bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low‐flow anaesthesia
Authors: COTTER S. M. , PETROS A. J. , DORÉ C. J. , BARBER N. D. , WHITE D. C. 
Published: February 2007

SummaryAn 8‐week survey was conducted to determine whether the introduction of low‐flow anaesthesia (a fresh gas flow of 4 litres/minute or less) into routine use would be acceptable to members of a representative anaesthetic department and if the consequent reduction in use of volatile anaesthetics would result in financial savings. The hourly consumption of the volatile agents was measured during anaesthesia conducted using either conventional or low fresh gas flows. Anaesthetists' acceptance of low‐flow anaesthesia was assessed using a questionnaire. Data were gathered on 286 patients undergoing inhalational anaesthesia for routine operative procedures. A 54.7% reduction in the consumption of isoflurane and a 55.9% reduction in that of enflurane was found. Of the 28 anaesthetists at the hospital, 21 would use low‐flow anaesthesia routinely. The routine use of low‐flow anaesthesia would therefore be acceptable and could result in annual savings of £26870 at Northwick Park Hospital.
Gastric emptying following Caesarean section and the effect of epidural fentanyl
Authors: GEDDES S. M. , THORBURN J. , LOGAN R. W. 
Published: February 2007

SummaryThe rate of absorption of paracetamol following oral administration was used as an indirect measure of the rate of gastric emptying. This was to determine the effect on gastric motility of the addition of fentanyl to a solution of local anaesthetic given into the epidural space to provide pain relief following Caesarean section. Thirty subjects were randomly allocated to receive either bupivacaine plus fentanyl or bupivacaine alone. The area under the curve of the graph of plasma paracetamol concentration versus time was calculated for each subject at 45 and 90 minutes after administration of the epidural injection, and this value was used as an index of the rate of gastric emptying. This study demonstrated that gastric emptying may be normal immediately following Caesarean section under epidural anaesthesia, but that if fentanyl is added to the epidural solution, gastric emptying is significantly slower in the first 45 minutes following surgery (p < 0.05).
Stressful pre‐operative preparation procedures
Authors: COBLEY M. , DUNNE J. A. , SANDERS L. D. 
Published: February 2007

SummaryOne hundred and twenty‐four patients (76 women and 48 men) were interviewed within the first 36 hours after operation. Fifty per cent of those studied were denture wearers. They were asked to fill in a questionnaire which registered their levels of distress about the various pre‐operative preparation procedures. The most common factors contributing to pre‐operative distress were waiting for transfer to the operating theatre, the prohibition of fluids and the removal of dentures.
Effect of prior administration of cold saline on pain during propofol injection
Authors: Barker P. , Langton J. A. , Murphy P. , Rowbotham D. J. 
Published: February 2007

SummaryA single‐blind, randomised, controlled study was undertaken to compare the efficacy of three methods of preventing pain during injection of propofol on induction of anaesthesia. Patients were allocated randomly to receive unmodified propofol, propofol with 0.05% lignocaine, propofol at 4°C and unmodified propofol preceded by 10 ml of 0.9% saline at 4°C. Prior injection of cold saline reduced the incidence of pain and discomfort significantly (22%) compared with unmodified propofol (75%; p < 0.005) and was similar to that after cold propofol (33%) and propofol with lignocaine (44%). There was no significant difference between the treatment groups.
Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement
Authors: SERPELL M. G. , MILLAR F. A. , THOMSON M. F. 
Published: February 2007

SummaryA randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200 000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.
Milrinone, a bridge to heart transplantation
Authors: WATSON D. M. , SHERRY K. M. , WESTON G. A. 
Published: February 2007

SummaryWe describe the use of a milrinone infusion as a bridge to heart transplantation in the treatment of severe congestive cardiac failure secondary to viral cardiomyopathy. The clinical improvement that occurred when milrinone was commenced made it possible to wean the patient from conventional cardiovascular support with an intra‐aortic balloon pump and dobutamine. There was an improvement in organ perfusion.
Potential errors in pulse oximetry III: Effects of interference, dyes, dyshaemoglobins and other pigments*
Authors: RALSTON A. C. , WEBB R. K. , RUNCIMAN W. B. 
Published: February 2007

