bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ketamine as analgesic for total intravenous anaesthesia with propofol
Authors: GUIT J. B. M. , KONING H. M. , COSTER M. L. , NIEMEIJER R. P. E. , MACKIE D. P. 
Published: February 2007

SummaryA prospective study of 18 patients who underwent noncardiac surgery was performed to study the use of ketamine as an analgesic during total intravenous anaesthesia with propofol. A comparison was made with the combination propofol/fentanyl. The propofol/ketamine combination resulted in haemodynamically stable anaesthesia without the need for additional analgesics. Postoperative behaviour was normal in all patients and none of the patients reported dreaming during or after the operation. Propofol seems to be effective in eliminating side effects of a subanaesthetic dose of ketamine in humans. We recommend the propofol/ketamine combination for total intravenous anaesthesia for surgery when stable haemodynamics are required.
Dr F. P. de Caux—the first user of curare for anaesthesia in England
Authors: WILKINSON D. J. 
Published: February 2007

SummaryCurare was used in the 19th century in England by a wide variety of scientists, physicians and veterinarians. Their experiments indicated many of the properties of the drug, but its clinical usage remained very limited and was reserved for cases of tetanus, hydrophobia and strychnine poisoning. Griffith and Johnson are usually credited with the introduction of curare into clinical anaesthesia in 1942, but a Dr F.P. de Caux working at the North Middlesex Hospital, London, in 1928 utilised curare in a series of seven patients. His work was not widely publicised and this contribution to anaesthetic history has been overlooked by subsequent authors.
Intra‐operative patient‐controlled sedation
Authors: RUDKIN G. E. , OSBORNE G. A. , CURTIS N. J. 
Published: February 2007

SummaryPatient‐controlled sedation using propofol is described in 23 ASA 1 patients undergoing surgical extraction of third molars. Cardiovascular and respiratory stability was maintained and sedation was no deeper than full eyelid closure with prompt response to verbal command. Amnesia for the extractions was common (70%), but there was no significant amnesia for recovery room events. Intra‐operative patient cooperation was good, postoperative patient satisfaction high and all patients stated they liked the self‐administration and would use the same technique again. Propofol dose was correlated with both procedure length (r = 0.587; p = 0.003) and surgical difficulty (rs= 0.550; p = 0.010).
Accidental injection of ether into the epidural space
Authors: MAPPES A. , SCHAER H. M. 
Published: February 2007

SummaryFive ml diethyl ether was accidentally injected into the epidural space via an epidural catheter at the end of a Caesarean section. Immediately the patient felt a hot and burning pain in her legs that led to paraparesis, with a sensory level to T8. The patient showed bilateral recovery of both motor and sensory functions 4 hours after the accident.
Postoperative analgesia after triple nerve block for fractured neck of femur
Authors: Hood G. , Edbrooke D. L. , Gerrish S. P. 
Published: February 2007

SummaryFifty patients with fractured neck of femur that required surgical correction with either a compression screw or pin and plate device were randomly allocated to receive one of two anaesthetic techniques, general anaesthesia combined with either opioid supplementation or triple nerve block (three in one block) with subcostal nerve block. The nerve blocks significantly reduced the quantity of opioid administered after operation; 48% of these patients required no additional analgesia in the first 24 hours. Plasma prilocaine levels in these patients were well below the toxic threshold, and peak absorption occurred 20 minutes after the injection. No untoward sequelae were associated with the nerve blocks.
Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation
Authors: WILSON I. G. , MEIKLEJOHN B. H. , SMITH G. 
Published: February 2007

SummaryWe have studied the effect of varying the timing of a prior dose of intravenous lignocaine 1.5 mg/kg on the cardiovascular and catecholamine responses to tracheal intubation. Forty healthy patients were given an intravenous injection of either placebo or lignocaine 2, 3 or 4 minutes before tracheal intubation. There was a significant increase in heart rate of 21–26% in all groups. There was no significant increase in mean arterial pressure in response to intubation in any group of patients given lignocaine before intubation, but in the placebo group, mean arterial pressure increased by 19.1% compared to baseline values (p < 0.05).
Potential errors in pulse oximetry
Authors: RALSTON A. C. , WEBB R. K. , RUNCIMAN W. B. 
Published: February 2007

