bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis
Authors: VYAS A. B. , LYONS S. M. , DUNDEE J. W. 
Published: February 2007

SummaryThe anaesthetic management of patients undergoing tracheal resection for tracheal stenosis and the advantage of the maintenance of spontaneous respiration without intubation of the distal tracheal segment is discussed. The case reports of two such patients using a continuous intravenous infusion of Althesin with maintenance of spontaneous respiration are presented. The technique expedited the surgical re‐anastomosis due to lack of instrumentation in the surgical field. While some mild respiratory depression as evidenced by carbon dioxide retention did occur, the technique is worthy of consideration for the procedure.
Neurological complications following general anaesthesia
Authors: SCHREINER ELIZABETH J. , LIPSON S. F. , BROMAGE P. R. , CAMPORESI E. M. 
Published: February 2007

SummaryA causal relationship between resulting neurological impairment and anaesthetic technique is often assumed after spinal or epidural anaesthesia, despite the rare occurrence of these complications. A postoperative neurological deficit may be closely associated with a general anaesthetic. We present three cases in which neurological sequelae followed recent general anaesthesia: all cases occurred within a period of one year at a single institution. These cases exemplify the difficulty in assuming a causal relationship between neurological deficit and anaesthetic technique.
Labetalol in tetanus
Authors: WESLEY A. G. , HARIPARSAD D. , PATHER M. , ROCKE D. A. 
Published: February 2007

SummaryThe cardiovascular instability in some cases of severe tetanus is due to increased circulating catecholamines. In 15 patients with this complication of tetanus, labetalol, a drug with alpha‐ and beta‐peripheral adrenergic blocking properties, was used in management. The drug was administered orally, by i.v. bolus or by continuous infusion. Wide variation in dosage was needed both from case to case and in the same patient during the course of his disease.In most cases the pulse and blood pressure were reduced by labetalol, although their variability was not much improved. The effect on the cardiac output and systemic vascular resistance ranged from modest reduction in both, to marked effect on cardiac output without any change in systemic vascular resistance. The alpha‐adrenergic blockage of labetalol is known to be less powerful than the beta‐blocking effect, and this property could be a disadvantage in the management of sympathetic overactivity in tetanus.
Hypotension during epidural analgesia for Caesarean section
Authors: LEWIS M. , THOMAS P. , WILKES R. G. 
Published: February 2007

SummaryThe incidence of hypotension occurring in women undergoing Caesarean section with epidural analgesia was investigated in 60 patients receiving an intravenous preload of two litres Hartmann's solution. Hypotension occurred in only 6.7% of patients. Central venous pressure measurements in 20 patients confirmed the safety of the technique. A comparison is made with other preloading techniques.
Pituitary cryoablation
Authors: DUTHIE A. M. , INGHAM V. , DELL A. E. , DENNETT J. E. 
Published: February 2007

SummaryPituitary ablation by the injection of alcohol through a transphenoidal needle has been practised for a number of years. In order to reduce the complications resulting from the spread of alcohol to neighbouring structures, a cryoprobe has been constructed which can be passed up through the needle into the gland and a series of localised lesions produced. The degree of pain relief is as good if not better than that obtained with alcohol. Only one instance of temporary blurring of vision resulted and hormonal disturbances were not seen. No difference was observed between the results obtained from the treatment of hormone‐dependent and hormone‐insensitive tumours. Pain caused in one patient by a benign tumour was unsuccessfully treated.
The determination of an effective cricoid pressure
Authors: Wraight W. J. , Chamney Anne R. , Howells T. H. 
Published: February 2007

SummaryA study of cricoid pressure was undertaken to relate the applied cricoid force with the resulting intraluminal cricopharyngeal (or oesophageal) pressure. The results indicate that whilst there was a wide range in normal adults a cricoid force of 44 N was judged to be effective in protecting the majority of adult patients from regurgitation.
Emergency extracorporeal oxygenation for an intratracheal foreign body
Authors: MAHARAJ R. J. , WHITTON I. , BLYTH D. 
Published: February 2007

SummaryThe emergency management of a patient presenting in respiratory failure due to critical tracheal stenosis caused by an intratracheal foreign body is described. The use of an extracorporeal oxygenator in the anaesthetic management of the patient is highlighted.
Pituitary cryoablation
Authors: DUTHIE A. M. 
Published: February 2007