SummaryElectrosurgery, patient motion and some types of lighting can cause errors in saturation readout; it is recommended that probes should be shielded from ambient lighting. Intravenous dyes can introduce gross but transient errors, which may also be present in in vitro measurements. Carboxyhaemoglobin causes overestimation of fractional saturation by an amount less than, but possibly close to, the percent of carboxyhaemoglobin present. Methaemoglobin causes the pulse oximeter readout to tend towards 85%. Fetal haemoglobin and bilirubin introduce no significant error, although they may interfere with in vitro measurements. Skin pigmentation can result in a slight decrease in accuracy. Nail polish may cause up to 6% underestimation of saturation; it is recommended that probes should be mounted sideways on fingers with nail polish or long nails. Adhesive tape or a vinyl glove across the probe has no demonstrable effect on accuracy. A blood sample should be analysed by a multiwavelength in vitro oximeter when an erroneous pulse oximeter reading is suspected, although errors may be introduced in the in vitro reading by fetal haemoglobin, bilirubin and intravenous dyes.
Francis Percival de Caux (1892–1965)
Authors: WILKINSON D. J. 
Published: February 2007

SummaryAll doctors practice medicine within the confines of what is termed ‘acceptable practice’. This acceptable practice is delineated by medical ethics, the actions of one's colleagues, social custom, and the laws of the country. Failure to conform to any or all of these constraints may result in professional ostracism or even loss of liberty. The life and work of Frances Percival de Caux clearly shows these effects in their most damaging manner.
A comparison of lignocaine with prilocaine in axillary brachial plexus anaesthesia
Authors: McCoy E.P. , Wilson C.M. 
Published: February 2007

SummaryTwenty patients received either lignocaine 1.5% with 1/200000 adrenaline (group L), or prilocaine 1.5% plain (group P) as a brachial plexus block for surgery to the upper limb, in a randomised double‐blind study. The two groups were comparable in age, weight and duration of surgery and there were no significant differences between the two groups with regard to onset, pattern or degree of sensory loss. The degree of motor loss was also comparable. The group L patients had a statistically significant longer duration of sensory loss than those in group P. All the blocks were performed using the same technique and provided complete surgical anaesthesia. Prilocaine 1.5% plain provides adequate sensory and motor blockade for brachial plexus anaesthesia and is a suitable agent for medium duration surgery to the upper limb.
Incidence of awareness with recall during general anaesthesia
Authors: LIU W. H. D. , THORP T. A. S. , GRAHAM S. G. , AITKENHEAD A. R. 
Published: February 2007

SummaryOne thousand patients who were anaesthetised between February and April 1990 at University Hospital, Nottingham were interviewed between 20 and 36 hours after their operation. Patients under 16 years of age, those who had undergone obstetric or intracranial surgery, those who were unable to communicate and patients who were discharged from hospital before the postoperative visit were not interviewed. A standard set of questions was used to determine the incidences of recall of events and dreams during the operation. These incidences were 0.2% and 0.9% respectively, considerably lower than reported in previous comparable studies.
Comparison of extradural and intravenous diamorphine as a supplement to extradural bupivacaine
Authors: LEE A. , McKEOWN D. , BROCKWAY M. , BANNISTER J. , WILDSMITH J. A. W. 
Published: February 2007

SummaryThe influence of route of administration (extradural as compared with intravenous) of diamorphine 0.5 mg/hour as a supplement to extradural bupivacaine (0.125% at 15 ml/hour) was investigated in two groups of 20 patients who underwent major abdominal gynaecological surgery. Significantly more patients in the intravenous group withdrew because of inadequate analgesia (p < 0.05). Those in the extradural group were significantly more drowsy throughout the study (p < 0.01), but no major side effects were encountered.
Evaluation of the Lamtec anaesthetic agent monitor
Authors: HUMPHREY S. J. E. , LUFF N. P. , WHITE D. C. 
Published: February 2007

SummaryThe Lamtec agent monitor is a compact anaesthetic analyser designed to measure halothane, isoflurane and enflurane. It shows good linearity and stability. The faster model can be used for end‐tidal measurements up to 25 breaths per minute. Calibration using a standard of the gas to be measured is recommended.
Antagonism of atracurium with neostigmine
Authors: Goldhill D. R. , Carter J. A. , Suresh D. , Whitehead J. P. , Flynn P. J. 
Published: February 2007

