bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two approaches to the axillary brachial plexus
Authors: HILL D. A. , CAMPBELL W. I. 
Published: February 2007

SummaryA new technique of cannulation of the axillary neurovascular sheath, using loss of resistance to saline, was evaluated and compared to the established technique of eliciting paraesthesiae with a short‐bevelled needle. The cannulation technique produced a more reliable block of axillary, musculocutaneous and radial nerves, significantly fewer incomplete blocks and a lower incidence of accidental vessel puncture.
The use of high‐dose intravenous immunoglobulins in Guillain‐Barré syndrome
Authors: RAHAG A. 
Published: February 2007

SummaryA patient with severe Guillain‐Barré syndrome responded to treatment with high‐dose intravenous immunoglobulins. It is suggested, on the basis of recent case reports, that immunoglobulins may have an important role in the future treatment of this immune‐mediated disease.
Fibreoptic oximetry in the diagnosis of aortocaval fistula
Authors: KHAN K. J. , TSANG G. M. K. , FIELDING J. W. L. , BION J. F. 
Published: February 2007

SummaryFibreoptic oximetry was used to confirm the clinical diagnosis of aortocaval fistula which occurred in a patient with an aortic aneurysm.
Central venous access in children via the external jugular vein
Authors: Taylor E. A. S. , Mowbray M. J. 
Published: February 2007

SummarySixty‐two children undergoing cardiac surgery were surveyed for the presence of external jugular veins. When present, these were used as a route for central venous catheterisation using a ‘J’ wire Seldinger technique. Only 54% of attempted insertions were successful but the results support greater efficacy in older children.
Gastric emptying after minor gynaecological surgery
Authors: MUSHAMBI M. C. , ROWBOTHAM D. J. , BAILEY S. M. 
Published: February 2007

SummaryGastric emptying was measured using the paracetamol absorption method in 30 patients immediately after a general anaesthetic for minor gynaecological surgery and in 10 female controls. Anaesthesia was induced with either propofol alone, propofol and alfentanil (4.5 fig.kg −1) or propofol andfentanyl (1.4 ng.kg−1) and maintained with intermittent propofol and 66% nitrous oxide in oxygen. Gastric emptying was delayed significantly in all patient groups when compared with volunteers. However, the delay in gastric emptying was similar in the three patient groups.
The relationship between the concentration of temazepam in cerebrospinal fluid and sedation in man
Authors: OSBORNE G. A. , BADCOCK N. R. , McGRATH P. M. , RUSSELL W. J. , FREWIN D. B. 
Published: February 2007

SummaryTwenty‐six patients received oral temazepam and subsequently spinal anaesthesia. Blood and lumbar cerebrospinal fluid temazepam levels were measured together with the degree of sedation. The plasma and cerebrospinal fluid concentrations correlated well with the temazepam dose but even better with the weight standardised dose (r = 0.65, p = 0.0003 and r = 0.75, p = p = 0.00001 respectively). Both the plasma and cerebrospinal fluid concentrations of temazepam were correlated with the patient's sedation (r = 0.42 p = 0.037, and r = 0.46 p = 0.021 respectively), but neither was strong. Thus, although the drug concentration at the receptor may be a major factor in producing sedation, others factors, possibly the receptor population or their responsiveness, are also important contributors.
Peroperative arterial hypoxaemia. The interaction between intrapulmonary shunt and cardiac output
Authors: WESTBROOK J. L. , SYKES M. K. 
Published: February 2007

SummaryA computer model of respiratory physiology was used to investigate the interaction between cardiac output and intrapulmonary shunting during anaesthesia. Significant degrees of arterial desaturation were demonstrated as the cardiac output was reduced. We suggest that volume expansion may correct some episodes of desaturation observed during anaesthesia.
A nasal CPAP system
Authors: THOMAS A. N. , RYAN J. P. , DORAN B. , POLLARD B. J. 
Published: February 2007

