bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dural taps revisited
Authors: STRIDE P. C. , COOPER G. M. 
Published: February 2007

SummaryThe records from 34 819 obstetric epidurals performed at Birmingham Maternity Hospital over the period 1969–1988 were examined. During that time there were 460 dural taps (overall incidence 1.3%). Of the methods used to detect the epidural space, loss of resistance to injection of saline was associated with the lowest incidence of dural tap (0.6%). The incidence of typical postdural puncture headache when managed conservatively was 86%. Provision of an epidural drip after delivery reduced the incidence of headache to 70%. Elective forceps delivery conferred no additional benefit, and tended to delay the onset of headache. Blood patches were performed on 135 patients and provided complete relief of headache in 93 (68%). A further 23 patients (16%) obtained partial relief.
Interpleural analgesia and phrenic nerve paralysis
Authors: LAUDER G. R. 
Published: February 2007

SummaryA case of phrenic nerve paralysis following interpleural analgesia for cholecystectomy is reported. The pre‐operative chest X ray was normal but chest X ray after cholecystectomy and interpleural analgesia revealed a raised right hemidiaphragm. This resolved after discontinuation of the interpleural analgesia and was probably a result of phrenic nerve paralysis produced by the interpleural local anaesthetic.
Anaesthetists' attitudes to parental presence at induction of general anaesthesia in children
Authors: Roman D. E. M. , Barker I. , Reilly C. S. 
Published: February 2007

SummaryAttitudes of anaesthetists of various grades working in different types of hospital in England and Wales, to parental presence in the anaesthetic room during induction of anaesthesia in children were assessed by means of a postal questionnaire. Of the 300 questionnaires sent out, 244 (82%) were completed. The majority of anaesthetists were in favour of parental presence in the anaesthetic room for induction of anaesthesia in children over the age of 1 year undergoing routine day case surgery. A small but significant number expressed reservations about some aspects of parental presence. The grade of anaesthetist and type of hospital did not appear to influence the response.
Isoflurane in labour
Authors: WEE M. Y. K. , HASAN M. A. , THOMAS T. A. 
Published: February 2007

SummaryA comparison of the analgesic efficacy of Entonox (50% nitrous oxide in oxygen) and Entonox with 0.2% isofturane was made in 18 consenting mothers during the first stage of labour. The inhalational gases were self‐administered during contractions over a 3 h study period using a standard Entonox demand valve and breathing system. Isoflurane 0.2% was added from an Ohmeda Isotec drawover vaporizer and the inspired concentration ofisoflurane was analysed continuously using a Datex Ultima analyser. Linear analogue scores for pain were significantly lower (p < 0.001) during the Entonox‐isoflurane administration compared with Entonox alone. Drowsiness was not a clinical problem and there was a high acceptance rate for Entonox‐isoflurane inhalational analgesia during labour.
Changes in blood flow and vascular resistance in the arm and leg during spinal anaesthesia and vasopressor therapy with methoxamine
Authors: FOGARTY D. J. , HOWE J. P. 
Published: February 2007

SummaryThe effects of subarachnoid block with hyperbaric bupivacaine 0.5% on forearm and calf blood flow and vascular resistance were examined using venous occlusion plethysmography in 10 fit patients. Following blockade there was an increase in mean (SD) calf blood flow from 2.0 (0.4) to 2.6 (1.2) ml.100 ml−1.min−1 (p = 0.057), a decrease in mean (SD) calf vascular resistance from 55 (15) to 38 (14) R units (p < 0.01), a decrease in mean (SD) forearm blood flow from 3.1 (1.2) to 1.8 (0.9) ml.100 mr−.min− (p < 0.01) and an increase in mean forearm vascular resistance from 38 (16) to 62 (24) R units (p < 0.01). Methoxamine 2 mg was administered intravenously when the mean arterial blood pressure decreased by 15%. There was a resultant marked increase in mean (SD) forearm blood flow from 1.8 (0.9) to 3.0 (0.8) ml.100 ml−1.min−1 (p < 0.001) but a decrease in mean (SD) calf blood flow from 2.6 (1.2) to 2.1 (1.4) ml.100 ml−1.min−1 (p = 0.11). Correspondingly, the mean (SD) forearm vascular resistance decreased from 62 (24) to 46 (17) R units (p < 0.01) with an increase in mean (SD) calf vascular resistance from 38 (14) to 56 (22) R units (p < 0.01). These findings indicate that whereas methoxamine produces the anticipated constrictor response in the calf vessels it causes a simultaneous reduction in vascular resistance in the forearm.
Trans‐septal left atrial catheterisation
Authors: FUKUTOME T. , KOHJIRO M. , SESE A. , UENO Y. 
Published: February 2007

