bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of insufflation leaks upon ventilation
Authors: WATT J. W. H. , FRASER M. H. 
Published: February 2007

SummarySome ventilator‐dependent patients use uncuffed tracheostomy tubes, resulting in fluctuations in the minute volume of ventilation. Bedside measurement of ventilation is difficult because of the insufflation and exsufflation leaks. This laboratory study of five different ventilators measured the tidal volumes achieved with three insufflation leaks introduced in an increasing order of magnitude and at three levels of compliance. The largest leak reduced the peak inflation pressure from 26 to 14 cmH2O in two pressure‐limited ventilators with a 35% loss of the initial tidal volume of 800 ml. The turbine‐driven pressure‐limited ventilator retained a peak pressure of 20.5 cmH2O and lost only 14% of the volume, whereas the volume ventilators lost 65% of the tidal volume. The loss of volume was 3% for every cmH2O decrease in airway pressure due to a leak, regardless of the ventilator or compliance. Using the Friedman test, the differences between the volume ventilators and the pressure ventilators were significant whilst the three pressure‐limited ventilators did not perform significantly differently from each other.
Intra‐ocular pressure during cardiopulmonary bypass‐a comparison of crystalloid and colloid priming solutions.
Authors: Abbott M. A. , McLaren A. D. , Algie T. 
Published: February 2007

SummaryRaised intra‐ocular presure secondary to alterations in plasma oncotic pressure has been implicated in the development of optic neuropathy after cardiopulmonary bypass. Patients presenting for open heart surgery received either crystalloid (n=9) or colloid (n=10) priming solutions for cardiopulmonary bypass. No differences in intra‐ocular pressure or plasma oncotic pressure occurred between the groups before the onset of cardiopulmonary bypass. Five minutes after the start of bypass the median intra‐ocular pressure increased to 31 mmHg in the crystalloid group compared with 13mmHg in the colloid group (p < 0.05). At the same time plasma oncotic pressure decreased from approximately 20mmHg in both groups to 10.6 mmHg with crystalloid and 15.7 mmHg with colloid primed cardiopulmonary bypass solutions (p < 0.05). Over the following hour of cardiopulmonary bypass, intra‐ocular pressure and plasma oncotic pressure tended to return towards their pre‐cardiopulmonary bypass values. Changes in plasma oncotic pressure, through fluid shifts, may have contributed towards this unexpected increase in intra‐ocular pressure with crystalloid primed cardiopulmonary bypass.
Epidural diamorphine
Authors: DANIEL M. , McGRADY E. M. 
Published: February 2007

SummaryIn a randomly allocated double blind study of 54 primigravidae, we examined the relative efficacy of the addition of diamorphine 3 mg to either an initial bolus or an infusion of bupivacaine. Both groups received an initial bolus of 10 ml of bupivacaine 0.25% followed by an infusion of bupivacaine 0.1% at 10 ml.h‐1. Group 1 received diamorphine 3 mg in the bolus and group 2 received diamorphine 3 mg in the initial 100 ml of infusion solution. Both groups had comparable total bupivacaine requirements. Analgesia, assessed by visual analogue scores, was superior at 7 h in group 2, but was similar at all other times. Sedation scores were significantly lower in group 2 for the first 3 h and the incidence of nausea was significantly lower in group 2. The addition of diamorphine, whether as a bolus or added to an infusion of bupivacaine, results in similar quality of analgesia, but there is a reduction in side effects when diamorphine is administered in an infusion.
Adrenaline administered via a nebulizer in adult patients with upper airway obstruction
Authors: MACDONNELL S. P. J. , TIMMINS A. C. , WATSON J. D. 
Published: February 2007

SummaryRacemic adrenaline administered via a nebulizer has been used successfully in children with upper airway obstruction resulting from croup and postintubation oedema. We report four adult cases of upper airway obstruction of differing aetiologies successfully managed with the administration of adrenaline via a nebulizer (1 mg in 5 ml of normal saline and repeated as necessary). This appears to be safe and effective in selected cases of upper airway obstruction with immediate benefits and few cardiovascular sequelae.
The effect of midazolam premedication on implicit memory activation during alfentanil‐nitrous oxide anaesthesia
Authors: DE ROODE A. , JELICIC M. , BONKE B. , BOVILL J. G. 
Published: February 2007

