bluuebunny/crossref_metadata_2025_split huggingface dataset:
A jet nebuliser for delivery of topical anaesthesia to the respiratory tract A comparison with cricothyroid puncture and direct spraying for fibreoptic bronchoscopy
Authors: Isaac P. A. , Barry J. E. , Vaughan R. S. , Rosen M. 
Published: February 2007

SummaryTopical anaesthesia of the respiratory tract for fibreoptic bronchoscopy was compared, in a single‐blind study, inhaled from a simple and inexpensive jet nebuliser, administered by cricothyroid injection or by a ‘spray‐as‐you‐go technique’. Each technique was supplemented by spraying lignocaine through the fibrescope and intravenous fentanyl‐droperidol sedation. Inhaled nebulisation was successfully used for 96% (46 of 48) of patients, was safe, effective and acceptable to the patient and bronchoscopist. The cricothyroid injection method produced better conditions than nebulisation in patients who had diagnostic bronchoscopy. The nebuliser technique is as satisfactory as the spraying technique in patients for diagnostic bronchial lavage in whom bleeding from a cricothyroid puncture is unacceptable. Patients who used the nebuliser were more satisfied. This technique may also be a useful method for ‘awake’ intubation.
Local application of EMLA and glyceryl trinitrate ointment before venepuncture
Authors: Gunawardene R. D. , Davenport H. T. 
Published: February 2007

SummaryOne hundred unpremedicated fit day surgery patients aged between 27 and 68 years were allocated randomly into one of four groups and EMLA, glyceryl trinitrate, EMLA and glyceryl trinitrate or a placebo ointment was applied to the dorsum of a hand. The pain and ease of venepuncture were determined at induction of anaesthesia 60 minutes later. Pain scores were also reassessed 1–2 hours after operation. Lower pain scores and easier venepuncture occurred when EMLA and glyceryl trinitrate ointment was applied to the dorsum of the hand.
Quality of life after intensive care
Authors: RIDLEY S. A. , WALLACE P. G. M. 
Published: February 2007

SummaryAn important aspect of effectiveness of intensive care services is change in the quality of life of survivors after critical illness. A questionnaire was compiled using established methods for assessment of quality of life and sent to all known survivors of a regional intensive care unit. Each patient's quality of life was then quantified using disability categories. The results show that patients with a good premorbid quality of life suffered a significant decline after critical illness. Similar important decreases in quality of life were found in younger patients and trauma victims. Quality of life may be a valuable consideration in determining the appropriateness of intensive care management.
Spinal catheter anaesthesia for Caesarean section in a patient with spina bifida
Authors: NUYTEN F. , GIELEN M. 
Published: February 2007

SummaryA patient with grossly deformed vertebral anatomy, scheduled for elective Caesarean section, expressed her wish to stay fully awake during the procedure. Epidural anaesthesia was considered to be impracticable, while dural puncture appeared possible only at thoracic level. Spinal anaesthesia using a subarachnoid catheter placed at T7‐8 was employed successfully.
Severe hypotension due to intramyometrial injection of prostaglandin E2
Authors: KILPATRICK A. W. A. , THORBURN J. 
Published: February 2007

SummaryTreatment of postpartum haemorrhage because of uterine atony with intramyometrial prostaglandin E2 1 mg, in an anaesthetised patient resulted in life‐threatening hypotension. Anaesthetists should be aware of the potential cardiovascular side effects of prostaglandins.
Laryngeal oedema from a neck haematoma A complication of internal jugular vein cannulation
Authors: RANDALLS B. , TOOMEY P. J. 
Published: February 2007

SummaryLaryngeal oedema occurred after formation of a neck haematoma after attempted internal jugular vein cannulation. This resulted in complete respiratory obstruction and respiratory arrest and it was impossible to ventilate her lungs manually or intubate her trachea. Oxygenation of the patient was only possible using transtracheal ventilation.
Minitracheotomy: complications and follow‐up with fibreoptic tracheoscopy
Authors: Randell T. , Kalli I. , Lindgren L. 
Published: February 2007