SummaryA newly designed 4 FG double‐lumen catheter with the second port located either 5 or 7 cm proximal to the tip was tested in five children undergoing open heart surgery. The catheter was inserted percutaneously and initially positioned in the superior vena cava, right atrium or inferior vena cava. During cardiopulmonary bypass, the tip of the catheter was repositioned manually in the left atrium across the interatrial septum. In all patients, left atrial pressure was monitored successfully while central venous pressure was monitored with the second port positioned in the superior vena cava. Removal of the catheter from the left atrium was easily performed and caused no problems.
Clinical features of neuroleptic malignant syndrome in basal ganglia disease
Authors: HAYASHI K. , CHIHARA E. , SAWA T. , TANAKA Y. 
Published: February 2007

SummaryHallervorden‐Spatz disease is a rare autosomal recessive disorder in which dopaminergic deficiency in the substantia nigra and its nigrostriatal projection has been identified. It is characterised by a slow but progressive course culminating in death. This case report describes a 13‐year‐old male, with a clinical diagnosis of Hallervorden‐Spatz disease, who developed recurrent episodes of an acute illness, the features of which closely resembled those of the neuroleptic malignant syndrome. However, in this patient there had been no exposure to neuroleptic medication. The clinical events in this case suggest that dopaminergic hypoactivity, which is characteristic of Hallervorden‐Spatz disease, can trigger episodes of neuroleptic malignant syndrome.
Intermittent thiopentone for teaching fibreoptic nasotracheal intubation
Authors: Yentis S. M. , Jankowski S. , Gregory I. C. 
Published: February 2007

SummaryA technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubatingfibrescope. During endoscopy patients spontaneously breathed oxygen‐enriched air and passage of the tracheal tube was facilitated by suxamethonium. Arterial blood pressure, heart rate and arterial oxygen saturation were monitored continuously. Time from loss of eyelash reflex to successful intubation was 113 (90) (35–480) s (mean (SD) (range)). Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients; the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.
Combined high frequency ventilation in the management of respiratory failure in late pregnancy
Authors: RAPHAEL J. H. , BEXTON M. D. R. 
Published: February 2007

SummaryWe describe a pregnant patient with respiratory failure due to an atypical pneumonia and asthma that was successfully treated with the combination of high frequency oscillatory ventilation and intermittent positive pressure ventilation. This combined high frequency ventilatory technique is not commonly used in adults with respiratory failure and is largely contraindicated in patients with prolonged respiratory time constants such as occurs in asthma because of the risk of gas trapping. We suggest that this technique be considered in cases of respiratory failure refractory to conventional intermittent positive pressure ventilation and, that with appropriate monitoring of airways pressure, is worthy of a trial in patients with prolonged respiratory time constants.
Capnothorax: implications for the anaesthetist
Authors: PEDEN C. J. , PRYS‐ROBERTS C. 
Published: February 2007

SummaryTen patients underwent a laparoscopic surgical technique for thoracic and cervical dissection of the oesophagus during oesophagogastrectomy. Thoracotomy was avoided with potential benefits to the patient. To facilitate surgical access the right lung was collapsed using a double‐lumen bronchial tube and carbon dioxide was insufflated into the right pleural cavity to compress the lung. Changes in haemodynamic and respiratory variables occurred. In the majority of the patients airway pressure and end‐tidal CO2 increased, despite alterations in ventilation. In five patients systolic blood pressure decreased suddenly by between 15 and 35 mmHg, and in four patients Spo2 decreased to 91% or less, despite an Fio2 of 1.0. If carbon dioxide was insufflated too fast, or the lung failed to deflate adequately, the clinical picture was that of a tension pneumothorax. One patient developed surgical emphysema and a contralateral pneumothorax. Postoperatively two patients had recurrent laryngeal nerve damage. Suggestions are made to minimise the changes in haemodynamic and respiratory variables during carbon dioxide insufflation into the thorax.
Fibreoptic intubation
Authors: JONES H. E. , PEARCE A. C. , MOORE P. 
Published: February 2007