SummaryEighty‐three patients were given midazolam 0.1 mg.kg‐1 by intramuscular injection as premedication before general anaesthesia with alfentanil‐nitrous oxide. During anaesthesia patients were presented (through headphones) with either statements about common facts of some years ago (group A) (n = 43) or new verbal associations, e.g. names of fictitious, nonfamous people (group B) (n = 40). In a previous study with the same anaesthetic technique, but without premedication there was significant activation of implicit memory (p < 0.001). In this study we found no explicit or implicit memory for the auditory information presented during anaesthesia. Midazolam premedication can prevent implicit memory activation during alfentanil‐nitrous oxide anaesthesia.
Magnesium deficiency in critically ill patients
Authors: ARNOLD A. , TOVEY J. , MANGAT P. , PENNY W. , JACOBS S. 
Published: February 2007

SummaryA study was performed to assess the value of estimation of intracellular magnesium in peripheral blood cells (red and mononuclear blood cells) in critically ill patients as an index of tissue magnesium content. A magnesium loading test was used to diagnose magnesium depletion in 16 critically ill patients. Patients were divided into magnesium depleted and non‐depleted groups according to their response to the loading test. Pre ‐infusion plasma and intracellular (blood cell) magnesium levels were measured. There were no significant differences between the magnesium depleted (mean plasma magnesium 0.81 mmol.l‐1, red blood cell magnesium 2.34mmol.l‐1, mononuclear blood cell magnesium 25.16mmol.kg‐1dry weight) and non‐depleted groups (mean plasma magnesium 0.90mmol.l‐1, red blood cell magnesium 2.18mmol.l‐1, mononuclear blood cell magnesium 18.1 mmol.kg‐1dry weight). We conclude that the diagnosis of magnesium depletion cannot be excluded in the face of normal plasma, red blood cell or mononuclear blood cell concentrations of magnesium.
Effects of ketamine on cerebral blood flow velocity in humans Influence of pretreatment with midazolam or esmolol
Authors: STREBEL S. , KAUFMANN M. , MAÎRE L. , SCHAEFER H. G. 
Published: February 2007

SummaryDuring normoventilation and‘light’, haemodynamically stable, steady‐state anaesthesia with isoflurane 0.3%, the effect of ketamine intravenously was investigated in 24 patients randomly assigned to one of the following groups: group 1 (control group) no ketamine, group 2 (ketamine group) ketamine 2mg.kg, group 3 (ketamine/midazolam group) ketamine 2mg.kg‐1 after pretreatment with midazolam and group 4 (ketamine/esmolol group) ketamine 2mg.kg ‐1 while maintaining mean arterial blood pressure at a preketamine level with esmolol. Ketamine‐induced cerebrovascular changes were measured by means of transcranial Doppler ultrasonography. Control readings in patients without ketamine challenge demonstrated stable cardiovascular and cerebrovascular baseline conditions. Cerebral blood flow velocity and mean arterial blood pressure, however, significantly increased after administration of ketamine without pretreatment. The increase in cerebral blood flow velocity could not be blocked by maintaining mean arterial blood pressure at baseline value with esmolol. In contrast, the effects of ketamine on cerebral blood flow velocity and mean arterial blood pressure were prevented by prior administration of midazolam. The results suggest that ketamine may significantly influence intracerebral haemodynamics via a direct drug effect rather than via a secondary effect due to changes in arterial carbon dioxide and/or mean arterial blood pressure.
Forced‐air warming maintains normothermia during orthotopic liver ransplantation
Authors: MÜLER C. M. , LANGENECKER S. , ANDEL H. , NANTSCHEV I. , HÖLZENBEIN T. J. , ZIMPFER M. 
Published: February 2007

SummaryWe evaluated the efficacy of forced‐air warming to maintain normothermia during liver transplantation. In a prospective, clinical trial 20 patients were randomly assigned to routine thermal management (circulating‐water mattress set at 42°C, intravenous fluid warming to 37°C and passive insulation) or routine management with additional forced‐air warming of head, chest, and arms. Core temperature was measured in the pulmonary artery. Morphometric and demographic characteristics were similar in each group, as was total administered fluid volume replacement. Core temperatures in each group decreased by about 0.6°C during the first 70min of anaesthesia and then by 0.9°C within 90 to 120 min in the patients given routine thermal management, but only by 0.4°C in those warmed with forced‐air. Subsequently, core temperatures in the control group increased to only 35.7, SD 0.25°C whereas those in the patients given forced‐air warming increased to 36.5, SD 0.2°C. Despite the relatively high ambient temperature, patients warmed only with a circulating‐water mattress and passive insulation became hypothermic during surgery. In contrast, when forced‐air warming was added to this routine thermal management, patients were normothermic at the end of surgery. Forced‐air warming prevented intra‐operative hypothermia during liver transplantation.
Postoperative neuroleptic malignant syndrome
Authors: Shaw A. , Matthews E.E. 
Published: February 2007

