bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed ACTH response to human corticotropin releasing hormone during cardiopulmonary bypass under diazepam‐high dose fentanyl anaesthesia
Authors: AMADO J. A. , DIAGO M. C. 
Published: February 2007

SummaryThe inhibitory effect of high dose fentanyl (0.1 mg.kg−1) and diazepam (0.5 mg.kg−1) anaesthesia on the pituitary‐adrenal response to coronary artery surgery during cardiopulmonary bypass was assessed by comparison of the adrenocorticotropic hormone and cortisol responses to intravenous boluses of either 0.1 mg (n = 14) or 0.2 mg (n = 14) human corticotropin releasing hormone administered 5 min after starting cardiopulmonary bypass, with the responses obtained in a control group (n = 14). Blood samples were taken before inducing anaesthesia, just before cardiopulmonary bypass and at 5, 20, 35, 50, 65 and 80 min thereafter. The administration of human corticotropin releasing hormone at both doses resulted in significantly greater plasma concentrations of adrenocorticotropic hormone at 50, 65 and 80 min compared to the control group; at the other sampling times there were no differences between the three groups. Plasma cortisol concentrations did not vary between the three groups at any sampling time. During cardiopulmonary bypass the early adrenocorticotropic responses to human corticotropin releasing hormone are blunted but later there is a good response, suggesting that the inhibitory effect of high dose fentanyl and diazepam anaesthesia takes place in the hypothalamus.
The relationship between clinical effect and concentrations of temazepam in plasma and cerebrospinal fluid
Authors: MOFFAT A. C. , OSBORNE G. A. , BADCOCK N. R. , MARANUCCI P. , NYMAN T. , RUSSELL W. J. 
Published: February 2007

SummaryThe clinical pharmacodynamics of temazepam were investigated in patients who received spinal anaesthesia. Total plasma and cerebrospinal fluid temazepam concentrations were measured and correlated with the clinical effects. Sedation was measured by three separate methods. None, including an aggregated score of all three measures, was correlated closely with either the plasma or the cerebrospinal fluid levels (p = 0.86 and 0.12 respectively). Anxiety was measured before and after premedication. The two scores were correlated but the change in anxiety after premedication did not correlate with either the plasma or the cerebrospinal fluid concentrations (p = 0.11 and 0.45 respectively). Short‐term memory was measured before and after premedication. The decline in short‐term memory ability was moderately well correlated with both the plasma and the cerebrospinal fluid levels (p = 0.0005 and 0.013 respectively). With temazepam, the variation in sedative and anxiolytic effects between subjects is explained not by differences in pharmacokinetics but rather by differences in the pharmacodynamic response. Because sedative and anxiolytic effects are poorly correlated, but the amnesic effect is well correlated with temazepam concentrations, different sites of action for these effects are suggested.
Stress response to tracheal intubation: direct laryngoscopy compared with blind oral intubation
Authors: PERNERSTORFER T. , KRAFFT P. , FITZGERALD R. D. , KRENN C. G. , CHIARI A. , WAGNER O. , WEINSTABL C. 
Published: February 2007

SummaryHaemodynamic and hormonal responses to tracheal intubation can be profound and associated with serious cardiovascular and cerebral side effects. The Augustine Guide, a device enabling blind oral intubation, has been introduced recently. The aim of our study was to compare the haemodynamic and hormonal stress response of this method with direct laryngoscopy. Thirty five patients (ASA 1 and 2) were randomly assigned to undergo either direct laryngoscopy (n = 17), or blind oral intubation (n = 18). Haemodynamic responses and concentrations of adrenaline, noradrenaline and prolactin were determined prior to induction, before intubation and 5 min after intubation. The median duration of intubation was 22 s for direct laryngoscopy vs 46 s for blind oral intubation (p < 0.05). Between the groups, no significant differences were observed for heart rate, systolic or mean arterial blood pressure. Serum levels of adrenaline decreased slightly after induction and remained unaltered after intubation in both groups. Noradrenaline (1.01 vs 0.66 nmol.l‐1) and prolactin (5.2 vs 2.9 nmol.l‐1) levels were significantly higher after direct laryngoscopy compared to blind oral intubation. Although blind oral intubation took significantly longer to perform than direct laryngoscopy, hormonal stress response was less pronounced. Blind oral intubation should therefore not be withheld from patients with impaired cardiovascular reserve.
Anaesthesia in an infant with Rubinstein‐Taybi syndrome
Authors: CRITCHLEY L. A. H. , GIN T. , STUART J. C. 
Published: February 2007

