bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children
Authors: Gadiyar V. , Gallagher T. M. , Crean P. M. , Taylor R. H. 
Published: February 2007

SummaryBoth caudal anaesthesia and non‐steroidal anti‐inflammatory drugs have been used in the management of postoperative pain in children. The aim of the present study was to evaluate the combination of caudal analgesia and rectally administered diclofenac in the treatment of pain following minor surgery in children. Thirty‐nine, ASA grade 1 or 2, children undergoing inguinal or penoscrotal surgery were randomly assigned to receive either a caudal block using 0.125% bupivacaine with adrenaline or a similar caudal block in combination with rectally administered diclofenac 1 mg.kg‐1. Children given a caudal block alone were more likely to need analgesia in the first 24 h postoperatively. It would appear that the combination of a caudal block and rectal diclofenac in children undergoing minor lower abdominal surgery reduces the need for subsequent analgesia.
Is there a need for a new inhalational anaesthetic agent?
Authors: JONES R. M. , WARD P. M. 
Published: February 2007

SummaryNew anaesthetic agents are continually being developed in an effort to prepare the ideal agent. Isoflurane is the first choice of many anaesthetists, although it clearly falls short of the ideal on a number of counts. The need and place for any new agent depends on comparing the properties of a theoretically ideal agent with those of isoflurane and the new agent. Desflurane is a step towards a more ideal inhaled agent; however, there is still the need to synthesise and evaluate new chemical entities in order that the ideal can more nearly be approached.
Physicochemical properties and pharmacodynamics of desflurane
Authors: EGER E. I. 
Published: February 2007

SummaryDesflurane is a new volatile, inhaled anaesthetic that differs significantly from presently available inhaled agents in being halogenated solely with fluorine. This fluorination produces a lower solubility and increased resistance to biodegradation. The lower solubility provides a more precise control over, and a more rapid awakening from, anaesthesia. The resistance to biodegradation suggests that toxicity from desflurane may be minimal or non‐existent. Limitations include a lesser potency and greater pungency at concentrations exceeding 1 minimum alveolar concentration (MAC). Other pharmacological properties are similar to those of isoflurane.
Circulatory effects of desflurane
Authors: CORIAT P. 
Published: February 2007

SummaryThe cardiovascular properties of desflurane and some other inhalational anaesthetics are outlined and compared, and the way in which they may be effectively used in clinical practice is considered. Desflurane appears to offer some advantages compared with currently available anaesthetics. Its effects on left ventricular function are moderate and the solubility of the agent in blood and tissue is remarkably less than isoflurane, enflurane, or halothane.
Recovery from outpatient anaesthesia
Authors: KORTTILA K. 
Published: February 2007

SummaryIn 1994, 66% of all surgery in the USA was performed as ambulatory surgery. Day surgery is also expanding to otlter countries worldwide. To provide safe anaesthesia and good outcomes for longer and more extensive operations performed in ambulatory facilities, patients must be carefully evaluated before surgery, their home readiness must be assessed, and they must fully understand all relevant information. Good outcome requires adoption of policies for safe discharge from the hospital. If a patient does not have an escort home, the surgical procedure should be cancelled or the patient admitted to the hospital. As the number of patients and complexity of scheduled surgical procedures increases, the outcome of day surgery will increasingly depend on the anaesthetist's skills. The recently introduced short‐acting drugs may further improve the outcome after day surgery by facilitating rapid recovery and an early return to normal daily activities.
A 5‐year survival study of general surgical patients aged 65 years and over
Authors: EDWARDS A. E. , SEYMOUR D. G. , MCCARTHY J. M. , CRUMPLIN M. K. H. 
Published: February 2007

SummaryA prospective 5‐year survival study of 900 patients, aged 65 years and over, undergoing a general surgical procedure, demonstrated that following an initial high mortality rate the survival of the group as a whole approached that of an age‐matched population. Non‐elective admissions, age 75 years and over, ASA grade 4–5 and major surgery were associated with a high early mortality. Mortality associated with malignancy extended over 1 year. The study reinforces the conclusion that age alone should be no bar to surgery and anaesthesia, endorses the findings of the National Confidential Enquiry into Peri‐operative deaths and emphasises the need to re‐examine the provision of anaesthetic and surgical services in District General Hospitals. The benefits of elective admission in the very old are highlighted, along with the potential for extension of day case surgery.
Uptake of desflurane during anaesthesia
Authors: WALKER T. J. , CHAKRABARTI M. K. , LOCKWOOD G. G. 
Published: February 2007