SummaryThis report describes neuroleptic malignant syndrome in a previously healthy 6‐year‐old child. Droperidol and metoclopramide had been given, and hyponatraemia may have been a precipitating factor. Treatment with dantrolene sodium combined with a forced alkaline diuresis resulted in a full recovery.
Pulmonary consequences of carbon dioxide insufflation for laparoscopic cholecystectomies
Authors: KENDALL A. P. , BHATT S. , OH T. E. 
Published: February 2007

SummaryTwenty patients having laparoscopic cholecystectomies were studied for changes in thoracic and lung compliance at 5, 10 and 15mmHg of intra‐abdominal pressure. Fifteen mmHg of intra‐abdominal pressure decreased the thoracic and the lung static compliance by 49 and 39% respectively. This was unaffected by the degree of head elevation. During the procedure the end‐tidal carbon dioxide increased by a mean of 1.6kPa at 1 h and 2.0kPa at 2h. This did not appear to be related to either the mean intra‐abdominal pressure or the total volume of carbon dioxide insufflated. The physiological changes and implications for anaesthetic practice are considered.
Clonidine: an adjunct in isoflurane N2O/O2 relaxant anaesthesia
Authors: GABRIEL A. H. , FARYNIAK B. , SOJKA G. , CZECH T. , FREYE E. , SPISS C. K. 
Published: February 2007

SummaryWe investigated the effect of clonidine in 19 patients having lumbar disc surgery under nitrous oxide/isoflurane/relaxant anaesthesia. The EEG, spinal and cortical somatosensory evoked potentials, and the brainstem auditory evoked potentials were recorded. After equilibration of the general anaesthetic, two successive infusions of clonidine (5μg.kg‐1) were given. After the second infusion of clonidine, the plasma concentration increased from 0.2(SEM 0.05) to 6.4(SEM 0.06) ng.ml‐1 (p < 0.05). In the EEG, δ‐activity was maintained, but the β‐fraction, and the 95% and 50% spectral frequencies were reduced. Total EEG power progressively decreased from 296(152‐397) μV2 to 108(51‐240) μV2. The somatosensory evoked spinal potential (N13) decreased in amplitude, (1.77(SEM 0.35) μV to 1.59(SEM 0.35) μV, p < 0.05) and increased in latency (14.37(SEM 0.29)ms to 14.69(SEM 0.31)ms, p < 0.05). The central conduction time increased from 6.47(SEM 0.16)ms to 6.92(SEM 0.25)ms, ns. There was no effect on the cortical somatosensory potentials, or the brainstem auditory evoked potentials. According to the EEG spectral indices, anaesthesia appeared to deepen despite a reduction in the end expiratory isoflurane concentration from 0.53(SEM 0.07) to 0.28(SEM 0.06)vol%, which indicated a reduction in anaesthetic requirements following clonidine.
A comparison of vital capacity breath and tidal breathing techniques for induction of anaesthesia with high sevoflurane concentrations in nitrous oxide and oxygen
Authors: YURINO M. , KIMURA H. 
Published: February 2007

SummaryVital capacity breath and tidal breathing techniques were compared for induction of anaesthesia with 7.5% sevoflurane in nitrous oxide, and oxygen. Thirty five subjects were randomly assigned to a vital capacity breath group (19) or to a tidal breathing group (16). The mean time for induction was faster with vital capacity breath (41 s) than with tidal breathing (52s, p < 0.05). Some involuntary movements were seen in the tidal breathing group but none in the vital capacity breath group. Coughing was seen in a quarter of the subjects in the tidal breathing group and in one subject of the vital capacity breath group. The vital capacity group showed excellent characteristics: rapid, and pleasant induction without premedication. We conclude that the vital capacity breath technique is necessary for the inhalation induction of anaesthesia; it provides enough overpressure to allow the subject to pass reliably and rapidly through the initial stages of excitement.
Cardiac arrest and resuscitation of a 6‐month old achondroplastic baby undergoing neurosurgery in the prone position
Authors: Kelleher A. , Mackersie A. 
Published: February 2007

