bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peri‐operative drug prescribing pattern and manufacturers' guidelines
Authors: KLUGER M. T. , GALE S. , PLUMMER J. L. , OWEN H. 
Published: February 2007

SummaryMany patients admitted for surgery are receiving regular drug therapy. Adverse effects may occur, either as a result of these drugs being stopped suddenly or because staff are unaware of significant interactions between certain drugs and anaesthetic agents or techniques. This study aimed to find out how regular drug medication is actually given in the peri‐operative period. In addition, pharmaceutical companies were contacted and asked for information about the effects of sudden withdrawal of their products and potential interactions with anaesthetic agents. We found that many drugs were omitted peri‐operatively with potentially significant effects. Pharmaceutical companies do not seem to appreciate the importance of this problem and not all of them give clear recommendations relevant to practising anaesthetists.
Cardiac anaesthesia in a patient with myotonic dystrophy
Authors: TANAKA M. , TANAKA Y. 
Published: February 2007

SummaryWe describe a patient with myotonic dystrophy who required open‐heart surgery for an atrial septal defect. He also had a sick sinus syndrome and an abnormal myocardium on histological examination. Anaesthesia using fentanyl, droperidol, nitrous oxide and a low concentration of enflurane was uneventful. Atelectasis of the left lung developed on the first postoperative day after removal of the tracheal tube. This was successfully treated by fibreoptic bronchoscopy.
Occupational health and pollution from anaesthetics
Authors: HALSEY M. J. 
Published: February 2007

SummaryThe Control of Substances Hazardous to Health Regulations require employers in the United Kingdom to evaluate and control the risks to health for all their employees from exposure to hazardous substances at work. This applies to those working in hospital operating theatres who may be exposed to anaesthetic gas pollution. These legal requirements coupled with continuing concern about the effective localised control of anaesthetic pollution, the potential chemical interactions in the upper atmosphere, as well as the analysis of the prospective study in the United Kingdom on the health of women doctors, have prompted a reassessment of the topic. Some of the original fears are without foundation but the overall conclusion is that we can still not regard anaesthetic pollution as a problem solved.
Effects of nicardipine on the circulatory responses to tracheal intubation in normotensive and hypertensive patients
Authors: OMOTE K. , KIRITA A. , NAMIKI A. , IWASAKI H. 
Published: February 2007

SummaryThis study was undertaken to examine the effects of nicardipine on circulatory responses to laryngoscopy and tracheal incubation in normotensive (n = 39) and hypertensive (n = 36) patients. Laryngoscopy and tracheal intubation were performed after induction of anaesthesia with thiamylal, followed by administration of intravenous saline or nicardipine 20 or 30 μg.kg−1 and suxamethonium. Blood pressure and heart rate were recorded, and rate‐pressure product was calculated. Nicardipine 20 and 30 μg.kg−1 prevented the increase in mean arterial pressure after intubation in normotensive and hypertensive patients (p < 0.01 compared with saline). The changes in heart rate after intubation were significantly greater in normotensive patients than in hypertensive patients when 20 or 30 μg.kg−1 of nicardipine was given (p < 0.05 and p < 0.01 respectively). Rate‐pressure product increased significantly (p < 0.01) after intubation in normotensive patients whether nicardipine was administered or not, but the increase was suppressed completely by nicardipine 20 or 30 μg.kg−1 in hypertensive patients. We conclude that nicardipine is effective in preventing the circulatory responses to laryngoscopy and tracheal intubation in hypertensive patients.
Internal jugular catheterisation
Authors: PINA J. , MORUJÃO N. , CASTRO‐TAVARES J. 
Published: February 2007

SummaryAn internal jugular catheter, which was inserted into a patient with a traumatic haemopneumothorax, accidentally entered the pleural cavity. This was initially undetected because the two signs most frequently used to confirm correct placement, those of blood reflux and fluctuation of central venous pressure with respiration, were positive. A number of precautions are suggested which should be taken when central venous catheters are inserted in patients with thoracic trauma.
A comparison of omeprazole and ranitidine for prophylaxis against aspiration pneumonitis in emergency Caesarean section
Authors: YAU G. , KAN A. F. , GIN T. , OH T. E. 
Published: February 2007