SummaryTransphenoidal ablation of the pituitary gland by the injection of alcohol is used for the relief of widespread cancer pain. A technique is described in which a cryoprobe is passed through a transphenoidal needle and a number of lesions produced within the gland. It is suggested that this method of pituitary ablation may prove to be as effective but accompanied by fewer complications than the injection of alcohol.
Chloroform anaesthesia in Liverpool
Authors: JONES I. W. 
Published: February 2007

SummaryThe introduction of chloroform into anaesthesia is described, together with an account of the parts played by Simpson and Waldie and their connexions with Liverpool. An account of the first chloroform anaesthetics administered in Liverpool is also given; David Waldie, who suggested the use of chloroform, was one of the administrators at the first demonstration.
The incidence of Homer's syndrome during lumbar extradural for elective Caesarean section and provision of analgesia during labour
Authors: Clayton K.C. 
Published: February 2007

SummaryOne hundred and fifty women in labour provided with extradural analgesia were monitored and an incidence of Homers syndrome of 1.33% was noted. Fifty women undergoing Caesarean section under extradural analgesia were also monitored and an incidence of Homer's syndrome of 4% was noted. From the results we found it impossible to predict which patients would develop a Horner's syndrome.
Epidural analgesia and instrumental delivery
Authors: WALTON P. , REYNOLDS F. 
Published: February 2007

SummaryIn patients given epidural analgesia who had singleton vertex vaginal deliveries the normal delivery rate was 57%, compared to 80% in all this group. The increase in instrumental delivery rate could partly be accounted for by parity (primigravidae are over‐represented in the epidural group), by obstetric and medical indications for epidurals, and by the need for sitting top‐ups to relieve perineal pain. There remained a small population of patients in whom epidurals may have contributed to the need for instrumental delivery.
Venous pressure and arm volume changes during simulated Bier's block
Authors: EL‐HASSAN K. M. , HUTTON P. , BLACK A. M. S. 
Published: February 2007

SummaryIn investigating the possible causes of an observed complication of intravenous regional anaesthesia, cubital fossa venous pressures were measured distal to an inflated tourniquet as standard 40 ml volumes of normal saline were injected. The maximal pressures obtainable were limited by tourniquet pressure since the veins compressed under the tourniquet acted as ‘Starling’ spillover resistors. Once the compressing pressures were reached, with continued injection, fluid passed easily into the systemic circulation with little further increase in venous pressure. The rates of rise and maximum values of venous pressures tended to be increased by increased injection rates, and by failure to exsanguinate the arm, but the choice of injection site was paramount. Compared with more distal injections, cubital fossa venous injections are more likely to lead to leakage under the tourniquet and should never be used for intravenous regional anaesthesia.
Pre‐operative alcohol infusion
Authors: St HAXHOLDT O. , KRINTEL J. J. , JOHANSSON G. 
Published: February 2007

SummaryThe influence of pre‐operative alcohol infusion on the requirement for analgesic supplementation with fentanyl in chronic alcoholic patients was studied. The chronic alcoholic was defined as a person having a regular daily alcohol consumption of over 70 g pure alcohol for at least 3 years. The mean annual consumption in the patients studied was 52 litres pure alcohol.A positive correlation between requirement for fentanyl and alcohol consumption was found. The amount of fentanyl required to achieve satisfactory analgesia (the ‘saturation dose’) was significantly higher (61%) in alcoholic than in non‐alcoholic patients. Once stable anaesthesia was achieved the maintenance dose was the same in alcoholic and non‐alcoholic patients.Preoperative infusion of alcohol significantly reduced the amount of fentanyl required to achieve anaesthesia in both alcoholic and non‐alcoholic patients (by 25% and 29% respectively). Furthermore it prevented some of the catecholamine mediated effects, such as increase in blood pressure, heart rate and blood glucose.
Valvular glottic obstruction following extubation
Authors: CHATTERJI S. , GUPTA N. R. , MISHRA T. R. 
Published: February 2007

SummaryA case of glottic valvular obstruction following extubation is reported. The cause was bilateral dislocation of arytenoidr due to coughing on the tracheal tube, which resolved automatically following a further bout of coughing.
Reduction of postoperative vomiting in high‐risk patients
Authors: Fisher M. McD. , Chin K. C. 
Published: February 2007

