bluuebunny/crossref_metadata_2025_split huggingface dataset:
Forty‐eight single‐shot epidural injections on the same patient
Authors: KATSAROS G. A. , HANDJIS G. P. , ANASTASIADES J. 
Published: February 2007

SummaryA patient is described who has received 48 single‐shot epidurals with plain lignocaine. No complications were encountered at any time. Nuclear magnetic resonance imaging confirmed that no dural damage had occurred.
Anaesthesia for the treatment of a giant cerebral aneurysm under hypothermic circulatory arrest
Authors: THOMAS A. N. , ANDERTON J. M. , HARPER N. J. N. 
Published: February 2007

SummaryThe anaesthetic management of a patient whose giant cerebral aneurysm was clipped is described. Profound hypothermia and thiopentone were used to provide cerebral protection during circulatory arrest. Atracurium was used to provide muscle relaxation; the level of neuromuscular block and plasma concentrations of atracurium and laudanosine were measured.
Management of low cardiac output syndrome after cardiac surgery using enoximone
Authors: WHITE D. A. , LATIMER R. D. , ODURO A. 
Published: February 2007

SummaryThis case report describes the use of enoximone, a potent phosphodiesterase F‐IV inhibitor with inotropic and vasodilator actions, to treat low output syndrome after cardiac surgery. The reduced cardiac output was unresponsive to a combination of inotropic drugs and intra‐aortic balloon counterpulsation was contraindicated. Cardiac output was increased dramatically by enoximone, but systemic vascular resistance and perfusion pressure remained low until the addition of metaraminol.
Clinical evaluation of double‐burst stimulation Its relationship to train‐of‐four stimulation
Authors: GILL S. S. , DONATI F. , BEVAN D. R. 
Published: February 2007

SummaryDouble‐burst stimulation was compared with train‐of‐four stimulation in 23 adult patients receiving atracurium. Train‐of‐four was interrupted in 11 subjects every 2 minutes by one double‐burst stimulation, and re‐applied 6–30 seconds later; the height of the first double‐burst response, compared with its control, was depressed slightly more than T1. The relationship between double‐burst stimulation ratio and train‐of‐four ratio was indistinguishable from the line of identity. The train‐of‐four response, if repeated more than 12 seconds after double‐burst stimulation, was not depressed compared with pre double‐burst stimulation values. Fifteen anaesthetists were asked to detect fade manually in the second part of the study, while train‐of‐four was recorded on the opposite arm. One hundred and fourteen determinations were made in 12 patients. Fade was detected manually more often with double‐burst stimulation than with TOF.
Impairment of left ventricular diastolic function during coronary artery bypass grafting
Authors: WEHLAGE D. R. , BÖHRER H. , RUFFMANN K. 
Published: February 2007

SummaryTwelve patients were studied by transoesophageal Doppler echocardiography to determine diastolic function during coronary artery bypass grafting. Haemodynamic and Doppler‐derived variables were measured after induction of anaesthesia and after closure of the sternum. Early diastolic filling of the left ventricle decreased from 55% to 35% during surgery. The contribution of atrial contraction to left ventricular filling increased from 41% to 62% (p < 0.001). We conclude that coronary artery bypass grafting results in impairment of diastolic function during the operation.
Respiratory tract infection and anaesthesia Haemophilus influenzae pneumonia that developed under anaesthesia
Authors: CAMPBELL N. N. 
Published: February 2007

SummaryA 2‐year‐old boy with symptoms of a minor upper respiratory tract infection developed Haemophilus influenzae pneumonia that presented as hypoxaemia under anaesthesia for minor emergency surgery. The patient required 72 hours of mechanical ventilation in an intensive care unit after the anaesthetic and thereafter made an uneventful recovery. The value of pre‐operative chest radiology and the possible contributory effect of anaesthesia are discussed.
Response to suxamethonium in a myasthenic patient during remission
Authors: ABEL M. , EISENKRAFT J. B. , PATEL N. 
Published: February 2007

SummaryA cumulative dose followed by an infusion was used to determine the dose response to suxamethonium in a patient with diagnosed my asthenia gravis who was in true remission (asymptomatic while receiving no therapy). The ED50 and ED90 values for suxamethonium were 0.08mg/kg and 0.20mg/kg, and an infusion rate of 3.2 mg/kg/hour was required to maintain a 90–95% depression of the single twitch response as monitored by integrated electromyography. These values are within the range for normal patients, and we conclude that myasthenic patients during a true remission may not demonstrate resistance to suxamethonium.
Minimum oxygen requirements during anaesthesia with the Triservice anaesthetic apparatus A study of drawover anaesthesia in the young adult
Authors: Tighe S.Q.M. , Turner G.A. , Merrill S.B. , Pethybridge R.J. 
Published: February 2007

