bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physostigmine in recovery from anaesthesia
Authors: Hamilton‐Davies C. , Bailie R. , Restall J. 
Published: February 2007

SummaryIntravenous ketamine anaesthesia has been used by the British army in the field for many years. A recognised problem has been the unpredictable recovery profile this produces. We anaesthetised 28 ASA 1 patients using a standard British military technique. At termination of the anaesthetic, half of the patients were given a physostigmine/glycopyrronium mixture and half were given the equivalent volume of saline 0.9%. There was a significant difference between the two groups with regard to recovery times (p < 0.001). There was no significant difference with regard to other variables. In trauma anaesthesia the improved recovery profile from the use of physostigmine following ketamine anaesthesia may lead to earlier evacuation ofthe patient.
Laryngeal mask airway insertion using cricoid pressure and manual in‐line neck stabilisation
Authors: GABBOTT D. A. , SASADA M. P. 
Published: February 2007

SummaryForty patients were studied to assess the ease of insertion of the laryngeal mask in the simultaneous presence of cricoid pressure and manual in‐line stabilisation of the neck. This was compared with the normal technique of laryngeal mask insertion in the same patients. Fibreoptic views obtained through the laryngeal mask were documented on each occasion. The device was inserted successfully in all 40 patients when the head was kept in the normal position. This was achieved on the first attempt in 33 patients. When cricoid pressure and manual in‐line neck stabilisation were applied, successful laryngeal mask insertion was only possible in 29 patients, with correct placement at the first attempt in 14 patients. The differences were statistically significant (p < 0.001). When cricoid pressure and neck stabilisation were applied, vocal cord visualisation through the laryngeal mask with a fibreoptic bronchoscope was only possible in 15 patients. With the head in the normal position the vocal cords were seen in 33 patients. The implications of these results are discussed with respect to the role of the laryngeal mask in the multiply injured patient.
Resuscitation skills of trainee anaesthetists
Authors: BELL J. H. , HARRISON D. A. , CARR B. 
Published: February 2007

SummaryWe assessed the basic and advanced cardiopulmonary resuscitation skills of 30 trainee anaesthetists in a simulated exercise. Only one person performed basic cardiopulmonary resuscitation as outlined in the 1992 European Resuscitation Council guidelines. The management of ventricular fibrillation and asystole were correctly carried out by eight (27%) and nine (30%) anaesthetists, respectively. Neither the seniority of the anaesthetists nor their postgraduate qualifications correlated with their performance level. We conclude that all trainee anaesthetists need to undergo regular training and assessment of their resuscitation skills.
Tracheal occlusion in the prone position in an intubated patient with Duchenne muscular dystrophy
Authors: Rittoo D. B. , Morris P. 
Published: February 2007

SummaryA 15‐year‐old boy with Duchenne muscular dystrophy developed complete airway obstruction under general anaesthesia when positioned prone for spinal surgery. Tracheobronchial compression against vertebral bodies facilitated by a shortened sternovertebral distance due to thoracic lordoscoliosis is suggested as the cause.
Percutaneous dilational tracheostomy Malposition leading to delayed weaning
Authors: Rigg C. D. , Edmondson L. 
Published: February 2007

SummaryWe report a patient in whom delayed weaning from ventilatory support was caused by the malposition of a percutaneous dilational tracheostomy tube. A fold of mucosa, identified at tracheoscopy, was found to be the limiting factor, and the situation was resolved by removal of the tracheostomy and reintubation. We believe that the case supports the routine use of a bronchoscope to check the position of the tracheostomy tube.
Comparison between two fibrescopes with different diameter insertion cords for fibreoptic intubation
Authors: Hakala P. , Randell T. 
Published: February 2007

SummaryTwo fibreoptic bronchoscopes with insertion cords of different diameters (3.7 and 5.0 mm) were compared during fibreoptic intubation in 84 adult patients (ASA 1‐2) undergoing orotracheal intubation under general anaesthesia. The fibrescope used was randomly selected. The incidence of resistance to passage of the tracheal tube through the vocal cords was higher using the thinner fibrescope, 14/40 (35%) as compared with the thicker fibrescope, 5/44 (11%) (p < 0.05). Intubation failed with the thinner fibrescope in 8/40 (20%) of patients, whereas all intubations with the thicker fibrescope were successful in six patients after manipulation of the tracheal tube (p < 0.01). With the thinner fibrescope manipulation of the tracheal tube after impingement led to intubation of the trachea in 6/14 (43%) patients. The duration of intubation was significantly shorter with the thicker fibrescope (p < 0.05). There were two instances of oesophageal intubation with the thinner fibrescope. A fibrescope with a thicker insertion cord is more suitable for orotracheal fibreoptic intubation in adult patients.
Cardiac function during orthotopic liver transplantation with venovenous bypass
Authors: CHEEMA S. P. S. , HUGHES A. , WEBSTER N. R. , BELLAMY M. C. 
Published: February 2007

