bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Mancunian way
Authors: HEALY T. E. J. , UN E. N. 
Published: February 2007

SummaryThe authors have examined early records of the administration of ether anaesthesia in Manchester and the lives of several medical men involved in these events. Charles Strange, a dentist and chemist, in a letter to the Manchester Guardian published on 14 January 1847, described a self‐administration of ether for dental extraction, but George Bowring, a surgeon, subsequently claimed the first anaesthetic administered by a doctor in Manchester. The merits of these claims are discussed in the light of the circumstances surrounding these events.
An audit of induction of anaesthesia in neonates and small infants using pulse oximetry
Authors: Kong A. S. , Brennan L. , Morgan‐Hughes J. 
Published: February 2007

SummaryThe frequency and seventy of hypoxaemia during induction of anaesthesia in neonates and small infants at the Norfolk and Norwich Hospital, a district general hospital, was compared, using pulse oximetry, with that of the nearest specialist hospital, the Queen Elizabeth Hospital for Sick Children in London. There were differences in staffing and the choice of anaesthetic techniques between the hospitals. One third of the patients in both hospitals experienced desaturation of more than 5% (moderate or severe hypoxaemia) at one or more recordings during induction. The highest incidence of hypoxaemia was associated with awake intubation. There was no statistical difference in the incidence or severity of hypoxaemia between the hospitals. In the district general hospital, moderate or severe hypoxaemia of greater than 30 s duration was more likely if an anaesthetist with a regular paediatric operating list was not present at induction (p < 0.01).
The occupational hazard of human immunodeficiency virus and hepatitis B virus infection
Authors: O'Donnell N. G. , Asbury A. J. 
Published: February 2007

SummaryWe have conducted a postal survey of members of the Association of Anaesthetists to ascertain perceived risks and preventive measures adopted with regard to the occupational hazard of Human Immunodeficiency Virus and Hepatitis B Virus infection. Despite recognition of the infection risk and the adoption of appropriate measures when managing known infected patients, the majority of anaesthetists have not implemented simple precautions in their daily routine work. Less than 16% of respondents routinely wear gloves and more than one in three still resheath needles. It would appear that the recommendations of the Association with regard to universal safety precautions have not been implemented by the majority of its members.
Anaesthesia for myocardial revascularisation
Authors: Underwood S. M. , Davies S. W. , Feneck R. O. , Walesby R. K. 
Published: February 2007

SummaryWe studied the effects on mycardial performance and metabolism of fentanyl/propofol and fentanyl/enflurane anaesthesia in 20 patients before coronary artery bypass grafting. Anaesthesia was induced with fenlanyl 20 ug.kg−1 and pancuronium 0.15 mg.kg−1. Patients received, by random allocation, either propofol by infusion, 6 mg.kg−1.h−1 reduced by half after JO min then adjusted as necessary (mean rate 2.8 mg.kg−1.h−1), or enflurane 0.8% inspired concentration for 10 min reduced to 0.6% and adjusted as required (mean 0.7%). Measurements were made before induction, after tracheal intubation, after skin incision and after sternotomy. There were no significant differences between the groups in any haemodynamic variables during the study. Following intubation both groups showed a rise in heart rate (p < 0.01) and cardiac index (p < 0.05). Systemic vascular resistance decreased after intubation (p < 0.05) then returned to baseline during surgery; stroke index was unchanged after intubation but was reduced during surgery (p < 0.01) as systemic vascular resistance increased. Regional and global coronary blood flow were maintained in both groups, as were myocardial oxygen consumption and lactate extraction ratio. However, lactate production did occur in one patient receiving enflurane and Holler monitoring confirmed ischaemia. One patient receiving propofol showed lactate production not accompanied by any Ecg changes. This study suggests that propofol may be a suitable alternative to enflurane as an adjunct to opioids in anaesthesia for coronary artery bypass grafting.
Upper oesophageal sphincter pressure during inhalational anaesthesia
Authors: Vanner R. G. , Pryle B. J. , O'Dwyer J. P. , Reynolds F. 
Published: February 2007

