bluuebunny/crossref_metadata_2025_split huggingface dataset:
Volatile agent use: perception and practice A survey of agent use over a 3‐year period
Authors: Tarpey J. , Lawler P. G. 
Published: February 2007

SummaryWe calculated the quantity, as MAC hours and MAC hours anaesthetic, of halothane, enflurane and isoflurane, used in this Health District over a 3‐year period. Halothane accounted for 77% of anaesthesia in the first year and for 57% in the final year. Overall usage of volatile agents decreased. Fifteen consultants and 19 senior registrars perceived, in a survey of practice, only a change in relative use of volatile anaesthetic agents with a large swing from halothane to both enflurane and isoflurane. Half the anaesthetists stated that the medicolegal consideration was the prime reason for their change. The perceived total demise of halothane does not appear to have been realised, despite individual anaesthetist's perceptions.
Opioid supplementation during propofol anaesthesia
Authors: MOFFAT A. C. , MURRAY A. W. , FITCH W. 
Published: February 2007

SummarySixty patients of ASA grade 1 or 2 who presented for minor daycase gynaecological or urological procedures were randomly allocated to three groups. Group A received fentanyl 1 μg/kg and Group B alfentanil 5 μg/kg prior to induction. Group C received no pre‐induction opioid. Anaesthesia was induced intravenously with propofol and maintained using nitrous oxide 67% in oxygen supplemented with 20‐mg bolus doses of propofol as required. The pre‐induction administration of fentanyl or alfentanil was not found significantly to affect either the doses of propofol required for induction or maintenance or the quality of anaesthesia compared with propofol alone. These results suggest that for minor outpatient procedures under general anaesthesia, the concomitant use of a short‐acting opioid confers no benefits over propofol with nitrous oxide and oxygen alone.
A clinical study into the possible intrinsic bradycardic activity of vecuronium
Authors: COZANITIS D. A. , ERKOLA O. 
Published: February 2007

SummaryForty female patients received a standardised anaesthetic technique with thiopentone sodium and enflurane. Half of the patients received, under double‐blind conditions, either physiological saline or glycopyrronium before induction of anaesthesia; 10 minutes after induction of anaesthesia, all patients received vecuronium 0.1 mg/kg. A further 10 patients received neither glycopyrronium nor vecuronium. The results show that vecuronium per se does not produce a decrease in heart rate.
Comparison of anxiety before induction of anaesthesia in the anaesthetic room or operating theatre
Authors: SONI J. C. , THOMAS D. A. 
Published: February 2007

SummaryAnxiety before induction of anaesthesia was studied in 100 patients who were allocated randomly to one of two groups. Patients in one group were anaesthetised in an anaesthetic room and those in the other group were anaesthetised inside the operating theatre. Both subjective and objective indices of anxiety were used in the comparison. Other factors that contributed to anxiety were assessed by a simple questionnaire. There was no significant difference in the level of anxiety between the two groups. The site of induction did not emerge as a major contributory factor to anxiety. The advantages and disadvantages of anaesthetic rooms are discussed.
Delayed detection of hypoxic events by pulse oximeters: computer simulations
Authors: VERHOEFF F. , SYKES M. K. 
Published: February 2007

SummaryThere is a variable delay between a reduction in alveolar Po2 and the decrease in arterial oxygen saturation recorded on a pulse oximeter. The decrease in arterial oxygen saturation in response to disconnexion of a paralysed patient from the breathing system, oxygen supply failure with continued mechanical ventilation and disconnexion of the fresh gas supply to Mapleson D and circle absorption breathing systems were studied by simulations on the MacPuf computer model of the cardiorespiratory system. The simulations revealed that there were marked differences between the rate of arterial desaturation which resulted from each of the three types of oxygen supply failure and that arterial oxygen saturation may reach dangerous levels before a pulse oximeter alarm is activated.
The Bain, ADE, and Enclosed Magill breathing systems A comparative study during controlled ventilation
Authors: CRISWELL J. , McKENZIE S. , DAY S. , DISLEY J. , BRUCE W. E. , SONI N. 
Published: February 2007