SummaryComplications and changes in tracheal mucosa after minitracheotomy were evaluated in 28 patients. Tracheal mucosa was inspected fibreoptically after the insertion of a minitracheotomy cannula, and then at 3‐day intervals until the cannula was removed. Thereafter, assessments were made every third day until the mucosa was considered normal. Three significant complications occurred: mediastinal puncture, paratracheal entrance of the cannula and subcutaneous emphysema. Difficulties at insertion of the minitracheotomy cannula were encountered in 15 of 28 patients (54%). Air flow detected through the cannula in one patient, and lack of air flow in another patient, were misleading signs of the position of the cannula. Passing a suction catheter in three patients and a normal end‐tidal carbon dioxide tracing in one patient, were also found to be misleading. The correct position and possible complications could be verified only by fibreoptic tracheoscopy. Changes in the tracheal mucosa were independent of the duration of minitracheotomy therapy.
Recovery after day‐case anaesthesia. A 24‐hour comparison of recovery after thiopentone or propofol anaesthesia
Authors: HEATH P. J. , OGG T. W. , GILKS W. R. 
Published: February 2007

SummarySixty patients who presented for day‐case dilatation and curettage were allocated randomly to receive either thiopentone or propofol for induction and maintenance of anaesthesia. One anaesthetist administered all the anaesthetics whilst all assessments were made by one other. The results indicate that early recovery of memory function, critical flicker fusion frequency and subjective feelings of tiredness, drowsiness and alertness were superior in the propofol group. There was a significant difference in subjective feelings of tiredness and drowsiness recorded by the two study groups at 24 hours. Memory function assessed by Wechsler logical memory function passages at 24 hours was impaired in the propofol group in comparison to a group of ’reference’ subjects.
Anaesthesia for laparoscopic cholecystectomy using the Nd:Yag laser. The implications for a district general hospital
Authors: GREVILLE A. C. , CLEMENTS E. A. F. 
Published: February 2007

SummaryWe describe the anaesthetic management of the first reported cholecystectomy by laparoscopic laser in the United Kingdom. The implications of the development of laser surgery in a district general hospital are discussed.
The use of diazepam in chloroquine poisoning
Authors: RAJAH A. 
Published: February 2007

SummaryA 39‐year‐old patient was found to be unconscious after having taken 2.5 g of chloroquine. Treatment consisted mainly of gastric lavage and diazepam. Experimental and clinical evidence is presented to show that diazepam in varying doses significantly decreases the mortality rate.
Caesarean section in a patient with haemoglobin SC disease and a phaeochromocytoma
Authors: PATTISON J. , HARROP‐GRIFFITHS A. W. , WHITLOCK J. E. , ROBERTS J. C. 
Published: February 2007

SummaryThe anaesthetic management of a patient with haemoglobin SC disease for lower segment Caesarean section and excision of a phaeochromocytoma is described. The patient was given a general anaesthetic for the surgical procedure after exchange transfusion had achieved an haemoglobin A concentration of greater than 50%. A live infant was delivered and a suprarenal phaeochromocytoma was excised during a 6.5 hour procedure. The patient's postoperative recovery was uneventful.
Postoperative sore throat: topical hydrocortisone
Authors: Stride P.C. 
Published: February 2007

SummaryForty patients undergoing tracheal intubation and controlled ventilation of the lungs for elective surgical procedures were studied. They were allocated randomly into one of two groups. The tracheal tubes used for group A patients were lubricated before insertion with water‐soluble 1% hydrocortisone cream. Those for group B patients were lubricated with KY jelly. The incidence of postoperative sore throat was found to be significantly greater in group A. Topical 1% hydrocortisone cream is therefore ineffective in the prevention of postoperative sore throat.
Was CEPOD right?
Authors: Ruiz K. , Aitkenhead A. R. 
Published: February 2007

SummaryThis retrospective study found that the long‐term (greater than 6 months) postoperative survival in ASA 4E and 5E patients was 41% and 21% respectively, in 1986. This supports the Confidential Enquiry into Peri‐operative Deaths’ recommendation that life‐saving surgery should not be withheld from patients who present in so serious a condition that they are unlikely to survive surgery.
Intravenous propofol anaesthesia using a computerised infusion system
Authors: WHITE M. , KENNY G. N. C. 
Published: February 2007

