bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of midazolam on the EEG during sedation of critically ill patients
Authors: VESELIS R. A. , REINSEL R. , MARINO P. , SOMMER S. , CARLON G. C. 
Published: February 2007

SummaryPatients who require mechanical ventilation are often sedated with midazolam. As clinical signs of sedation are often confusing or nonexistent, and there are few adverse side effects when large doses are infused over a period of days, substantial drug accumulation can result in these critically ill patients, despite the short half‐life of midazolam. An objective monitor of sedation would help maintain sedation at a constant level despite changing pharmacokinetic values in patients. We undertook this study to describe the electroencephalographic changes which occur with intravenous midazolam in critically ill patients, and to determine if a relationship exists between these changes and the depth of sedation as measured using a clinical scoring method. A series of 31 critically ill patients who required intravenous midazolam during mechanical ventilation were studied. Four different levels of sedation were defined ranging from execution of verbal commands to no response to suctioning through the tracheal tube or sternal rub. Electroencephalographic recordings were obtained in patients on a daily basis and a concurrent sedation level was determined. High frequency electroencephalogram activity decreased as sedation level increased. This was reflected in decreases in the spectral edge (17.61 to 10.56 Hz (p = 0.0024)), the median frequency (4.27 to 2.56 Hz (p = 0.0278)), and the logarithm of the absolute power in the beta, (p = 0.0012), and beta2 (p < 0.0001) bands. An incidental finding of asymmetry in power between right and left frontal electrodes was observed, with right‐sided power being 9–18% greater (p < 0.001). This form of monitoring of midazolam sedation in critically ill patients, which may allow better discrimination of different sedation levels than clinical examination alone, may be useful in guiding administration of midazolam to produce a constant sedative effect. Changes in electroencephalogram power, a useful sign of cerebral ischaemia, may be affected by the use of midazolam, which appears to cause asymmetry in power.
Dexmedetomidine as intramuscular premedication in outpatient cataract surgery
Authors: VIRKKILÄ M. , ALI‐MELKKILÄ T. , KANTO J. , TURUNEN J. , SCHEININ H. 
Published: February 2007

SummaryAlpha2 agonists have been shown to decrease intra‐ocular pressure in ophthalmic surgery. We studied the effects of dexmedetomidine, a new a2 agonist, on intra‐ocular pressure, haemodynamic parameters, sedation, anxiolysis and dryness of mouth in 35 (Asa physical status 1–3) patients undergoing day‐case cataract surgery under peri‐ocular anaesthesia. Five different doses of dexmedetomidine (0.25, 0.5, 0.75, 1.0 and 1.5 μg.kg−1) were used in this double‐blind, randomised and placebo‐controlled study. The trial drug was administered into the deltoid muscle 60 min before surgery. The 1.0 μg.kg−1 dose of dexmedetomidine produced a 32% reduction of intra‐ocular pressure (p = 0.002). This dose induced moderate sedation, but was not associated with significant haemodynamic changes. A significant decrease in heart rate and systolic blood pressure was seen only with the highest dose of dexmedetomidine. Our results suggest that dexmedetomidine 1.0 μg.kg−1 produces sedation and a reduction of intra‐ocular pressure with minimal haemodynamic side effects when given intramuscularly as premedication before cataract surgery under regional anaesthesia.
Intra‐operative monitoring of cerebral haemodynamics in a patient with Takayasu's arteritis
Authors: KAWAGUCHI M. , OHSUMI H. , NAKAJIMA T. , KURO M. 
Published: February 2007

SummaryTranscranial Doppler and continuous measurements of jugular venous oxygen saturation were used to monitor intra‐operative cerebral haemodynamics in a patient with Takayasu's arteritis who underwent carotid revascularisation. These techniques were found to be of clinical value for detection of cerebral hypoperfusion and assessment of the effects of therapeutic intervention.
The levering laryngoscope
Authors: McCOY E. P. , MIRAKHUR R. K. 
Published: February 2007

SummaryThis is a report of a modification of the standard Macintosh laryngoscope blade to facilitate tracheal tube placement in cases of difficult visualisation of the larynx. The modification offers the unique advantage of a hinged blade tip, controlled by a lever on the handle of the larygoscope which allows elevation of the epiglottis while decreasing the overall laryngoscopic elevation or levering movement required. It is an adaptation which can be applied to most laryngoscope blades, does not require any special training in its use and will prove useful for both routine intubations as well as those which may be difficult and associated with an anterior larynx.
The distance between the grille of the laryngeal mask airway and the vocal cords
Authors: ASAI T. , LATTO I. P. , VAUGHAN R. S. 
Published: February 2007