SummaryThirty‐six servicemen were anaesthetised using the Triservice anaesthetic apparatus. They were allocated randomly into one of two groups, to breathe spontaneously or to receive artificial ventilation, and into subgroups who were given air alone, or air supplemented with 1 or 4 litres/minute of oxygen. A further 12 subjects were studied subsequently using 0.5 litres/minute of added oxygen. Intra‐operative blood gases were compared with those of awake premedicated controls. Artificial ventilation was associated with an unchanged arterial oxygen tension with air alone; in the other subgroups arterial oxygen tension was higher than with spontaneous respiration when related to inspired oxygen fraction (p < 0.05). Air anaesthesia caused significant hypoxaemia with spontaneous ventilation (p < 0.05), and 50% of the subjects required assisted ventilation. There was also a significant respiratory acidosis (p < 0.05). Intermittent positive pressure ventilation is the method of choice for field anaesthesia when oxygen is unavailable. Spontaneous respiration must be supplemented with at least 0.5 litres/minute of oxygen.
Factors that influence the induction dose of propofol
Authors: McCleane G. J. , Fogarty D. F. , Watters C. H. 
Published: February 2007

SummaryFactors that influence the induction of anaesthesia with propofol were investigated in a prospective study of 1000 patients. Pre‐operative albumin and urea concentrations correlated with the minimum induction dose of propofol, but less strong correlations were found with haemoglobin, globulin and total protein concentrations. Age was an important influence on the induction dose of propofol (r = 0.34) which was also closely related to ASA grade. Induction of anaesthesia with propofol is dependant on a number of variables, and this study suggests that pre‐operative albumin and urea concentrations are important.
Lumbar epidural diamorphine following thoracic surgery
Authors: PATRICK J. A. , MEYER‐WITTING M. , REYNOLDS F. 
Published: February 2007

SummaryTwenty‐two patients received a single dose of diamorphine 5 mg through a lumbar epidural catheter before thoracic surgery. The patients were transferred after surgery to a high dependency unit where they were allocated randomly to receive either an infusion of epidural diamorphine at a rate of 1 mg/hour (group 1) or bolus doses of epidural diamorphine 5 mg on demand (group 2). There was no statistically significant difference between the groups in visual analogue pain scores in the first 18 postoperative hours. Arterial carbon dioxide tension was elevated in both groups and was consistently higher in group 1 than in group 2, with a statistically significant intergroup difference 12 hours after operation. Respiratory rate was not a useful index of respiratory depression. The commonest nonrespiratory side effect was urinary retention, but the incidences of this and other minor side effects were similar in the two groups.
Incremental spinal anaesthesia using a 32‐gauge catheter
Authors: KESTIN I. G. , GOODMAN N. W. 
Published: February 2007

SummaryIncremental spinal anaesthesia using a 32‐gauge intrathecal catheter was studied in 13 males scheduled for transurethral resection of the prostate or repair of inguinal hernia. The spinal technique failed in four patients. Dose‐response curves were obtained in the remaining nine patients using increments of 0.5% plain bupivacaine. The spinal block was extended safely and reliably without cardiovascular instability. No patient had any postoperative headache and all catheters were removed intact.
Echocardiographic assessment of the haemodynamic effects of propofol: a comparison with etomidate and thiopentone
Authors: GAUSS A. , HEINRICH H. , WILDER‐SMITH O. H. G. 
Published: February 2007

SummaryThe haemodynamic effects of propofol (2 mg/kg), etomidate (0.2 mg/kg) and thiopentone (4 mg/kg) were studied in 30 ASA 1 and 2 patients in whom anaesthesia had been induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg, vecuronium 0.1 mg/kg and atropine 10 μg/kg, and maintained with nitrous oxide in oxygen. Arterial pressure was measured directly and left ventricular diameters were determined by transoesophageal echocardiography. Systolic blood pressure after propofol and thiopentone and the end‐systolic quotient (systolic pressure/end‐systolic diameter), a measure of inotropy, decreased. Fractional shortening (end‐diastolic ‐ end‐systolic diameter/end‐diastolic diameter) decreased only in the thiopentone group. Diastolic blood pressure and end‐diastolic diameter (a measure of preload) did not change in any of the groups, and the etomidate group showed no changes in the haemodynamic variables measured. Propofol shows simultaneous negative inotropy and afterload reduction, while thiopentone is exclusively negatively inotropic.
Epidural blood patch for treatment of subarachnoid fistula in children
Authors: KUMAR V. , MAVES T. , BARCELLOS W. 
Published: February 2007