SummaryThe amount of desflurane required to maintain an end‐expired concentration of 8% was measured in 30 ASA 1 and 2 patients undergoing elective spinal surgery. The anaesthetic was administered using a computer‐controlled closed circle system. After an initial period during which the expired concentration of desflurane was stabilised (4 min) the rate of uptake showed a bi‐exponential decline. Mean cumulative usage of desflurane was 10.1 ml of liquid at 30min, 14.8ml at 60min, 25.4ml at 120min, 35.8 at 180min.
Antiemetic efficacy of prophylactic ondansetron in laparoscopic cholecystectomy
Authors: KOIVURANTA M. K. , And E. LÄÄRÄ , RYHÄNEN P. T. 
Published: February 2007

SummaryThe antiemetic efficacy of ondansetron given prophylactically was investigated in a randomised, double‐blind, placebo‐controlled trial of 63 patients undergoing laparoscopic cholecystectomy. The patients received intravenously prior to anaesthesia either ondansetron 4 mg or placebo. The same standardised general anaesthetic technique was used. Nausea, emetic episodes and the need for rescue medication were recorded for 24 h postoperatively. Nausea was experienced by 64% of the patients in the ondansetron group and 56% in the placebo group, and emetic episodes occurred in 45% and 50% of the patients in the two groups, respectively. The proportions of patients given rescue antiemetic medication were 45% and 44%, respectively. No clinically important adverse events were observed. In conclusion, ondansetron given prior to anaesthesia in a dosage of 4mg did not prevent postoperative nausea and vomiting after laparoscopic cholecystectomy.
Anaesthesia for day‐care arthroscopy
Authors: GUPTA A. , KULLANDER M. , EKBERG K. , LENNMARKEN C. 
Published: February 2007

SummaryA study was undertaken to compare desflurane‐ and isoflurane‐based anaesthesia in patients undergoing day‐care arthroscopic surgery. Anaesthesia was induced with propofol 2–3 mg.kg‐1 and a laryngeal mask airway was inserted after loss of the eyelash reflex. Patients were then randomly divided into two groups to receive maintenance anaesthesia with either isoflurane or desflurane delivered in oxygen and nitrous oxide. Alfentanil was used as the analgesic during the operation. Early recovery was assessed by measurement of the times to eye opening, extubation and ability to give a date of birth. Psychomotor recovery was assessed by performance on the finger tapping and perceptive accuracy tests. Mood was evaluated using visual analogue mood scores and the mood adjective checklist. Discharge times were also measured. Early recovery was significantly quicker following desflurane anaesthesia but no differences between the groups were found in psychomotor tests. The mood adjective checklist showed that patients in the isoflurane group had a greater total mood score and were more calm than those in the desflurane group; this was particularly evident 2h after anaesthesia. The discharge times were similar for the two groups. Desflurane is a satisfactory alternative to isoflurane for day care anaesthesia.
Regional anaesthesia for repeat Caesarean section in a patient with phantom limb pain
Authors: Uncles D. R. , Glynn C. J. , Carrie L. E. S. 
Published: February 2007

SummaryThe triggering of phantom limb pain by subarachnoid or epidural anaesthesia has been well described leading to the suggestion that neuraxial regional anaesthesia is relatively contraindicated in lower limb amputees. We report our experience of the provision of anaesthesia for repeat Caesarean section on two occasions in such a patient. Intrathecal fentanyl and morphine supplementation of bupivacaine successfully abolished peri‐operative phantom limb pain, whereas epidural anaesthesia was associated with recurrence of phantom limb pain upon regression of the block
Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine
Authors: Greenhalgh C. A. 
Published: February 2007

SummaryA 19‐year‐old obstetric patient had a respiratory arrest shortly after receiving intrathecal sufentanil and bupivacaine as part of a combined epidural/spinal technqiue for pain relief in labour.
The efficacy and optimum time of administration of ranitidine in the prevention of the acid aspiration syndrome
Authors: Escolano F. , Sierra P. , Ortiz J. C. , Cabrera J. C. , Castaño J. 
Published: February 2007

