He developed a supraventricular tachycardia refractory to a variety of treatments. Phenylephrine consistently abolished the dysrhythmia, probably by acting directly to stimulate the arterial baroreceptors and hence vagal output. Vasopressor therapy should be considered in Wolff‐Parkinson‐ White syndrome tachyarhythmias, when circumstances permit.
Indoramin‐induced hypotension. An evaluation during ear, nose and throat surgery
Authors: Millar S.W. , Thurlow A.C. , Findley I.L. 
Published: February 2007

SummaryIndoramin, a competitive α1‐adrenoceptor antagonist, was administered intravenously to 12 fit patients aged 20–49 years during general anaesthesia with either halothane or enfluranefor ear, nose and throat surgery. A mean decrease of systolic blood pressure of 6 mmHg followed the initial dose of 0.1 mg/kg. Systolic blood pressures of 70–80 mmHg were achieved in nine patients using 0.29–4 mg/kg. The maximum effect of every dose was achieved within 3 minutes, with a probable duration of action of at least 30 minutes. Large changes of heart rate did not occur, though there was gradual slowing of the heart during each series of incremental administrations. Junctional rhythm, sometimes with bradycardia and hypotension, occurred in five patients (four in halothane group; one in en‐flurane group). Because of this, and the greater than ten‐fold variation in decrease of blood pressure for a single weight‐related dose, indoramin is not recommended for the reduction of blood pressure during halothane anaesthesia.
The haemodynamic effects of intravenous induction
Authors: GROUNDS R. M. , TWIGLEY A.J. , CARLI F. , WHITWAM J. G. , MORGAN M. 
Published: February 2007

SummaryThe haemodynamic changes following induction of anaesthesia with equipotent doses of propofol and thiopentone have been compared. Propofol caused a significant fall in arterial blood pressure and total peripheral resistance, with a slight fall in cardiac output. There were no changes in heart rate. Apart from an initial, but statistically insignificant increase in heart rate, similar changes were produced by thiopentone, but to a lesser degree. It is concluded that induction of anaesthesia with propofol results in acceptable haemodynamic changes, but that the agent is more depressant to the cardiovascular system than thiopentone.
Failed intubation
Authors: LYONS G. 
Published: February 2007

SummaryBetween 1978 and 1983, the tracheas of eight patients could not be intubated in the maternity unit of St James' University Hospital, Leeds. The incidence of failed intubation on our labour ward is approximately one for every 300 general anaesthetics given. The results of postoperative investigations in these patients are reported.
Haemodynamic changes during induction of anaesthesia with midazolam and diazepam (Valium) in patients undergoing coronary artery bypass surgery
Authors: KAWAR P. , CARSON I. W. , CLARKE R. S. J. , DUNDEE J. W. , LYONS S. M. 
Published: February 2007

SummaryMidazolam 0.3 mg/kg and diazepam 0.5 mg/kg were used for induction of anaesthesia in two groups of 10 patients each undergoing coronary artery bypass surgery. Haemodynamic variables were measured during induction of anaesthesia, after pancuronium and following tracheal intubation. Haemodynamic indices were derived, from these measurements using standard formulae. The induction of anaesthesia with midazolam produced a slight but significant increase in heart rate. There was a significant fall in systemic arterial pressure and pulmonary artery pressure following both drugs. Despite the fall in systemic arterial pressure, the cardiac index was maintained in patients who received midazolam. The cardiostimulatory effect of laryngoscopy and tracheal intubation was not prevented by either of the benzodiazepines and morphine in the dosage used. Midazolam is a suitable alternative to diazepam as part of an intravenous induction regimen in patients with ischaemic heart disease.
The end of the crystalloid era?
Authors: TWIGLEY A. J. , HILLMAN K. M. 
Published: February 2007