SummaryOne hundred and sixty‐two Chinese women undergoing emergency Caesarean section were allocated at random on admission to the labour ward to receive one of three regimens for orally administered chemoprophylaxis against acid aspiration: ranitidine 150 mg 6 hourly with sodium citrate at induction of anaesthesia, omeprazole 40 mg 12 hourly with sodium citrate, or omeprazole 40 mg 12 hourly alone. Intragastric pH and volume were measured immediately after induction of anaesthesia. Ten patients (17%) in the omeprazole‐only group, three (6%) in the omeprazole and citrate group and one (2%) in the ranitidine group had an intragastric pH < 2.5 and volume > 25 ml (p < 0.05). The use of sodium citrate resulted in higher intragastric pH but larger intragastric volumes (p < 0.05). The sodium citrate and ranitidine regimen was the most cost‐effective among the three.
Late postoperative nocturnal dips in oxygen saturation in patients undergoing major abdominal vascular surgery
Authors: REEDER M. K. , GOLDMAN M. D. , LOH L. , MUIR A. D. , CASEY K. R. , LEHANE J. R. 
Published: February 2007

SummaryTwenty‐four patients (23 male) who presented for aortic reconstructive surgery were studied with pulse oximetry on a pre‐operative night and during the first five postoperative nights. Patients with five or more dips in oxygen saturation of greater than 4% (with a prompt recovery back toward baseline of 3% or more) per hour of monitoring were classified as having a significant abnormality of respiration. Pre‐operatively, four of 24 patients (17%) demonstrated such an abnormality. Postoperatively, 12 patients (50%) met these criteria on at least one of the first five postoperative nights and six of these had two or more nights with severe episodic hypoxaemia. Frequent severe episodic dips in arterial oxygen saturation (to less than 85% saturation) occurred in the late postoperative period at a time when oxygen therapy would usually have been discontinued. Pre‐operative overnight pulse oximetry studies fail to predict the development of abnormal respiratory patterns in the postoperative period in the majority of patients.
Fatal pulmonary embolism following spinal anaesthesia for Caesarean section
Authors: McHALE S. P. , TILAK M. D. V. , ROBINSON P. N. 
Published: February 2007

SummaryPulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo‐embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be the first time this has been reported.
Alfentanil increases intracranial pressure when intracranial compliance is low
Authors: MOSS E. 
Published: February 2007

SummaryIntracranial pressure increases following the administration of alfentanil 1 mg are reported in five patients with suspected normal pressure hydrocephalus who were undergoing infusion of saline into a lateral ventricle to measure cerebrospinal fluid outflow resistance. The increase in intracranial pressure was accompanied by a fall in mean arterial pressure. These observations show that, when the intracranial compliance is reduced, alfentanil can cause considerable increases in intracranial pressure and decreases in cerebral perfusion pressure.
2% propofol for sedation in the intensive care unit
Authors: Ewart M. C. , Yau K. W. , Morgan M. 
Published: February 2007

SummaryA 2% solution of propofol has been compared with the 1% formulation for sedation in patients whose lungs were being mechanically ventilated in an intensive care unit following coronary artery bypass surgery. There were no significant differences in the amount of propofol used in the two groups, the rate of propofol infusion or the number of changes made to the infusion rate to maintain the desired level of sedation. Recovery times and times to tracheal extubation were similar. The mean heart rates of those receiving 2% propofol were significantly higher throughout the period of the study for no apparent reason. Propofol 2% was found to be safe, easy to administer and a practical alternative to the 1% solution for sedating cardiac surgical patients.
Electronic and disposable patient‐controlled analgesia systems
Authors: Robinson S. L. , Rowbotham D. J. , Mushambi M. 
Published: February 2007

SummaryWe have compared the performance of the Baxter disposable with the Graseby electronic patient‐controlled analgesia system in 30 patients following major gynaecological surgery. Patients were allocated randomly to receive analgesia via the Baxter or Graseby device for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative pain relief or sedation as measured by visual analogue scale. Requirements for antiemetic drugs and patient acceptability were similar. Mean (SEM) morphine demanded over 30 h was 35.7 (6.6) in the Graseby group and 35.1 (8.5) in the Baxter group.
Effects of timolol ophthalmic solution on the intra‐ocular pressure rise induced by suxamethonium and tracheal intubation
Authors: Bricker S. R. W. , McGalliard J. N. , Mercert N. P. , Smith G. T. H. , Trimble R. B. , Mostafa S. M. 
Published: February 2007

SummaryThirtv patients received topical application of either timolol ophthalmic solution 0.25%, or normal saline, 2 h before elective ophthalmic surgery in a double‐blind study. The responses to suxamethonium and tracheal intubation were compared by measuring intra‐ocular pressure before induction of anaesthesia, 1 mm after administration of thiopentone 2–4 mg·kg−1 min after administration of suxamethonium 1 mg·kg−1, and I, 2.5 and 5 min after tracheal intubation. There was no significant difference between the groups.
Difficulty in extubation
Authors: BROCK‐UTNE J. G. , JAFFE R. A. , ROBINS B. , RATNER E. 
Published: February 2007