SummaryIn order to evaluate the efficacy of a single oral dose of ranitidine 150 mg and the optimum time for its administration, we studied pH and volume measurements in 138 surgical patients, who formed six groups according to the time elapsed from ranitidine administration to gastric fluid aspiration as follows: group A: no ranitidine, group B: 60–90 min, group C: 91–120 min, group D: 121–150min, group E: 151–180min and group F: > 180min. The patients from groups B, C, D, E and F had a significant increase in gastric pH and a significant decrease in gastric fluid volume when compared to the patients from group A. 33.3% (95% CI 16.63–53.22%) of patients in group A were deemed‘at risk’of acid aspiration compared to 0.9% (95% CI 0.02–4.90%) in the other groups. No significant differences were found between the patients receiving ranitidine after 60 min with respect to risk of acid aspiration. It is concluded that a single oral dose of ranitidine 150mg is effective against the acid aspiration syndrome 60min after administration.
The effect of alkalinisation of lignocaine on axillary brachial plexus anaesthesia
Authors: Gormley W. P. , Hill D. A. , Murray J. M. , Fee J. P. H. 
Published: February 2007

SummaryAlkalinisation of local anaesthetic drugs is a controversial technique for improving regional blockade. Forty‐two patients scheduled for upper limb surgery received axillary brachial plexus anaesthesia using a cannula technique. Patients were randomly allocated to receive either lignocaine 1.5% with 1 in 200 000 adrenaline (pH = 4.2) or lignocaine 1.5% with I in 200000 adrenaline (pH = 7.2). There was no significant difference in the incidence of satisfactory blockade or distribution of anaesthesia between the two groups. The percentage of patients with complete anaesthesia at 10, 20 and 30 min following injection was significantly increased in the alkalinised group with regard to the ulnar and median nerves, and the median cutaneous nerve of the arm (p < 0.05). In the alkalinised group, there was a significant reduction in the time to useful anaesthesia and a reduced requirement for adjuvants (p < 0.05). There was no effect on the duration of anaesthesia.
The palpation of pulses
Authors: Mather C. , O'Kelly S. 
Published: February 2007

SummaryIn 554 anaesthetised patients, the times taken to separately palpate and identify each of the carotid, radial, brachial and femoral pulses were recorded. The patients were divided into three groups based on the form of airway management chosen (tracheal tube, facemask or laryngeal mask airway). Our results demonstrate that in the operating theatre environment the identification of the radial pulse is the most rapid and reliable; by 5s, 98% and by 10s, more than 99% of radial pulses were identified. The carotid pulse was not so easily identified, requiring 10s to enable an identification rate of greater than 95%. The presence of a laryngeal mask airway or a tracheal tube did not hinder the identification of carotid pulse.
Propofol infusion anaesthesia and the immune response in elderly patients undergoing ophthalmic surgery
Authors: PIRTTIKANGAS C‐O. , SALO M. , PELTOLA O. 
Published: February 2007

SummaryIn our earlier studies, propofol infusion anaesthesia increased the percentage of T helper cells in middle‐aged surgical patients undergoing minor or major surgery. In the present study we compared the effects of total intravenous propofol anaesthesia and combined isoflurane anaesthesia on the immune response to ophthalmic surgery in elderly patients. Twenty patients (median age 75 years, ASA 2–3) were randomly allocated to receive total intravenous propofol anaesthesia (median total dose of propofol 710 mg) or combined isoflurane anaesthesia (median end‐expiratory concentration of isoflurane 0.45 vol %). The following were measured pre‐operatively, at the end of operation and on the first postoperative morning: leucocyte and differential counts: percentages of lymphocyte subpopulations (CD3, CD4, CD8, CD20, CD16) and monocytes (CD14); phytohaemagglutinin‐, concanavalin A ‐ and pokeweed mitogen‐induced and unstimulated lymphocyte proliferative responses: polyclonal immunoglobulin synthesis as well as serum cortisol concentrations. The immune response to ophthalmic surgery was basically similar in both anaesthetic groups. The percentage of T helper cells in the blood circulation increased in the propofol group (p < 0.05) but not in the isoflurane group. The difference in the time‐response profile for T helper cell percentages between the groups was also statistically significant (p < 1.01).
The effect of passive smoking on the incidence of airway complications in children undergoing general anaesthesia
Authors: LYONS B. , FRIZELLE H. , KIRBY F. , CASEY W. 
Published: February 2007