SummaryThe distance between the grille of the laryngeal mask airway and the vocal cords was measured with afibreoptic bronchoscope in 30 male and 30 female patients. The mean distance was 3.6 cm (SD 0.5 cm; range 2.5–4.7 cm) in males and 3.1 cm (SD 0.5 cm; range 2.0–4.2 cm) in females. These results suggest that the cuff of an uncut 6.0 mm tracheal tube would often lie between the vocal cords when the tube is fully inserted through a laryngeal mask airway. To avoid this complication, the tracheal tube must protrude more than 9.5 cm beyond the grille of the laryngeal mask airway. When either neck extension or flexion is required, the laryngeal mask airway should be removed as the margin of safety is small.
Near fatal pulmonary hypertension after surgical repair of congenital diaphragmatic hernia
Authors: FROSTELL C. G. , LÖNNQVIST P. A. , SONESSON S. E. , GUSTAFSSON L. E. , LÖHR G. , NOACK G. 
Published: February 2007

SummaryThe addition of 10–20 parts per million nitric oxide to the inspired gas was successful in controlling near fatal pulmonary hypertension after surgical repair of a congenital diaphragmatic hernia in a neonate. A preceding prostacyclin infusion was unable to prevent the failure of pulmonary perfusion. No side effect of nitric oxide therapy was observed, and ventilatory support could be substantially reduced as a result of the treatment. On the basis of the striking and lifesaving effects of nitric oxide therapy demonstrated in this child, we believe that nitric oxide treatment will prove to be a major contribution to the management of postoperative pulmonary hypertensive crises.
Near infrared spectroscopy in adults
Authors: HARRIS D. N. F. , BAILEY S. M. 
Published: February 2007

SummaryDoes the Invos near infrared spectroscopy monitor detect intracranial oxygenation, or reflect oxygenation of extracerebral tissues? The change in Invos regional cerebral oxygenation was studied during a doubling of middle cerebral artery flow with hypercapnia. There was no significant change in regional cerebral oxygenation, which suggests that the Invos does not reflect intracerebral oxygenation, possibly because of its narrow optode separation. The use of near infrared spectroscopy in adults may require a more powerful machine.
Zingiber officinale (Ginger)–an antiemetic for day case surgery
Authors: Phillips S. , Ruggier R. , Hutchinson S. E. 
Published: February 2007

SummaryThe effect of powdered ginger root was compared with metoclopramide and placebo. In a prospective, randomised, double‐blind trial the incidence of postoperative nausea and vomiting was measured in 120 women presenting for elective laparoscopic gynaecological surgery on a day stay basis. The incidence of nausea and vomiting was similar in patients given metoclopramide and ginger (27% and 21%) and less than in those who received placebo (41%). The requirement for postoperative antiemetics was lower in those patients receiving ginger. The requirements for postoperative analgesia, recovery time and time until discharge were the same in all groups. There was no difference in the incidence of possible side effects such as sedation, abnormal movement, itch and visual disturbance between the three groups. Zingiber officinale is an effective and promising prophylactic antiemetic, which may be especially useful for day case surgery
Intranasal fentanyl titration for postoperative pain management in an unselected population
Authors: STRIEBEL H. W. , POMMERENING J. , RIEGER A. 
Published: February 2007

SummaryA randomised, double‐blind study was undertaken to investigate the suitability of intranasally administered fentanyl for postoperative pain management under routine conditions in an unselected population. For postoperative pain relief, patients received either 0.027 mg fentanyl intranasally and sodium chloride 0.9% intravenously (intranasal group, n = 53) or sodium chloride 0.9% intranasally and 0.027 mg fentanyl intravenously (intravenous group, n = 59). These doses were repeated every 5 min until the patients were free of pain or refused further analgesia. Pain severity was evaluated before beginning opioid titration and 5, 10, 15, 20, 30, 40, 50, 60, 70 and 80 min thereafter. Adequate pain relief was achieved in 52 of 53 patients in the intranasal and in all patients in the intravenous group. Pain intensities evaluated on a 101‐point numerical rating scale as well as on a verbal rating scale decreased significantly in both study groups within 5 min. At the 15 min measurement point, numerical rating scale pain intensity and at the 10 and 20 min point, verbal rating scale pain intensity was significantly lower in the intravenous group. The incidence of side effects was low in both groups and no patient complained of intranasal pain. Intranasally administered fentanyl would appear to be suitable for the management of postoperative pain.
Classification and severity of postdural puncture headache
Authors: CORBEY M.P. , BERG P. , QUAYNOR H. 
Published: February 2007