SummaryDifficulties in removing the tracheal tube from the trachea are relatively uncommon. We report here a case of difficult extubation which was precipitated by pulling off the pilot balloon and valve assembly in order to deflate the cuff.
Preparation of the critically ill for interhospital transfer
Authors: RUNCIE C. J. , REEVE W. R. , WALLACE P. G. M. 
Published: February 2007

SummaryChanges in monitoring and therapy during the preparation of 100 critically ill patients for interhospital transfer by a specialist team were documented prospectively with the aim of providing guidelines for nonspecialists. Severity of illness scores were recorded before and after preparation. Median duration of preparation for ambulance journeys was 50 min and for aeroplane journeys was 82 min. During preparation, a portable electrocardiogram and pulse oximeter were attached to 21 and 76 patients respectively and intra‐arterial pressure monitoring was continued or instituted in 88 patients. Supplemental oxygen and intravenous fluids were the therapies most commonly increased or instituted by the transport team; mechanical ventilation, positive end‐expiratory pressure and inotropic drugs were increased or instituted less frequently. Median therapeutic intervention scores before and after preparation were 21 and 23 respectively, highlighting the need to increase rather than withdraw support for transfer.
Intra‐operative patient‐controlled sedation
Authors: RUDKIN G. E. , OSBORNE G. A. , FINN B. P. , JARVIS D. A. , VICKERS D. 
Published: February 2007

SummaryPropofol and midazolam were compared for intra‐operative patient‐controlled sedation in 40 Asa 1 day patients undergoing surgical extraction of third molar teeth under local anaesthesia. All patients initially received 0.7 ng.kg−1 fentanyl. Patients in the propofol group self‐administered 20 mg (2 ml over 6 s) bolus doses of propofol; successful demands averaged 8.0 (SD 4.4) and unsuccessful demands (during the 1 min lockout period) 2.8 (SD 4.1). The midazolam group self‐administered 0.5 mg (2 ml over 6 s) bolus doses and averaged 14.0 (SD 6.3) and 17.6 (SD 19.8) successful and unsuccessful demands respectively. Postoperative memory, measured with delayed free recall, and postoperative mental performance, measured with the frequency accrual speed test index, were both significantly less impaired in the propofol group. Although there was no significant difference in patient satisfaction, measured postoperatively, propofol was judged the more suitable agent for patient‐controlled sedation, because of its more rapid response to fluctuating intra‐operative requirements, superior recovery characteristics and beneficial effect on mood.
Propofol and hypothermic cardiopulmonary bypass
Authors: LAYCOCK G. J. A. , ALSTON R. P. 
Published: February 2007

SummaryThe effects of propofol during low flow (1.6 l.min−1.m−2) hypothermic (27–29°C) cardiopulmonary bypass on systemic haemodynamic and metabolic variables were studied in 20 patients in a parallel group comparison. Patients in the control group underwent two consecutive control periods, whereas those in the propofol group underwent a control period followed by a ‘propofol’ period during which they received an intravenous bolus of propofol 5 mg.kg−1 followed by an infusion at a rate of 20 mg.kg−1.h−1. Haemodynamic and metabolic variables were measured at the end of each period. The propofol group showed a significant reduction in both systemic vascular resistance (p < 0.001) and systemic oxygen uptake (p < 0.05). There was a small but significant fall in lactate in the control group (p < 0.02); however, there was no significant change in the propofol group. These findings could indicate impaired tissue perfusion, although they more likely indicate systemic metabolic depression with washout of lactate from previously hypoperfused tissues.
Thoracic epidural infusion for postoperative pain relief following abdominal aortic surgery: bupivacaine, fentanyl or a mixture of both?
Authors: GEORGE K. A. , CHISAKUTA A. M. , GAMBLE J. A. S. , BROWNE G. A. 
Published: February 2007

SummaryThirty patients who had undergone elective abdominal aortic surgery were studied in a prospective, randomised double‐blind comparison of thoracic epidural 0.2% bupivacaine alone, thoracic epidural fentanyl alone and thoracic epidural 0.2% bupivacaine combined with fentanyl. Pain relief, pulmonary function, cardiovascular stability and side effects were assessed. Pain relief was excellent in the combined bupivacaine‐fentanyl series, being significantly better than the other groups (p < 0.05) during the entire study period and was not accompanied by hypotension. Forced expiratory parameters were reduced in all groups throughout the study to 50–60% of the pre‐operative values, but there were no significant differences between groups. The incidence of side effects attributable to either epidural bupivacaine or fentanyl was low. This study supports the increasing use of epidural infusion analgesia for postoperative pain management after abdominal surgery.
The human wedge
Authors: Goodwin A.P.L. , Pearce A.J. 
Published: February 2007