SummaryTwenty‐eight patients who had a history of severe postoperative vomiting were divided into two groups. The first group received various anaesthetic drugs and the second group received a pethidine promethazine premedication and thiopentone, alcuronium, fentanyl and droperidol. There was a significant reduction in postoperative vomiting as assessed by vomiting score in both groups of patients, with the second group having a greater reduction in vomiting score than the control group. Nine of the patients in the second group have received the same anaesthetic uneventfully on a subsequent occasion. We propose that reassurance and the anaesthetic technique described can significantly reduce the incidence of postoperative vomiting in a high risk group.
Expectations and experiences of anaesthesia in a District General Hospital
Authors: Clifton P.J.M. 
Published: February 2007

SummaryPatients were asked about their pre‐anaesthetic assessment, expectations and experiences of anaesthesia, during the first postoperative day. Of the 100 patients interviewed, 95 were visitedpre‐operatively by an anaesthetist, 46 patients denied being anxious, and nine said they were very anxious. Middle‐aged patients seemed to be more apprehensive, and older patients less apprehensive. Thirty‐nine patients had specific worries about anaesthesia, and nine patients expected to have problems on this occasion. Of the 70 patients premedicated, 61 became less anxious andlor drowsy. Of the 55 patients receiving postoperative analgesia, 53 received good to moderate pain relief. Only five patients remembered being visited postoperatively. Despite 86 patients showing 171 well recognised anaesthetic sequelae, 99 patients said that they were satisfied with their anaesthetic.
Radionuclide assessment of cardiac function
Authors: COMMIN P. , CORIAT P. , FAUCHET M. , KURAL S. , MENASCHE P. , ROMARY D. , ECHTER E. 
Published: February 2007

SummaryPre‐operative radionuclide angiography, a non‐invasive technique for evaluating ventricular function, was performed on 34 consecutive patients undergoing aortobifemoral bypass grafting for abdominal aortic occlusive disease, to determine whether pre‐existing coronary artery disease causes significant modification of cardiac function.Patients were divided into two groups according to medical history. Group I had 23 patients with no symptoms of coronary artery disease and Group II had 11 patients, six with previous myocardial infarction and five with angina pectoris. There was a significant difference in left ventricular ejection fraction and in cardiac output between these two groups. A flow‐directed pulmonary artery catheter was inserted in eight patients in Group II who had an ejection fraction less than 50% and a nitroglycerin infusion was used in six cases to maintain pulmonary capillary wedge pressure below 20 mmHg. In the other patients, only central venous pressure was monitored. All patients had uneventful operative courses.It is concluded that left ventricular function is significantly altered in patients with symptoms of both abdominal aortic occlusive disease and coronary artery disease. By contrast, cardiac function is normal in patients free from symptoms of coronary artery disease, and central venous pressure monitoring seems sufficient in the management of these patients during aortobifemoral bypass grafting.
Mandatory sublingual buprenorphine for postoperative pain
Authors: BULLINGHAM R. E. S. , O'SULLIVAN G. , McQUAY H. J. , POPPLETON P. , ROLFE M. , WEIR L. , MOORE R. A. 
Published: February 2007

SummaryThis study examined the analgesic effect, vital signs and side effects when 0.4 mg doses of buprenorphine were given pre‐emptively for the treatment of postoperative pain after elective total hip replacement. Pain intensity, pain relief, retrospective peak pain intensity and pain relief, sedation, vital signs and side effects were measured 1 hour after surgery and then in the morning and evening of the first 2 postoperative days. There was a significant improvement in pain measured over the 3 days, with concomitant reduction in side effects and sedation. However, there was a significant increase in the number of patients with a pulse rate greater than 100 beats per minute. No particular benefit for postoperative pain relief was observed in patients receiving buprenorphine premedication in comparison with those who had received morphine or placebo.
Thyroid storm during beta blockade
Authors: STRUBE P. J. 
Published: February 2007