SummaryWe describe the case of a 6‐month‐old achondroplastic baby who underwent foramen magnum decompression to relieve congenital cervical cord compression. During the procedure, acute hypotension occurred secondary to cord compression, and following attempts to alleviate this, torrential haemorrhage ensued and air was entrained into the circulation through large venous channels in the surgical field. This resulted in an asystolic cardiac arrest from which the baby was resuscitated whilst remaining in the prone position. Haemorrhage remained difficult to control and a second episode of air embolism occurred 5min later leading to a profound bradycardia and hypotension again requiring full cardiorespiratory resuscitation in the prone position. In total, 11 min elapsed before an adequate spontaneous cardiac output was re‐established. The procedure was abandoned and the patient transferred to the intensive care unit for postoperative management. An electroencephalogram performed after 24 h was reported as normal, and clinically the child made a full neurological recovery.
Maternal position during induction of spinal anaesthesia for Caesarean section
Authors: Inglis A. , Daniel M. , McGrady E. 
Published: February 2007

SummaryForty women presenting for elective Caesarean section under spinal anaesthesia were randomly assigned to have anaesthesia induced in either the sitting or right lateral positions; 2.5 ml 0.5% hyperbaric bupivacaine was injected over 10 s before the mother was placed in a supine position with a 20° lateral tilt. The onset time and height of the subsequent analgesic and anaesthetic block was measured. It took longer to site spinal needles in the lateral position (240 vs 115 s, p < 0.001). There was a faster onset of sensory block to the sixth thoracic dermatomal level (8 vs 10 min, p < 0.001), in the lateral group, although onset time to T4 was comparable. There was no difference in maximum block height or degree of motor block. Mothers in the lateral group required more ephedrine in the first 10m after siting the spinal (13.5 vs 10.5 mg, p < 0.05).
Compliance with an incident report scheme in anaesthesia
Authors: JAYASURIYA J. P. , ANANDACIVA S. 
Published: February 2007

SummaryVoluntary, anonymous reporting of incidents which occur during anaesthesia is a mechanism for obtaining information about such problems. Our objective was to estimate the compliance with reporting such incidents. For 3 months, alongside the incident report form, another form, which had to be completed for every patient, was used. This form listed a series of defined events which could occur intra‐operatively. Compliance with the incident reports was estimated by comparing the data obtained from the two sets of forms. Overall compliance was only about 30%. There were differences in compliance for different events. Compliance was high with more serious events and poor in the case of common events, or when successful recovery had occurred. In order to improve compliance, incident report forms should be available on each anaesthetic machine and staff should be made more aware of the fact that reportable incidents are not limited to events which harmed the patient, but also include those which could have affected patient safety.
A comparison of the stress response to laryngoscopy
Authors: McCOY E. P. , MIRAKHUR R. K. , McCLOSKEY B. V. 
Published: February 2007

SummaryThe cardiovascular changes and catecholamine concentrations were compared in 20 patients before and after laryngoscopy with either the Macintosh or the McCoy laryngoscope blades. Following induction with fentanyl and thiopentone and muscle relaxation with vecuronium the vocal cords were visualised for 10 s with either the Macintosh or McCoy blade, chosen at random. Heart rate, arterial blood pressure and plasma noradrenaline and adrenaline concentrations were measured before, and at, laryngoscopy, and 1, 3 and 5 min later. There was a significant increase in both heart rate (33%) and arterial blood pressure (27%) after laryngoscopy using the Macintosh blade (p < 0.01). Use of the McCoy blade did not result in any significant change in either heart rate or arterial blood pressure. There was a slight increase (p > 0.05) in plasma noradrenaline concentrations using the Macintosh blade which persisted for 5 min after laryngoscopy. This was not observed with the McCoy blade. There was no change in plasma adrenaline concentrations with either blade during the 5 min after laryngoscopy when compared to the values before laryngoscopy. It is concluded that the stress response to laryngoscopy is less marked with the use of the McCoy blade and is probably due to a reduction in the force necessary to obtain a clear view of the larynx.
Early proponents of cardiac massage
Authors: And H. Böhrer , GOERIG M. 
Published: February 2007

SummaryOpen‐chest cardiac massage in humans to treat chloroform syncope was first performed by Niehans in Berne and Langenbuch in Berlin in the late 1880s. Closed‐chest cardiac massage in humans was advocated by Koenig and Maass in Göttingen in the last two decades of the 19th century. The closed technique was used in Central Europe for several decades to treat chloroform syncope.
Patients’attitudes to rectal drug administration
Authors: Vyvyan H.A.L. , Hanafiah Z. 
Published: February 2007