SummaryWe have studied the effect of varying the flow of a venovenous bypass system during orthotopic liver transplantation. During these manipulations, central venous (n = 9) or pulmonary artery occlusion (n = 9) pressures were kept constant. There was no change in right ventricular systolic or diastolic function in either group, suggesting that any conformational change of the ventricle during bypass is not of functional significance. The extrapolated volume loading required to compensate for the absence of bypass is of the order of 3000 ml.
Cardiovascular effects of desflurane in experimental animals and volunteers
Authors: WEISKOPF R. B. 
Published: February 2007

SummaryDesflurane (difluoromethyl‐1‐fluoro‐2,2,2‐trifluoroethyl ether [1‐653]) was introduced into clinical practice in 1992. The present review summarises the current state of knowledge of the cardiovascular effects of desflurane, with emphasis on investigations published in the past 2 years, and compares desflurane's effects with those of isoflurane, and where available, sevoflurane. Desflurane produces two distinct cardiovascular actions. First, desflurane decreases left ventricular systolic and diastolic function to an extent similar to that of isoflurane. It decreases systemic vascular resistance and mean arterial blood pressure in a dose‐dependent fashion. Heart rate is unchanged at lower steady‐state concentrations, but increases with higher concentrations. Addition of nitrous oxide maintains heart rate unchanged, increases systemic vascular resistance and mean arterial blood pressure, but decreases cardiac output. Secondly, when the end‐tidal concentration of desflurane is very rapidly increased to concentrations exceeding 1 MAC, in the absence of premedication, desflurane increases sympathetic activity, heart rate and mean arterial blood pressure. Prior administration of fentanyl, esmolol or clonidine blunts this response. The response and the ability of fentanyl to blunt it probably account for the disparate results in published studies on the use of desflurane in patients undergoing coronary artery bypass graft surgery.
Inhalational anaesthesia at the extremes of age: paediatric anaesthesia
Authors: OLSSON G. L. 
Published: February 2007

SummaryThe relevant physiological and pharmacokinetic differences between adults and infants and children are considered, and the advantages and disadvantages of the available inhalation anaesthetics are discussed. Desflurane shows promise as a new paediatric anaesthetic as it allows rapid changes in the depth of anaesthesia. However, irritant effects on the airways make desflurane unsuitable for induction. Desflurane anaesthesia, following halo thane induction, seems to be well tolerated.
Low‐flow anaesthesia
Authors: BAUM J. A. , AITKENHEAD A. R. 
Published: February 2007

SummaryAlthough many anaesthesia machines are equipped with circle rebreathing systems, inhalational anaesthesia remains frequently performed using relatively high fresh‐gas flows. The major advantages of rebreathing techniques can be achieved only if the fresh‐gas flow is reduced to 1 l.min‐1 or less. Although there are potential risks associated with low‐flow anaesthesia, modern anaesthesia machines meet all the technical requirements for the safe use of low‐flow techniques if they are used in conjunction with equipment for monitoring inhaled and exhaled gas concentrations; these monitors are already increasingly available and, in the near future, are likely to become an obligatory safety standard in many countries. For both economic and ecological reasons, the use of new inhalational anaesthetics, with low tissue solubility and low anaesthetic potency, can be justified only if the efficiency of administration is optimised by using low‐flow anaesthetic techniques.
Economic analysis and pharmaceutical policy: a consideration of the economics of the use of desflurane
Authors: EGER E. I. 
Published: February 2007