SummaryNasopharyngeal pressures were compared in eight subjects breathing through either a nasal CPAP system or facemask CPAP system at afresh gas flow of 50, 75 and 100 l.min−1. During nose breathing there was no significant difference in nasopharyngeal pressure between the two systems. During mouth breathing pressures were significantly lower with nasal CPAP. During nose breathing at 75 l.min−1 the mean inspiratory and expiratory pressures in cmH2O (SD) were 3.4 (0.68) and 5.9 (0.55) for nasal CPAP and 3.3 (0.71) and 6.3 (0.73) for facemask CPAP. The respective pressures during mouth breathing were 0.3 (0.73) and 2.9 (1.74) for nasal CPAP and 3.9 (0.73) and 5.8 (0.82) for facemask CPAP.
The effect of nitrous oxide on laryngeal mask cuff pressure
Authors: LUMB A. B. , WRIGLEY M.W. 
Published: February 2007

SummaryWe have studied the effect of nitrous oxide on the cuff pressure of a laryngeal mask both in vitro and in vivo. In laboratory tests, we showed that nitrous oxide and carbon dioxide diffuse across the cuff wall much more rapidly than nitrogen and oxygen. Differing partial pressures of these gases across the cuff wall therefore give rise to changes in volume and pressure within the cuff. We then studied 18 patients undergoing general anaesthesia with nitrous oxide, and found a consistent and linear increase in cuff pressure in all patients. After 30 min, the mean pressure had increased by 30 mmHg, and there was approximately 10% nitrous oxide in the cuff. It is difficult to relate these findings to pressure on pharyngeal structures, but methods of limiting the rise in intracuff pressure are discussed.
Transdermal hyoscine with patient‐controlled analgesia
Authors: SEMPLE P. , MADEJ T. H. , WHEATLEY R. G. , JACKSON I. J. B. , STEVENS J. 
Published: February 2007

SummaryTransdermal hvoscine (Scopoderm TTS CIBA) was compared with placebo in 67 patients receiving postoperative analgesia via a patient‐controlled analgesia system. All patients underwent an abdominal hysterectomy and had a standard anaesthetic. They were followed up in recovery and daily for 3 days postoperatively. Fewer patients in the hyoscine group suffered emetic sequelae in recovery and on the third postoperative day (p < 0.05). The hyoscine group received half the number of supplementary antiemetic doses compared to placebo. However, despite transdermal hyoscine there was still a high (78%) incidence of nausea and vomiting. The only significant (p < 0.05) increase in side effects attributable to hyoscine was a higher reported incidence of visual disturbance on the second day.
Pulmonary collapse during anaesthesia in children with respiratory tract symptoms
Authors: WILLIAMS O. A. , HILLS R. , GODDARD J. M. 
Published: February 2007

SummaryA frequent dilemma facing the anaesthetist is the child with respiratory tract symptoms. The risks of anaesthesia and surgery in these patients have not been clearly established. We present three cases which illustrate a potentially serious complication which may arise. Our patients each had symptoms of cough, but were systemically healthy. Two of the children had absent clinical signs, whilst the third had a normal chest X ray. However, during surgery and anaesthesia each child developed significant pulmonary collapse, associated with desaturation on oximetry
High frequency jet ventilation for microlaryngeal laser surgery
Authors: DHARA S. S. , BUTLER P. J. 
Published: February 2007

SummaryThe use of a triple lumen central venous catheter, which can be shielded from laser irradiation by metal tape, as a conduit for high frequency jet ventilation in six children, is described. The problems of anaesthesia for laryngeal laser surgery and the advantages of the technique described in this paper are discussed.
Clinical use of a small soda lime canister in a low‐flow to‐and‐fro system
Authors: LOCKWOOD G. G. , KADIM M. Y. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryIt may be possible to overcome the classical disadvantages of a to‐and‐fro system by the use of a small soda lime canister. We report our experience of such a system in a series of 13 adult patients requiring mechanical ventilation of the lungs during surgery. The system was found to be convenient to use and the charge of soda lime had sufficient absorptive capacity to last throughout the great majority of surgical cases. Using afresh gas flow of 11.min−1, the ratio of inspired isoflurane concentration to isoflurane vaporizer setting was found to be approximately one half after 10 min of anaesthesia. This ratio was maintained throughout the procedure, except for a few minutes following each change in vaporizer setting. A to‐and‐fro system using a small soda lime canister is a convenient alternative to the circle system for low‐flow anaesthesia.
Instrumental bronchial tears
Authors: CONACHER I. D. 
Published: February 2007

