bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnanolone emulsion
Authors: HøGSKILDE S. , NIELSEN J. W. , CARL P. , SøRENSEN M. B. 
Published: February 2007

SummaryThe anaesthetic activity of pregnanolone (a metabolite of progesterone) in emulsion formulation administered intravenously to male mice was compared with that of Althesin. The loss of righting reflex for 15 seconds was used to estimate the anaesthetic effect. The mean anaesthetic dose (AD50) for the pregnanolone emulsion was 5.25 mg/kg and for Althesin, 2.8 mg/kg. The mean lethal dose (LD50) was 44 mg/kg for pregnanolone and 54 mg/kg for Althesin. The sleeping time after pregnanolone was 2.5–3.5 times longer than after Althesin in dosages above 7.5 mg/kg. No signs of pain or local reaction from injection were observed for either of the drugs. The onset of action was fast for both drugs, with only‐minor signs of excitation, and recovery was rapid and without excitation. The results indicate that the anaesthetic properties of pregnanolone emulsion are very similar to those of Althesin. Further studies will show whether it can fill the major vacuum left in anaesthetic practice after the withdrawal of Althesin.
Phaeochromocytoma as a cause of pulmonary oedema
Authors: BLOM H. J. , KARSDORP V. , BIRNIE R. , DAVIES G. 
Published: February 2007

SummaryPhaeochromocytoma can mimic many serious disease entities. This report describes a 43‐year‐old man who presented with pulmonary oedema due to a phaeochromocytoma. Predominantly adrenaline‐secreting tumours seem to predispose to this complication. Labetalol, a combined alpha‐ and beta‐receptor blocker, should be considered as the initial treatment in these cases and continued during surgery.
A nasal adhesion following prolonged nasotracheal intubation
Authors: SHERRY K. M. , MURDAY A. 
Published: February 2007

SummaryA patient who presented with nasal obstruction 4 months after prolonged pernasal tracheal intubation is described. The cause of the obstruction was an adhesion which extended from the septum to the inferior turbinate. The evidence in support of long‐term pernasal tracheal intubation is presented and the aetiology of this complication is discussed.
Pre‐oxygenation and the parturient patient
Authors: RUSSELL G. N. , SMITH C. L. , SNOWDON S. L. , BRYSON T. H. L. 
Published: February 2007

SummaryThe effects of pre‐oxygenation were studied by continuous expired oxygen analysis in twenty pregnant patients and ten nonpregnant controls. The Magill system and a demand valve breathing system were both studied with tidal and vital capacity breathing. Rapid pre‐oxygenation was possible with the demand valve system but the technique was associated with air leaks around the mask. Vital capacity breathing with the Magill system was inefficient in practice because of rebreathing and air leaks, and the recently proposed four vital capacity breath technique provided suboptimal alveolar oxygenation in pregnant subjects. Oxygenation in pregnant subjects was significantly faster than in nonpregnant controls and was achieved after just 2 minutes of tidal breathing from a standard Magill system with a prefilled reservoir. Care was necessary to ensure a gas‐tight seal around the facemask.
Antacid therapy for emergency Caesarean section
Authors: THORBURN J. , MOIR D. D. 
Published: February 2007

SummaryOne hundred patients undergoing emergency Caesarean section were treated with cimetidine 200 mg intramuscularly when the decision was made to deliver the patient by Caesarean section and, preceding general anaesthesia, 30 ml of 0.3 M sodium citrate was administered orally. No routine antacid therapy was employed during labour. No patient had a gastric aspirate pH of less than 2.7, and only one of less than 3. The regimen is simple and effective, and treats only those patients at risk of acid aspiration.
Comparison of etomidate and propofol for anaesthesia in microlaryngeal surgery
Authors: DE GROOD P. M. R. M. , MITSUKURI S. , VAN EGMOND J. , RUTTEN J. M. J. , CRUL J. F. 
Published: February 2007

SummaryPropofol and etomidate were compared as hypnotics in total intravenous anaesthesia for microlaryngeal surgery combined with jet ventilation. Two groups of 15 patients were studied. In group 1, propofol 2.0 mg/kg was used for induction. For maintenance a continuons infusion of 12 mg/kg/hour was used for the first 10 minutes, followed by 9 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour thereafter. In group 2, the induction dose of elomidate was 0.3 mg/kg followed by continuons infusion of 1.8 mg/kg/hour for 10 minutes, 1.5 mg/kg/hour for the next 10 minutes and 1.0 mg/kg/hour thereafter. Alfentanil was given for analgesia and suxamethonium for muscle relaxation. The propofol group showed better surgical conditions, more stable anaesthesia and better recovery according to the Steward score. Recovery times to opening eyes on command were comparable for both groups.
Intrathecal morphine in aortic aneurysm surgery
Authors: DAVIS I. 
Published: February 2007