SummaryThe anaesthetic management of a 5‐month‐old Chinese infant with Rubinstein‐Taybi syndrome requiring bilateral inguinal hernia repairs is described. This is a rare congenital syndrome characterised by mental retardation, broad thumbs and first toes, craniofacial abnormalities, recurrent respiratory infections and, in one third of cases, congenital heart disease. General anaesthesia combined with caudal block was successfully used. The main complications encountered were minor difficulties with intubation and easily precipitated episodes of oxygen desaturation.
A comparison of the priming properties of two central venous catheters and one pulmonary artery catheter
Authors: SANDERSON P. M. 
Published: February 2007

SummaryThe time taken to prime the individual lumina of two multilumen central venous catheters (Viggo‐Spectramed 14G 20 cm Hydrocath and Vialon 14G 20cm Deltacath) and one pulmonary artery catheter (Viggo‐Spectramed 110cm 7.5F Pentacath) at flows between 5 ml.h‐1 and 99ml.h‐1 is reported. The catheters supplied by different manufacturers but of identical length and gauge have significantly different priming times (p < 0.001). A protocol which may be used to prime the individual lumina of the three catheters studied is described. By means of an in vitro test the accuracy of this protocol is validated.
Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery A comparison of thoracic and lumbar routes
Authors: Chisakuta A. M. , George K. A. , Hawthorne C. T. 
Published: February 2007

SummaryThirty‐three patients who had undergone elective open cholecystectomy were studied in a prospective, randomised comparison of thoracic (n = 17) and lumbar (n = 16) epidural routes of administration of a mixture of bupivacaine 0.2% with fentanyl 10μg.ml‐1 for postoperative pain. Pain relief cardiovascular stability, respiratory rate and side effects were assessed by a‘blinded’observer at specific times in the 24 h study period. The thoracic epidural route proved significantly more reliable than the lumbar and provided effective analgesia in all patients (p < 0.05). This was not accompanied by significant hypotension or respiratory depression. The incidence of side effects attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p < 0.05). This study supports the use of the thoracic epidural route for postoperative pain management after upper abdominal surgery.
Sedation with intravenous infusions of propofol or thiopentone
Authors: WILDER‐SMITH O. H. G. , KOLLETZKI M. , WILDER‐SMITH C. H. 
Published: February 2007

SummaryThe aim of this study was to investigate pain perception during thiopentone or propofol infusions for sedation. Thirty ASA 1 or 2 patients received a two step infusion of either thiopentone (step 1: 1.25 mg.kg‐1 followed by 2.5 mg.kg‐1.h‐1; step 2: 1.25 mg.kg‐1 and 12.5 mg.kg‐1.h‐1; n = 15) or propofol (step 1: 0.5 mg.kg‐1, 1 mg.kg‐1.h‐1; step 2: 0.5 mg.kg‐1, 5 mg.kg‐1.h‐1; n = 15) for sedation. At control and 10 min after the start of each infusion dosage, reaction times and thermal pain detection thresholds were determined. We found no clinically or statistically significant depression of thermal pain detection thresholds during propofol or thiopentone infusions and these are, therefore, unlikely to be associated with clinically relevant hyperalgesia.
Analgesia after Caesarean section
Authors: DENNIS A. R. , LEESON‐PAYNE C. G. , HOBBS G. J. 
Published: February 2007

SummaryA double‐blind placebo‐controlled study was performed to assess the analgesic effect of rectal sodium diclofenac 100mg after Caesarean section using subarachnoid hyperbaric bupivacaine 0.5% and morphine 0.2mg. During the 48h follow‐up period, both placebo and diclofenac groups had comparable analgesia as measured by visual analogue scores (VAS) at rest and on movement. However, diclofenac prolonged the mean time to first analgesia by more than 5h from 13h 45 min in the placebo group to 18 h 58min (p < 0.03). The incidence of side effects (nausea, vomiting, itching, excessive lochia loss and the need for additional analgesia) were comparable in each group.
Postoperative analgesia with transdermal fentanyl following lower abdominal surgery
Authors: BROOME I. J. , WRIGHT B. M. , BOWER S. , REILLY C. S. 
Published: February 2007