SummaryThe metabolic response to surgery causes sodium and water retention. It does not seem logical to pour crystalloid solutions into patients in the peri‐operative period, particularly when these solutions can cause deterioration in lung function. Plasma volume must be maintained to prevent a decreased blood flow to vital organs such as the kidneys. Blood or colloid solutions, not crystalloid solutions, should be used for this purpose, since the latter are distributed throughout the whole extracellular space and are less effective in maintaining plasma volume. Water given as 5% dextrose should be given in minimal quantities to maintain intracellular hydration. Patients undergoing minor to moderate surgery when they are likely to be drinking within 24 hours do not usually require any intravenous infusion. Moreover, to administer intravenous fluids to these patients may cause harm. No fluid regimens should be inflexible and the patient's size, age and fluid losses should be taken into account.
Intravenous regional anaesthesia with ketamine
Authors: Amiot J.F. , Palacci J.H. 
Published: February 2007

SummaryKetamine, 40 ml 0.5% solution, was used in the technique of intravenous regional anaesthesia in 14 patients undergoing upper limb surgery. Satisfactory analgesia was obtained in 12 of the patients. The method is limited by the fact that all patients became unconscious within a few minutes of tourniquet release, and that this could not be prevented by naloxone.
Stanley Rowbotham
Authors: CONDON H. A. , GILCHRIST E. 
Published: February 2007

SummaryStanley Rowbotham was born in 1890 and spent the first years after qualification in 1915 with the Royal Army Medical Corps (RAMC). His career in anaesthesia began after the Armistice, when he was posted with Ivan Magill to Harold Gillies's plastic surgery unit at Sidcup. Together. they laid the foundations of tracheal anaesthesia. A versatile and inventive anaesthetist. Stanley Rowbotham later pioneered in the fields of thyroid anaesthesia, basal narcosis, local and intravenous analgesia and in the use of muscle relaxants. He also introduced cyclopropane into this country.
Epidural buprenorphine for postoperative analgesia. A controlled comparison with epidural morphine.
Authors: Wolff J. , Carl P. , Crawford M.E. 
Published: February 2007

SummaryIn a double‐blind controlled study. epidural buprenorphine 0.3 mg was compared with 4 mg of epidural morphine for postoperative pain relief the first 24 hours after major orthopaedic surgery. The degree of analgesia was equal and sarisfactory in both groups. Duration of action was 620 minutes with buprenorphine and 580 minutes with morphine, which was not significantly deferent. The only serious side effects were recorded in the morphine group, with two patients complaining of pruritus and give of urinary retention. In conclusion, epidural buprenorphine did not offer any advantages in preference to morphine for postoperative pain relief following orthopaedic surgery.
Ketamine by continuous infusion in status asthmaticus
Authors: STRUBE P. J. , HALLAM P. L. 
Published: February 2007

SummaryA 13‐year‐old girl was admitted to the intensive care unit with status asthmaticus. Conventional bronchodilator therapy failed to relieve her bronchospasm. In order to try and avoid artificial ventilation, a continuous intravenous infusion of ketamine was used with success. The total dose rate was 40 μg/kg minute for a period of 8 hours; this was given at a decreasing rate. She regained consciousness 30 minutes after the end of the infusion and became well orientated after one hour. Ketamine is a useful drug in the intensive treatment of status asthmaticus and should be tried before a decision is taken to start mechanical ventilation.
Diabetes mellitus and open heart surgery
Authors: WATSON B. G. , ELLIOTT M. J. , PAY D. A. , WILLIAMSON M. 
Published: February 2007

SummaryA method, based on bedside determinations of blood glucose by nursing staff, was designed to control the administration of insulin to diabetic patients during and following open heart surgery. A computer‐controlled intravenous infusion pump was used to deliver the insulin. Excellent control of the hyper‐glycaemia normally associated with open heart surgery was achieved, with 84 percent of measured blood glucose values falling within 2 mmol/litre of the target value of 6 mmol/litre. The method proved to be simple, effective, and safe.