SummaryThe Enclosed Magill, Humphrey ADE and the Bain breathing systems are all used for controlled ventilation of the lungs. This study compares the three systems in vitro with a lung model and in clinical practice. No difference was observed, with ventilatory variables commonly used in clinical practice, between the Bain and the ADE, while significantly lower end‐tidal carbon dioxide values were observed with the Enclosed Magill (about 7%). Lower fresh gas flows can be used under these circumstances to maintain normocapnia with the Enclosed Magill than either the Bain or the Humphrey ADE.
The chronotropic effect of acetylcholine in the presence of vecuronium and atracurium A study in the isolated perfused rabbit heart
Authors: BELLIS D. J. , DAY S. , BARNES P. K. 
Published: February 2007

SummaryThe bradycardia produced by 1 μg acetylcholine in the isolated perfused rabbit heart, in the presence of vecuronium and atracurium, was studied and compared with control. Vecuronium at a concentration of 2.5 μg/litre and atracurium 6 μg/litre did not enhance the negative chronotropic effect of acetylcholine. Atracurium produced a statistically significant inhibition of the negative chronotropic effect of acetylcholine.
Continuous brachial plexus blockade A technique that uses an axillary catheter to allow successful skin grafting
Authors: RANDALLS B. 
Published: February 2007

SummaryAn 82‐year‐old woman sustained a full thickness burn of her hand. A technique for producing anaesthesia of the brachial plexus via an indwelling catheter is described. Confirmation of the catheter position was obtained by X ray. Bupivacaine was infused via the catheter after operation to produce immobilisation of the hand to ensure multiple skin grafts would take. Consequent with this goal was excellent postoperative analgesia.
Unexpectedly extensive conduction blocks in obstetric epidural analgesia
Authors: MORGAN B. 
Published: February 2007

SummaryLife‐threatening extensions of conduction block during obstetric epidural analgesia can be classified according to the risk to the mother. High blocks that occur in the presence of the anaesthetist should present a readily treatable problem. Reports of total spinal anaesthesia that occur with no anaesthetist in attendance call for a reappraisal of present practice. Changes in current anaesthetic practice, which might increase safety with epidural analgesia, are top‐ups by midwives, but only when the anaesthetist is on the delivery suite: repeated assessment of the nature of the conduction block by an anaesthetist: and continuous infusions with anaesthetist‐only top‐ups.
Paediatric postoperative analgesia A comparison of rectal diclofenac with caudal bupivacaine after inguinal herniotomy
Authors: Moores M.A. , Wandless J.G. , Fell D. 
Published: February 2007

SummaryForty‐three children for day case inguinal herniotomy under general anaesthesia were assigned randomly to receive either 1 ml/kg caudal bupivacaine 0.25% or rectal diclofenac 0.25 mg/kg intra‐operatively to provide postoperative analgesia. Pain and demeanour were assessed by an observer in the early postoperative period after operation and by questionnaire for the parents over the first 24 hours. Caudal bupivacaine provided more pain‐free patients at first but later the incidence of pain was similar in the two treatment groups. Rectal diclofenac is a useful alternative to caudal blockade in this group of patients.
Variables of patient‐controlled analgesia 4: the relevance of bolus dose size to supplement a background infusion
Authors: OWEN H. , KLUGER M. T. , PLUMMER J. L. 
Published: February 2007

SummaryA range of self‐administered demand doses of morphine (0.4, 0.7 and 1.0 mg) were prescribed to supplement a fixed‐rate infusion (1.5 mg/hour) for pain control after gynaecological surgery. The number of demand doses administered during the first 25 hours after surgery was not significantly influenced by size of demand dose. There was a significant linear trend to increasing amount of demanded morphine with increasing bolus size. These results cast doubt on the usefulness of the concept of a minimum effective analgesic concentration of morphine.
Pharmacokinetics of glycopyrronium in parturients
Authors: ALI‐MELKKILÄ T. , KAILA T. , KANTO J. , IISALO E. 
Published: February 2007

SummaryA sensitive radioreceptor assay was used to determine the pharmacokinetics of glycopyrronium 6 μg/kg after intramuscular (deltoid muscle) administration in eight Caesarean section patients. A fast absorption rate was found with a mean maximum plasma concentration (Cmax of 6.3 (SD 1.5) ng/ml, a mean time to Cmax (Tmax) of 10.0 (3.8) minutes and the elimination half‐life (Tl of 33.4 (1.92). The respective AUC0–8 h value was 5.61 (1.27) hours ng/ml. This dose produced a significant increase in the maternal heart rate after 10 minutes (p < 0.05) and an antisialogogue effect after 30 minutes (p < 0.05) of the drug injection. Almost half of drug (48.3%) was excreted into the urine within 3 hours. There were no measurable levels of glycopyrronium in the lumbar cerebrospinal fluid (CSF) after 60 minutes of drug injection. The concentrations of glycopyrronium in the umbilical venous (0.28 (0.25) ng/ml) and in the umbilical arterial (0.18 (0.11) ng/ml) plasma after 86 minutes of drug injection were low and clinically insignificant, as was the case in the amniotic fluid (0.15 (0.08) ng/ml).
Tracheal intubation under fluoroscopic control X ray‐guided orotracheal intubation in three cases of impossible direct laryngoscopy
Authors: Innocente F. , Ori C. , Giron G. P. 
Published: February 2007