SummaryA subarachnoid‐cutaneous fistula developed in two children after the placement of a catheter in the subarachnoid space for drainage of cerebrospinal fluid. The management of this iatrogenic complication with epidural blood patch is described.
Acute airway obstruction, hypertension and kyphoscoliosis
Authors: WRIGHT P. M. C. , ALEXANDER J. P. 
Published: February 2007

SummaryAn elderly woman developed acute respiratory obstruction after choking on a bolus of food. On rigid bronchoscopy no foreign body, or anatomical obstruction was seen, but airway obstruction recurred during emergence from general anaesthesia, and was thought to be functional in nature. A recurring airway obstruction followed, relieved by induction of anaesthesia and by sedation. This was subsequently demonstrated to be caused by a tortuous aorta which impinged intermittently on the anterior tracheal wall, as a result of kyphoscoliosis of the thoracic spine. We attribute the relief of airway obstruction by general anaesthesia to a reduction in arterial blood pressure.
Ketamine, midazolam and vecuronium infusion Anaesthesia for Down's syndrome and congenital heart disease
Authors: RILEY D. P. , McBRIDE L. J. 
Published: February 2007

SummaryA ketamine, midazolam and vecuronium infusion was used for total intravenous anesthesia in a patient with Down's syndrome, a ventricular septal defect and pulmonary hypertension. A mixture of ketamine 200 mg, midazolam 5 mg and vecuronium 12 mg in 50 ml of normal saline was infused at 0.5 ml/kg/hour. This simple technique and ventilation with 100% oxygen maintained tissue oxygenation and cardiovascular stability.
Rhabdomyolysis and operating position
Authors: Targa L. , Droghetti L. , Caggese G. , Zatelli R. , Roccella P. 
Published: February 2007

SummaryRhabdomyolysis during routine surgery was studied in three groups of patients who had surgery, with limited trauma to muscle, in the lateral and supine positions, and prone on the spinal frame. A range of blood tests was performed (before surgery, and on the first, third and seventh day after operation). These showed that a creatine kinase increase in the 24 hours and the early appearance of myoglobin in the serum were the best indicators. Rhabdomyolysis was associated with the lateral position and long lasting surgery. No blood test before surgery was of any predictive value.
Introducing an acute pain service
Authors: CARTWRIGHT P. D. , HELFINGER R. G. , HOWELL J. J. , SIEPMANN K. K. 
Published: February 2007

SummaryAn acute pain service in a new district general hospital is described. We have reported the incidence of severe pain, common postoperative anaesthetic problems and patient satisfaction in relation to the analgesic technique. Over half the patients were treated by intermittent intramuscular injection of opioid, but increase in the use of continuous intravenous therapy and in particular patient‐controlled analgesia, was welcomed by both medical and nursing staff.
Cardiovascular effects of epidural local anaesthetics
Authors: KERKKAMP H. E. M. , GIELEN M.J.M. 
Published: February 2007

SummaryThe cardiovascular effects of 20 ml 0.75% bupivacaine with adrenaline 5 μg/ml injected epidurally were compared with those of 20 ml 0.75% ropivacaine with adrenaline. Cardiovascular measurements were performed with a transthoracic electrical bioimpedance monitor. The maximum mean arterial blood pressure decreased significantly from baseline values after both solutions, but the decrease after 20 minutes was more pronounced with bupivacaine (21 %) than with ropivacaine (9.6%). Stroke volume increased significantly in both groups (52% for bupivacaine and 29% for ropivacaine). Cardiac output increased significantly from baseline values 2 minutes after epidural administration; the mean of the maximum increase was 64% for bupivacaine and 53% for ropivacaine (NS). The mean of the maximum increase of the ejection fraction was 13% in the bupivacaine group and 9% in the ropivacaine group, but was only significantly different from baseline values following bupivacaine. There was no difference in the onset time or height of the sensory block between the groups. The cardiovascular changes can be ascribed to sympathetic blockade and to systemic absorption of the local anaesthetics and adrenaline.
Topical amethocaine in strabismus surgery
Authors: WATSON D. M. 
Published: February 2007