SummaryTwo case reports of bronchial tears following airway instrumentation are presented, one of which resulted in death. Both patients developed pneumothoraces and other complications after attempts had been made under general anaesthesia to insert bronchial stents. It appeared that bronchial tears were made during instrumentation with the stent introducer and these cases demonstrate that great care should be taken when rigid materials, such as plastic guides and bougies, are used blindly in the airway.
Factors influencing epidural catheter migration
Authors: Bishton I. M. , Martin P. H. , Vernon J. M. , Liu W. H. D. 
Published: February 2007

SummaryThe incidence and amount of migration of epidural catheters was investigated in a prospective randomised study of 153 women who required analgesia in labour. Inward or outward migration occurred in 36% of patients. Inward migration by 1–3 cm occurred in 21 (13.7%) patients and outward migration by 1 cm or more occurred in 34 (22.2%); three (2%) catheters migrated out through the skin. There were significant positive correlations between outward migration and weight, body mass index, and depth of the epidural space. There was no relationship between migration and height, age, intervertebral space used or duration of catheterisation. Problems with epidural block were no more likely in patients in whom migration of I cm or more occurred compared with those in whom migration was limited to a maximum of ± 0.5 cm. However, the pattern of problems was different. All cases of failed epidural block occurred in patients whose epidural catheter migrated outward by 2.5 cm or more. Unilateral blockade was not more likely if migration of 1 cm or more occurred.
Perineuronal morphine in intercostal block
Authors: Sternlo J. E. , Hägerdal M. 
Published: February 2007

SummaryIn a double‐blind, randomised study the potential benefits of combining low‐dose morphine with bupivacaine for intercostal nerve blocks for analgesia after biliary surgery were investigated. There was no significant improvement in pain scores or consumption of supplementary analgesics when morphine was added to bupivacaine. This investigation supports the findings of other workers who showed that perineural morphine was ineffective for postoperative pain relief.
Haemodynamic stability during general anaesthesia for intra‐ocular surgery: the effect of topical oxybuprocaine
Authors: Lytle J. , Thomas N. F. 
Published: February 2007

SummaryLocal anaesthesia is frequently used in combination with light general anaesthesia to reduce the reflex responses to surgical stimulation. This combination has not previously been evaluated for intra‐ocular surgery. During cataract extraction under general anaesthesia, the effect of topical anaesthesia with oxybuprocaine 0.4% on the pressor response was compared with normal saline in a control group. The simple technique of instilling local anaesthetic drops into the conjunctival sac blocked the pain pathway sufficiently to prevent the pressor response to surgical stimulation (p < 0.001). Higher inspired concentrations of enflurane were required in the control group to achieve and maintain haemodynamic stability (p < 0.001).
Intravenous regional anaesthesia with 0.5% prilocaine or 0.5% chloroprocaine
Authors: Pitkänen M. T. , Suzuki N. , Rosenberg P. H. 
Published: February 2007

SummaryTen healthy male volunteers received intravenous regional anaesthesia of the upper limb on two separate occasions using 40 ml of 0.5% prilocaine or 40 ml plain 0.5% chloroprocaine by random allocation. Using a double‐blind method, the onset and recovery of sensory block was tested (pinprick) in the four main nerve areas. The onset and recovery of motor block was measured by squeezing a rubber balloon connected to a manometer. The symptoms after deflation of the tourniquet were recorded. Seven volunteers in both groups developed total anaesthesia in 20 min. Complete motor block occurred in 12.3 min with prilocaine and 11.3 min with chloroprocaine. Sensation recovered in all areas in 7.6 min with prilocaine and 10.0 min with chloroprocaine (ns). Motor function recovered in 8.4 and 12.0 min respectively (p < 0.01). Six volunteers in the chloroprocaine group showed signs of venous irritation and/or antecubital urticaria in the test arm for 30–45 min after the deflation. Four volunteers in the chloroprocaine group had increased in heart rate (>20%) and one of them short periods ofjunctional rhythm during the first 2 min after tourniquet deflation. Mild, short‐lived Cns side effects occurred in both groups.
Failed extradural anaesthesia for Caesarean section. Complication of subsequent spinal block
Authors: BECK G. N. , GRIFFITHS A. G. 
Published: February 2007