SummaryIn a randomised, placebo‐controlled, double‐blind study involving 81 patients undergoing total abdominal hysterectomy, the postoperative analgesia provided by transdermal fentanyl given at 25, 50, or 75μg.h‐1 for 72h was compared with a placebo group. The efficacy of the Transdermal Therapeutic System was related to the rate of fentanyl delivery, higher rates being associated with significantly lower visual analogue pain scores (24, 20, 17 and 13, for placebo, 25, 50 and 75μg.h‐1 respectively) and reduced patient controlled analgesia morphine requirements (44, 38, 33 and 31 mg respectively). Patients’overall sedation scores were not increased by transdermal fentanyl, but respiratory rates decreased with higher transdermal fentanyl dosage.
The effect of maternal obesity on labour and labour pain
Authors: RANTA P. , JOUPPILA P. , SPALDING M. , JOUPPILA R. 
Published: February 2007

SummaryConsecutive obese (n = 53) and non‐obese parturients (n = 609) were prospectively evaluated during labour to analyse the influence of maternal obesity on labour pain and outcome. Excessive pre‐pregnancy weight was classified as a body mass index of 30 kg.m‐2 or more. Pain intensity was measured using an 11 point visual scoring scale. Obese parturients had more complicated pregnancies (hypertension and diabetes) and their babies weighed significantly more (3865g versus 3592 g, p<0.001). These differences did not affect labour pain experience, or the duration or mode of delivery. Eighty‐five percent of the obese parturients and 83% of the controls had high maximal pain scores during the first stage (> 7). Both groups received similar analgesia. More technical problems (p = 0.03) were experienced in establishing epidural analgesia for obese parturients, but this did not influence the success of pain treatment. After delivery, obese women were significantly more content with the pain relief received; only 12% vs 23% in the control group complained of poor pain control (p = 0.03). In this study, obesity and increased fetal size did not complicate labour or its outcome. Critical patient assessment should be emphasised, however, due to the physiological and medical problems present in obese parturients.
Anterior spinal artery syndrome
Authors: Djurberg H. , Haddad M. 
Published: February 2007

SummaryA case of unexpected paraplegia after oesophageal resection under general anaesthesia combined with epidural analgesia and intra‐operative intercostal block is described. Patients with compromised cardiovascular and respiratory function undergoing thoracic or major abdominal surgery can benefit significantly intra‐operatively from a combination of general anaesthesia and regional analgesia. The continued use of regional analgesia into the postoperative period offers even more advantages. General anaesthesia administered before regional analgesia may, however, mask complications related to the regional technique and delay the instigation of corrective measures. The blood supply to the anterior part of the spinal cord, through the artery of Adamkiewicz, may be impaired intra‐operatively leading to neurological sequelae known as the anterior spinal artery syndrome, characterised by loss of motor function with intact or partially intact sensory function. Patients at risk of developing the syndrome can be identified pre‐operatively.
Edrophonium as an antagonist of vecuronium‐induced neuromuscular block in the elderly
Authors: Kitajima T. , Ishii K. , Ogata H. 
Published: February 2007

SummaryTrain‐of‐four stimuli were applied to the ulnar nerve using an accelograph in 10 elderly patients (aged 70–82 years) and 10 younger patients (aged 27–54 years). Anaesthesia was induced with thiopentone 5mg.kg‐1 and was maintained with nitrous oxide (66%) oxygen and sevoflurane (1 MAC). Vecuronium 0.1mg.kg‐1 was used for paralysis, and reversed with intravenous edrophonium 0.75mg.kg‐1 and atropine 0.015mg.kg‐1 when the train‐of‐four ratio returned to 25%. The times from initial administration of vecuronium to completion of maximal block were 211.5 (SD 66.9) s and 154.0 (SD 39.7) s in the elderly and younger patients, respectively (p < 0.05). The times from maximal block to 25% recovery of train‐of‐four ratio were 64.8 (SD 36.3) min and 61.8 (SD 36.3) min in the elderly and younger patients, respectively. There was no statistically significant difference between them. The reversal times from 25% to 75% of the train‐of‐four ratio after the administration of edrophonium were 210.0 (SD 136.7) s and 177.0 (SD 100.4) s in the elderly and younger patients, respectively. There was no statistically significant difference between them. The authors were unable to show that healthy elderly patients differ significantly from younger patients in the neuromuscular blocking effect of vecuronium and the reversal effect of edrophonium.
Variable‐dose patient‐controlled analgesia
Authors: OWEN H. , PLUMMER J. , ILSLEY A. , HAWKINS R. , ARFEEN Z. , TORDOFF K. 
Published: February 2007