SummaryIn 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium‐induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 μg/kg, 35 μg/kg, 55 μg/kg or 75 μg/kg). The recovery times to a train‐of‐four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average TI of between 8.8% and 14.9%. There was no difference in the recovery times between the patients given neostigmine 35 μg/kg, 55 μg/kg or 75 μg/kg. Recovery after neostigmine 15 μg/kg was significantly slower than after the higher doses. One patient given neostigmine 75 μg/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 μg/kg of neostogmine as a single bolus.
Colloid solutions in the critically ill
Authors: STOCKWELL M. A. , SONI N. , RILEY B. 
Published: February 2007

SummaryAll patients admitted to an Intensive Care Unit were randomised to receive all volume replacement fluid as either human albumin solution or a synthetic colloid. A total of 475 patients were admitted during the study period. Patients' age, sex, APACHE score and calculated risk of death were assessed on admission. Outcome was assessed as length of Intensive Care stay and mortality. There was no difference between the groups. Subgroups of patients with APACHE score greater than 10, calculated risk of death greater than 50% and length of stay greater than 5 days were also evaluated but no significant differences were found between treatment groups. The use of albumin rather than 3.5% polygeline for volume replacement in the Intensive Care Unit has no influence on outcome.
An evaluation of the Brüel and Kjær monitor 1304
Authors: McPEAK H. B. , PALAYIWA E. , ROBINSON G. C. , SYKES M. K. 
Published: February 2007

SummaryA laboratory evaluation was performed on the Brüel and Kjœr multigas monitor 1304, incorporating a pulse oximeter. The instrument was tested for accuracy, stability, response and delay times, frequency response and the effects of water vapour, alcohol, cyclopropane and sevoflurane. The instrument's performance was found to be within or very close to the manufacturer's specifications for accuracy, stability and response and delay times. It was unaffected by water vapour and alcohol and the effect of cyclopropane on the vapour channel was lower than has been reported for other analysers. The response to sevoflurane was of the same order as that of the other vapours. A 90% response to square wave changes of gas composition was maintained up to 60 breaths.min−1 for CO2, O2, and N2O and up to 40 breaths.min−1 for the vapours when the nafion sampling tube was used.
The ‘whoosh’ test
Authors: Lewis M. P. N. , Thomas P. , Wilson L. F. , Mulholland R. C. 
Published: February 2007

SummaryWe describe a previously unreported test to confirm accurate needle placement in caudal epidurals. Of 26 patients undergoing caudal epidural, 19 (73%) had correct needle placement as determined by epidurography. All of these had a positive‘whoosh' test. There were no false positives.
Propofol and serum potassium
Authors: Fogarty D.J. , McCleane G.J. 
Published: February 2007

SummaryThe aim of this study was to examine the effect of propofol and propofol with suxamethonium on serum potassium concentration during induction of general anaesthesia. Forty patients were studied during elective surgery and serum electrolytes were measured before and after the induction of anaesthesia. Patients were allocated at random into two groups to receive either propofol alone or with suxamethonium. The serum potassium fell by 0.04 mmol.l−1 by 5 min after induction with propofol alone but had recovered to the pre‐induction level by 10 min. The serum potassium rose by 0.23 mmol.l−1 when a combination of propofol and suxamethonium was used for the induction of anaesthesia.
V̇o2 and V̇co2 following tourniquet deflation
Authors: Hoka S. , Yoshitake J. , Arakawa S. , Ohta K. , Yamaoka A. , Goto T. 
Published: February 2007