SummaryTwo cases of unexpected high spinal anaesthesia following failed extradural anaesthesia for Caesarean section are described. In both cases rapid and unexpected advance of blockade, after the subarachnoid injection of moderate doses of local anaesthetic, required tracheal intubation. In one of the cases 15 ml of 0.9% saline, but no local anaesthetic, had been injected into the extradural space, suggesting that the mechanism involved is the cephalad displacement of the cerebrospinal fluid by extradural fluid, and not leakage of extradural anaesthetic solution into the subarachnoid space.
The influence of arm position and cardiac output on bolus clearance from the arm
Authors: McLINTIC A. J. , MARTIN W. , TWEDDEL A. C. 
Published: February 2007

SummaryThe importance of arm position and cardiac output on the clearance of a bolus injection from the arm was assessed in 63 patients using technetium‐99m. Injections were made in the left arm which was either adducted, abducted or adducted with the forearm flexed over the lower chest. The clearance of isotope was assessed by measuring the amount of radioactivity remaining in the arm at 10 s intervals and calculating it as a fraction of the injected dose. The clearance of Tc‐99m was significantly faster and more complete from the abducted arm than from the adducted arm. There was no correlation between clearance and cardiac output.
Anaesthetic machine checking practices
Authors: MAYOR A. H. , Eaton J. M. 
Published: February 2007

SummaryForty anaesthetists, of all grades, were interviewed without prior warning and questioned about the checks they had performed on their anaesthetic equipment before use. The results reveal that a substantial percentage (up to 41%) of anaesthetists perform inadequate checks. Furthermore, of those that do, few follow the Association of Anaesthetists of Great Britain and Ireland's recent guidelines.
The Extensometer—use in spontaneously ventilating awake volunteers
Authors: BRIMACOMBE J. , MacFIE A. , MASTERS A. 
Published: February 2007

SummaryThe extensometer is a new device with potential in the field of respiratory pattern analysis. This paper describes the physical principles upon which the extensometer depends and also assesses its performance as a noninvasive respiratory monitor in respect of its ability to measure tidal volume and to determine obstructive breathing patterns in awake volunteers in the supine position over a limited time period. Further developments of the device are outlined and the current status of torso transducers in anaesthesia and intensive care are discussed.
Estimation of tidal volume from the reservoir bag
Authors: Kulkarni P. R. , Lumb A. B. , Platt M. W. , Nunn J. F. 
Published: February 2007

SummaryThe accuracy of 21 anaesthetists in estimating tidal volumes from reservoir bag movements was assessed using a model lung apparatus. The breathing system configuration (Mapleson A or D), the grade of anaesthetist, and the years of anaesthetic experience had no effect on accuracy. Greater precision of tidal volume estimation was observed with larger tidal volumes and lower fresh gas flows. The mean systematic error of 18 of the 21 anaesthetists was greater than zero, indicating a general tendency to overestimate tidal volume. This study therefore strengthens the view that clinical observations should be supplemented with information from continuous monitoring devices.
Vital capacity breath technique for rapid anaesthetic induction: comparison of sevoflurane and isoflurane
Authors: Yurino M. , Kimura H. 
Published: February 2007

SummaryThis study compares vital capacity rapid inhalational induction of anaesthesia with sevoflurane and isoflurane. Forty‐six volunteers undergoing the procedure had one of the two agents: 25 had sevoflurane and 21 isoflurane. Subjects were unpremedicated and breathed approximately 1.7 MAC equivalents of either vapour. There were no significant differences in the patients' monitored cardiovascular, respiratory, and electrocardiographs variables. The mean time for induction of anaesthesia with sevoflurane (120 s) was significantly shorter than with isoflurane (145 s), reflecting its higher blood‐gas solubility. There were fewer induction complications in the sevoflurane group. Subjects in the sevoflurane group found the induction of anaesthesia more pleasant and were more willing to undergo it again compared to subjects in the isoflurane group. We conclude that sevoflurane is superior to isoflurane in vital capacity rapid inhalational induction of anaesthesia, particularly in instances where premedication should be avoided.
Baroreflex control of heart rate during high thoracic epidural anaesthesia
Authors: Goertz A. , Heinrich H. , Seeling W. 
Published: February 2007