SummaryPropofol offers many advantages as a total intravenous anaesthetic agent compared with other agents. However, considerable experience is necessary in order to give an uncomplicated anaesthetic. A mathematical model which describes the pharmacokinetic behaviour of the drug was incorporated into a computerised delivery system which enables the anaesthetist to achieve and maintain a target blood concentration of propofol and to manipulate this at will. The system was used to provide general anaesthesia for 33 healthy patients who underwent general surgery. A strong statistical relationship was found between measured blood propofol concentrations and the corresponding computer predictions (y =−0.50+1.36x). No significant differences in this relationship were found between patients who breathed spontaneously (y =−0.71x+1.43x) and those who received intermittent positive pressure ventilation (y =−0.33+1.32x).
Epidural fentanyl and 0.5% bupivacaine for elective Caesarean section
Authors: KING M. J. , BOWDEN M. I. , COOPER G. M. 
Published: February 2007

Summary Either 100 μg fentanyl or 2 ml saline was added to 0.5% bupivacaine administered epidurally for elective Caesarean section in 30 patients, in a double‐blind randomised study. Bupivacaine 0.5% was administered until a complete sensory block was established extending to the 4th thoracic dermatome. One of the patients who received epidural fentanyl required intravenous alfentanil and Entonox and another, Entonox only briefly during surgery, compared with seven in the control group who required intravenous alfentanil and Entonox and one who required Entonox only. Postoperative analgesia was of longer duration in those who received epidural fentanyl (p < 0.01). There were no deleterious effects on neonatal or maternal outcome.
The effect of diltiazem on the cardiovascular response to tracheal intubation
Authors: MIKAWA K. , IKEGAKI J. , MAEKAWA N. , GOTO R. , KAETSU H. , OBARA H. 
Published: February 2007

SummaryTheefficacy of diltiazem in the attenuation of the cardiovascular response to laryngoscopy and tracheal intubation was studied in patients who received 0.2 or 0.3 mg/kg diltiazem 60 seconds before the start of laryngoscopy. These data were compared with a control group who received saline. Each group consisted of 10 patients who had elective surgery. Patients who received saline showed a significant increase in mean arterial pressure and rate pressure product associated with tracheal intubation. These increases after tracheal intubation were reduced in diltiazem‐treated patients compared with those of the control group (p < 0.05). The data suggest that a bolus injection of diltiazem is a simple, practical and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.
A low flow open circle system for anaesthesia Part I: Laboratory evaluation at normal and high frequencies
Authors: CHAKRABARTI M. K. , STACEY R. G. W. , HOLDCROFT A. , WHITWAM J. G. 
Published: February 2007

Summary A circle breathing system was connected by deadspace tubing to an open system valveless ventilator. The minimum volume of this tubing, required to prevent dilution of anaesthetic gas in the breathing system by the driving gas of the ventilator, was determined at frequencies of 15, 30, 60, 100 and 150 breaths/minute, with tidal volumes that ranged from 100 to 1100 ml and a fresh gas supply to the circle system of 1, 2 and 4 litres/minute. At 15 breaths/minute, tidal volumes equal to or less than the deadspace volume could be used safely without any mixing with the ventilator driving gas, when a fresh gas flow of 2 litres/minute or above is supplied to the circle system. At 1 litre/minute of fresh gas flow, mixing occurred at tidal volumes less than the deadspace volume. Mixing of gas occurred in the system at frequencies greater than 30 breaths/minute even when the tidal volume was much less than the deadspace volume. However, at high frequencies of ventilation, since the tidal volume requirement decreases, deadspace tubing with a safe internal volume, that is greater than 600 ml, may be used up to 100 breaths/minute.
A low flow open circle system for anaesthesia Part 2: Clinical evaluation
Authors: HOLDCROFT A. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

Summary A prototype valveless ventilator was attached by open deadspace tubing to a circle system and used to ventilate the lungs of 12 patients with low flows of anaesthetic gases for periods between 60 and 120 minutes during intra‐abdominal surgery. Anaesthesia was induced with thiopentone and maintained with nitrous oxide 50% in oxygen and enflurane. This was reduced to 2 litres/minute after a 10‐minute period of nitrogen wash out and stabilisation of anaesthetic gas concentration, with an initial anaesthetic gas flow of 6 litres/minute. The concentration of oxygen, carbon dioxide, nitrous oxide and enflurane were measured in the outflow from both the anaesthetic machine and the inspiratory limb of the circle system. The measured mean inspired oxygen and nitrous oxide concentrations showed no significant variation throughout the low flow period of the study. This new low flow open circle ventilation system appears to offer some advantages in terms of safety and versatility over other systems which are discussed.
Propofol sedation after open heart surgery A clinical and pharmacokinetic study
Authors: McMurray T. J. , Collier P. S. , Carson I. W. , Lyons S. M. , Elliott P. 
Published: February 2007