SummaryThere is no absolute reference for oxygen saturation, although multiwavelength in vitro oximeters are accepted as the ‘gold standard’. Regardless of whether fractional or functional saturation is used by manufacturers to calibrate their oximeters, evaluation against fractional saturation is recommended since this is the clinically relevant variable. The use of standard notation and comparisons based on bias and precision is recommended. The accuracy of pulse oximetry is intrinsically limited by the use of only two wavelengths, and is dependent on the initial calibration population. The empirical algorithms used to convert the signal to its ‘readout value’ and the quality control of hardware may both be important sources of variability between oximeters. Change in blood temperature may introduce errors in pulse oximeter and in vitro oximeter saturation readings, but these will be clinically insignificant. Changes in blood pH should not decrease pulse oximetry accuracy.
Potential errors in pulse oximetry
Authors: WEBB R. K. , RALSTON A. C. , RUNCIMAN W. B. 
Published: February 2007

SummaryThe published studies of pulse oximeter performance under conditions of normal, high and low saturation, exercise, poor signal quality and cardiac arrhythmia are reviewed. Most pulse oximeters have an absolute mean error of less than 2% at normal saturation and perfusion; two‐thirds have a standard deviation (SD) of less than 2%, and the remainder an SD of less than 3%. Some pulse oximeters tend to read 100% with fractional saturations of 97–98%. Pulse oximeters may be suitable hyperoxic alarms for neonates if the alarm limit chosen is directly validated for each device. Pulse oximeters are poorly calibrated at low saturations and are generally less accurate and less precise than at normal saturations; nearly 30% of 244 values reviewed were in error by more than 5% at saturations of less than 80%. Ear, nose and forehead probes respond more rapidly to rapid desaturation than finger probes, but are generally less accurate and less precise. Ear oximetry may be inaccurate during exercise. Low signal quality can result in failure to present a saturation reading, but data given with low signal quality warning messages are generally no less accurate than those without. Cardiac arrhythmias do not decrease accuracy of pulse oximeters so long as saturation readings are steady.
Caesarean section in undiagnosed Eisenmenger's syndrome
Authors: GILMAN D. H. 
Published: February 2007

SummaryAn obstetric patient is described in whom the first sign of cardiac disease was unexplained hypoxaemia during emergency anaesthesia for antepartum haemorrhage, with an eventual fatal outcome. The case highlights the importance of patient information at the booking clinic, and the implications of a raised haemoglobin in early pregnancy.
Chickenpox pneumonia, its complications and management
Authors: CLARK G. P. M. , DOBSON P. M. , THICKETT A. , TURNER N. M. 
Published: February 2007

SummaryWe report three cases of chickenpox pneumonia in adults, all of whom required intermittent positive pressure ventilation. One patient developed a variety of complications, and another, a pregnant woman, required extracorporeal membrane oxygenation.
Pulse oximetry compared with Doppler ultrasound for assessment of collateral blood flow to the hand
Authors: PILLOW K. , HERRICK I. A. 
Published: February 2007

SummaryIschaemic injury to the hand after arterial cannulation is a rare but well documented complication and routine testing of the adequacy of collateral circulation is widely advocated. The widespread availability of the pulse oximeter in the operating theatre, its applicability in circumstances where the patient is unable to cooperate, and its dependence on pulsatile blood flow suggest that this device could potentially be usefully applied to the assessment of collateral blood flow. The reliability of the pulse oximeter to detect the presence or absence of collateral circulation was prospectively compared to Doppler ultrasound in 109 hands from 64 adult patients. Nine hands demonstrated inadequate ulnar collateral flow, one hand demonstrated inadequate radial collateral flow and a persistent median artery was found in one hand. In all patients the results of pulse oximeter testing (probe placed on the thumb) correlated precisely with the results obtained with the Doppler device (probe located over the lateral aspect of the superficial palmar arch). These results demonstrate pulse oximetry to be a reliable method of assessing collateral blood flow to the hand before arterial cannulation.
Single operator cardiopulmonary resuscitation in ambulances
Authors: GREENSLADE G. L. 
Published: February 2007