SummaryA randomised study was performed to assess the effect of topical 1% amethocaine hydrochloride on postoperative analgesia requirements after strabismus surgery. Forty children scheduled for elective operation were allocated randomly to receive either topical amethocaine or normal saline. Postoperative analgesia was evaluated with the use of a four‐point assessment score and analgesic requirements. The topical amethocaine provided significantly better postoperative analgesia (p < 0.001) as measured by both the assessment score and the postoperative analgesia requirement.
The effect of micropore filters on the aspiration test in epidural analgesia
Authors: CHARLTON G. A. , LAWES E. G. 
Published: February 2007

SummaryContinuous epidural analgesia may be complicated by intravascular or subarachnoid injection of local analgesic, with disastrous consequences. One of the techniques described to prevent these complications is the aspiration test. It is the current standard of practice to employ a micropore bacterial filter for epidural infusions. We present an in vitro study of nine commercially available bacterial filters to determine whether or not the aspiration test could be reliably performed through them. Eight of the nine filters (except the Perifix, Braun) were found to be unreliable if air and liquid were both present in the system (air lock). The role of the aspiration test and the use of micropore filters in epidural analgesia are discussed, as are the implications and possible solutions in practice of this cause of failure of the test.
Lumbar regional anaesthesia and prophylactic anticoagulant therapy
Authors: WILLE‐JØRGENSEN P. , JØRGENSEN L. N. , RASMUSSEN L. S. 
Published: February 2007

SummaryA survey has been carried out in all Danish anaesthetic departments (n = 80) regarding the attitude towards the use of epidural/spinal lumbar analgesia in patients who were receiving prophylactic anticoagulant therapy for the prevention of thromboembolism. About 60% of the departments used the techniques in patients receiving low‐dose heparin and no side effects had been experienced. Spinal and epidural anaesthesia were in general regarded as being contraindicated in patients fully anticoagulated with vitamin K antagonists. In the world literature, the attitude towards the combination is conflicting. No randomised trial has been performed and complications are almost entirely confined to patients fully anticoagulated with vitamin K antagonists. Only one case of an epidural haematoma has been recorded when subcutaneous low‐dose heparin was used as thromboprophylaxis.
Cardiovascular effects of intravenous clonidine
Authors: CARABINE U. A. , WRIGHT P. M. C. , HOWE J. P. , MOORE J. 
Published: February 2007

SummaryThe effect of clonidine on the pressor and heart rate response to tracheal intubation was studied in a placebo‐controlled, randomised, double‐blind trial. Thirty patients were pretreated with either clonidine 1.25 μg/kg, or clonidine 0.625 μg/kg or an equivalent volume of normal saline, given intravenously 15 minutes before induction of anaesthesia. The attenuation of the pressor response to intubation of both clonidine groups was statistically significant compared to the saline group. Neither dose of clonidine completely abolished the increase in either heart rate or blood pressure. There was no difference in attenuation between the clonidine treatments; this indicated that the lower dose may be the more appropriate.
Papaveretum infusions in infants under 6 months of age
Authors: Jones S. E. F. , Stokes M. A. 
Published: February 2007

SummaryThe effectiveness of a continuous low dose papaveretum infusion for the relief of postoperative pain was assessed in 29 infants aged 1–6 months nursed on the infant surgical ward following major abdominal surgery. Trained nursing staff were able to adjust the dosage within prescribed guidelines and satisfactory analgesia was obtained with a regimen which delivered up to 0.0375 mg/kg/hour, approximately half the dose recommended in children older than 12 months. There was one case of clinically significant respiratory depression.
Observations on deliberate dural puncture with a Tuohy needle: depth measurements
Authors: HOLLWAY T. E. , TELFORD R. J. 
Published: February 2007

SummaryObservations were made during the use of a Tuohy needle to perform deliberate dural puncture for the insertion of lumbar drains to improve operating conditions for intracranial aneurysm surgery. The most striking finding was the distance from identification of the epidural space to penetration of the dura. We postulate that this was because of tenting of the dura by the blunt Tuohy needle. This was facilitated by the absence of a negative epidural space pressure because an open system was used, which allowed time for pressure equilibration. This minimised the reactive forces across the dura. Aspiration and rotation of the Tuohy needle revealed dural puncture in some cases.
Observations on deliberate dural puncture with a Tuohy needle: pressure measurements
Authors: TELFORD R. J. , HOLLWAY T. E. 
Published: February 2007