SummaryOne hundred adult patients attending for day case surgery were surveyed by anonymous questionnaire in order to determine their attitudes to rectal drug administration. Fifty four patients did not want an analgesic drug (diclofenac sodium) administered rectally whilst under anaesthesia, all preferring to take it orally if available. Ninety eight patients thought that drugs administered per rectum should always be discussed with them beforehand and a few had very strong feelings about this route of administration. We suggest that prescribers of rectal diclofenac should always discuss it with patients pre‐operatively. Whilst many are happy to have suppositories, some young patients are sensitive about this and prefer to take such medication by mouth.
Relationship of admission thyroid function tests to outcome in critical illness
Authors: RAY D. C. , DRUMMOND G. B. , WILKINSON E. , BECKETT G. J. 
Published: February 2007

SummaryOne hundred and eighty patients had serum thyrotropin, total triiodothyronine and free thyroxine concentrations measured within 3h of admission to the Intensive Therapy Unit to assess whether thyroid function tests could predict outcome in critical illness. Overall mortality was 30.6%. Nonsurvivors were older (p = 0.001), and had higher AP ACHE II scores (p < 0.001) and predicted mortalities (p < 0.001). There was no difference in the median values of thyrotropin, total triiodothyronine and free thyroxine concentrations between survivors and nonsurvivors. Thyrotropin concentration was subnormal in 15 patients, normal in 152 and elevated in 13 patients. In contrast, 80 patients had subnormal triiodothyronine concentration. Free thyroxine was subnormal in five patients. Thyrotropin, total triiodothyronine and free thyroxine concentrations were not related to outcome (p = 0.360, p = 0.622, p = 0.726, respectively). No variable independently predicted death. Total triiodothyronine concentrations were lower in patients who received dopamine before admission to the intensive therapy unit than in those who did not (p = 0.008); thyrotropin and free thyroxine concentrations were not influenced by dopamine administration. Serum concentrations of thyrotropin, total triiodothyronine and free thyroxine measured within 3 h of admission to the intensive therapy unit are not predictive of outcome.
Time course of action and intubating conditions following vecuronium, rocuronium and mivacurium
Authors: WIERDA J. M. K. H. , HOMMES F. D. M. , NAP H. J. A. , van den BROEK L. 
Published: February 2007

SummaryThe purpose of this study was to compare the time course of action and tracheal intubating conditions of vecuronium, rocuronium and mivacurium in anaesthetised patients. Anaesthesia consisted of thiopentone, fentanyl, N2O/O2 and isoflurane. After a 2 × ED90 dose the first attempt at tracheal intubation was made at 90s. If required, maintenance doses of 0.5 × ED90 were administered. The intubating conditions after rocuronium were significantly better than those after vecuronium and mivacurium. The average onset times of rocuronium (172 s) and vecuronium (192 s) were significantly shorter than that of mivacurium (229 s). The clinical duration and recovery time were significantly shorter after mivacurium (13 and 6min, respectively) than with vecuronium (33 and 14min, respectivelys) and rocuronium (28 and 11 min, respectively). We conclude that rocuronium might be of advantage whenever the interval between the administration of the muscle relaxant and tracheal intubation must be short, whereas mivacurium may be of benefit if fast spontaneous recovery is required.
Comparison of central venous pressure measurements in the intrathoracic and the intra‐abdominal vena cava in critically ill children
Authors: LITMANOVITCH M. , HON H. , LUYT D. K. , DANCE M. , MATHIVHA L. R. 
Published: February 2007

SummaryA prospective study was conducted to compare simultaneous intrathoracic and intra‐abdominal central venous pressures in 10 critically ill, ventilated paediatric intensive care patients. Central venous pressures were measured using the water column technique over a 6h study period. There was excellent correlation between intrathoracic and intra‐abdominal vena caval pressure measurements (r = 0.974, p < 0.001). The difference between paired measurements did not exceed the limits of agreement (± 2SD, – 2.36 to 4.42cm H2O). The mean (SD) difference between readings was small (1.03 ± 1.69 cmH2O) and was within clinically tolerable limits. These data suggest a clinically useful, close relationship between intra‐abdominal and conventional intrathoracic central venous pressure measurement in this group of patients.