SummaryCardiopulmonary resuscitation en route to hospital is performed by a single‐handed operator in many British ambulances. In this study, three emergency ventilation devices, and mouth‐to‐mouth breathing, were compared for effectiveness in unintubated patients. Seventeen paramedics used each method on a Laerdal manikin in a randomised order, under identical conditions. Three experienced cardiopulmonary resuscitation instructors repeated the tests in a moving ambulance. There were significant differences in minute volume (p < 0.01) and number of effective chest compressions (p < 0.05); mouth‐to‐mouth breathing produced the best overall results and the simplest device was a close second. The value of automatic ventilators for single‐operator cardiopulmonary resuscitation in unintubated patients is questioned.
Wound infiltration of local anaesthetic after lower segment Caesarean section
Authors: Trotter T. N. , Hayes‐Gregson P. , Robinson S. , Cole L. , Coley S. , Fell D. 
Published: February 2007

SummaryThe analgesic efficacy of subcutaneous wound infiltration with 20 ml of 0.5% bupivacaine after elective lower segment section Caesarean section was studied in 28 patients in a double‐blind randomised controlled manner using a patient‐controlled analgesia system. The mean 24‐hour morphine consumption of the placebo group and the bupivacaine group was similar (76 mg and 68 mg respectively). Analysis of the cumulative hourly morphine consumption failed to show any statistically significant differences between the groups. However, on a weight‐adjusted basis statistically significant differences in morphine consumption were demonstrated, although these may not be clinically important. Subjective experiences of pain, nausea and drowsiness assessed by linear analogue scoring were similar in both groups.
Comparison of the effects of oral nizatidine and ranitidine on gastric volume and pH in patients undergoing gynaecological laparoscopy
Authors: POPAT M. T. , DYAR O. J. , BLOGG C. E. 
Published: February 2007

SummaryNinety patients who presented for elective gynaecological laparoscopy as day cases were allocated at random to three groups and studied on a double blind basis to compare the effects of nizatidine, ranitidine or placebo on gastric secretion. All the patients received the active drugs or placebo orally at least 45 minutes before the induction of anaesthesia. After tracheal intubation gastric fluid was aspirated via an orogastric tube and the volume and pH of the aspirate were measured. Venous blood samples were obtained at the times of gastric sampling to determine the plasma levels of the drugs. The proportion of patients with both pH > 2.5 and volume < 25 ml were 100%, 90%, and 92.9% in the nizatidine, ranitidine and placebo groups respectively. There was no difference in volume between groups. Two patients in the nizatidine group without a measurable aspirate had blood levels less than the therapeutic range. The median pH values in both treated groups were significantly greater than in the placebo group, but there were no differences between the two treated groups. There were 19 (67.8%) patients in the placebo group with pH < 2.5. This was significantly higher than the 2 (7.4%) and 6 (20%) in the nizatidine and ranitidine groups respectively. When the time interval between drug administration and induction of anaesthesia was divided arbitrarily into 45‐90 minutes and > 90 minutes, all the patients in the nizatidine and ranitidine groups with pH < 2.5 were given the drugs in the 45–90 minute interval; this suggests a latent period is required before the gastric pH increases. Nizatidine may be an effective protective agent against acid aspiration syndrome.
Timing of surgery in congenital diaphragmatic hernia
Authors: CHARLTON A. J. , BRUCE J. , DAVENPORT M. 
Published: February 2007

SummaryEighty‐six consecutive patients with congenital diaphragmatic hernia presenting within 6 hours of birth to a regional neonatal surgical unit were reviewed. Patients were managed under a policy of delayed surgery which has evolved during the 6‐year study period. Overall survival (to leave hospital) was 70.9%. There were only seven postoperative deaths (10.3% of operations). Analysis of the 25 deaths in the light of postmortem findings and published exclusion criteria indicates that the availability of extracorporeal membrane oxygenation would have made little difference to overall survival.
A comparison of different pre‐oxygenation techniques in the elderly
Authors: McCARTHY G. , ELLIOTT P. , MIRAKHUR R. K. , McLOUGHLIN C. 
Published: February 2007