SummaryThe purpose of this study was to compare the peri‐operative conditions produced by intrathecal morphine with those that result from conventional analgesia in aortic aneurysm surgery. Low‐dose intrathecal morphine provides a level of analgesia during operation indistinguishable from that of moderate doses of parenteral opiate, but is no more effective in attenuating autonomic responses to the procedure. Analgesia is prolonged into the postoperative period, does not cause clinically evident respiratory depression and can be enhanced by small doses of intravenous opiate. The principal advantage of intrathecal morphine is the avoidance of irregular and inadequate pain relief in the early, and most painful, part of the postoperative period. Low‐dose intrathecal morphine appears safe, effective and feasible in aortic aneurysm surgery and provides an alternative to traditional management with parenteral opiates.
Carbon dioxide laser bronchoscopy
Authors: CONACHER I. D. , PAES M. L. , MORRITT G. N. 
Published: February 2007

SummaryThe records of 20 patients who underwent carbon dioxide laser bronchoscopy were analysed retrospectively. Many of the cases presented with evidence of severe obstruction of the trachea or major bronchi and were regarded as highly at risk from anaesthesia. The majority of problems in the 35 laser sessions related to the use of a rigid bronchoscope for delivering the laser and to the ventilalory difficulties associated with the airway pathology. Invasive arterial monitoring for blood gas analysis and blood pressure measurement proved essential to detect and correct changes of a potentially serious nature. This experience is compared and contrasted with that of others.
Piriform fossa perforation during attempted tracheal intubation
Authors: WENGEN D. F. à 
Published: February 2007

SummaryPerforation of the piriform fossa is a rare complication of attempted tracheal intubation. The consequences vary from cervical emphysema to respiratory distress, mediastinitis, septic shock, empyema pyopneumothorax and death. The mortality rate due to mediastinitis is over 50%, so early diagnosis and management can improve survival. This case report describes one case and discusses the diagnosis and management of this complication.
Tracheopathia osteochondroplastica
Authors: SMITH D. C. , PILLAI R. , GILLBE C. E. 
Published: February 2007

SummaryA 60‐year‐old man presented for aortocoronary saphenous vein grafting; tracheal intubation was found to be difficult before surgery. Bronchoscopy at the time suggested tracheal carcinoma, but subsequent biopsy of the trachea demonstrated tracheopathia osteochondroplastica. The condition is described and its implications for anaesthetists are discussed.
Intercostal nerve blockade for children
Authors: Shelly M.P. , Park G.R. 
Published: February 2007

SummaryA modified technique of intercostal nerve blockade is described which is suitable for use in children. Ten patients received intercostal nerve blockade on a total of 29 occasions in order to provide analgesia following liver transplantation and to facilitate weaning from artificial ventilation of the lungs. The opioid requirement of patients who received intercostal nerve blockade was considerably lower than that of those who did not; 56% of the children who received intercostal nerve blockade required no additional analgesia. One child, the first to receive intercostal nerve blockade, developed a pneumothorax following the procedure. The technique has proved to be safe in skilled hands. It is an acceptable method of postoperative analgesia in children after liver transplantation and may be a useful technique in the management of other paediatric patients.
Bradycardia during intra‐abdominal surgery
Authors: COVENTRY D. M. , McMENEMIN I. , LAWRIE S. 
Published: February 2007

SummaryThe aim of the present study was to examine, in a double‐blind, randomised manner, the effects of glycopyrronium 0.005 mg/kg, atropine 0.01 mg/kg or a placebo (normal saline) on the frequency of bradycardia in 92 patients scheduled for major abdominal or gynaecological surgery. All patients received fentanyl, halothane and vecuronium. The frequency of bradycardia in the group that received saline was 18%. No cases occurred in either anticholinergic group. Mean heart rates intra‐operatively were not significantly different between the atropine and glycopyrronium groups. It is suggested that the routine use of pre‐operative anticholinergic agents should be considered when a similar anaesthetic technique is employed.
Comparison of two regional techniques for postoperative analgesia in children following herniotomy and orchidopexy
Authors: CROSS G. D. , BARRETT R. F. 
Published: February 2007

