bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acupuncture and transcutaneous stimulation analgesia in comparison with moderate‐dose fentanyl anaesthesia in major surgery
Authors: Kho H. G. , Eijk R. J. R. , Kapteijns W. M. M. J. , van Egmond J. 
Published: February 2007

SummaryThe efficacy of acupuncture and transcutaneous stimulation analgesia, supplemented by small doses of fentanyl (mean 1.2 μg/kg, SD 1.7) was compared with moderate‐dose fentanyl anaesthesia (mean 22.9 μg/kg, SD 2.8) in 29 patients who underwent surgery for retroperitoneal lymph node dissection. The present study describes the anaesthetic techniques and comparison of haemodynamics, demand for analgesies after surgery, recovery and blood gases, restoration of urinary and bowel functions, convalescence in terms of self‐reliance and the postoperative course in respect of fatigue and morbidity. A more rapid return of consciousness, an absence of hypercapnia and a smaller decrease in pH were observed in patients who received acupuncture and transcutaneous stimulation (p < 0.05). No clinically relevant disadvantages attributable to the method were demonstrated.
Examination of cardiorespiratory changes during upper gastrointestinal endoscopy
Authors: MURRAY A. W. , MORRAN C. G. , KENNY G. N. C. , MACFARLANE P. , ANDERSON J. R. 
Published: February 2007

SummaryCritical events including hypoxaemia, arrhythmias and myocardial ischaemia may occur more frequently during endoscopic procedures than during anaesthesia. A study was undertaken to assess the cardiovascular changes and to evaluate suitable monitoring techniques to detect critical events during sedation and endoscopy. Twenty patients scheduled to undergo a prolonged endoscopic procedure which required deep sedation were studied. Continuous recordings of electrocardiogram, heart rate and arterial oxygen saturation were made and arterial pressure was recorded at one‐minute intervals. The study commenced immediately before administration of sedatives, continued for the duration of the examination and for one hour following the examination. Oxygen saturation decreased in all patients during the examination to a mean of 82.9% (SD 11.9), and remained below baseline for the duration of the examination and into the recovery period. Statistically significant increases and reductions of systolic arterial pressure and rate‐pressure product were found during the procedures compared with baseline values recorded before administration of sedatives. Sixteen of the 20 patients developed tachycardia during the examination. Ten patients developed ectopic foci which were supraventricular, ventricular or both in origin. Electrocardiogram changes resolved during the recovery period. Myocardial ischaemia was assessed by S‐T segment depression and a significant correlation was found between S‐T segment depression and hypoxaemia, although the magnitude of the S‐T depression was small and may not have been detected clinically. No correlation was found between S‐T segment depression and arterial pressure, heart rate or rate‐pressure product. Regular and frequent assessments of arterial pressure and heart rate are desirable but the results confirm the importance of monitoring arterial oxygen saturation in addition to arterial pressure and the electrocardiogram.
The effect of the Trendelenburg position on lower oesophageal sphincter tone
Authors: HEIJKE S. A. M. , SMITH G. , KEY A. 
Published: February 2007

SummaryMeasurements were made of gastric, lower oesophageal and barrier pressures in the supine, moderate and steep Trendelenburg positions in 10 healthy female patients during balanced anaesthesia. Adoption of the Trendelenburg position resulted in no significant changes in any measurement, with the exception of a small increase (0.1 kPa) in intragastric pressure in the steep head‐down position. We conclude that the steep Trendelenburg position should not predispose to regurgitation in healthy patients.
Posthypoxic myoclonus (the Lance‐Adams syndrome) in the intensive care unit
Authors: HARPER S. J. , WILKES R. G. 
Published: February 2007

SummaryThe neurological assessment of patients admitted to the intensive care unit after successful resusitation from cardiopulmonary arrest may be difficult. We describe the cases of two patients who developed myoclonus within 24 hours of hypoxic respiratory and cardiac arrest. Initially, the clonic movements were thought to be generalised convulsions and were treated as such, until it became evident that the patients were aware and distressed. Posthypoxic myoclonus is a rare complication of successful cardiopulmonary resusitation. Recognition depends on the awareness that the syndrome exists, and is important so that correct therapy can be instituted. There may be important prognostic implications. Both our patients had normal intellectual recovery with moderate residual neurological disability from their movement disorder.
A coaxial technique for facilitating one‐lung ventilation
Authors: CONACHER I. D. 
Published: February 2007