SummaryThe efficacy of five different techniques of pre‐oxygenation before a modified rapid intubation sequence was assessed, using oxygen saturation measurement, in patients aged over 65 years. Twenty patients in each group were pre‐oxygenated using four deep breaths or normal tidal breathing for 1, 2, 3, or 4 minutes. The acceptable period of apnoea was defined as the time taken to desaturate to 93%. The mean times (SD) taken to reach this end‐point were 3.7 (1.6), 4.1 (1.2), 5.4 (1.7), 5.4 (1.4) and 5.2 (1.7) minutes respectively. The apnoea times with 2, 3 and 4 minutes pre‐oxygenation were not significantly different from each other but were significantly longer than after four deep breaths and 1 minute. It is concluded that a pre‐oxygenation period of at least 2 minutes should be employed in the elderly before a rapid sequence induction.
Rectus sheath and mesosalpinx block for laparoscopic sterilization
Authors: FFARCS B.E. Smith , MacPherson G.H. , de Jonge M. , Griffiths J.M. 
Published: February 2007

SummaryThirty patients scheduled to undergo laparoscopic sterilisation were allocated at random to receive either a standardised general anaesthetic and rectus sheath block (group A), or standardised general anaesthetic combined with both rectus sheath and mesosalpinx blocks (group B). Group B patients had significantly less postoperative pain, as assessed by linear analogue scores (p < 0.025), and analgesic requirement (p < 0.05). By the 8th postoperative hour all 15 group B patients had been discharged from hospital, whilst only seven of 15 patients in group A were considered suitable for discharge at this time, (p < 0.05).
Morphine compared with diamorphine
Authors: ROBINSON S. L. , ROWBOTHAM D. J. , SMITH G. 
Published: February 2007

SummaryThe dose requirements and side effects of morphine were compared with those of diamorphine administered by patient‐controlled analgesia in 40 patients following elective total hip replacement. Patients were allocated randomly to receive in a double‐blind manner either morphine or diamorphine for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative sedation, nausea, well‐being, pain relief and requirements for antiemetic drugs. The dose requirement for diamorphine was approximately 50% of that for morphine.
Intra‐operative patient‐controlled sedation
Authors: OSBORNE G. A. , RUDKIN G. E. , CURTIS N. J. , VICKERS D. , CRAKER A. J. 
Published: February 2007

SummaryThe quality of sedation and postoperative recovery have been assessed for intra‐operative sedation provided by either patient‐controlled sedation with propofol or a standard method using divided doses of midazolam and fentanyl, in 40 ASA 1 day surgery patients undergoing extraction of third molar teeth under local analgesia. Patient‐controlled sedation with propofol produced sedation no deeper than full eyelid closure with prompt response to verbal command, but deeper levels were seen in three patients in the midazolam and fentanyl group. Patient satisfaction was higher in the patient‐controlled sedation propofol group for both subjective intra‐operative feelings (p < 0.01) and willingness to have the procedure again in the same manner (p < 0.05). Amnesia was more limited to intra‐operative events (rather than extending into the postoperative period) in the patient‐controlled sedation propofol group (p < 0.05). Drug dose was correlated with duration of procedure and surgical difficulty in the patient‐controlled sedation propofol group but not in the midazolam and fentanyl group. Postoperative testing included a new computerised test, the FAST index, which indicated a dose‐dependent reduction in cognitive function in the midazolam and fentanyl group, which persisted until the time of discharge. Changes in cognitive function in the patient‐controlled sedation propofol group in the same postoperative interval were significantly less and not related to propofol dose.
Clinical evaluation of a spinal catheter technique in femoro‐popliteal graft surgery
Authors: Morrison L. M. M. , McClure J. H. , Wildsmith J. A. W. 
Published: February 2007

SummaryThe use of a 24‐gauge catheter for continuous spinal anaesthesia was evaluated in 20 patients undergoing femoro‐popliteal graft surgery for occlusive disease. The catheter was inserted through either a Tuohy or Quincke‐tip needle and isobaric amethocaine used for the initial injection. In five patients identification of the subarachnoid space was not straightforward, but clear difficulty with catheter insertion was encountered in only one. The range of blocks seen was wider than expected, but it was adequate for surgery 15 minutes after injection in 16 of the 20 patients. In another three the injection of a small dose of hyperbaric bupivacaine produced the necessary extension of block. Two patients (10%) required a general anaesthetic, one because of grossly inadequate spread of solution, the other because the catheter kinked and prevented injection of a second dose after the start of surgery.
Assessing intravenous cannulation and tracheal intubation training
Authors: Wilson M. E. 
Published: February 2007