SummaryA randomised study was carried out in 60 patients to assess the influence of tracheal tube tip design on the ease of railroading a tracheal tube during fibreoptic intubation. A new design of tracheal tube with a tapered tip, without a bevel, was compared with a tracheal tube of standard design. The new design was found to be greatly superior in both oro‐ and nasotracheal fibreoptic intubation, when compared with the traditional tracheal tube (p < 0.001). The shape of the tip of a tracheal tube is an important determinant of the ease of railroading the tube over an inserted fibrescope.
Lumbar plexus block: an anatomical study
Authors: HANNA M. H. , PEAT S. J. , D'COSTA F. 
Published: February 2007

SummaryThe anatomy of the lumbar plexus and the various approaches used to perform lumbar plexus blockade are reviewed. A single needle technique for a posterior approach to the plexus at the L2–3 interspace is described. This technique was used bilaterally in six intact cadavers, and the extent of spread of an injected dye was documented photographically during a subsequent detailed dissection of the region. In all cases, dye was confined to the posterior part of the psoas muscle, and tracked down the nerves of the lumbar plexus. No dye was seen anterior to the psoas, around the sympathetic chain, on the sacral plexus or in the extradural or subarachnoid spaces. Further studies in patients with needle position and drug dispositon being confirmed using computerised tomography and X ray scanning were in agreement with the results observed in the cadavers. This technique represents a simple approach to the lumbar plexus which does not require needle localisation by X ray screening.
Inadvertent suppression of a fixed rate ventricular pacemaker using a peripheral nerve stimulator
Authors: O'FLAHERTY D. , WARDILL M. , ADAMS A. P. 
Published: February 2007

SummaryElectromagnetic interference usually produces only minor effects in patients with pacemakers. Nevertheless, the possibilities of serious and even fatal consequences of this complication must be recognised. This case reports an unusual anaesthetic source of interference, caused by activation of a popular nerve stimulator, resulting in cardiac arrest in a patient with a fixed‐rate ventricular pacemaker.
A computer‐controlled closed anaesthetic breathing system
Authors: LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryWe describe the design and working of a computer‐controlled, closed anaesthetic breathing system which rapidly achieves and maintains a prescribed end‐tidal concentration ofisoflurane in oxygen. The system is simple to set up and not expensive; the only nonstandard component is a modified glass syringe. We have demonstrated that gas analysers may contribute as much as the patient to the accumulation of nitrogen within the breathing system. Details of our clinical experience with the system are presented in an accompanying article.
A combined chest drain and intrapleural catheter for post‐thoracotomy pain relief
Authors: Broome I. J. , Sherry K. M. , Reilly C. S. 
Published: February 2007

SummaryThis study examined the effectiveness of a new type of chest drain, which incorporates an additional lumen within its wall to facilitate the administration of intrapleural bupivacaine. Nine patients who received a bolus dose of 1.5 mg.kg−1 bupivacaine with 1:200 000 adrenaline through this chest drain used less morphine, and had lower visual analogue pain scores in the first 6 h after thoracotomy than patients in whom a standard chest drain had been used. Bupivacaine levels were found to be within safe limits in all patients.
Nitrous oxide uptake during spontaneous and controlled ventilation
Authors: BENGTSON J. P. , BENGTSSON A. , STENQVIST O. 
Published: February 2007

SummaryThe rate of uptake of nitrous oxide was studied in 40 orthopaedic patients anaesthetised with either enflurane or isoflurane in nitrous oxide and with either spontaneous or controlled ventilation. A variant of the Douglas bag method was used in combination with low fresh gas flows to a circle system. There were no significant differences in nitrous oxide uptake between the groups and the uptake rates followed‘the square root of time concept', with an overall best fit curve of 1080.t‐0.505 ml.70 kg‐1.min‐1. During spontaneous ventilation, the nitrous oxide uptake rate was similar or even higher than the corresponding rate during controlled ventilation, in spite of lower minute volumes.
Acute respiratory distress during Caesarean section under spinal anaesthesia A probable case of anaphylactoid reaction to Syntocinon
Authors: MORRISS W. W. , LA VIES N. G. , ANDERSON S. K. , SOUTHGATE H. J. 
Published: February 2007