SummaryThis study compares the quality and duration of analgesia in two groups of patients aged between 1 and 13 years who received either caudal anaesthesia with plain bupivacaine 0.25% or an iliohypogastric and inguinal nerve block combined with skin infiltration using bupivacaine 0.25% with adrenaline 1:200 000. The results indicate no significant difference in the duration or quality of the analgesia provided by the two techniques. There was no difference in the incidence of vomiting or the time of first micturition between the two groups.
Local tissue oxygenation following radial artery cannulation
Authors: MURRAY J. M. , MOWBRAY A. 
Published: February 2007

SummaryThe effect of radial artery cannulation on local tissue oxygenation and acid‐base balance was studied in 20 patients. Using capillary samples drawn from each thumb, a significant difference was observed between capillary Po2 on each side (p < 0.001), with the higher Po2 on the cannulated side. There were no significant differences between sides in terms of [H+] or Pco2. It is considered that the differences in capillary Po2 were due to local tissue vasodilatation. The presence of chlorbutol in the sodium heparin flushing solution is implicated as the causative factor. Further study of 20 patients using preservative‐free heparin demonstrated no significant differences between cannulated and non‐cannulated sides in terms of capillary Po2, Pco2 or [H+]. Sodium heparin with chlorbutol appears to improve local tissue oxygenation and is recommended for use in flushing solutions for invasive arterial monitoring.
Tracheal versus intravenous atropine
Authors: BRAY B. M. , JONES H. M. , GRUNDY E. M. 
Published: February 2007

SummaryAtropine 600 μg was given either intravenously or intratracheally and the change in heart rate noted in a double‐blind, randomised study of 40 anaesthetised patients. There was no significant difference between the two groups in the maximum increase in heart rate, 20.3 beats/minute in the tracheal compared to 21.4 beats/minute in the intravenous group. However, the maximum increase occurred significantly earlier in the tracheal group, 45.5 seconds after administration compared to 95.5 seconds in the intravenous group (p < 0.01, 95% confidence interval 36.8–63.2 seconds). This study supports the clinical observation that tracheal and intravenous atropine are equally effective and suggests that the trachea should be the route of choice when a rapid response is required.
Large dose epidural sufentanil
Authors: MADEJ T. H. , WATSON N. C. , MARTIN B. C. 
Published: February 2007

SummaryThe postoperative analgesic management of a patient who was intolerant of morphine and pethidine is described. An epidural infusion of fentanyl up to 1 μg/kg/hour was ineffective for analgesia in the first 18 hours. Subsequently. 50‐μg boluses and an infusion of 0.5 μg/kg/hour sufentanil provided satisfactory analgesia with minimal side effects for 28 hours.
Feedback control of neuromuscular blockade
Authors: WAIT C. M. , GOAT V. A. , BLOGG C. E. 
Published: February 2007

SummaryA simple system for closed‐loop control of neuromuscular blockade is described. It comprises a Datex Relaxograph, a small relay and a syringe pump. The equipment is commercially available and requires no complex custom‐built electronics. Atracurium was infused in a semicontinuous manner to 11 patients who underwent general anaesthesia for a variety of surgical procedures. Neuromuscular blockade oscillated within a narrow range around the preset level. The mean rate of infusion of atracurium was 0.5 mg/kg/hour (SD 0.13). The mean recovery time was 25.5 minutes (SD 7.95).
Severe acute asthma and the menstrual cycle
Authors: LENOIR R. J. 
Published: February 2007

SummaryThree cases of severe acute asthma associated with menstruation are reported. All required admission to an intensive therapy unit and intermittent positive pressure ventilation of the lungs for one week or more. Several bronchodilator drugs and anaesthetic agents were employed in an effort to reduce the severe bronchospasm. In each case, improvement appeared to coincide with the end of menstruation. An awareness of the association of asthma and menstruation by those involved in intensive therapy may help in the management of similar cases.
Lupus anticoagulant
Authors: MALINOW A. M. , RICKFORD W. J. K. , MOKRISKI B.L.K. , SALLER D.N. , McGUINN W. J. 
Published: February 2007