SummaryA simple graphical method is described that allows the assessment of a student's progress while learning intravenous cannulation and tracheal intubation. Thirty‐four students were studied during their initial training; 91% of those students who obtained a sufficient number of trials to allow a final assessment to be made met the criterion of 80% success for cannulation and 95% achieved similar success in intubation. Thirty‐one ambulance staff who returned for a 3‐day refresher course were also assessed; 44% (for intravenous cannulation) and 61% (for tracheal intubation) met the 80% success criterion.
Nausea and vomiting with use of a patient‐controlled analgesia system
Authors: Robinson S. L. , Fell D. 
Published: February 2007

SummaryThe incidence of nausea and vomiting following patient controlled analgesia and intramuscular morphine injections on demand was compared in a double‐blind randomised study of 32 healthy patients undergoing elective cholecystectomy. There were no significant differences between the two groups in mean 24 hour postoperative morphine consumption, subjective experience of pain, nausea and sedation assessed by visual linear analogue scoring, and the postoperative requirements for antiemetic therapy.
Incidence and management of airway problems in the CHARGE Association
Authors: Stack C.G. , Wyse R.K.H. 
Published: February 2007

SummaryThe airway problems associated with anaesthesia in patients with the CHARGE Association have been underreported. We undertook a retrospective review of 50 cases, of which anaesthetic records were available for 37 patients. Apart from choanal atresia and cleft lip and palate, 56% of patients had some other upper airway abnormality. There appeared to be greater difficulty in tracheal intubation with increase in age in four patients. The incidence and management of airway abnormalities are discussed.
Comparison of the combined effects of atropine and neostigmine with atropine and edrophonium on the lower oesophageal sphincter
Authors: HEIJKE S. A. M. , SMITH G. , KEY A. 
Published: February 2007

SummaryIn two groups (n = 11) of healthy patients, we have measured gastric, lower oesophageal and barrier pressures before and after antagonism of neuromuscular block during anaesthesia with nitrous oxide and isoflurane. In one group, atropine 1.2 mg and neostigmine 2.5 mg were given and in the second group atropine 0.6 mg with edrophonium 1 mg/kg. One minute after administration of the reversal agents, there was a significantly greater reduction in barrier pressures in the neostigmine and atropine group than in the edrophonium and atropine group, but subsequently, there was no significant difference between the two groups. We conclude that there is no clinical difference between the two reversal mixtures in terms of the risk of regurgitation in the immediate period after reversal.
Plasma catecholamine response to cataract surgery: a comparison between general and local anaesthesia
Authors: BARKER J. P. , VAFIDIS G. C. , ROBINSON P. N. , HALL G. M. 
Published: February 2007

SummaryWe studied the plasma catecholamine, plasma glucose and cardiovascular responses to cataract surgery in 20 elderly patients allocated randomly to receive either general anaesthesia or local anaesthesia by retrobulbar block. Local anaesthesia prevented the increase in plasma noradrenaline, adrenaline and glucose concentrations found in those patients who received general anaesthesia and also improved cardiovascular stability. The results show the beneficial effects of local anaesthesia in preventing the hormonal, metabolic and cardiovascular changes found when cataract surgery is conducted under general anaesthesia.
Oral ketamine
Authors: PETROS A. J. 
Published: February 2007

SummaryFour cases of severely mentally handicapped young adults requiring day care dental treatment are reported. All had required varying degrees of restraint during previous dental treatments, which had been distressing for the patient, the relatives and the ward staff. In all cases, administration of oral ketamine 10 mg/kg, 30–60 minutes before the procedure, facilitated subsequent induction of anaesthesia.
Inaccuracy of pulse oximetry in patients with severe tricuspid regurgitation
Authors: STEWART K. G. , ROWBOTTOM S. J. 
Published: February 2007

SummaryThe accuracy of pulse oximetry was studied in a group of patients with severe tricuspid regurgitation. Measurements of arterial oxygen saturation from a finger and an ear probe were compared with those from a radial arterial blood sample analysed in vitro. Lower values were obtained using the pulse oximeter; the difference ranged from +2% to —11%. The discrepancies between pulse oximeter and laboratory oximeter readings were greater in this group of patients than in a control group who did not have tricuspid regurgitation. There was, however, no correlation between the magnitude of this discrepancy and either the peak central venous pressure or the venous pulse pressure.