SummaryA case of life‐threatening respiratory distress during a Caesarean section under spinal anaesthesia is reported. Possible causes of the event including anaphylactoid reactions and the methods of their diagnosis are discussed. The most likely cause of the episode was felt to be an anaphylactoid reaction to Syntocinon.
Analgesia after laparoscopic sterilization Effect of 2% lignocaine gel applied to Filshie clips
Authors: Barclay K. , Calvert J. P. , Catling S. J. , Edwards N. D. , Rees A. 
Published: February 2007

SummaryWe performed a randomised controlled study in patients undergoing day case laparoscopic sterilisation to assess whether coating Filshie clips with 2% lignocaine gel prior to application to the Fallopian tubes would reduce postoperative pain. Sixty‐two patients were studied, in 33 of whom the Filshie clips were coated in sterile 2% lignocaine gel. Pain scores in the lignocaine gel group were significantly lower than in the control group at 1 h after return to the ward, but no differences were found immediately on return to the ward, or at discharge or at 24 h. There were no significant differences between the two groups in postoperative analgesic requirements or in side effects.
Decreased cardiac index as an indicator of tension pneumothorax in the ventilated patient
Authors: BEARDS S. C. , LIPMAN J. 
Published: February 2007

SummaryWe describe three critically ill patients receiving pressure‐controlled ventilation who suffered acute hypotensive episodes associated with the development of tension pneumothoraces. In four documented episodes of tension pneumothorax a major decrease in cardiac index was the most consistently detected abnormality. The expected increases in central venous pressure and heart rate did not occur in three of the episodes in two of the patients, both of whom were receiving inotropic therapy. Any increases in airway pressure could not be assessed on pressure‐controlled ventilation. The physiology of tension pneumothorax in the ventilated patient is described and the importance of decreased cardiac index as a haemodynamic indicator of tension pneumothorax is discussed.
External ophthalmoplegia after total intravenous anaesthesia
Authors: Marsch S. C. U. , Schaefer H.‐G. 
Published: February 2007

SummaryEye‐opening and eye movements were assessed in 110 awake and cooperative ASA class 1 and 2 patients after elective ENT surgery with total intravenous anaesthesia using propofol, fentanyl and atracurium. Following tracheal extubation and after regaining consciousness 21 patients showed a complete transient bilateral inability to open their eyes combined with a total gaze paresis, while another 30 patients showed an impairment of eye‐opening and/or eye movements to a lesser extent. In all patients affected symmetrical recovery of both impaired eye‐opening and eye movements occurred during the following 20 min. The occurrence of ophthalmological symptoms was not related to the duration of anaesthesia or the propofol infusion rate. Thus a complex ophthalmological phenomenon occurred after total intravenous anaesthesia in approximately 50% of awake and cooperative patients. The aetiology of this phenomenon and the implications for the understanding of the mechanisms of general anaesthesia remain to be determined.
Single oral dose ondansetron in the prevention of postoperative nausea and emesis
Authors: RUST M. , COHEN L. A. 
Published: February 2007

SummaryIn two placebo‐controlled, double‐blind, multicentre studies, the efficacy and safety of single oral doses of ondansetron 4mg, 8mg and 16 mg were evaluated for the prevention of postoperative nausea and vomiting in female inpatients. For the total study populations, 26% (European study) and 32% (US study) of placebo‐treated patients experienced no emesis compared with 54% (European study) and 52% (US study) of patients treated with ondansetron 16 mg, the most effective dose. Similarly, 22% (European study) and 19% (US study) of placebo‐treated patients experienced no nausea compared with 42% (European study) and 34% (US study) of ondansetron 16mg‐treated patients. All ondansetron doses in both studies were statistically superior to placebo (emesis p ≤ 0.007; nausea p ≤ 0.033). Slightly lower percentage differences in complete response between placebo and ondansetron for both nausea and emesis were observed for patients with a previous history of postoperative nausea and emesis compared with patients with no previous history, with ondansetron 16 mg being the most effective dose for both patient groups. In the US study, a slightly greater percentage of patients undergoing non‐gynaecological surgery had no nausea and no emesis compared with patients undergoing gynaecological surgery in both the placebo and ondansetron treatment groups. Again, ondansetron 16 mg was the most effective dose in both surgery types. Ondansetron was well tolerated, with only headache being reported as a significant problem in both studies. Overall, ondansetron 16 mg was the most effective dose in patients with and without a previous history of postoperative nausea and emesis undergoing both gynaecological and non‐gynaecological surgery.
Comparative effects of laryngeal mask and tracheal tube on total respiratory resistance in anaesthetised patients
Authors: BOISSON‐BERTRAND D. , HANNHART B. , ROUSSELOT J. M. , DUVIVIER C. , QUILICI N. , PESLIN R. 
Published: February 2007