SummaryTwo hundred and five patients, aged 16–45 years, undergoing day care surgery were given a spinal anaesthetic using either a 26‐or a 27‐gauge Quincke point spinal needle. The occurrence of headache and accompanying symptoms postoperatively was analysed from 186 returned questionnaires. The incidence of classical postdural puncture headache was 4.5% following the use of a 26‐gauge needle and 8% with a 27‐gauge needle (p > 0.05). A further group of patients suffering headache after dural puncture was identified, the postdural puncture‐related headache. The headache and accompanying symptoms were similar to that seen with a postdural puncture headache except that it was not aggravated by posture. A system of grading the severity of both type of headache is presented and standardised criteria for the classification of postdural puncture headache are proposed.
The anaesthetic management of patients with dystrophic epidermolysis bullosa
Authors: GRIFFIN R. P. , MAYOU B. J. 
Published: February 2007

SummaryThe case notes and anaesthetic charts of 44 patients with dystrophic epidermolysis bullosa were reviewed retrospectively. A total of 390 general anaesthetics were performed for 469 surgical procedures over a 10‐year period. Procedures included repair of syndactyly, dilatation of oesophageal strictures, extraction of teeth, excision of skin tumours and other procedures related to dystrophic epidermolysis bullosa. Anaemia, thrombocytosis and hypoalbuminaemia was found in many patients pre‐operatively. Damage to skin or mucosa occurred peri‐operatively. Four patients developed bullae around the head and neck, two patients developed oral or pharyngeal bullae and three patients developed conjunctival abrasions including one with a new corneal ulcer. There were no reports of laryngeal bullae and no bullae associated with intramuscular injections or the use of limb tourniquets. Thirty‐one patients (70%) had evidence of oesophageal strictures and six regurgitated peri‐operatively. In all cases there was a history of oesophageal disease. In 10 patients (23%) intubation of the trachea was difficult. It was carried out by various methods including blind nasal andfibreoptic intubation or by using the laryngeal mask airway. One patient requiring a series of general anaesthetics had a tracheostomy formed after fibreoptic intubation. Previous reports have suggested problems with the use of suxamethonium, nondepolarising muscle relaxants and thiopentone. These agents were all used in many of our patients without any adverse effects. There was one intra‐operative death in a 35‐year‐old woman having an oesophageal dilatation which was complicated by oesophageal rupture.
Propofol infusion anaesthesia and immune response in minor surgery
Authors: PIRTTIKANGAS C.‐O. , PERTTILÄ J. , SALO M. , VAINIO O. , LIUKKO‐SIPI S. 
Published: February 2007

SummaryThis study was set up to evaluate the effects of propofol infusion anaesthesia on immunological function in minor surgery. Twenty‐seven patients (median age 51 years, ASA 1‐2) scheduled for minor breast surgery were randomly assigned to two groups. Anaesthesia was induced in group 1 with propofol 2.5 mg.kg‐1 and maintained with propofol 12 mg.kg‐1.h‐1 and 30% O2 in air, whereas in group 2 anaesthesia was induced with thiopentone 4 mg.kg‐1 and maintained with 70% N2O in O2. Fentanyl and vecuronium were used in both groups. The percentages of T cells (p < 0.001), B cells (p < 0.01) and memory T cells increased (p < 0.01) in both groups. T helper cell percentages increased in the propofol but not in the thiopentone group (p < 0.05). The percentages of natural killer cells decreased from pre‐induction values in both groups (p < 0.001). No changes were seen in lymphocyte proliferative responses. Minor breast surgery under propofol or conventional combined anaesthesia had only minor effects on the immune response. The higher percentage of T helper cells after propofol anaesthesia compared to conventional combined anaesthesia is beneficial, but its clinical importance remains to be determined.
The Ohmeda Rascal II
Authors: LOCKWOOD G. G. , LANDON M. J. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryThe Ohmeda Rascal II is a multigas analyser and pulse oximeter for dedicated anaesthetic use. It uses the Raman scattering of laser light to identify and quantify oxygen, nitrogen, carbon dioxide, nitrous oxide and three volatile anaesthetic agents. Its response times equal or better the published response times of infrared or photo‐acoustic devices. It is linear within the clinical ranges of all gases and vapours, simple to use, requires no maintenance, holds its calibration well, and is a suitable monitor for clinical and research use.
Midlatency auditory evoked potentials and purposeful movements after thiopentone bolus injection
Authors: SCHWENDER D. , KLASING S. , MADLER C. , PÖPPEL E. , PETER K. 
Published: February 2007