SummaryThree patients are described in whom it was impossible to visualise the larynx at direct laryngoscopy. Tracheal intubation was successfully and rapidly achieved with the aid of continuous fluoroscopy.
Epidurography in premature infants
Authors: NIEKERK J. VAN , BAX‐VERMEIRE B. M. J. , GEURTS J. W. M. , KRAMER P. P. G. 
Published: February 2007

SummaryA caudal epidural catheter was inserted in 20 premature, high risk infants for abdominal or thoracic surgery under combined caudal epidural and general anaesthesia. Epidurography was used to confirm the position of the catheter which was found to be misplaced in three patients. The catheter penetrated the dura in one case, in another the tip was located in an epidural vessel and in the third the catheter was seen to be curled up within the epidural space. It was concluded that epidurographic control is essential with this method of anaesthesia in very small infants, in whom it was found to provide considerable advantages despite serious risks.
Prolonged neuromuscular blockade with vecuronium in a neonate with renal failure
Authors: HAYNES S. R. , MORTON N. S. 
Published: February 2007

SummaryAn 11‐day‐old neonate with renal failure caused by dysplastic kidneys was anaesthetised with thiopentone, vecuronium, nitrous oxide and oxygen, for insertion of a long‐term peritoneal dialysis catheter. Complete neuromuscular block of 210 minutes’duration ensued after the initial dose of vecuronium (97 μg/kg). Partial block persisted for a further 30 minutes. The prolonged neuromuscular block in this case may have been because of proportionately greater dependence on renal clearance of vecuronium in neonates.
Alkalinisation of prilocaine for intravenous regional anaesthesia
Authors: ARMSTRONG P. , BROCKWAY M. , WILDSMITH J. A. W. 
Published: February 2007

SummaryTen volunteers underwent intravenous regional anaesthesia on two separate occasions using 40 ml prilocaine 0.5% to which was added 5 ml of either saline 0.9% or sodium bicarbonate 8.4%. Addition of sodium bicarbonate decreased the time of onset of loss of sharp touch and temperature sensations and of motor power. Time to full recovery of the arm was slower with the alkalinised solution and nine of the subjects preferred this block. The addition of sodium bicarbonate to prilocaine for intravenous regional anaesthesia may be clinically useful.
‘Leopard’ syndrome
Authors: RODRIGO M. R. C. , CHENG C. H. , TAI Y. T. , O'DONNELL D. 
Published: February 2007

Summary‘Leopard’ syndrome is a rare inherited disorder associated with a high prevalence of cardiac abnormalities. General anaesthesia for dental treatment in a patient who had cardiomyopathy and bizarre electrocardiographs abnormalities associated with this syndrome is described. A thorough cardiac assessment is advised in a patient with multiple lentigines, although no clinical symptoms or signs may be found. Even if no cardiac abnormality is found before it is better to re‐assess the patient, since abnormalities may develop later. The assessment should be repeated if any abnormality was detected before but without clinical significance, since the disease is progressive and may progress more rapidly in some patients than in others.
Acute infective airway obstruction associated with subglottic stenosis
Authors: PHILLIPS J. J. , SANSOME A. J. 
Published: February 2007

SummaryPre‐existing subglottic stenosis in a 22‐month‐old child with laryngotracheobronchitis resulted in failure to intubate the trachea on the intensivé therapy unit. Tracheostomy was necessary in the operating theatre to secure the airway. The implications for safe management are discussed.
Behaviour of small children before induction. The effect of parental presence and EMLA and premedication with triclofos or a placebo
Authors: PAGE B. , MORGAN‐HUGHES J. O. 
Published: February 2007