SummaryWe compared the effects of the laryngeal mask and tracheal tube on total respiratory resistance in 10 anaesthetised, mechanically ventilated patients undergoing otological microsurgery. The subjects were randomly divided into two groups. In the first group, the tracheal tube (Rüsch) was inserted for the first series of measurements. This was then replaced by a laryngeal mask (Intavent) and a second series of measurements was made during the first hour of operation. In the second group, the same protocol was applied with inverse order in the use of the devices. From the measurement of respiratory flow and pressure at the airway opening, total respiratory resistance was calculated by multiple linear regression. The data were corrected to eliminate the previously determined nonlinear resistance of the two devices. Arterial blood pressure, electrocardiogram, oxygen saturation and end‐tidal carbon dioxide concentration were continuously monitored. With the laryngeal mask and the tracheal tube, mean (SE) minute ventilation was 9.4(0.9)l.min‐1 and 8.1 (0.9)l.min‐l, respectively for end‐tidal carbon dioxide concentrations between 3.6 and 4.1%. Although the glottic resistance was included in the measurement performed with the laryngeal mask but not with the tracheal tube, mean (SE) total respiratory resistance was not significantly different with the two devices (0.61(0.32) and 0.69(0.35) kPa.l‐1.s, respectively). Leakage was avoided with the laryngeal mask because the insufflation pressure never exceeded 1.7 kPa except in one patient suffering from severe chronic obstructive pulmonary disease who had a total respiratory resistance of 1.45kPa.l‐1.s. During the first hour of the operation all respiratory variables remained stable irrespective of the device used.
Plasma concentrations of alfentanil following epidural administration
Authors: van der LELY F. HAAK , BURM A. G. L. , van KLEEF J. W. , BOVILL J. G. , VLETTER A. A. 
Published: February 2007

SummaryThe plasma concentration‐time profile of alfentanil following epidural administration was determined in eight patients undergoing lower abdominal surgery under nitrous oxide (66%)‐oxygen (33%)‐halothane (0.3%) anaesthesia, supplemented with intravenous sufentanil. Alfentanil (1 mg) was administered epidurally before induction of general anaesthesia. Blood samples for the determination of plasma alfentanil concentrations by capillary gas chromatography were collected at intervals until 12h after the epidural injection. Peak plasma concentrations [mean (SD)] were 9.7 (2.3)ng.ml‐1, and were attained in a median (range) time of 90 (30‐120) min. The results suggest that alfentanil is slowly absorbed from the epidural space into the general circulation.
Inhalation anaesthesia and the Kearns‐Sayre syndrome
Authors: LAUWERS M. H. , VAN LERSBERGHE C. , CAMU F. 
Published: February 2007

SummaryKearns‐Sayre syndrome is an extremely rare mitochondrial myopathy, characterised by retinitis pigmentosa associated with progressive external ophthalmoplegia. Cardiac conduction abnormalities are common and range from bundle branch block to third degree atrioventricular block. Generalised degeneration of the central nervous system has also been reported. We describe the anaesthetic management of a child afflicted by this syndrome. The major anaesthetic complication in this disease is sudden third degree atrioventricular block which may lead to death in the absence of an artificial cardiac pacemaker.
Mediastinitis and sepsis syndrome following intubation
Authors: GAMLIN F. , CALDICOTT L. D. , SHAH M. V. 
Published: February 2007

SummaryA patient developed sepsis syndrome with shock 7 h after an anaesthetic for a shoulder replacement. Tracheal intubation had been difficult and required the use of a stylet and gum‐elastic bougies. A gastrografin swallow subsequently demonstrated an oesophageal perforation and mediastinitis was diagnosed at surgical exploration. She survived after a prolonged period of intensive care treatment.