SummaryBaroreflex control of heart rate after cardiac sympathectomy induced by thoracic epidural anaesthesia was evaluated in 30 patients who were randomly assigned to group I (bupivacaine 0.25%), group 2 (bupivacaine 0.5%) or group 3 (control). Plasma volume expanders were given to equalise preload conditions, as assessed using transoesophageal echocardiography. All measurements were made under general anaesthesia. Baroreflex sensitivity was determined from the heart rate response to phenylephrine and nitroglycerine. There was no difference in cardiac slowing in response to phenylephrine between the three groups. Baroreflex sensitivity, measured as cardiac acceleration in response to nitroglycerine, was significantly lower (p < 0.01) in groups 1 and 2 (1.8 and 1.5 ms.mmHg−1 respectively) compared with group 3 (3.5 ms.mmHg−1) with no differences between the two bupivacaine concentrations. The results suggest that baroreflex‐mediated response to decreases in arterial pressure is dependent on the integrity of the sympathetic nervous system.
Vecuronium: an anthropometric comparison
Authors: HOUGHTON I. T. , AUN C. S. T. , OH T. E. 
Published: February 2007

SummaryThis study set out to determine if there was any resistance to vecuronium in Nepalese studied in Nepal compared with Nepalese, Chinese and European patients studied in Hong Kong. The four groups, each of 10 male and 10 female patients, were intubated 60s after administration of 0.1 mg.kg−1 vecuronium. The Nepalese patients in Nepal had significantly less satisfactory intubating conditions (p = 0.002). Similarly, male patients had significantly less satisfactory conditions than female patients (p = 0.004). Some anthropometric measurements were significantly different between the patients in Nepal and those in Hong Kong. There were also sex‐related anthropometric differences. It is suggested that differences in response to vecuronium could be explained by differences in distribution volume and muscle mass
Opioid sensitivity of chronic pain: a patient‐controlled analgesia method
Authors: McQUAY H. J. , JADAD A. R. , Carroll D. , Faura C. , Glynn C. J. , Moore R. A. , LIU Y. 
Published: February 2007

SummaryTwenty‐two patients with chronic pain of malignant or nonmalignant origin were given intravenous morphine by patient‐controlled analgesia. A prestudy judgment was made from the characteristics of the pain as to whether it was nociceptive or neuropathic. Analgesic efficacy was assessed by a nurse‐observer; adverse events were noted and plasma morphine and metabolitie concentrations measured. Three categories of opioid response were distinguished. Good responders obtained > 70 mm relief on the visual analogue scale, with minimal or manageable adverse events. Moderate responders obtained < 70 but > 30 mm relief with more problematic adverse events, and poor responders had < 30 mm relief with troublesome adverse events. This method for the study of opioid sensitivity allowed a wide dosage range to be studied. The simultaneous analgesic and adverse event measurements showed that the spectrum of observed response was wide, and response category could be judged for the majority by 4 h. In those with poor or moderate response, adverse event severity limited further dose increment. The relationship between pain characteristics and response showed that some pains judged to be neuropathic had a good response to opioid (5/13), and some pains judged to be nociceptive did not (5/14). The study suggests that the pattern of response is not as black and white as the prediction of good response from nociceptive pain and poor from neuropathic pain would suggest, although nociceptive pain was more likely than neuropathic pain to show a good response. For the moderate responders opioid titration may, in the absence of other effective treatments, be useful, but the analgesic endpoint may not be totally satisfactory. The method provides an operational definition of opioid sensitivity.
Does hypothermia protect against the development of hepatitis in paracetamol overdose?
Authors: BLOCK R. , JANKOWSKI J. A. Z. , LACOUX P. , PENNINGTON C. R. 
Published: February 2007

SummaryA 24‐year‐old female presented in hospital following self‐poisoning with a dose of greater than 30 g of paracetamol (acetaminophen), taken both as co‐proxamol (dextropropoxyphene and paracetamol) and paracetamol. She arrived in hospital more than 18 h after ingestion of the drug. On admission, she was profoundly hypothermic, with a rectal temperature of 19°C. Her paracetamol level was 943 μmol.l−1 which, when related to the time of ingestion, implied a very high risk of hepatocellular damage as well as fulminant liver failure, even if she was treated with the antioxidant n‐acetylcysteine. The patient's condition was stabilised by initial resuscitation with fluids, vasoactive drugs, and active rewarming. N‐acetylcysteine therapy was begun promptly. This patient's liver function tests remained entirely normal in spite of the delay in presentation and she made a rapid and complete recovery. This remarkable clinical course indicates a possible role for therapeutically induced hypothermia in the management of severe paracetamol overdose, particularly in the group of patients who seek medical attention some hours after ingestion of the drug and who therefore remain at high risk, despite treatment with n‐acetylcysteine.