SummaryThe aim of this study was to assess whether passive smoking affected the frequency of airway complications in children undergoing general anaesthesia. One hundred and twenty‐five children undergoing general anaesthesia for elective daycase surgery were monitored for adverse respiratory events and desaturation during induction, intra‐operatively and in the recovery room. Oxygen saturation was monitored throughout and a venous sample was taken for estimation of carboxyhaemoglobin levels. Parents were asked to fill in a questionnaire detailing their smoking habits. Sixty‐three of the children were passive smokers with a potential daily exposure varying from 5–130 cigarettes. There was no difference in the frequency of respiratory events between passive smokers and those not exposed to cigarette smoke at induction or intra‐operatively. However, in the recovery room, desaturation was significantly more common in passive smokers (p<0.02). This was related to the cumulative number of cigarettes smoked by individuals to whom the child was exposed (p<0.05). Neither carboxyhaemoglobin levels nor domiciliary address were predictive of desaturation. This study suggests that passive smoking contributes to postoperative arterial oxygen desaturation following general anaesthesia in children.
Patient satisfaction with general anaesthesia
Authors: WHITTY P. M. , SHAW I. H. , GOODWIN D. R. 
Published: February 2007

SummaryA questionnaire to evaluate patient satisfaction following general anaesthesia was designed with the aid of focus groups. A subsequent audit identified aspects of care which could be improved on the basis of responses to the satisfaction questionnaire. It is possible to design a discriminating satisfaction questionnaire for general anaesthesia.
A comparison of retrospective versus contemporaneous nausea scores with patient‐controlled analgesia
Authors: McINDOE A. K. , WARWICK P. , O'CONNOR M. 
Published: February 2007

SummaryIn the search for an effective method of reducing the incidence of postoperative nausea, a standardised system of patient assessment is required. We examined 76 patients who had undergone elective total abdominal hysterectomy and were receiving patient‐controlled analgesia with morphine. Nausea scores were obtained using an 11‐point rating score. Repeated contemporaneous assessments were compared with a single retrospective score made 5 days after surgery. Retrospective nausea scores were higher than those recorded contemporaneously. Maximum contemporaneous score showed greater agreement with the retrospective score than did the median, mean, or minimum contemporaneous score. Collectively, these results suggest that patients tend to remember their episodes of nausea vividly, even if these episodes were punctuated by relatively nausea‐free periods. The variability between the two sets of results suggests that contemporaneous and retrospective nausea scores should not be used interchangeably.
Pathological changes associated with short‐term nasal intubation
Authors: O'CONNELL J. E. , STEVENSON D. S. , STOKES M. A. 
Published: February 2007

SummaryIn order to define the incidence and anatomical site of nasal damage following nasotracheal intubation, we investigated 100 consecutive patients undergoing dental extractions under general anaesthesia. Patients were questioned pre‐operatively about the physiological function of their noses and examined by anterior rhinoscopy for anatomical abnormalities. Examinations were repeated postoperatively, looking specifically for haemorrhage, mucosal tears and septal and turbinate disruption. Minor bruising was common (54%) and most frequently involved mucosa overlying the inferior turbinate and adjacent septum. In two cases bruising involved the middle turbinate. There was no relationship between the number of attempts at intubation and subsequent damage. Pre‐operative otolaryngological assessment failed to identify those patients who subsequently proved difficult or impossible to intubate nasally and incorrectly predicted difficulty in 11 patients who had pre‐existing deviation of the nasal septum. In conclusion, short‐term nasotracheal intubation was not associated with significant nasal morbidity, and pre‐operative anatomical assessment failed to identify those in whom nasal intubation proved difficult or impossible.
Postoperative cognitive impairment in the elderly
Authors: HERRICK I. A. , GANAPATHY S. , KOMAR W. , KIRKBY J. , MOOTE C. A. , DOBKOWSKI W. , ELIASZIW M. 
Published: February 2007