SummaryOne hundred adult patients who required mechanical ventilation after open heart surgery for coronary revascularisation were studied. All received a standard premedication and a high dose opioid anaesthetic. On arrival in the intensive care unit they were allocated randomly to receive either propofol or midazolam to maintain sedation within a predetermined range. Patients who received propofol underwent extubation of the trachea, using standard criteria, after a mean time (log‐transformed) of 7.6 minutes after sedation for approximately 17 hours. The corresponding time was 125 minutes in those given midazolam. There were significantly higher morphine requirements during sedation, and higher arterial carbon dioxide tensions 30 minutes after extubation of the trachea, in patients who received midazolam. Pharmacokinetic analysis in 20 patients showed that the elimination half‐life of propofol was prolonged (470 minutes) and clearance was reduced (1.14 litres/minute) compared with subjects who had not undergone cardiopulmonary bypass. The rapid clinical recovery was reflected in a rapid redistribution half‐life (13.4 minutes), but this was also longer than the redistribution time of 2–4 minutes in other patients.
Electro‐acupuncture and postoperative emesis
Authors: Ho R. T. , Jawan B , Fung S. T. , Cheung H. K. , Lee J. H. 
Published: February 2007

Summary One hundred unpremedicated female patients of ASA grade 1 or 2 who underwent laparoscopy as outpatients were allocated randomly to one of four groups. All patients received general anaesthesia withfentanyl, thiopentone, halothane, nitrous oxide and oxygen; suxamethonium was given to facilitate tracheal intubation. In the recovery room, group I (control) received no treatment; group 2 received electro‐acupuncture at the P6 point (Neiguan) on the right side for 15 minutes, group 3 received transcutaneous electrical nerve stimulation at the P6 point on the right side for 15 minutes and group 4 received prochlorperazine 5 mg intravenously. Any act of vomiting, including dry retching, during the first 3 postoperative hours was regarded as postoperative emesis. The incidence of postoperative emesis was 11/25 (44%) in group 1, 3/25 (12%, p > 0.05) in group 2, 9/25 (36%) in group 3, and 3/25 (12%, p < 0.05) in group 4. Our results suggest that electro‐acupuncture is as effective as prochlorperazine, and may be better than transcutaneous electrical nerve stimulation, in reducing postoperative emesis.
The effect of diclofenac and nefopam on postoperative dental pain
Authors: Goucke C. R. , Keaveny J. P. , Kay B , Healy T. E. J. , Ryan M. 
Published: February 2007

Summary Eighty‐two outpatients who received general anaesthesia for surgical removal of maxillary or mandibular third molars were given either diclofenac 75 mg or nefopam 20 mg intramuscularly for postoperative pain control. They and the control group were also allowed oral paracetamol as required. The results showed that there was no significant pain relief from these single intramuscular injections.
Propofol for long‐term sedation in the intensive care unit* A comparison with papaveretum and midazolam
Authors: HARRIS C. E. , GROUNDS R. M. , MURRAY A. M. , LUMLEY J. , ROYSTON D. , MORGAN M. 
Published: February 2007

SummaryThirty‐seven patients with a wide range of illnesses were studied during mechanical ventilation of the lungs in an intensive care unit. Fifteen were sedated with a continuous propofol infusion, with analgesia provided by bolus doses of papaveretum. Twelve received a continuous infusion of papaveretum, supplemented by bolus doses of midazolam. The level of sedation was assessed every four hours and measurements were made of haemodynamic and respiratory variables. Levels of sedation were generally satisfactory in both groups. Six patients who received propofol required the use of muscle relaxants, because of their strong respiratory drives, to achieve synchronisation with the ventilator. There was no significant difference in respiratory or haemodynamic variables between the groups, but several patients required inotropic support because of their disease. There was no evidence of inhibition of adrenal steroidogenesis in the propofol group. Propofol can be a useful sedative agent in the intensive care unit, but sedative regimens should be tailored to individual patient requirements.
Peri‐operative care in restrictive respiratory disease
Authors: PATRICK J. A. , MEYER‐WITTING M. , REYNOLDS F. , SPENCER G. T. 
Published: February 2007