SummaryOne size of patient‐controlled analgesia demand dose does not suit all patients after surgery. We have constructed a new patient‐controlled analgesia system (variable‐dose patient‐controlled analgesia) in which patients have a choice of demand dose sizes. In an initial trial, patients could choose between 0.5, 1.0 or 1.5mg morphine. Patients readily understood the system and were all 'satisfied’ (n = 1) or‘very satisfied’ (n = 9) with the system. Only two patients sought‘complete relief from pain, most reported seeking’ moderate relief. All patients obtained‘a lot of relief or‘complete relief with this patient‐controlled analgesia system. This preliminary experience suggests that variable dose patient‐controlled analgesia warrants further investigation and comparison with conventional patient‐controlled analgesia.
The use of the Hayek Oscillator during microlaryngeal surgery
Authors: MONKS P. S. , BROOMHEAD C. J. , DILKES M. G. , McKELVIE P. 
Published: February 2007

SummaryAn externally mounted cuirass ventilator, the Hayek Oscillator, was used on 41 patients undergoing surgery to the larynx without the use of a tracheal tube. Gas exchange and cardiovascular parameters remained satisfactory during the use of this technique, which offers a significant advance over existing tubeless methods of anaesthesia.
Retracted: The effect of the anticoagulation regimen on endothelial‐related coagulation in cardiac surgery patients
Authors: BOLDT J. , SCHINDLER E. , WELTERS I. , WITTSTOCK M. , STERTMANN W. A. , HEMPELMANN G. 
Published: February 2007

SummaryHeparin is still the most commonly used anticoagulant in cardiac surgery necessitating cardiopulmonary bypass. In recent years, endothelial‐related coagulation (e.g. thrombomodulin I protein C‐system) has enlarged our knowledge of the regulation of haemostasis. In a controlled randomised study, the influence of different regimens of anticoagulation on the thrombomodulin I protein C‐system was studied. Sixty patients undergoing elective coronary artery bypass grafting were randomly allocated into four groups (n = 15) to receive: 300 IU.kg‐1 of heparin before bypass; 600 IU.kg‐1 of heparin; 300 IU.kg‐1 of heparin as bolus followed by a continuous infusion of 10 000 IU.h‐1 until the end of bypass; or 600IU.kg‐1 of heparin plus“high dose” aprotinin (2 million IU of aprotinin before bypass, 500 000 IU.h‐1 until the end of the operation and 2 million IU added to the bypass pump prime). Grouping was blinded for the surgeon and the anaesthetist. Plasma concentrations of thrombomodulin, protein C and (free) protein S as well as thrombin/antithrombin III were measured by enzyme ‐linked‐immunosorbent assays after induction of anaesthesia, during and after bypass, at the end of surgery, 5h after bypass, and on the first postoperative day. Activated clotting time was significantly longer during bypass in group 2 (566 (60)s) and group 4 (655 (59)s), whereas standard coagulation parameters showed no differences between the four groups. Blood loss and use of homologous blood and blood products were highest in groups 2 and 3. Thrombomodulin plasma levels were similar (and normal) at baseline (< 40 ng.l‐1), decreased during bypass and reached baseline values postoperatively without showing significant group differences. Protein C did not show any differences among the groups within the investigation period.‘Free’ protein S plasma levels were most reduced in group 1 (from 68 (8)% to 48 (9)% after bypass). Thrombin/antithrombin III plasma concentrations increased most in groups 1 (to 69 (14) μg.l‐1 after bypass) and 2 (to 48 (7) ng.l‐1 after bypass), whereas they remained significantly lower in groups 3 and 4. The thrombomodulin/protein C‐system was not significantly influenced by the regimen of anticoagulation. Administration of‘high‐dose’ heparin was associated with the highest blood loss, which could not be related to endothelial‐associated coagulation.
Severe hyperventilation and respiratory alkalosis during pressure‐support ventilation: report of a hazard
Authors: Chui P. T. , Joynt G. M. , Oh T. E. 
Published: February 2007

SummaryA 53‐year‐old woman with a flaccid quadriparesis developed severe hyperventilation and respiratory alkalosis during pressure‐support ventilation. A gas leak in the ventilator system caused a loss of positive end‐expiratory pressure and autocycling of the ventilator. Large ventilator breaths were then delivered because a high level of pressure support was set in a patient with low respiratory impedance. The complication is rare and its occurrence requires a combination of patient and equipment factors. Awareness of the responsible factors will promote detection and prevention of the hazard.
Postoperative laryngeal competence
Authors: Stanley G. D. , Bastianpillai B. A. , Mulcahy K. , Langton J. A. 
Published: February 2007