SummaryA tube for bronchial intubation is described. A long (48 cm), small bore (5.0 mm internal diameter), cuffed, bronchial plastic tube is inserted coaxially within a large bore tracheal tube (10.0 mm) used for ventilation. The inner tube is designed primarily as a blocker to be inserted with a fibreoptic or optical bronchoscope, but can be effected blindly with a stylet. Several methods of inserting the inner tube and ensuring correct placement were used in 10 males undergoing thoracic surgery. If the bronchial cuff is inflated the tube can be used either as a blocker or as a conduit for suction and conventional and differential ventilatory techniques. Early clinical experience suggests that the technique is an alternative method of facilitating one‐lung ventilation.
Midazolam‐droperidol premedication for cardiac surgery A comparison with papaveretum and hyoscine
Authors: Antrobus J. H. L. , Abbott P. , Carr C. M. E. , Chatrath R. R. 
Published: February 2007

SummaryA combination of midazolam and droperidol given intramuscularly was compared with papaveretum and hyoscine for premedication of patients about to undergo cardiac surgery. Midazolam and droperidol proved to be a very satisfactory combination, producing superior sedation and anxiolysis with good cardiovascular stability.
Patients' desire for information about anaesthesia Scottish and Canadian attitudes
Authors: Lonsdale M. , Hutchison G. L. 
Published: February 2007

SummaryPatients in Canada and Scotland were asked to complete a pre‐operative questionnaire examining their desire for information relating to anaesthesia. In both Canada and Scotland, patients under the age of 50 years had a greater wish to receive information than those who were older (p < 0.0001). In Canada, female patients were found to be more keen to receive pre‐operative information than males of the same age group (p < 0.05). The priority given to individual pieces of information was remarkably similar in both countries. Details of dangerous complications of anaesthesia and surgery were consistently rated of low priority, with high priority going to postoperative landmarks such as eating and drinking. Both countries rated meeting the anaesthetist before surgery as the highest priority of all.
Comparison of high and low doses of suxamethonium
Authors: STEWART K. G. , HOPKINS P. M. , DEAN S. G. 
Published: February 2007

SummaryIn a double‐blind study, 67 young adult patients undergoing anaesthesia for dental extractions were allocated at random to receive either 0.5 mg/kg or 1.5 mg/kg suxamethonium. A greater increase in arterial pressure was seen following induction in the 1.5 mg/kg group, although overall intubating conditions were similar in the two groups. Suxamethonium‐associated muscle pains were significantly more common in the group which received the larger dose (p>0.05).
Effect of sufentanil on intracranial pressure in neurosurgical patients
Authors: WEINSTABL C. , MAYER N. , RICHLING B. , CZECH T. , SPISS C. K. 
Published: February 2007

SummaryThe effects of sufentanil on intracranial pressure, mean arterial pressure, cerebral perfusion pressure and heart rate were studied in 20 neurosurgical intensive care unit patients. Epidural intracranial pressure probes were implanted in patients who suffered head injury, intracerebral haemorrhage or underwent tumour resection. Sufentanil was given intravenously in sequential doses of 0.5, 1.0 and 2.0 μg/kg. Fifteen minutes elapsed after each dose. The patients were allocated to either group 1 (baseline intracranial pressure < 20 mmHg) or group 2 (baseline intracranial pressure > 20mmHg). Intracranial pressure did not change significantly in either group. Therefore the falls in mean arterial pressure with the highest dose in both groups and with 1.0 μg/kg in group 2, closely reflect corresponding reductions in cerebral perfusion pressure. As sufentanil in itself exerts no effects on intracranial pressure, concomitant haemodynamic changes are the critical factor for an adequate cerebral perfusion pressure.
Postoperative obstructive sleep apnoea
Authors: REEDER M. K. , GOLDMAN M. D. , LOH L. , MUIR A. D. , CASEY K. R. , GITLIN D. A. 
Published: February 2007