SummaryThe effect of thiopentone on the middle latency auditory evoked potentials was investigated in 12 patients during induction of anaesthesia with thiopentone 5 mg.kg‐1. 100% oxygen was administered throughout the induction, and when the patient moved purposefully a further bolus (2 mg.kg‐1) was given, and anaesthesia continued in the normal way. The middle latency auditory evoked potentials were elicited before and during the induction. Binaural clicks (70 dB above normal hearing threshold) were presented at a rate of 9.3 per s. Averages of 1000 responses were analysed off line, and a fast Fourier transformation of the middle latency auditory evoked potentials were used to calculate the power spectrum of the averages. Awake, the patients had large peak to peak amplitudes and a normal waveform. The power spectra showed a high energy between 30‐40 Hz. After induction the latencies of waves Na, Pa, Nb and PI and the amplitudes of the waves Na/Pa, Pa/Nb, and Nb/PI were decreased or completely attenuated. Both effects lasted for 4 min. When movement occurred (after 4–6 min), the values returned to awake. The second bolus repeated the changes.
Excursions of the cervical spine during tracheal intubation: blind oral intubation compared with direct laryngoscopy
Authors: FITZGERALD R. D. , KRAFFT P. , SKRBENSKY G. , PERNERSTORFER T. , STEINER E. , KAPRAL S. , WEINSTABL C. 
Published: February 2007

SummaryThe most appropriate technique for performing tracheal intubation in patients with cervical spine injury is debatable. Recently, a new device enabling blind oral intubation (Augustine GuideTM) with the patient's head and neck in the neutral position has been introduced. The aim of this study was to compare the extent of upper cervical spine movement during intubation with this device compared to direct laryngoscopy. Twelve patients (Mallampati I and II), without a cervical spine injury, were intubated using the Augustine GuideTM and afterwards by direct laryngoscopy. Both procedures were viewed radiographically. Extension in the upper cervical spine was determined at the point of the maximum excursion. By evaluating the joints occiput‐C3 together as a functional unit, blind oral intubation caused 17° (median) less extension compared to direct laryngoscopy (p < 0.01). The median differences observed for the individual joints were: 7° in occiput‐C1 (p < 0.05), 5° in C1‐2 (p < 0.01) and 6° in C2‐3 (p < 0.01) respectively. Since we assume that intubation‐induced excursions of the injured spine are even higher, blind oral intubation might be a safe alternative for airway management in this special group of trauma victims.
Acute paraplegia following intrathecal phenol block in the presence of occult epidural malignancy
Authors: MORGAN R. J. , STELLER P. H. 
Published: February 2007

SummaryA 68‐year‐old woman with an invading adenocarcinoma of the lung underwent intrathecal phenol block for chest wall pain. Acute paraplegia resulted immediately following the procedure. Subsequent CT scan showed dural compression from an epidural metastasis five segments above the site of the phenol injection. This was confirmed at surgical decompression of the spinal cord and by histological findings. The cause of the paraplegia, which has not recovered, was probably spinal coning.
A comparison of pre‐ and postoperative tonsillar infiltration with bupivacaine on pain after tonsillectomy A pre‐emptive effect?
Authors: Ørntoft S. , Løngreen A. , Møiniche S. , Dhal J. B. 
Published: February 2007

SummaryThirty‐five healthy patients aged 15–36 years scheduled for bilateral tonsillectomy were randomly allocated to receive the following treatments: tonsillar infiltration with 0.25% bupivacaine 5 min before surgical incision (n = 12); identical tonsillar infiltration administered after both tonsils had been surgically removed (n = 12); infiltration with isotonic saline 5 min before the operation (n = 11). There were no significant differences between groups in pain scores (VAS) at rest or during drinking of 100 ml of water as measured at 4 h postoperatively or on the 1st, 2nd, 3rd and 8th postoperative days. Four, five and three patients in the pre‐operative bupivacaine, postoperative bupivacaine, and saline groups, respectively, received one dose of 0.1 mg.kg‐1 morphine intravenously (p = 0.76). Cumulative acetylsalicylic acid requirements during the observation period were not significantly different between groups (p = 0.78). These results suggest that pre‐operative infiltration of 0.25% bupivacaine has no beneficial pre‐emptive analgesic action compared to both an identical treatment administered after tonsillectomy and a placebo.
Intra‐ocular pressure changes in patients with glaucoma
Authors: Barclay K. , Wall T. , Wareham K. , Asai T. 
Published: February 2007