SummaryUpper oesophageal sphincter pressure was recorded with a Dent sleeve in 30 patients breathing nitrous oxide, oxygen and halothune. Twenty‐three patients, after thiopentone induction, received suxamethonium and had their trachea intubated either before (group A, n = 11), or after (group B,n = 11), a study period of inhalational anaesthesia. Group C (n = 8 j received an inhalational induction. Mean (SD) sphincter pressure after loss of consciousness was 8 (7) mmHg (group A), 6 (5) mmHg (group B) and 24 (13) mmHg (group C) increasing to 79 (7) mmHg in group A immediately after intubation. With an end‐tidal halothane concentration of 1.5%, mean sphincter pressure in group B, 16 (7) mmHg, was significantly lower than in group A, 45 (21) mmHg (p < 0.001 J and group C, 27 (14) mmHg (p < 0.05). Halothane had no dose‐related effect on sphincter pressure. Insertion of a laryngeal mask in group C (n = 7) had no significant effect on sphincter pressure. Induction and maintenance of anaesthesia with halothane, unlike thiopentone or suxamethonium, maintained a degree of upper oesophageal sphincter tone, although three patients in this study had sphincter pressures of less than 10 mmHg and would therefore have been at risk of regurgitation in the presence of gastro‐oesophageal reflux.
Influence on hearing of 22 G Whitacre and 22 G Quincke needles
Authors: Sundberg A. , Wang L. P. , Fog J. 
Published: February 2007

SummaryAudiograms were performed pre‐operatively and 2 days postoperatively in 48 patients given spinal anaesthesia for transurethral resection oj the prostate. Hearing levels were examined at 1000 Hz and below. Either 22 G standard design (Quincke) needles (n—25) or 22 G pencil‐point design (Whitacre) needles (n = 23) were used. Hearing loss of 10 dB or more at two or more frequencies were observed in six of 25 patients in the Quincke group and in two of 23 patients in the Whitacre group. The mean hearing level was more reduced in the Quincke group. The shape of the tip of the spinal needle seems to be of some importance to the effects on hearing level that mav occur after spinal anaesthesia.
An evaluation of a combined spinal/epidural needle set utilising a 26‐gauge, pencil point spinal needle for Caesarean section
Authors: Westbrook J. L. , Donald F. , Carrie L. E. S. 
Published: February 2007

SummaryWe have conducted a prospective study into the ease of use and incidence of postdural puncture headache with the ‘Portex’ combined spinal/epidural set. The pack contains a 16‐gauge Tuohy needle of standard 8 cm shaft length with a matching 26‐gauge pencil point spinal needle. The study included 150 consecutive combined spinal/epidural anaesthetics for lower segment Caesarean section. Eighty‐eight percent of the cases fulfilled the criteria as technically perfect, i.e. cerebrospinal fluid obtained at the first attempt after identifying the epidural space. There were two cases of significant postdural puncture headache requiring blood patch due to puncture by the 26‐gauge spinal needle giving an incidence of 1.3%. This compares favourably with previously reported rates in obstetric patients.
Implicit memory tested in children during inhalation anaesthesia
Authors: BONKE B. , VAN DAM M. E. , VAN KLEFF J. W. , SLIJPER F. M. E. 
Published: February 2007

SummaryMemory for stimuli presented during inhalation anaesthesia was tested in 80 children undergoing eye surgery. Two groups were exposed, in a random double‐blind study, to repeated neutral phrases including either the colour orange or green. A postoperative colouring task was used as a test of implicit memory to detect any preference for the colour named under anaesthesia. No colour preference attributable to implicit memory could be demonstrated. One patient had a distinct preference for the named colour. No patient remembered any intra‐operative events.
Isoflurane and propofol for long‐term sedation in the intensive care unit
Authors: MILLANE T. A. , BENNETT E. D. , GROUNDS R. M. 
Published: February 2007

SummaryPropofol and isoflurane have been reported recently to offer better sedation than alternative agents in patients who require long‐term ventilation in the Intensive Care Unit. This is the first report of a direct comparison between propofol and isoflurane. Twenty‐four patients predicted to require artificial ventilation for at least 48 h were entered into a randomised crossover study to monitor sedation quality and time to recovery from sedation. There were no significant differences between the two agents in either end‐point, with over 95% optimal sedation achieved by the use of each drug. Few adverse events were noted. Technological advances in the administration of volatile agents as long‐term sedatives in the Intensive Care Unit may facilitate their more widespread use.
The Riyadh Intensive Care Program applied to a mortality analysis of a teaching hospital intensive care unit
Authors: JACOBS S. , ARNOLD A. , CLYBURN P. A. , WILLIS B. A. 
Published: February 2007