SummaryA 74‐year‐old man presenting for aortic reconstructive surgery showed severe, previously undiagnosed obstructive sleep apnoea during overnight oximetry monitoring before operation. Postoperatively, in the first 4 hours following extubation, he suffered 238 episodes of respiratory obstruction. These events were associated with frequent arousals, large fluctuations in systolic and diastolic blood pressure. Administration of nasal continuous positive airways pressure abolished the obstructions and allowed an uninterrupted night's sleep, with a significantly reduced blood pressure. Subsequent dips in oxygen saturation as a result of respiratory obstruction recurred on the fifth postoperative night. We conclude that pre‐operative overnight oximetry may be useful in identifying those patients at risk of postoperative upper airway obstruction. Use of nasal continuous positive airway pressure may prevent the occurrence of early postoperative obstruction and the associated haemodynamic changes.
Exaggerated epidural blockade resulting from unusual spread of bupivacaine in a patient with low back pain
Authors: POPAT M. T. , JADAD A. R. , GLYNN C. J. 
Published: February 2007

SummaryA 75‐year‐old woman with chronic low back pain was given bupivacaine and methylprednisolone epidurally through a catheter in the L1–L2 interspace. An unusual spread of bupivacaine resulted in a block from the C4 to the L1 dermatome with no relief of back pain. Injection of a radiopaque dye and subsequent X rays showed a similar spread. The possible causes are discussed.
Life‐saving use of extracorporeal membrane gas exchange in severe, acute respiratory failure
Authors: FISHER A. P. , JAYAWARDENE B. , RAMSTEAD K. D. , FISHER A. R. 
Published: February 2007

SummaryA 41‐year‐old man developed acute respiratory failure in association with thoracotomy and decortication for a persisting pleural collection secondary to a stab injury. The use of veno‐venous extracorporeal membrane gas exchange proved life‐saving.
Chemical meningism after lumbar facet joint block with local anaesthetic and steroids
Authors: THOMSON S. J. , LOMAX D. M. , COLLETT B.‐J. 
Published: February 2007

SummaryA case is reported in which chemical meningism occurred after lumbar facet joint block with methylprednisolone acetate and bupivacaine. This complication was probably due to inadvertent dural puncture. The use of steroids in facet joint injections is questioned.
Thoracic epidural analgesia in a patient with bilateral phaeochromocytoma undergoing coronary artery bypass grafting
Authors: LIEM T. H. , MOLL J. E. , BOOIJ L. H. D. J. 
Published: February 2007

SummaryA patient suffering from phaeochromocytoma and coronary artery stenoses needed coronary artery bypass grafting before adrenalectomy. High thoracic epidural analgesia (T1‐T2) with bupivacaine and sufentanil in combination with general anaesthesia was used. Plasma adrenaline and noradrenaline concentrations decreased during the period before bypass grafting compared to the baseline value and no important haemodynamic changes were seen during this period. Thoracic epidural analgesia failed to suppress the release of catecholamine during the bypass period. After the operation, the plasma catecholamine concentrations returned to the baseline value. Excellent analgesia (visual analogue scale = 1‐2) was achieved with a postoperative epidural, but the plasma catecholamine concentration increased considerably.
Use of the Inspiron nebuliser during continuous positive airway pressure ventilation
Authors: HARDWICK M. , DICKSON G. , CLUTTON‐BROCK T. 
Published: February 2007

SummaryThe Inspiron Nebuliser 002305 with air entrainment was assessed as a gas delivery device in a continuous positive airway pressure system. Inspired oxygen concentrations, total gas flows and pressures within the system were measured over a range of settings, with and without positive end expiratory pressure. Inspired oxygen concentrations and total flows were completely disrupted when a positive end expiratory pressure valve was applied, and the system failed to generate continuous positive airway pressure. We would not therefore recommend the Inspiron nebuliser as a gas delivery system for continuous positive airway pressure.
Cardiovascular effects of nasotracheal intubation
Authors: Smith J. E. , Grewal M. S. 
Published: February 2007