SummaryA thyrotoxic patient who had received beta‐adrenoceptor blockers pre‐operatively suffered an episode of severe heart failure immediately following thyroidectomy and required artificial ventilation of the lungs for six hours. The possible causes are discussed and the likelihood of thyroid storm unmitigated by beta adrenergic blockade suggested.
Oral or nasal intubation after cardiac surgery? A comparison of effects on heart rate, blood pressure and sedation requirements
Authors: Fletcher R. , Olsson K. , Helbo‐Hansen S. , Nihlson C. , Hederstrom P. 
Published: February 2007

SummaryThe aim of this study was to observe the effects of the position of the tracheal tube on cardiac performance or sedation requirements after cardiac surgery. There were no significant differences in heart rate, systolic blood pressure, or rate‐pressure product during the first 16 hours postoperatively when 41 orally intubated patients were compared with 32 patients who were reintubated nasally. The two groups received similar amounts of sedative drugs postoperatively. During attempted nasal intubation, bleeding developed in four patients, and in three of these and four others the tube could not be passed. Failed nasal intubation gave rise to nasal discomfort in three of seven patients. Orally intubated patients complained more often of sore throat after extubation, whereas those who had been nasally intubated complained of discomfort in the nose and throat. We conclude that nasal re‐intubation carries no advantage over oral intubation for ventilation after cardiac surgery.
Insulin‐dependent diabetic patients during surgery and labour
Authors: BOWEN D. J. , DAYKIN A. P. , NANCEKIEVILL M. L. , NORMAN J. 
Published: February 2007

SummaryTwenty seven insulin‐dependent diabetic patients received a continuous intravenous infusion of an insulin‐glucose‐potassium solution whilst undergoing elective surgical or obstetric procedures. The dose of insulin was adjusted according to blood glucose values. It was concluded that the regimen is safe and simple to manage and should result in good control of blood glucose levels.
Intravenous regional analgesia
Authors: DAVIES J. A. H. , HALL I. D. , WILKEY A. D. , SMITH J. E. , WALFORD A. J. , KALE V. R. 
Published: February 2007

SummaryTwo cases are described in which congestion of the arm occurred during intravenous regional analgesia. One case exhibited signs of serious local anaesthetic toxicity, while a significant plasma bupivacaine level was demonstrated in the other. In a study in a volunteer, leakage of contrast medium past the cuff was demonstrated radiologically only when congestion of the arm was produced. The Hoyle double cuff apparatus has narrow runs producing less tissue compression than a standard blood pressure cuff inflated to the same pressure. It may sometimes not occlude the brachial artery when inflated to a pressure based on the systolic arterial pressure measured with a standard cuff and congestion of the arm may then result. Increases in arterial blood pressure occurring during the procedure can also lead to congestion of the arm. Congestion may increase the risk of local anaesthetic agent leaking past the tourniquet into the systemic circulation. Recommendations are made about the choice of cuff gauge pressure and the prevention of arm congestion occurring during intravenous regional analgesia.
Effect of premedication on the induction dose of thiopentone in children
Authors: DUNCAN B. B. A. , ZAIMI F. , NEWMAN G. B. , JENKINS J. G. , AVELING W. 
Published: February 2007

SummaryThe effective dose of thiopentone in 90% (ED90) of unpremedicated children is 10.5 mg/kg. This is significantly greater (p < 0.01) than in premedicated children. The ED90 in children premedicated with TDP (a mixture of trimeprazine, droperidol and physeptone with atropine) is 4.2 mg/kg which is significantly less (p < 0.05) than with trimeprazine and atropine (ED90 5.2 mg/kg) or papaveretum and hyoscine (ED90 5.0 mg/kg).
Acute pulmonary oedema
Authors: KAMAL R. S. , AGHA S. 
Published: February 2007

SummaryA case of postoperative laryngeal spasm is presented in which severe pulmonary oedema developed after the laryngeal spasm was relieved. The management is discussed and some suggestions for prevention of pulmonary oedema in similar circumstances made. The pathophysiology of pulmonary oedema after acute upper airway obstruction is described.
Intercostal nerve block by jet injection
Authors: Seddon S. J. , Clayton K. C. 
Published: February 2007

SummaryA jet injector was used to perform intercostal nerve block as a method of intra‐operative and postoperative pain relief at cholecystectomy, using a concentrated solution of local analgesic. This method was shown to be as successful as the conventional needle technique. The risk of pneumothorax, and the problems of the local analgesic solution used are discussed.
Pituitary alcohol injection for cancer pain
Authors: COOK P. R. , CAMPBELL F. N. , PUDDY B. R. 
Published: February 2007