SummarySeveral factors have to be considered in determining the cost of applying a new inhalational anaesthetic such as desflurane into clinical practice. Factors beyond the immediate control of the anaesthetic practitioner include the price set by the manufacturer (although this may be influenced by economic and political pressures), and the physical‐pharmacological properties of the anaesthetic (e.g. vaporization, potency, solubility). The anaesthetic practitioner can minimise cost by applying lower inflow rates. Lower solubility (and hence lower uptake) provides a greater economy at lower inflow rates than does higher solubility. Furthermore, lower solubility permits the use of lower inflow rates with greater precision to the control of anaesthesia, and greater ease of application. At present unit prices, the cost of desflurane approximately equals that of isoflurane when a 1 l.min‐1 inflow rate is used. The use of lower inflow rates presupposes that such rates do not allow the production of toxic compounds in recirculating gases. Modern equipment makes low‐flow anaesthesia reliable and easy to control, and as desflurane is not degraded by the standard carbon dioxide absorbents, its use in low‐flow systems is effective and economical. These cost considerations do not take into account the savings that may result from a more rapid recovery from anaesthesia, nor do they take into account the increased expense of capital equipment needed to apply a new anaesthetic.
Economic analysis and pharmaceutical policy
Authors: ROVIRA J. 
Published: February 2007

SummaryEconomic evaluation, a comparative analysis of alternative actions in terms of costs and consequences, allows rational decisions to be made concerning the deployment of resources (people, time, equipment, facilities and knowledge). Pharmaceutical policy reflects the various objectives of the many social groups, some of which are conflicting. While new methodologies for evaluation of health care programmes still need to gain wider acceptance, resource limitations for both care providers and decision makers make economic analysis an increasingly important tool.
The use of the McCoy laryngoscope in patients with simulated cervical spine injuries
Authors: Laurent S. C. , de Melo A. E. , Alexander‐Williams J. M. 
Published: February 2007

SummaryWe studied the laryngoscopic view in 167 patients with their head and necks held in the neutral position with manual in‐line stabilisation and cricoid pressure to simulate the patient with a suspected cervical spine injury. Each patient underwent laryngoscopy using both a McCoy and a Macintosh laryngoscope. The best view obtained by each laryngoscope was graded according to standard guidelines. The results showed that the McCoy was never worse than the Macintosh. It improved the Macintosh grade by 1 grade in 41% and by 2 grades in 8% (p < 0.001). Difficult laryngoscopy, defined as the inability to see the glottis (grade 3 or 4), was found in 56 (33%) with the Macintosh laryngoscope and only eight (5%) (p < 0.001) with the McCoy laryngoscope. We suggest that patients with a suspected cervical spine injury and a full stomach should be intubated using a McCoy in preference to a Macintosh laryngoscope.
Effect of intravenous fluid preload on vasoactive peptide secretion during Caesarean section under spinal anaesthesia
Authors: POUTA A. M. , KARINEN J. , VUOLTEENAHO O. J. , LAATIKAINEN T. J. 
Published: February 2007

SummaryThe endogenous release of the vasoactive peptides atrial natriuretic peptide and endothelin‐1 may modify maternal haemodynamic responses to a rapid intravenous volume load used to prevent hypotension at elective Caesarean delivery under spinal anaesthesia. Twenty‐two healthy pregnant women were examined during elective Caesarean section at term pregnancy. They were randomly assigned to receive either 2000ml of Ringer lactate solution (crystalloid group) or 500ml of 6% hydroxyethyl starch + 1000 ml of Ringer lactate solution (colloid group). The mean (SEM) concentration of atrial natriuretic peptide in plasma increased from 10.9 (1.5) to 24.7 (5.1)pmol.l‐1during crystalloid infusion and from 10.3 (1.4) to 28.2 (5.6)pmol.l‐1during colloid infusion. A slight decrease in endothelin‐1 levels was found during colloid infusion. A significant increase in the release of atrial natriuretic peptide in response to volume load may decrease vascular tone and initiate diuresis, thereby attenuating the effect of volume load on blood pressure during elective Caesarean delivery.
A valuable monitor of splanchnic perfusion?
Authors: Trinder T. J. , Lavery G. G. 
Published: February 2007

SummaryMinimally invasive assessment of the adequacy of perfusion of the gastrointestinal tract has become clinically feasible with the availability of the gastric tonometer. This modified nasogastric tube permits calculation of the pH of the gut mucosal cells; a low tissue pH may indicate tissue hypoxia due to regional hypoperfusion. Such regional hypoperfusion is often undetected by other monitors and, if it occurs intra‐operatvely, may result in a poor outcome following major surgery. In critical illness, the splanchnic area seems to be particularly vulnerable to hypoperfusion and such a regional oxygen deficit is implicated in the causation of organ dysfunction/failure. Recent studies have begun to define the circumstances in which splanchnic tissue acidosis develops and several therapies have been proposed to reverse the regional oxygen deficit. This review seeks to clarify whether or not the tonometer is a valuable addition to our current monitoring aids.
Transient radicular irritation after single subarachnoid injection of isobaric 2% lignocaine for spinal anaesthesia
Authors: Hampl K. F. , Schneider M. C. , Bont A. , Pargger H. 
Published: February 2007