SummaryWe performed a randomised prospective study in 20 patients with glaucoma to examine the effects of tracheal intubation and laryngeal mask insertion on intra‐ocular pressure, mean arterial blood pressure and heart rate. After induction of anaesthesia with propofol, intra‐ocular pressure decreased significantly below baseline values in both the laryngeal mask and tracheal tube groups. After insertion of the laryngeal mask, intra‐ocular pressure remained significantly below baseline values in all patients. In contrast, tracheal intubation was associated with a significant increase in intra‐ocular pressure to above baseline values in three out of eight patients. Insertion of the laryngeal mask had minimal effects on mean arterial blood pressure and heart rate, whereas tracheal intubation significantly increased both factors relative to pre‐intubation values.
Patients’knowledge of anaesthetic practice and the rôle of anaesthetists
Authors: Swinhoe C. F. , Groves E. R. 
Published: February 2007

SummaryPatients were questioned pre‐operatively to assess the level of their knowledge with regard to anaesthetic qualifications, anaesthesia and the role of anaesthetists. Thirty‐five percent did not realise that anaesthetists were qualified doctors and only 25% could mention any duties that anaesthetists might have outside the operating theatre. However, those questioned were better informed about the anaesthestist's role in monitoring the patient during surgery and recovery.
Haemodynamic and oxygen transport effects of propofol infusion in critically ill adults
Authors: NIMMO G. R. , MACKENZIE S. J. , GRANT I. S. 
Published: February 2007

SummaryThe effects of a sedative infusion of propofol on haemodynamics and oxygen transport were examined in critically ill adult patients. Ten patients receiving mechanical ventilation for treatment of septic shock and respiratory failure were given a decreasing rate propofol infusion designed to achieve and maintain a stable sedation level. Full cardiovascular and oxygen transport variables, arterial blood lactate concentrations and sedation scores were measured before infusion and at 1, 3 and 6 h after starting the infusion. There were significant reductions in mean (SEM) heart rate (97.3(2.9) to 85.7(3.9) beat.min‐1 p < 0.05), mean arterial pressure (87.6(3.7) to 76.2(4.1)mmHg p < 0.05) and systemic vascular resistance index (1461(137) to 1327(141) dyne.s.cm‐5.m‐2 p < 0.05), with no significant change in cardiac filling pressures. There were no significant changes in cardiac output, oxygen delivery, oxygen consumption or arterial blood lactate concentrations. Controlled propofol sedation is well tolerated in appropriately monitored and resuscitated critically ill adult patients, and appears to have no major effects on whole‐body oxygen transport.
Recovery of mivacurium and doxacurium versus vecuronium in the isolated forearm
Authors: CAMPKIN N. T. A. , HOOD J. R. , FELDMAN S. A. 
Published: February 2007

SummaryTo assess rate of biophase recovery, the recovery from neuromuscular block with mivacurium in the isolated forearm was compared with that from vecuronium simultaneously administered into the other isolated forearm of six volunteers. In a second series of similar experiments, recovery from doxacurium was compared with that from vecuronium. Neuromuscular block was monitored using the adductor pollicis mechanomyographic response to ulnar nerve stimulation at 0.2 Hz. Comparable degrees of maximum twitch tension depression were obtained in each series. In the first series, mean (SD) 25–75% recovery index for mivacurium was 8.4 (1.5) min and 10.5 (1.9) min for vecuronium. In the second series, mean (SD) recovery index for doxacurium was 18.3 (4.2) min and 12.2 (5.0) min for vecuronium. The recovery index of doxacurium in the isolated forearm was significantly greater, and the recovery index of mivacurium significantly less, than the recovery index of simultaneously administered vecuronium. Mivacurium block in the isolated forearm recovers rapidly, although not faster than after systemic injection; this is consistent with a drug that is retained in the biophase despite rapid plasma metabolism. Doxacurium block in the isolated forearm is slow to recover, compared with vecuronium; this suggests that high affinity for the biophase may contribute to its long duration of action.