SummaryIntubation time, arterial pressure, heart rate and arterial oxygen saturation during nasotracheal intubation effected with the Macintosh laryngoscope blade were compared with those during orotracheal intubation. The 60 patients studied received a standardised general anaesthetic and were randomly allocated to one of two groups immediately before tracheal intubation. The mean nasal intubation time (33.2 seconds) was significantly greater than mean oral intubation time (14.8 seconds). The mean arterial pressure changes in the nasal group were significantly greater and more prolonged than in the oral group. The mean heart rate in the nasal group was significantly lower than in the oral group during the first minute after intubation, after which heart rates were similar. There were no significant differences between the two groups with regard to arterial oxygen saturation levels at any stage.
Plasma etomidate levels in mother and fetus
Authors: GREGORY M. A. , DAVIDSON D. G. 
Published: February 2007

SummaryThe most commonly used induction agent in anaesthesia for Caesarean section is still thiopentone. The increasing incidence of Caesarean section for delivery of premature babies from a hostile environment may call in question the assumption that the dose of thiopentone received by the neonate will not cause depression in the hours following birth. Previous studies on thiopentone for Caesarean section have shown inconsistency in umbilical vein/maternal vein ratios. We have studied plasma etomidate levels in maternal and umbilical blood at the time of delivery to see whether equilibrium, occurs with this agent. We were able to demonstrate an umbilical/maternal vein etomidate ratio of 0.5 (SD 0.18), with no relation to time in the range encountered. Also, the uterine artery/uterine vein etomidate ratio was 0.86 (SD 0.33), suggesting that etomidate uptake into the fetus is effectively complete. Further, in all cases the neonatal plasma etomidate levels were less than half those measured at recovery of consciousness in adults in other studies, despite a larger induction dose than is usually used.
A survey of secondary transfers of head injured patients in the south of England
Authors: VYVYAN H. A. L. , KEE S. , BRISTOW A. 
Published: February 2007

SummaryA survey by questionnare was carried out to look into the provision of facilities for the secondary transfer of head injured patients, as well as difficulties encountered. An 84.6% response rate was achieved from 110 hospitals in six regions in the south of England. The results showed that 21% of hospitals had been unable to make a transfer in the previous year, and delays were commonly experienced by 23.7% of hospitals. The nursing attendance during transfer was satisfactory, but the quality of medical escort was poor, and the standard of monitoring equipment available was unacceptable. Methods of improving the situation include implementation of the recommendations of the Royal College of Surgeons, as well as the Association of Anaesthetists’recommendations for standards of monitoring and provision of intensive care.
The automatic implantable cardioverter‐defibrillator
Authors: CARR C. M. E. , WHITELEY S. M. 
Published: February 2007

SummaryThis paper describes the anaesthetic management of a patient who had an automatic implantable cardioverter‐defibrillator. The working principles of the device, the indications for its insertion and the postoperative complications, are discussed. An increasing number of cardioverter‐defibrillators are being implanted in the UK. At least two general anaesthetics are required for each patient; one for implantation of the device and a second for testing its efficiency in terminating ventricular tachycardia and ventricular fibrillation. In future, the number of patients presenting for noncardiac surgical procedures is likely to increase, therefore every anaesthetist should be aware of the problems involved in management.
Extracorporeal circulation in the management of massive propanolol overdose
Authors: MCVEY F. K. , CORKE C. F. 
Published: February 2007

SummaryA case of refractory hypotension following propanolol overdose is reported. Management included isoprenaline, glucagon and extracorporeal circulatory support using femoral vein‐femoral artery bypass. The unreliability of neurological observations, especially unreactive pupils, in the presence of drug overdose is reiterated.
The use of the Penlon Nuffield 200 in a monoplace hyperbaric oxygen chamber
Authors: LEWIS R. P. , SZAFRANSKI J. , BRADFORD R. H. , SMITH H. S. , CRABBE G. G. 
Published: February 2007

SummaryWe modified a Penlon Nuffield 200 for use in a monoplace hyperbaric oxygen chamber by feeding back the chamber pressure to the reducing valve of the Nuffield 200. This provides a compensating mechanism, allowing the ventilator to deliver adequate tidal volumes at pressures of up to 3 atmospheres. We report the laboratory testing of the ventilator and our experience of ventilating two patients with carbon monoxide poisoning. Although compensation is not complete the modification is adequate for short‐term clinical use in patients in whom the airway is compromised but who need hyperbaric oxygen therapy.
Comparison of propofol and thiopentone for laryngeal mask insertion
Authors: Brown G. W. , Patel N. , Ellis F. R. 
Published: February 2007