SummaryA computerised system of prediction of death using the Riyadh Intensive Care Program was applied retrospectively over a 17‐month period to data collected prospectively on 1155 patients admitted to our intensive care unit. Variables which enable organ failure scores to be generated were recorded daily to make these predictions. Consultant medical opinion predicted that outcome was hopeless in 55% (115/209) of the patients who died. The predictive power of the computer demonstrated a sensitivity of 14.8% and a specificity of 99.8%. It is possible that the occurrence of three false predictions of death in the latter part of the series may have been related to a change in our antibiotic policy. We would be unhappy to recommend the general use of a computerised program for prediction of death without careful explanation of its significance and dangers.
Advanced trauma life support
Authors: BENNETT J. R. , BODENHAM A. R. , BERRIDGE J. C. 
Published: February 2007

SummaryThe experience of Advanced Trauma Life Support training received by three anaesthetists is discussed with particular reference to the teaching of airway management, the grade of staff who should attend the present courses and the relevance to the British hospital system. We conclude that these courses are useful but limited by their inflexibility and failure to recognise the difference in skill mix in the British setting.
Patient‐controlled epidural analgesia following post‐traumatic pelvic reconstruction
Authors: NOLAN J. P. , DOW A. A. C. , PARR M. J. A. , DAUPHINEE K. , KALISH M. 
Published: February 2007

SummaryA randomised, single‐blinded study was conducted to compare patient‐controlled epidural analgesia with continuous infusion epidural analgesia for the treatment of pain following post‐traumatic pelvic reconstruction. The patient‐controlled group (n = 11) received a background infusion of 4 ml.h−1 of bupivacaine 0.125% with fentanyl 1 μg.ml−1, and 3–6 ml bolus doses, self administered, as required (with a 15 min lockout interval). The continuous infusion group (n = 12) received a continuous infusion of the same solution through an identical apparatus, but with the demand button deactivated. This was started at 10 ml.h−1 and adjusted by the anaesthetist, as required, up to a maximum of 25 ml.h−1. Pain scores, side effects, and the volumes of drug infused were recorded over the first 3 postoperative days. One patient from each group was withdrawn because of catheter‐related problems. Pain scores were similar and the incidence of nausea and pruritus was low in both groups. There was no recorded instance of respiratory depression or hypotension and there was no significant difference between the groups in the volumes of drug solution received. Patient satisfaction was equally very good in both groups. Patient‐controlled epidural analgesia is an effective means of providing pain relief after post‐traumatic pelvic reconstruction, but did not significantly reduce analgesic requirements in comparison with continuous infusion epidural analgesia.
The caudal boundary of the thoracic paravertebral space
Authors: LÖNNQVIST P. A. , HILDINGSSON U. 
Published: February 2007

SummaryThe caudal limit of the thoracic paravertebral space was examined in 13 human cadavers. The origin of the psoas major muscle was found to completely seal off the paravertebral space below the level of the 12th thoracic vertebra. The possibility of caudal spread of a thoracic paravertebral block below this level through the paravertebral space would appear unlikely.
Postoperative oxygenation in the elderly following general or local anaesthesia for ophthalmic surgery
Authors: McCarthy G. J. , Mirakhur R. K. , Elliott P. 
Published: February 2007

SummaryPeripheral oxygen saturation was recorded on the pre‐operative night (between 2400 and 0600 h), the immediate postoperative period (first 60 min) and the first postoperative night (2400 to 0600 h) in 18 elderly patients aged 70 years or over presenting for elective ophthalmic surgery. Nine patients had surgery performed under general anaesthesia employing muscle relaxants and controlled ventilation and nine under local anaesthesia using a peribulbar block. The median (interquartile range) percentage of time during which the patients had an oxygen saturation of less than 90% was 0 (0–0.2) and 0.04 (0–0.4) on the pre‐operative night, 0.7 (0–1.4) and 0.3 (0–1.2) in the immediate postoperative period, and 0.05 (0–0.16) and 0 (0–0.3) on the postoperative night in the general and local anaesthesia patients respectively. There were no significant differences between general and local anaesthesia in respect of these data and the overall incidence of significant desaturation was low. The present study could not demonstrate any adverse effect of general anaesthesia on oxygen saturation in patients undergoing minimally invasive surgery.
Comparison of recovery index of rocuronium or vecuronium with simultaneously administered pancuronium in the isolated forearm
Authors: FAWCETT W. J. , FAUVEL N. J. , FELDMAN S. A. 
Published: February 2007