SummaryThe effect of the prescription of triclofos 70 mg/kg orally 90 minutes before operation on the behaviour of 263 children aged 1 to 5 years was studied in a blind, randomised, placebo‐controlled trial. EMLA was applied to the dorsum of one hand when the premedication was administered, and all the children were accompanied by a parent during induction of anaesthesia. The frequency of satisfactory behaviour was significantly higher in the triclofos group (p < 0.02), but the time spent in the recovery ward was increased.
Blood contamination of anaesthetic and related staff
Authors: HARRISON C. A. , ROGERS D. W. , ROSEN M. 
Published: February 2007

SummaryThe incidence of skin contamination of anaesthetic and related staff by patient's blood and saliva was studied during 270 anaesthetics in Cardiff hospitals over seven continuous days in October 1989. A survey was also made of current Hepatitis B immunisation status and glove‐wearing habits of 75 anaesthetists. Blood from 35 (14%) patients caused skin contamination of 65 staff during 46 incidents. Twenty‐eight (61%) of the contamination incidents occurred during vessel cannulation. Five (8%) of the 65 staff contaminated by blood already had cuts on their hands. There were nine incidents (4%) of skin contamination by saliva. Fifty‐three (71%) anaesthetists were immunised against Hepatitis B. Only seven (9%) anaesthetists wear gloves for oral or nasal intubation, six (8%) for insertion of peripheral venous cannulae, 47 (63%) for insertion of arterial lines and 67 (89%) for insertion of central lines. All anaesthetic and associated staff should wear gloves on a routine basis.
Treatment of atelectasis of upper lung lobes. Selective bronchial suctioning with J‐shaped catheter tip and guide mark
Authors: KUBOTA Y. , TOYODA Y. , KUBOTA H. , ASADA A. , UEDA Y. , HIROTA Y. 
Published: February 2007

SummaryWe developed a technique for blind bronchial suction using a curved‐tip catheter with a guide mark, for the treatment of atelectasis of the lower and middle lobes of the lung. Suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design. We treated successfully two cases of atelectasis of the right upper lobes using a Rusch Metras bronchography catheter with a guide mark which is not readily available. Therefore we devised a J‐shape tipped catheter with a guide mark. We have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter.
Mechanical ventilation during low‐flow anaesthesia. Experience with an alternative to the bag‐in‐bottle
Authors: BERNTMAN L. , LUTTROPP H. H. , WERNER O. 
Published: February 2007

SummaryClinical experience with low‐flow anaesthesia during controlled ventilation of the lungs is described. The anaesthesia circle is separated by a corrugated hose that serves as a large deadspace. This open connexion has no bellows or overflow valve and therefore the risk of mechanical dysfunction is small. No mixing of circle and ventilator gas occurs during normal operation. Major decreases in the oxygen concentration in the system are unlikely even if the fresh gas flow is interrupted or significant leaks from the circle occur because 100% oxygen is delivered by the ventilator. A hose volume larger than 1650 ml prevented gas mixing at tidal volumes of 380–1170 ml. There was no system‐related mishap in over 600 patients, who comprised about 40% of the neurosurgical patients anaesthetised during that period. The cost of isoflurane was reduced to about 33% of that incurred during previous periods.
Anaesthesia for cardioversion. A comparison between propofol, thiopentone and midazolam
Authors: Gupta A. , Lennmarken C. , Vegfors M. , Tydén H. 
Published: February 2007

SummaryThis study compares the induction and recovery characteristics, haemodynamic changes and side effects of propofol, thiopentone and midazolam when used as the anaesthetic agents for cardioversion. Recovery after midazolam was significantly longer (p < 0.05) than with either thiopentone or propofol. There was no difference in the recovery times between thiopentone and propofol. There was a significant decrease in mean arterial pressure 2 minutes after induction with propofol and midazolam. Three patients each in the thiopentone and propofol groups needed assisted ventilation because of apnvea, and four patients each in the propofol and midazolam groups had low Spo2 values (<95%). Flumazenil was used to reverse the effects of midazolam in eight patients and five of these were still drowsy 4 hours after the procedure. This study indicates that thiopentone is the most satisfactory agent for anaesthesia for cardioversion.
Posture and epidural catheter insertion. The relationship between skill, experience and maternal posture on the outcome of epidural catheter insertion
Authors: STONE P. A. , KILPATRICK A. W. A. , THORBURN J. 
Published: February 2007