SummaryConditions for insertion of the laryngeal mask were assessed following induction of anaesthesia with either propofol 2.5 mg/kg or thiopentone 4.0 mg/kg in 80 patients premedicated with diazepam 10 mg. Insertion following induction with thiopentone resulted in a greater incidence of gagging (p < 0.01). The use of additional induction agent, where necessary, resulted in no ultimate significant difference between the groups for the provision of satisfactory conditions.
Haemodynamic effects of propofol in children
Authors: Short S. M. , Aun C. S. T. 
Published: February 2007

SummaryThe haemodynamic effects of induction of anaesthesia with propofol in children were studied. Two hundred and sixteen children (ASA 1) were randomly allocated to receive one of six different doses of propofol, from 1.6 mg/kg to 2.6 mg/kg, in 0.2 mg/kg increments. Noninvasive measurement of blood pressure showed that mean arterial pressure was reduced by approximately 15% after 1 minute, and by 30% after 5 minutes. The reduction in pulse rate over a 5‐minute period was approximately 17%. These changes were similar in each group, regardless of the dose administered. The propofol was mixed with lignocaine, 0.5 mg/ml, and the incidence of pain on injection into a vein on the dorsum of the hand was 24%. We conclude that, within the dose range of our study, the haemodynamic disturbance after induction of anaesthesia with propofol in children is not dose related.
Hysteria
Authors: ADAMS A. P. , GOROSZENIUK T. 
Published: February 2007

SummaryHysteria as a cause of failure to recover consciousness following general anaesthesia is a rare event. This case report describes such an instance in a young, healthy 22‐year‐old female suffering severe dental phobia who was undergoing dental conservation. The literature is reviewed and a summary of the possible physiological mechanisms involved is given.
Reversible renal failure following opioid administration
Authors: HILL S. A. , QUINN K. , SHELLY M. P. , PARK G. R. 
Published: February 2007

SummaryA patient who received intravenous papaveretum during and after operation developed anuria and biochemical evidence of impaired renal function in the first 6 hours after surgery. Administration of naloxone 0.4 mg was associated with a sustained improvement in urine output. Mean arterial pressure did not change significantly. The impairment of renal function may have been related to high plasma concentrations of codeine, one of the constituents of papaveretum.
Environmental contamination during tracheal suction
Authors: COBLEY M. , ATKINS M. , JONES P. L. 
Published: February 2007

SummaryThe extent of airborne environmental bacterial contamination which occurs following tracheal suction has been investigated in patients undergoing intermittent positive pressure ventilation in the intensive therapy unit. Two methods of performing suction, one using a conventional open technique and one using a closed system (Stericath), have been compared. Significantly lower levels of environmental contamination were observed when the closed system was used.
Inhaled nebulised fentanyl for postoperative analgesia
Authors: Higgins M.J. , Asbury A.J. , Brodie M.J. 
Published: February 2007

SummaryThe effects of three concentrations of inhaled nebulised fentanyl citrate solution given for postoperative pain relief were studied. Each of 30 patients inhaled one dose of 3 ml of solution nebulised over 9 min. A combined analysis of pain relief, time to further analgesia and effect on respiratory frequency showed the highest concentration (318 μg/ml fentanyl base) to be more effective (p < 0.01) than the two lower concentrations (159 μg/ml and 64 μg/ml) which were indistinguishable from each other. There were no major side effects. This study provides evidence for the efficacy and safety of inhaled fentanyl for postoperative analgesia. Estimation of the delivered doses did not support the hypothesis that fentanyl is more effective by this route compared with other parenteral routes. Further studies are required to improve the method of delivery and investigate the pharmacodynamic features of this technique.
Parents in the anaesthetic room
Authors: Ryder I. G. , Spargo P. M. 
Published: February 2007

SummaryOne hundred and forty‐one parents were asked to complete a questionnaire about their reactions after accompanying their child during induction of anaesthesia. Of 139 respondents, 99% believed that their presence was of benefit to their child, and 95% believed that they helped the anaesthetist. The degree of anxiety experienced by the parent did not significantly affect this view, nor was the degree of anxiety affected by the method of induction chosen by the anaesthetist.