SummaryThis study evaluated the safety and cognitive impact of patient‐controlled analgesia with fentanyl compared to patient‐controlled analgesia with morphine among elderly postoperative patients. In addition, two screening tests for cognitive impairment, the Mini Mental Status Exam and the Short Portable Mental Status Questionnaire, were compared. Ninety‐six elderly patients were randomly allocated to receive patient‐controlled analgesia with either fentanyl or morphine following hip or knee arthroplasty. Patients were evaluated postoperatively for clinical confusion, cognitive function test results, adequacy of analgesia, drug use and complications. Fentanyl produced less depression in postoperative cognitive function compared to morphine. The incidence of clinical confusion was not statistically different between groups (4.3% for fentanyl versus 14.3% for morphine). Fentanyl patients used more opioid based on a dose ratio of 100:1 suggesting that this dose ratio is inadequate. The incidence of urinary retention was lower in the fentanyl group. A poor agreement between the two tests of cognitive impairment mandates caution when peri‐operative cognitive function is compared using different tests.
Tracheal intubation through the laryngeal mask using a gum elastic bougie in the presence of cricoid pressure and manual in line stabilisation of the neck
Authors: Gabbott D. A. , Sasada M. P. 
Published: February 2007

SummaryForty adult patients hud a gum elastic bougie passed blindly through a laryngeal mask on two occasions, after standard insertion, and after the application of cricoid pressure with manual in line stabilisation of the neck. After standard insertion the bougie entered the trachea on 11/40 occasions. With manual in line stabilisation of the neck and cricoid pressure applied, the bougie entered the trachea on 9/40 occasions. These results were not statistically significant. Blind passage of a gum elastic bougie through a laryngeal mask does not provide a reliable route into the trachea in either of the circumstances studied.
What changes drug metabolism in critically ill patients‐III? Effect of pre‐existing disease on the metabolism of midazolam
Authors: PARK G. R. , MILLER E. 
Published: February 2007

SummaryLiver samples were obtained at hepatectomy from patients with end stage alcoholic liver disease (n = 5), primary biliary cirrhosis (n = 5) and chronic rejection needing retransplantation (n = 5). Normal liver material was also obtained from five organ donors. From these samples microsomes were made containing cytochrome P450 3A. The amount of this enzyme was measured by Western immunoblotting and its function assessed by measuring the rate of production of two metabolites of midazolam, 1‐hydroxy midazolam and 4‐hydroxy midazolam. There was a wide range in all groups for both the expression and function of this enzyme. Liver tissue affected by cirrhotic disease showed greater preservation of enzyme function than that affected by hepatocellulur disease. There was a good correlation between the expression of the enzyme and production of the 1‐hydroxy metabolite, but a poor correlation between production of the 4‐hydroxy metabolite and expression. This poor correlation may reflect the failure to measure the specific enzyme responsible for producing 4‐hydroxy midazolam.
Gas kinetics during nitrous oxide analgesia for labour
Authors: EINARSSON S. , STENQVIST O. , BENGTSSON A. , NORÉN H. , BENGTSON J. P. 
Published: February 2007

SummaryHypoxaemia may occur after hyperventilation with nitrous oxide during labour. The purpose of this study was to assess whether diffusion hypoxia is a contributory factor. Twenty‐four parturients were randomly allocated to receive 50 or 70% nitrous oxide in oxygen. The median nitrous oxide inhalation time per contraction was 58 s and 33 s, respectively. The end‐tidal carbon dioxide and the minute ventilation remained unchanged. The end‐tidal oxygen concentration was lowest at 120s, reaching 15.4% in both groups. The oxygen saturation did not differ between the groups with a lowest median value of 96% before the start of nitrous oxide inhalation. Two parturients had episodes ofdesaturation. Both had low end‐tidal oxygen concentrations in association with the desaturation but, as the end‐tidal nitrous oxide concentrations were low, the desaturations could not be attributed to diffusion hypoxia.
Effect of bupivacaine‐induced spinal block on the hypnotic requirement of propofol
Authors: TVERSKOY M. , FLEYSHMAN G. , BACHRAK L. , BEN‐SHLOMO I. 
Published: February 2007

SummaryThe hypnotic dose‐response of propofol was compared with its combination with either bupivacaine‐induced spinal block or intramuscular bupivacaine 12.5mg in 105 men, divided into three groups of 35, undergoing lower abdominal, pelvic or lower limb surgery. Dose‐response curves were determined for each group using bootstrap analysis. Bupivacaine‐induced spinal block at the level of T8‐T9 was found to reduce the ED50, of propofol by 39%. While this enhancement of hypnotic effect by spinal block is mostly attributable to reduced afferent input, differences in its potency between drugs suggest a role for additional factors.