SummaryWe investigated the incidence of postoperative laryngeal incompetence in 40 patients undergoing lower limb arthroplasty. Patients were randomly allocated to one of two groups using a standardised general anaesthetic/muscle relaxant technique; in group A the patients’ lungs were ventilated via a laryngeal mask airway and in group B via a tracheal tube. Following recovery from general anaesthesia, at a time when patients were considered safe for discharge back to the general ward, they were asked to swallow 20 ml of barium, and an immediate portable chest X ray was taken. The X rays were examined for evidence of tracheopulmonary aspiration. Contrary to previous studies the incidence of aspiration was low, occurring in only one patient. This aspiration was, however, clinically silent. The exact mechanism of this apparent laryngeal incompetence, which occurred in a patient from the tracheal tube group, is unclear. Due to the relatively small numbers of patients studied no conclusions can be drawn about the relative benefits of the use of the laryngeal mask airway with regard to postoperative laryngeal competence.
The anaesthetic management of Caesarean section for placenta praevia: a questionnaire survey
Authors: Bonner S. M. , Haynes S. R. , Ryall D. 
Published: February 2007

SummaryThe purpose of this study was to determine current UK anaesthetic practice regarding the use of regional anaesthesia in the management of patients with placenta praevia presenting for Caesarean section. We asked the members of the Obstetric Anaesthetists Association to complete a postal questionnaire in which a range of clinical situations involving varying degrees of placenta praevia were presented. In each case respondents were asked whether they would be willing to use regional anaesthesia. A wide variety of clinical practice was demonstrated. Anaesthetists with two or more obstetric sessions were more willing to use regional anaesthesia for Caesarean section in the presence of placenta praevia in both elective and emergency situations associated with haemorrhage.
Bilateral paravertebral analgesia for major abdominal vascular surgery: a preliminary report
Authors: Richardson J. , Vowden P. , Sabanathan S. 
Published: February 2007

SummaryParavertebral analgesia is highly effective in blocking unilateral afferent input from the trunk, but its bilateral use does not appear to have been described. Eight patients undergoing major abdominal vascular surgery had pre‐operative bilateral paravertebral catheters inserted. A dose of 25 ml of bupivacaine 0.5% divided between the two catheters provided the basis of an effective intra‐operative analgesic regimen which was continued postoperatively by infusion of bupivacaine for 4 days. Diclofenac and morphine completed a balanced analgesic regimen which was started pre‐operatively and continued for 5 and 3 days respectively. Cardiovascular stability was notable throughout surgery, even with aortic clamping and all patients were extubated at the end of surgery. Good quality analgesia was obtained as assessed by low postoperative pain scores at rest and on movement. Three patients were not admitted to the intensive care unit, where mean stays for the group was 10 h (range 0‐24 h) and mean hospital stay was 10 days (range 7–14). There were no additional demands made on the nursing staff and no postoperative pain‐related complications occurred. We conclude that bilateral paravertebral analgesia, as part of a balanced analgesic technique, is an alternative method of providing effective afferent blockage for major abdominal surgery.
An evaluation of two concentrations of hyaluronidase for supplementation of peribulbar anaesthesia
Authors: Brydon C. W. , Basler M. , Kerr W. J. 
Published: February 2007

SummaryWe studied the effect of the addition of hyaluronidase to a mixture of lignocaine 2% and bupivacaine 0.75% for peribulbar anaesthesia in 60 patients presenting for elective intra‐ocular surgery. Using a randomised, double‐blind design, patients were allocated to one of three groups: no hyaluronidase (group A) (n = 20); hyaluronidase 50 iu.ml‐1 (group B) (n = 20); hyaluronidase 150 iu.ml‐1 (group C) (n = 20). The speed of onset of the block, the presence of akinesia, analgesia and the need for supplementary injections were assessed. The addition of 150 iu.ml‐1 of hyaluronidase resulted in a mean (SEM) time to akinesia of 9.2 (0.9) min compared to 10.9 (0.9) min in the control group and 10.7 (1.1) min in those receiving the lower dose. Fewer patients in group C required a further injection (20%) than those in groups A (40%) or B (45%). None of the findings were statistically significant. Hyaluronidase was not associated with any complications.