SummaryThis study was undertaken to investigate the outcome of epidural catheter insertion in the sitting or lateral position in mothers during labour. An initial prospective randomised study period (144 patients) suggested that the sitting position offered some superiority over the lateral in terms of technical ease of insertion. It was concluded, by minimising the subjective aspects in a follow‐up, prospective nonrandomised study period (152 patients), that the determining factor lies in the skill and experience of the anaesthetist. There was no significant difference in complication rates or maternal discomfort between the two positions in either study period.
Long‐term patient‐controlled analgesia in children
Authors: MOWBRAY M. J. , GAUKROGER P. B. 
Published: February 2007

SummaryThree children who received patient‐controlled analgesia for periods of up to 41 days are described. In each case patient‐controlled analgesia allowed pain control to be achieved in difficult situations. No patient developed tolerance or clinical signs of dependence. This use of long‐term patient‐controlled analgesia warrants further evaluation.
pH‐adjustment and discomfort caused by the intradermal injection of lignocaine
Authors: Martin A. J. 
Published: February 2007

SummaryOne hundred adult day‐case patients who required intravenous access had cannulae inserted using local anaesthesia with 1% lignocaine, 1% lignocaine with adrenaline or the corresponding pH‐adjusted solutions. The local anaesthetic solutions were modified by the addition of 1 ml 8.4% sodium bicarbonate to 10 ml lignocaine. Pain scores at different stages of cannulation were noted and showed a significant reduction after use of pH‐adjusted solutions (p < 0.02 for the plain lignocaine, and < 0.001 for the lignocaine with adrenaline). Modification of the pH of lignocaine solutions by the addition of sodium bicarbonate is a simple method significantly to reduce the discomfort caused by the infiltration of the local anaesthetic.
Induction agents for day‐case anaesthesia A double‐blind comparison of propofol and midazolam antagonised by flumazenil
Authors: NORTON A. C. , DUNDAS C. R. 
Published: February 2007

SummaryEarly postoperative recovery was studied using sedation scoring, measurement of flicker fusion frequency and completion of Trieger test figures in 60 male patients who presented for vasectomy under general anaesthesia as day patients. Anaesthesia was induced in groups I and 2 (20 patients each) with mean (SD) doses of 0.16 (0.04) mg/kg or 0.16 (0.03) mg/kg midazolam respectively; group 2 received flumazenil 0.55 (0.19) mg after completion of surgery. The remaining 20 patients (group 3) received propofol 1.50 (0.24) mg/kg. Anaesthesia was maintained with isoflurane vaporized in 33% oxygen and nitrous oxide in all patients. Flumazenil tended to improve tests of recovery after midazolam anaesthesia, but early recovery after propofol anaesthesia was associated with better psychomotor test results and less impairment of mental state as judged by sedation and amnesia scoring.
Arterial to end‐tidal carbon dioxide tensio difference during laparoscopy Magnitude and effect of anaesthetic technique
Authors: BRAMPTON W. J. , WATSON R. J. 
Published: February 2007

SummaryThe relationship between arterial carbon dioxide tension and end‐tidal carbon dioxide tension was studied in 25 patients during laparoscopy. Thirteen patients received general anaesthesia and 12 epidural anaesthesia. The overall mean difference between arterial and end‐tidal carbon dioxide tensions was 0.44 kPa (95% confidence intervals 0.28–0.60 kPa) which was significantly less than that reported in studies during other procedures. The reasons for this difference are probably associated with the physiological changes induced by CO2 pneumoperitoneum and steep Trendelenburg positioning. The choice of anaesthetic technique did not affect the arterial to end‐tidal carbon dioxide tension difference significantly (p > 0.9).
A comparison of three methods of axillary brachial plexus anaesthesia
Authors: BARANOWSKI A. P. , PITHER C. E. 
Published: February 2007

SummaryOne hundred patients scheduled for elective outpatient hand surgery had blockade of the axillary brachial plexus by one of three techniques; insertion of a catheter into the brachial plexus sheath (n = 25), use of paraesthesia (n = 50) or use of the nerve stimulator (n = 25) to localise the plexus. Only two patients required general anaesthesia for the planned surgery. Assessment of the dermatomes blocked did not demonstrate a statistical difference between the success rates of the three groups. The more nerves detected in the paraesthesia and the nerve stimulator groups before injection of local anaesthetic the higher the success rate of the block. We advocate use of the nerve stimulator technique in view of the possible risk of neurological damage associated with paraesthesia and the technical difficulties with the catheter technique, for routine brachial plexus blockade.