SummarySeveral cases have been reported recently in which symptoms suggestive of transient radicular irritation occurred following the use of hyperbaric 5% lignocaine for spinal anaesthesia. We report on three patients in whom we observed similar symptoms attributable to this kind of radicular irritation following uneventful spinal anaesthesia using isobaric 2% lignocaine. All three patients underwent minor gynaecological procedures and developed burning pains in the buttocks within 24 h of surgery. The long‐term outcome was not clear for all the patients, but in at least one the pain disappeared.
The effect of tunnelling on epidural catheter migration
Authors: Bougher R. J. , Corbett A. R. , Ramage D. T. O. 
Published: February 2007

SummaryA prospective, randomised study of 82 patients having postoperative epidural analgesia was performed to determine whether the tunnelling of an epidural catheter influences its migration. Tunnelling of the catheter subc utaneously for a distance of 5 cm reduced the incidence of inward migration of I cm or more (p < 0.01) compared to a standard method affixation with a transparent adhesive dressing. This effect was more marked if the epidural catheter was sited in the thoracic rather than the lumbar area. Sixty two percent (n = 26) of tunnelled catheters remained within 0.5cm of their original position compared to 38% (n = 16) of non‐tunnelled catheters, although this difference was not statistically significant. Outward catheter migration was not reduced by subcutaneous tunnelling.
Skin sensitivity of the arm
Authors: van den Berg A. A. 
Published: February 2007

SummaryOne hundred and sixty seven operating theatre personnel familiar with the practice of venous cannulation were asked to rank (in increasing order from one to five, corresponding to least to most painful) their opinion of the pain which they considered might accompany venous cannulation of each of five vein sites on the upper limb (dorsum of arm, dorsum of hand, cephalic, ventrum of arm and cubital fossa) which may be selected for this purpose. The skin sensitivity of each of the test sites of each volunteer was then assessed with a test device comprising a Tuohy needle and clamp, which together weighed 75.02g. Following random application of the device to each of the test sites, the volunteer was asked to rank (in increasing order from one to five, corresponding to least to most painful) the actual pain felt. Analysis of pain expectations showed that there was no significant consensus view as to which site would be most tender. Following application of the test device the tenderness of the five sites was ranked (i) according to frequencies: dorsum of arm <dorsum of hand < cephalic <ventrum of arm < cubital fossa and, (ii) following statistical analysis: dorsum of arm = dorsum of hand = cephalic <ventrum of arm < cubital fossa. There was no correlation between expected and actual skin sensitivities. Knowledge of the different skin sensitivities of the upper limb may be useful when selecting a vein for venepuncture or the insertion of an indwelling venous catheter.
An economic evaluation of propofol/fentanyl compared with midazolam/fentanyl on recovery in the ICU following cardiac surgery
Authors: SHERRY K. M. , McNAMARA J. , BROWN J. S. , DRUMMOND M. 
Published: February 2007

SummaryA comparison was made of the drug costs and nursing dependency of patients undergoing elective cardiac surgery and routine postoperative recovery for two anaesthetic techniques using either propofol with low dose fentanyl or midazolam with high dose fentanyl. Estimates of resource use were based on a randomised clinical trial undertaken at the Northern General Hospital, Sheffield. Times from entry to the intensive care unit until extubation and discharge were recorded for 70 patients and were transformed to nursing shifts. Nursing dependency was calculated on the basis of one nurse per ventilated patient and 0.5 nurse from the start of the shift after extubation. Nursing costs were allocated on the basis of the patient's status at the beginning of each shift in line with the hospital's staffing policy. All drugs used from the morning of the operation until discharge were recorded. Costs of nursing and drugs were calculated. The total cost of patients in the propofol group was 13.3% less than midazolam patients (p = 0.043, for geometric means Cl 0.4% to 27.8%). The clinical study was not designed for economic endpoints; however, it demonstrated achievable savings in propofol‐treated patients.
Assessment of neuromuscular block at the thumb and great toe using accelography in infants
Authors: KITAJIMA T. , ISHII K. , OGATA H. 
Published: February 2007