SummaryA series of isolated forearm experiments is described in which rocuronium or vecuronium were injected into one arm, and pancuronium injected simultaneously into the contralateral arm. The time for 25%–75% twitch recovery (recovery index) was recorded in both arms. The recovery indices of rocuronium and vecuronium were similar, but that of pancuronium significantly longer. Because the recovery indices compared in any one experiment occurred in the presence of identical background plasma concentration, the differences observed in recovery index between pancuronium and either rocuronium or vecuronium are due to different rates of dissociation from the effect compartment at the neuromuscular junction.
Dose‐response for analgesic effect of amitriptyline in chronic pain
Authors: McQUAY H. J. , CARROLL D. , GLYNN C.J. 
Published: February 2007

SummaryA randomised, double‐blind, multiple dose, crossover study with three 3‐week treatment periods was set up to compare the analgesic efficacy and adverse effects of amitriptyline in oral doses of 25, 50 or 75 mg. Patients used diaries to assess their pain, and clinic assessments were made at the end of each treatment period. It was found that in 29 patients with chronic (more than 2 months) pain, amitriptyline 75 mg provided significantly greater efficacy than amitriptyline 25 or 50 mg. There was no significant difference in mood scores between the different doses of amitriptyline, but sleep was judged significantly better with 75 mg compared with 25 mg. The incidence of adverse effects was significantly higher with the 75 mg dose, and the principal adverse effects were dry mouth and drowsiness. In the context of chronic pain, the analgesic effect of amitriptyline was shown to have a dose‐response unrelated to mood elevation, but there was a dose‐response for the incidence of adverse effects.
The ‘SiteRite’ ultrasound machine—an aid to internal jugular vein cannulation
Authors: ARMSTONG P. J. , CULLEN M. , SCOTT D. H. T. 
Published: February 2007

SummaryThe ‘SiteRite’ is a portable ultrasound imaging system designed to aid vein location during internal jugular vein cannulation. It was compared to the use of anatomical landmarks for internal jugular vein cannulation. It was easy to use and gave good quality images, increased the speed of cannulation, decreased the number of attempts to locate the internal jugular vein and reduced the failure rate, although it had no effect on the incidence of carotid artery puncture.
Epidural tramadol for postoperative pain relief
Authors: Delilkan A. E. , Vijayan R. 
Published: February 2007

SummaryThe efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Sixty patients undergoing abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1 tramadol 50 mg; group 2 tramadol 100 mg; group 3 10 ml of bupivacaine 0.25%. The drugs were administered at the patients' request with each patient being allowed four doses in the first 24 h following surgery. Blood pressure, pulse rate, respiratory rate, arterial blood gas analyses, pain scores, the interval between doses and the occurrence of any side effects were recorded. Pain scores (assessed using a visual analogue scale) were significantly less (p < 0.05) at 3, 12, and 24 h in patients receiving tramadol 100 mg than in those receiving tramadol 50 mg or bupivacaine. The mean interval between doses for groups 1, 2 and 3 was 7.40 h, 9.36 h and 5.98 h respectively. The mean interval in group 2 was significantly longer than in group 3 (p < 0.05). The incidence of nausea and vomiting in group 2 was significantly higher than in group 3 (p < 0.05).
Thyrotropin concentration predicts outcome in critical illness
Authors: ROTHWELL P. M. , UDWADIA Z. F. , LAWLER P. G. 
Published: February 2007

SummaryConcentrations of thyrotropin, total thyroxine, total tri‐iodothyronine and cortisol were measured on admission to an intensive care unit in 200 consecutive patients who did not receive dopamine. Thyrotropin concentration was subnormal (< 0.4 mU.l−1) in 25 patients (12%) and increased (> 5.0 mU.r') in 27 (13%). Mortality in these groups differed 22‐fold (88% and 4% respectively) despite comparable Apache II outcome predictions (51% and 32%). Thyrotropin concentration correlated positively with total thyroxine concentration (r = 0.46, p < 0.001) and negatively with cortisol concentration (r =–0.56, p < 0.001). In 15 of the patients with increased thyrotropin concentration on admission, repeat measurements were made on recovery and were normal in 13. The high frequency of abnormal thyrotropin concentrations casts doubt on the assumption of euthyroidism in critical illness. Admission thyrotropin concentration is of prognostic value in critically ill patients.
Pethidine has a local anaesthetic action on peripheral nerves in vivo
Authors: ARMSTRONG P. J. , MORTON C. P. J. , NIMMO A. F. 
Published: February 2007