SummaryThe use of trans‐sphenoidal pituitary alcohol injection was assessed in a district general hospital for the treatment of diffuse bilateral cancer pain in 26 patients. Fourteen patients received a total of 43 injections. Hormonal and non‐hormonal dependent cancers were treated, with complete pain relief in ten patients and partial relief in a further seven patients. The duration of relief was variable, and usually less than 6 weeks, although two patients had complete pain relief for 5 and 7 months respectively.No cases of meningitis or cerebrospinal fluid rhinorrhoea occurred. Nasal antiseptics and vasoconstrictors were not used. Temporary pupil dilatation occurred in eight patients, of whom one had prolonged blurred vision for small print. Transient diabetes insipidus was common (53%), although only five patients needed permanent treatment. Death from their disease occurred in 65% of patients within 3 months. Survival was shorter than in series from specialist centres, suggesting later referral for pain relief. The technique is an inexpensive and valid form of treatment for cancer pain in a district hospital, but should not be undertaken lightly in view of the possible complications.
Infusion analgesia for acute war injuries A comparison of pentazocine and ketamine
Authors: BION J. F. 
Published: February 2007

SummaryContinuous intravenous infusions of ketamine and pentazocine have been used to provide analgesia in 18 patients with acute war injuries. The drugs were given alternately. Both drugs produced effective pain relief, but the quality of analgesia was superior following pentazocine because of its sedative properties. Arterial blood pressure and respiratory rate were maintained following ketamine but tended to fall after pentazocine. It is suggested that ketamine would be the better agent in patients with hypovolaemia or respiratory depression.
A comparison between the midline and paramedian approaches to the extradural space
Authors: Griffin R.M. , Scott R.P.F. 
Published: February 2007

SummaryA prospective, randomised study was devised to compare the midline and paramedian approaches to the extradural space in women during labour. The two approaches were equally successful with respect to catheter insertion and analgesia and had a similar incidence of complications, although the paramedian approach caused patients more discomfort. Since only 2 ml of 1% lignocaine with adrenaline were infiltrated prior to insertion of the Tuohy needle, a greater volume of the local anaesthetic may reduce the discomfort of using the paramedian approach.
Ventilatory effects of pre‐ and postoperative diamorphine
Authors: MALINS A. F. , GOODMAN N. W. , COOPER G. M. , PRYS‐ROBERTS C. , BAIRD R. N. 
Published: February 2007

SummaryTwenty‐two patients were studied before and after major abdominal vascular surgery to determine the effect on ventilation of 5 mg diamorphine given either extradurally or intramuscularly. Diamorphine depressed ventilation maximally at 30 minutes when given by either route. Before operation resting ventilation was reduced by 37% after extradural and 17% after intramuscular diamorphine; Paco2 increased by an average Of 0.5 kPa (either route); ventilation at 7.3 kPa Paco2, was reduced 40% after extradural and 33% after intramuscular diamorphine.After operation the effect of diamorphine on ventilation was qualitatively similar but resting baseline ventilation was increased from 9.4 to 10.9 litres/minute. The highest individual Paco2 values were found during the pre‐operative study: 6.5 kPa after extradural diamorphine, 6.4 kPa after intramuscular diamorphine. Pain relief was unsatisfactory after intramuscular diamorphine. Four out of sir patients requested further analgesia by 3 hours after administration. No patient who received extradurul diamorphine required further analgesia for at least 6 hours.
The need for analgesic cover after ENT surgery—comparison of nefopam and papaveretum
Authors: Hannington‐Kiff J.G. 
Published: February 2007

SummaryIntra‐operative intramuscular injections of either papaveretum 0.3 mg/kg or nefopam 0.4 mg/kg were given to alternate patients to promote smooth emergence from ENT anaesthesia in a consecutive series of 40 children. Observations over a period of 30 minutes following completion of surgery showed that emergence was satisfactory in 19 out of 20 children given papaveretum, and in 15 out of 20 children given nefopam. The study confirms that this indication for papaveretum is justifiably popular and that nefopam is a useful alternative mainly because it does not cause respiratory depression. There are no previous reports of the use of nefopam in children.