SummaryWe examined changes in O2 uptake, CO2 output, blood pressure and heart rate following tourniquet deflation in 23 patients undergoing orthopaedic surgery of the lower extremities. A pneumatic tourniquet was applied for periods ranging from 21 to 106 min (mean 51 min). Prerelease values of V̇o2 (O2 uptake at each min) and V̇co2 (CO2 output at each min) were 201 (37) and 174 (38) (mean (SD)) ml.min−1 respectively. Significantly, V̇o2 and V̇co2 increased by 55% and 80%, respectively, at 2 min after tourniquet release and returned to prerelease values within 8 min. The blood pressure fell significantly and the heart rate rose significantly. The increases in CO2 output and O2 uptake were dependent on the length of tourniquet inflation time; Y = 4.7 X (tourniquet time) +54, r = 0.88, (p < 0.001) for CO2, and Y = 1.3 X (tourniquet time) +99, r = 0.52, (p < 0.05) for O2. The slope of the increase in CO2 output as a function in inflation time was 3.6 times greater than that of O2 uptake. In conclusion, CO2 output and O2 uptake increased transiently after tourniquet deflation and the extent of the increase in CO2 output is more than threefold as compared with that in O2 uptake.
Upper oesophageal sphincter pressure and the effect of cricoid pressure
Authors: VANNER R. G. , O'DWYER J. P. , PRYLE B. J. , REYNOLDS F. 
Published: February 2007

SummaryUpper oesophageal sphincter pressure has been measured in 24 patients with a sleeve device. The median sphincter pressure when awake was 38 mmHg. and when anaesthetised and paralysed was 6 mmHg. After tracheal intubation, cricoid pressure was applied at measured values between 5 and 50 N using a hand‐held cricoid yoke while the sphincter pressure was recorded in two head and neck positions: with and without a standard intubating pillow with neck support. A cricoid force of 40 N increased sphincter pressure to above 38 mmHg in all the patients and the use of the pillow did not alter this effect. With the application of cricoid pressure, operating department assistants raised sphincter pressure to above 38 mmHg in only 50% of patients. Laryngoscopy made little difference to the effect of cricoid pressure except in one patient in whom it reduced the sphincter pressure by 27 mmHg.
Ketorolac for postoperative analgesia in elderly patients
Authors: Smallman J. M. B. , Powell H. , Ewart M. C. , Morgan M. 
Published: February 2007

SummaryKetorolac was compared with papaveretum followed by paracetamol plus dextropropoxyphene orally', for postoperative pain relief in elderly orthopaedic patients. Seventy‐two patients over the age of 65 years were entered into a double‐blind, randomised trial. Pain and pain relief were recorded during an intramuscular and an oral phase, lasting up to 8 days, and a global assessment was made at the end of the study. No difference was demonstrated between the two treatment groups. The incidence of side effects was similar in both groups. It was concluded that ketorolac could provide pain relief equivalent to papaveretum for many patients.
A comparison of two approaches to sciatic nerve block
Authors: Kilpatrick A. W. A. , Coventry D. M. , Todd J. G. 
Published: February 2007

SummaryThis study compared the posterior and popliteal fossa approaches for sciatic nerve block. Patients scheduled to undergo foot surgery were allocated randomly into one of two groups: group A (n = 20) received sciatic nerve block via the posterior approach and group B (n = 20) received a block using the popliteal fossa approach. All blocks were performed with the aid of a peripheral nerve stimulator and alkalinised 0.5% bupivacaine with 1 in 200 000 adrenaline was injected in a dose of 2 mg.kg Nineteen of 20 blocks in group A were successful compared with nine of 20 in group B (p < 0.01). There was no significant difference between the groups in respect of time to onset or duration of block. Patients in group B reported less discomfort during performance of the sciatic nerve block but required supplementary nerve blocks more frequently. We recommend the use of the posterior approach for sciatic nerve block.
Appropriate use of local anaesthetic for venous cannulation
Authors: HARRISON N. , LANGHAM B. T. , BOGOD D. G. 
Published: February 2007

SummaryA departmental survey indicated that the large majority of anaesthetists believed that injection of local anaesthetic before insertion of an intravenous cannula was unnecessary if a cannula of 18 gauge or smaller was used, because injection of local anaesthetic would be more painful than insertion of the cannula. A study was undertaken to test this hypothesis. The results showed that intravenous cannulation with a cannula of 18, 20 or 22 gauge was significantly (p < 0.006) more painful than a subcutaneous injection of 1% lignocaine. We recommend that subcutaneous injection of local anaesthetic should be considered before insertion of any size of intravenous cannula.
Treatment of acute severe asthma assisted by hypothermia
Authors: BROWNING D. , GOODRUM D. T. 
Published: February 2007