SummaryWe assessed neuromuscular block at the thumb and great toe using accelography after the administration of vecuronium in infants. Train‐of‐four stimuli were simultaneously applied to the ulnar and tibial nerves using cutaneous electrodes. Anaesthesia was maintained with nitrous oxide (66%) in oxygen and sevoflurane (1%). Vecuronium 0.1mg.kg‐1 was used for paralysis and reversed with intravenous neostigmine 0.04mg.kg‐1 with atropine 0.02mg.kg‐1 when the train‐of‐four ratio on the right great toe returned to 25%. The mean (SD) times from initial administration of vecuronium to completion of maximal block on the thumb and great toe were 78 (21.1) s and 75 (14.3) s, respectively (p>0.05). The times from maximal block to 25% recovery of twitch height at the thumb and great toe were 46 (9.1) min and 45 (9.0) min, respectively. The reversal time from 25% to 75% of the train‐of‐four ratio after the administration of neostigmine was 136 (49.1)s. We conclude that neuromuscular monitoring of the great toe in infants may be a suitable alternative when the thumb is inaccessible.
The effect of prophylactic clonidine on postoperative shivering
Authors: VANDERSTAPPEN I. , VANDERMEERSCH E. , VANACKER B. , MATTHEUSSEN M. , HERIJGERS P. , VAN AKEN H. 
Published: February 2007

SummayThe primary goal of this study was to assess the influence of clonidine administered after induction on postoperative shivering after elective peripheral surgery. The effect of clonidine on intra‐operative haemodynamics (blood pressure and heart rate) during the first 30 min after induction and on the postoperative sedation of the patient was also investigated. Two hundred and eighty male ASA 1 and 2 patients, undergoing elective peripheral surgery were randomly administered either placebo or clonidine 2 μg.kg‐1 intravenously over 10 min after induction of anaesthesia. Clonidine was found to reduce the total incidence (p = 0.024), the severity (p = 0.005) and the duration (p= 0.01) of postoperative shivering. Clonidine did not increase postoperative sedation or diminish overall consciousness. We conclude that administration of clonidine 2 μg.kg‐1 intravenously after induction of anaesthesia is safe and reduces postoperative shivering in this group of patients.
A study of the incorrect use of ventilator disconnection alarms
Authors: CAMPBELL R. M. , SHEIKH A. , CROSSE M. M. 
Published: February 2007

SummaryPressure‐sensitive ventilator disconnection alarms may fail to function correctly when used with discharging compliance ventilators such as the Manley Blease. The increase in gas flow on disconnection generates raised pressure owing to the resistance provided by components of the breathing system. Thirty‐four anaesthetists, who were unaware of the nature of the survey, were observed to see if previous recommendations for the correct adjustment of the ventilator alarm were being followed. It was found that 77% of alarms were incorrectly adjusted and would not have alarmed in the event of a true disconnection occurring.
Misplacement of multihole epidural catheters‐a report of two cases
Authors: Sala‐Blanch X. , Martinez‐Palli G. , Agusti‐Lasus M. , Nalda‐Felipe M. A. 
Published: February 2007

SummaryThe misplacement of a multilwie (three lateral holes) epidural catheter such that it lies partly in the subdural space is demonstrated in two patients by means of epidurographic studies.
Postoperative morbidity following cataract surgery
Authors: BARKER J. P. , VAFIDIS G. C. , HALL G. M. 
Published: February 2007

SummaryTwo hundred and thirty‐one patients were questioned the day following their cataract surgery to ascertain the incidence of postoperative morbidity. One hundred and nineteen patients received local anaesthesia (LA) and 112 received general anaesthesia (GA). There was a significant difference in the incidence of nausea (21% in G A group, 3% in LA group, p < 0.01), sore throat (41% G A group, 3% LA group, p < 0.01), and bruising of the eye (15% G A group, 39% LA group, p < 0.01). There was no significant difference in the incidence of vomiting, headache, double vision, the severity of postoperative pain, or the need for analgesia. The time before the patients drank and ate postoperatively was significantly shorter in the local anaesthetic group (1.3 h and 1.8 h LA group, 4.1 h and 6.7 h GA group respectively, p < 0.01).