SummaryCirculating lupus anticoagulant occurs in 5–37% of all patients with systemic lupus erythematosus. Its occurrence is not restricted to collagen vascular disease states. Lupus anticoagulant causes a prolongation of certain laboratory coagulation studies yet it is associated in vivo with a history of systemic intravascular thromboses. Placental vessels are also affected. Less than one in six pregnancies complicated by the presence of this auto‐antibody is successful. Treatment of afflicted parturients with anti‐platelet therapy has increased perinatal survival rates. Derangements in the coagulation profile and concomitant anti‐platelet therapy confound the rational use of regional anaesthesia in the management of labour and delivery in these high‐risk pregnancies.
Anaesthesia and septo‐optic dysplasia
Authors: SHERLOCK D. A. , McNICOL L. R. 
Published: February 2007

SummarySepto‐optic dysplasia (De Morsier's syndrome) is a common cause of congenital optic nerve hypoplasia. Associated abnormalities such as hypothalamic/pituitary dysfunction, hypotonia or spasticity, may result in affected children presenting for surgical procedures under general anaesthesia. A 3.5‐year‐old boy with the undiagnosed condition had his Achilles tendons elongated under an uncomplicated general anaesthetic. The postoperative period was complicated by coma and a major convulsive seizure which responded to glucose and steroids. The importance of awareness of this condition in short children with poor visual acuity who require general anaesthesia is stressed, and the presenting features of seven other cases are demonstrated.
Comparison of trichloroethylene and enflurane as adjuncts to nitrous oxide and relaxant anaesthesia
Authors: Rice A. S. C. , Reynolds F. 
Published: February 2007

SummaryForty women who underwent gynaecological surgery were randomly allocated to receive trichloroethylene. enflurane, or enflurane plus fentanyl as adjuncts to nitrous oxide/relaxant anaesthesia with controlled ventilation. No serious cardiac dysrhythmias were seen in any group. Each patient was observed postoperatively' for 4 hours by a nurse blind to the technique used, and questioned at 24 hours by a similarly blinded anaesthetist. Recovery after trichloroethylene was not significantly prolonged although postoperative analgesia by visual analogue was better, opiate analgesia was required less frequently and there was less nausea and vomiting than in either of the enflurane groups.We argue for the continued use of trichloroethylene by this technique, because it costs one hundred times less than enflurane and because of the potential morbidity of the postoperative opiate dosage required after enflurane.
The influence of anaesthesia on the acute phase protein response to surgery
Authors: SIMPSON P. J. , RADFORD S. G. , LOCKYER J. A. 
Published: February 2007

SummaryThe influence of anaesthesia on the peri‐operative changes in acute phase protein concentrations was studied in 18 patients undergoing elective cholecystectomy. A standard anaesthetic technique was supplemented either by one of two different doses of fentanyl, or by halothane. Eleven proteins were studied but the acute phase response was significantly altered by the anaesthetic technique for only two, fibrinogen and antichymotrypsin. The concentration of these proteins tended to be lower with 2–3 μg/kg fentanyl than with either halothane or fentanyl 12 μg/kg. There was no evidence of variation in stress suppression between the three techniques. The mechanism of any anaesthetic influence on the acute phase response is uncertain and this study is too small to assess its clinical significance.
The respiratory effects of isoflurane, enflurane and halothane in spontaneously breathing children
Authors: MURAT I. , CHAUSSAIN M. , HAMZA J. , SAINT‐MAURICE Cl. 
Published: February 2007

SummaryThe respiratory effects of halothane, isoflurane and enflurane were assessed during nitrous oxide anaesthesia (N2O 50%) in three groups of unstimulated, spontaneously breathing children who weighed 10–20 kg and were aged 1–6 years. Respiratory variables were measured or calculated from capnographic and pneumotachographic recordings at three multiples of minimal alveolar concentration (MAC). The slope of the carbon dioxide response was measured. Similar increases in end tidal carbon dioxide were found for the three agents at each MAC multiple, and similar decreases in tidal volume and in the slope of the ventilatory response to carbon dioxide. A dose‐related tachypnoea occurred with halothane and a significant decrease in the duration of inspiration and the duration of each breath at the deepest level of anaesthesia. A significant increase in both these times occurred with enflurane, and a decrease in respiratory rate. No change in respiratory rate occurred with isoflurane at increasing alveolar concentrations whereas at each level of anaesthesia inspiratory time was significantly reduced.
One year's experience with the APACHE II severity of disease classification system in a general intensive care unit
Authors: JACOBS S. , CHANG R. W. S. , LEE B. 
Published: February 2007