SummaryPressure recordings were made during passage of a Tuohy needle from the interspinous ligament to the subarachnoid space for lumbar drain insertion. Epidural space pressures were always positive. Negative pressures were seen only at the moment of entry into the subarachnoid space. These were artefactual and were caused by tenting of the dura by the blunt Tuohy needle. Use of a closed measurement system such as this facilitates the development of large transdural pressure gradients because of the inability of the epidural space pressure to equilibrate with atmospheric pressure. This may contribute to ease of dural puncture.
Possible inadvertent subdural block following attempted stellate ganglion blockade
Authors: BRUYNS T. , DEVULDER J. , VERMEULEN H. , DE COLVENAER L. , ROLLY G. 
Published: February 2007

SummaryA case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex sympathetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered.
Nurse‐controlled intravenous analgesia
Authors: Murphy D. F. , Opie N. J. 
Published: February 2007

SummaryNurse‐controlled continuous intravenous opioid analgesia was evaluated prospectively in 60 patients after thoracotomy. The rate of opioid infusion was adjusted, and bolus doses were administered, as required to maintain patient comfort. The patients evaluated their pain using a visual analogue scale on 10 occasions during the first 48 hours after surgery. Pain scores remained consistently low throughout the period of measurement. Over the study period there was a 30‐fold difference between the least and greatest requirement for opioid to achieve adequate analgesia. No major side effects were encountered. The study indicates that nurse‐controlled intravenous analgesia can be successfully used for pain relief after thoracotomy.
Analgesic efficacy of controlled‐release dihydrocodeine
Authors: WOTHERSPOON H. A. , KENNY G. N. C. , McARDLE C. S. 
Published: February 2007

SummaryA prospective, double‐blind, single‐dose placebo‐controlled four‐part crossover study of 12 healthy volunteers was carried out to compare the analgesic efficacy of controlled‐release dihydrocodeine tablets 60, 90 and 120 mg (DHC Continus tablets, Napp Laboratories) in cold‐induced pain. Subjects received each of the four treatments in a random order using a latin square design. On each of the four study days, the volunteers performed cold pressor tests, before dose and again at 4, 8 and 12 hours after dose. Subjects rated their pain continuously over a 120‐second period using a visual analogue scale. At 4 hours there was a significant reduction in pain in subjects who received 120 mg or 90 mg tablets compared with placebo, and in subjects who received 120 mg tablets compared with those who received 60 mg tablets. At 8 hours, 120 mg and 90 mg dihydrocodeine were still better than placebo. There was no significant difference in side effects between treatments.
Intra‐ocular pressure changes using the laryngeal mask airway and tracheal tube
Authors: HOLDEN R. , MORSMAN C. D. G. , BUTLER J. , CLARK G. S. , HUGHES D. S. , BACON P. J. 
Published: February 2007

SummaryIntra‐ocular pressure was measured before and throughout airway establishment with either the laryngeal mask airway or tracheal tube. Similar measurements were made on removal of either airway and the amount of coughing noted in the first minute after removal. There was a significantly smaller increase in intra‐ocular pressure (p < 0.001) using the laryngeal mask airway, both on placement and removal, than with the tracheal tube. Postoperative coughing was significantly reduced using the laryngeal mask airway (p < 0.001). There was a significantly greater rise in heart rate using the tracheal tube (p < 0.01) probably related to an increased cardiovascular response. The laryngeal mask airway is recommended as an alternative to tracheal intubation in routine and emergency intra‐ocular surgery.
Protamine—the need to determine the dose
Authors: KEELER J. F. , SHAH M. V. , HANSBRO S. D. 
Published: February 2007

SummaryA simple method of protamine titration using the Hemochron system was compared with an empirical dose protocol for reversal of heparinisation following cardiopulmonary bypass in 40 patients undergoing elective myocardial revascularisation. Protamine titration revealed a wide range for protamine requirement and resulted in a significant reduction in protamine dose compared with the empirical dose protocol (p < 0.01). Heparin reversal was assessed as adequate in all patients. The titration technique was easy and straightforward to use in the operating theatre.