SummaryA 20‐year‐old woman in status asthmaticus who failed to respond to conventional therapy and ventilation of the lungs with 0.5–2.0% halothane, was cooled to 30°C for almost 5 days as the arterial carbon dioxide tension rose above 15 kPa. Halothane was not of immediate value, contrary to other reports. A reduction in carbon dioxide production by controlled hypothermia permitted more suitable ventilation parameters, but extensive muscle weakness caused by a steroid‐induced myopathy complicated weaning from respiratory support. Prospective measurement of serum creatinine phosphokinase concentration in patients given high dose corticosteroids may herald the onset of a myopathy.
The use of propofol and alfentanil by infusion in military anaesthesia
Authors: WILSON R. J. T. , RIDLEY S. A. 
Published: February 2007

SummaryA total intravenous technique using propofol and alfentanil was used successfully in four battlefield casualties treated at a British Military Field Hospital during the recent Gulf conflict. All patients made a rapid recovery of adequate quality for prompt evacuation. We believe that the use of propofol and alfentanil as an induction and maintenance regimen for military anaesthesia merits further evaluation and comparison with established techniques.
Influence of converting enzyme inhibition on isoflurane‐induced hypotension for cerebral aneurysm surgery
Authors: Van Aken J. , Leusen I. , Lacroix E. , De Somer A. , Roily G. , Calliauw L. 
Published: February 2007

SummaryTwenty‐five patients (aged 18 to 72 years), who recovered after the first bleed from a cerebral aneurysm, were operated on under neuroleptanaesthesia. Isqflurane was added to induce hypotension, ft was found that the required hypotension (51 (SEM 1) mmHg) could be obtained and maintained at much lower isoflurane concentrations (less than 1%) after blockade of the angiotensin converting enzyme activity by enalaprilat (2.5 mg i.v.) than without such inhibition. During the hypotension which lasted 78 (Sem 10) min, only minor adjustments of the isoflurane concentration (0.70 (0.04%) were needed. The desired level of hypotension was obtained with preservation of the cardiac output and without tachycardia. No resistance to the blood pressure lowering effect of isoflurane was observed. On recovery from anaesthesia, a small increase of blood pressure above control values was seen in 16 patients and was easily reversed by small doses of clonidine (mean total dose: 220 (61) μg). The operative conditions were excellent and the postoperative recovery was uneventful and complete in 23 patients.
Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction
Authors: Messent M. , Sullivan K. , Keogh B. F. , Morgan C. J. , Evans T. W. 
Published: February 2007

SummaryThe outcome of adult respiratory distress syndrome complicating cardiopulmonary bypass has changed little in recent years. A retrospective, case‐controlled study was designed to assess the incidence of the adult respiratory distress syndrome in these circumstances and the extent to which it could be linked with pre and peri‐operative predictive factors. Eleven patients who developed the syndrome out of 840 who underwent cardiopulmonary bypass over a 9 month period were compared with 53 controls matched for sex, operation and surgeon. The incidence of adult respiratory distress syndrome and its mortality were 1.3% and 53% respectively. Significant predictors were a high intra and postoperative intervention score, the total volume of blood pumped during bypass (>300 l) and age (>60 years). These risk factors should alert the clinician to the possibility of severe postoperative pulmonary complications.
Tramadol: pain relief by an opioid without depression of respiration
Authors: VICKERS M. D. , O'FLAHERTY D. , SZEKELY S. M. , READ M. , YOSHIZUMI J. 
Published: February 2007

SummaryTwo independent clinical trials were conducted simultaneously. In one, tramadol and pethidine were compared in 30 patients by patient‐controlled analgesia during the first 24 h following abdominal surgery. The mean 24 h consumption of tramadol and pethidine was 642 mg and 606 mg respectively, giving a potency estimate of tramadol relative to pethidine of 0.94 (95% confidence interval 0.72–1.17). In the second trial, the effect on respiration of three doses of tramadol (0.5, 1.0, and 2.0 mg.kg−1) was compared with that of morphine sulphate (0.143 mg.kg−1) by intravenous injection during stable halothane anaesthesia. At approximately 1.5 times the equipotent dose, as estimated from the first trial, tramadol transiently depressed the rate of respiration but had no effect on end‐tidal carbon dioxide tension. Morphine caused apnoea or considerable depression of ventilation. The results suggest that mechanisms other than opioid receptor activity play a significant role in the analgesia produced by tramadol.