SummaryThe APACHE II sickness score was applied prospectively for one year in a general intensive care unit in Saudi Arabia. Two hundred and ten patients were studied, 66 of whom died in hospital. The mean APACHE II score of survivors was 11 (SD 7.1) and of non‐survivors, 25.3 (SD 8.8). The mean Risk of Death was 13.3% (SD 13.1) for the survivors and 47.2% (SD 25.8) for non‐survivors. The differences in APACHE score and Risk of Death between survivors and non‐survivors are highly significant (p < 0.0005 for both). No patient survived who had a Risk of Death greater than 60% and none died with a Risk of Death less than 7%. The sensitivity of the APACHE II system in predictions of death can be improved if the scores on the day of admission and on the 3rd day are taken into account.
Feedback during patient‐controlled analgesia using a speech synthesiser
Authors: Hodsman N. B. A. , Kenny G. N. C. , Gillies G. W. A. , McArdle C. S. 
Published: February 2007

SummaryPatients who use on‐demand analgesia prefer voice feedback rather than buzzer tones to indicate operation of the apparatus. Twenty‐four patients had experience of a patient‐controlled analgesia apparatus which incorporated a sophisticated feedback of buzzer tones and a speech synthesiser. Of those who expressed a preference, fifteen preferred the speech synthesiser and only one preferred the buzzer tones. The speech synthesiser is a reliable, inexpensive and simple method of supplying feedback to patients when such apparatus is used.
Propofol infusion for sedation in intensive care
Authors: NEWMAN L. H. , McDONALD J. C. , WALLACE P. G. M. , LEDINGHAM I. McA. 
Published: February 2007

SummaryTen patients, with a range of illness severity, received a continuous 8‐hour infusion of undiluted propofol for sedation while undergoing mechanical ventilation in a general intensive care unit. The level of sedation was assessed hourly and measurements were made of haemodynamic, respiratory, haematological and biochemical variables. Sedation remained satisfactory in most patients throughout the study period, with only occasional alterations in infusion rate, and eight patients required further sedative therapy within 45 minutes of discontinuation of the propofol infusion. Arterial pressure tended to decrease from baseline values; mean and diastolic pressures demonstrated a significant decrease (p < 0.05) at 4, 7 and 8 hours during the infusion. Adrenal steroidogenesis was not inhibited significantly.Propofol infusion proved to he a useful and readily controllable sedative agent, and discontinuation of the drug was followed by rapid recovery in most cases. The critically ill may be particularly sensitive to the cardiovascular depressant properties of the drug.
The effects of vecuronium on intra‐ocular pressure
Authors: MIRAKHUR R. K. , SHEPHERD W. F. I. , LAVERY G. G. , ELLIOTT P. 
Published: February 2007

SummaryThe effects of vecuronium on intra‐ocular pressure were investigated in doses of O.1 mg/kg during steady state anaesthesia (n = 5), 0.1 mg/kg as part of a normal sequence induction preceded by thiopentone (n = 10), and 0.15 mg/kg as part of a rapid sequence induction with vecuronium administered prior to thiopentone (n = 10). Administration of vecuronium during steady state anaesthesia was associated with a significant decrease. Vecuronium produced a small reduction in pressure during a normal sequence induction, following a significant reduction after thiopentone. Tracheal intubation during normal sequence and rapid sequence inductions produced increases in pressure above the pre‐intubation value (significantly so in the case of normal sequence induction); however, the intra‐ocular pressure always remained helow the pre‐induction value, which suggests that vecuronium 0.15 mg/kg is a suitable relaxant as part of a rapid sequence induction technique where the use of suxamethonium is contraindicated.
Ketamine infusion
Authors: PARK G. R. , MANARA A. R. , MENDEL L. , BATEMAN P. E. 
Published: February 2007

SummaryA patient with acute lymphatic leukaemia developed a bilateral fulminating Pseudomonas aeruginosa pneumonia and required controlled ventilation of the lungs. Marked agitation, hypotension and bronchospasm unresponsive to conventional bronchodilators presented a therapeutic challenge. A continuous intravenous infusion of midazolam failed to provide adequate sedation. A continuous intravenous infusion of ketamine resulted in better sedation, an increase in arterial pressure and a dimunition of bronchospasm. The clinical improvement was maintained for the 5 days during which ketamine was infused. Plasma concentrations of ketamine and its metabolites are reported.