SummaryIn a double‐blind, randomised study, we have examined the effects of the addition of pethidine 100 mg to 40 ml prilocaine 0.25% for intravenous regional anaesthesia in healthy volunteers. During intravenous regional anaesthesia the hand and forearm are isolated from the rest of the circulation and pethidine interaction with central opiate receptors does not occur. Pethidine increased the speed of onset and extent of sensory and motor block, reduced tourniquet and forearm pain, and subjectively improved the quality of the block. Pethidine has local anaesthetic action on peripheral nerves in vivo.
The parallel Lack anaesthetic breathing system
Authors: OOI R. , LACK J. A. , SONI N. , WHITTLE J. , PATTISON J. 
Published: February 2007

SummaryThe parallel Lack system is a new modification of the Mapleson A system comprising separate inspiratory and expiratory tubes. To determine that the function of the system was that anticipated of a Mapleson A, the fresh gas flow requirements to prevent rebreathing during spontaneous ventilation were assessed in three situations: (I) a lung model (2) conscious volunteers and (3) anaesthetised patients. Two sets of criteria to define rebreathing were used; (A) those based on changes in ventilation or end‐expired carbon dioxide tension and (B) minimum inspired carbon dioxide tension. Using A, rebreathing occurred at afresh gas flow to minute ventilation ratio (Vfjve) of 0.75 for the lung model, and 0.73 for conscious volunteers. These results were comparable to those obtained for a Magill attachment. They were also close to the point at which mechanical dead space began to increase in the lung model. Criteria B gave much lower values for the onset of rebreathing. Rebreathing was present by criteria A in five of the six anaesthetised patients at afresh gas flow of 60 ml.kg ‘.min’ (Vfjvf of 0.78). The results confirm that the parallel Lack behaves as a Mapleson A system. The resistance to breathing posed by the parallel Lack was also comparable to the Magill system.
An evaluation of the effect of vasodilatation on oxygen saturations measured by pulse oximetry and venous blood gas analysis
Authors: BROOME I. J. , MILLS G. H. , SPIERS P. , REILLY C. S. 
Published: February 2007

SummaryMeasurements of arterial oxygen saturation were estimated using a pulse oximeter under conditions of reactive hyperaemia in the arms of 10 volunteers. Oxygen saturation measured by pulse oximetry was significantly lower, and venous oxygen saturation measured by co‐oximetry was significantly higher, in the hyperaemic arm than in the other arm. Pulse oximeters analyse the pulsatile component of blood flow and exclude nonpulsatile causes of absorption in estimating arterial oxygen saturation. The pulsatile component is assumed to be purely of arterial origin. However, other vessels may pulsate when vasodilatation occurs and pulse oximeter saturation readings taken under these conditions may not give a true reflection of arterial saturation.
A prospective randomised study of local versus general anaesthesia for cataract surgery
Authors: Campbell D. N. C. , Lim M. , Muir M. Kerr , O'Sullivan G. , Falcon M. , Fison P. , Woods R. 
Published: February 2007

SummaryOne hundred and sixty‐nine patients (aged 65–98 years) were randomised to receive either local or general anaesthesia for cataract surgery. Cognitive function was assessed using a battery of psychometric tests performed pre‐operatively, and at 24 h, 2 weeks and 3 months postoperatively. Oxygen saturation, blood pressure and heart rate were monitored and the results recorded throughout the anaesthetic and immediate recovery period. In the general anaesthetic group, 19% of patients experienced at least one episode of oxygen desaturation during the procedure compared with none in the local anaesthetic group. Pulse rate and blood pressure were stable in the local anaesthetic group compared with the general anaesthetic group where marked fluctuations were noted; 61% of patients in the general anaesthetic group experienced falls in systolic blood pressure greater than 30% of the pre‐induction value. No evidence of long‐term postoperative cognitive dysfunction was detected and there was no significant difference between the performances of the two groups.