SummaryA total of 139 of 473 severely disabled, mainly ventilator‐dependent patients required some form of surgery. Such patients require surgery more frequently than normal individuals, both because of their disability and because even minor unrelated disorders superimposed on permanent disability cause greater handicap. We report the peri‐operative management and postoperative complications of 142 operations on 83 patients between 1982 and 1987. A simple inhalational anaesthetic technique was used; opioids and muscle relaxants were seldom given. Negative pressure ventilation was employed in the postoperative period when appropriate, and was combined with vigorous chest physiotherapy. There were three peri‐operative deaths, but the overall death rate in the patients who underwent surgery was no greater throughout the study period than in those who did not require surgery. We believe that an aggressive surgical approach is appropriate in severely disabled, ventilator‐dependent patients.
A comparison of the effects of omeprazole and ranitidine on gastric secretion in women undergoing elective Caesarean section
Authors: EWART M. C. , YAU G. , GIN T. , KOTUR C. F. , OH T. E. 
Published: February 2007

SummaryThis study compares the efficacy of omeprazole and ranitidine at reducing gastric secretion in obstetric patients. Sixty‐five women scheduled to undergo elective Caesarean section under general anaesthesia were randomly allocated to receive either omeprazole 40 mg or ranitidine 150 mg orally at 2200 hours the night before and at 0600 hours on the morning of surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. All patients had gastric aspirates less than 25 ml. None of the omeprazole group had an aspirate of pH less than 3.5. Six patients (19%) in the ranitidine group had aspirates of pH less than 3.5, a significant difference from the omeprazole group (p < 0.05). Of these six, two (6%) had aspirates of pH less than 2.5. Hence this study showed that omeprazole was more effective and consistent than ranitidine at maintaining gastric pH greater than 3.5.
Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief
Authors: VERCAUTEREN M. , LAUWERS E. , MEERT T. , HERT S. DE , ADRIAENSEN H. 
Published: February 2007

SummarySufentanil 25 μg plus clonidine 1 μg/kg administered epidurally was compared with epidural sufentanil 50 μg alone in a double‐blind fashion for pain relief in 40 patients after abdominal surgery. The duration of complete pain relief was significantly longer in those who received the mixture. Oxygen saturation was reduced 10 and 20 minutes after sufentanil alone, but remained stable after sufentanil and clonidine. There were significant decreases in arterial blood pressure in the latter group that were maximum between 20 and 120 minutes after administration.
Postoperative hypoxaemia: mechanisms and time course
Authors: JONES J. G. , SAPSFORD D. J. , WHEATLEY R. G. 
Published: February 2007

SummaryPostoperative hypoxaemia results predominantly from two mechanisms. Gas exchange is impaired during anaesthesia as a result of reduced tone in the muscles of the chest wall and probably alterations in bronchomotor and vascular tone, and the resulting changes persist into the postoperative period. In addition, there is an abnormality of control of breathing, which results in episodic obstructive apnoea. These episodes continue for several days after operation and are related to sleep pattern and analgesic administration, although the precise effects of different analgesic regimens have not been evaluated. Oxygen administration is effect in reducing the degree of hypoxaemia.
Incidence and range of carboxyhaemoglobin in blood for transfusion
Authors: Freeman R. , Perks D. 
Published: February 2007

SummaryNo statistically significant difference was found between the levels of carboxyhaemoglobin detected in samples from 42 blood units and their sample side arms. A cooximeter was used. However, carboxyhaemoglobin in a range of 1.1–6.9% was found in 18 out of a further 100 side arm samples taken randomly from the blood bank.
Regional anaesthesia and cough effectiveness
Authors: HARROP‐GRIFFITHS A. W. , RAVALIA A. , BROWNE D. A. , ROBINSON P. N. 
Published: February 2007

SummaryWe report the results of a study of the effects of spinal and epidural anaesthesia for Caesarean section on commonly used indicators of a patient's ability to cough effectively. Both spinal and epidural anaesthesia, after the achievement of a block adequate for surgery, were associated with statistically significant decreases (p < 0.05) in all the respiratory variables recorded: forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate and maximum expiratory pressure. We conclude that although the observed changes are unlikely to impair the normal patient's ability to cough effectively in these circumstances, there may be clinically significant impairment in the presence of an inadvertently high block or in a patient with pre‐existing pulmonary disease.