SummaryThe important part of resuscitation in late pregnancy is the relief of aortocaval compression. A manoeuvre to relieve aortocaval compression (the human wedge) is described and evaluated. Eighteen qualified midwives performed basic life support in the supine and wedged position employing the human wedge. Performance was assessed using the Laerdal Resusci Anne Skillmeter. There was no difference (p = 0.4761) in performance of mouth‐to‐mouth expired air ventilation between the two positions. External cardiac compressions were performed significantly better (p = 0.0005) in the wedged position than in the supine position. The human wedge may provide an alternative to other methods of relieving aortocaval compression.
Patient‐controlled analgesia: a double‐blind study in burn patients
Authors: CHOINIERE M. , GRENIER R. , PAQUETTE C. 
Published: February 2007

SummaryA double‐blind controlled study was performed to assess the efficacy and safety of patient‐controlled analgesia in burn patients. This method was compared with conventional analgesic therapy consisting of intermittent intravenous morphine injections. Twenty‐four adult patients hospitalised for burn injuries participated in the study. The McGill Pain Questionnaire, visual analogue scales and verbal‐numeric scales were administered at regular intervals to measure various components of the patients' pain experience, degree of pain relief, anxiety levels, adverse side effects and overall treatment efficacy. Although statistical significance was found in only one measure, the results suggested better pain control in patients who were administered morphine by patient‐controlled analgesia as compared with intermittent injections. Analysis of the side effects showed no difference between the groups. The amount of morphine administered over the trial period was also similar for the two groups but considerable interpatient variability was seen. Although further research is needed to determine the conditions for optimal use of patient‐controlled analgesia, it is concluded that it is a safe, effective and improved method for controlling pain in selected burn patients.
Fibreoptic intubation in cicatricial membranes of the pharynx
Authors: DIVATIA J. V. , UPADHYE S. M. , SAREEN R. 
Published: February 2007

SummaryTwo patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. In both patients, a single opening in the membrane provided access to both the larynx and oesophagus. Fibreoptic intubation allowed both a thorough assessment of the pathology and subsequently the passage of a cuffed tracheal tube to secure the airway. To overcome the problem of respiratory obstruction while thefibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre‐oxygenation and voluntary hyperventilation followed by breath‐holding during bronchoscopy, was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes fibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx.
Isosorbide dinitrate spray
Authors: Bijoria K. , Wig J. , Bajaj A. , Sapru R. P. 
Published: February 2007

SummaryWe evaluated the efficacy of isosorbide dinitrate buccal spray (Isomack) in attenuating the cardiovascular response to laryngoscopy and tracheal intubation in 60 patients undergoing elective surgery under general anaesthesia. Patients were allocated to one of three groups of 20 patients each. Group 1 patients were administered placebo buccal spray 90 s before induction of anaesthesia. Groups 2 and 3 had isosorbide dinitrate spray 30 and 90 s before induction of anaesthesia. Systolic, diastolic and mean arterial pressures and heart rate were monitored. After the spray, group 3 patients had a significant decrease in systolic arterial pressure (p < 0.01). At 1 min after intubation, systolic, diastolic and mean arterial pressures showed a significant increase in group 1 patients (24.9 mmHg, 14.2 mmHg and 18.7 mmHg respectively). In contrast, groups 2 and 3 showed a significant decrease in these parameters (p < 0.01). Although significant tachycardia was present following intubation in all the three groups, the degree of tachycardia was greater in groups 2 and 3 (p < 0.01).
Delayed profound respiratory depression after premedication with trimeprazine
Authors: CHAMBERS F. A. , O'LEARY E. , GORMLEY P. K. , FLYNN N. M. 
Published: February 2007

SummaryDelayed, profound respiratory depression occurred in a 4‐year‐old boy, who had been premedicated with trimeprazine 4 h after tonsillectomy. This is a rare, but potentially fatal idiosyncratic reaction.
An evaluation of the Rapid Infusion System
Authors: ROTHEN H. U. , LAUBER R. , MOSIMANN M. 
Published: February 2007

SummaryThe performance of the Rapid Infusion System was evaluated in the laboratory. Using a conventional mixture of two units of packed red cells, two units of fresh frozen plasma and 500 ml crystalloid, a single line and a driving pressure of 300 mmHg, the highest flow in our study was 970 ml.min−1 (2.8 mm catheter, no stopcock). With a 1.6 mm venous cannula the measured flow was 640 ml.min−1. Additional diluting of the standard ‘blood cocktail’ did not add much to the performance of the system. When primed with tap water 21°C (12°C respectively), the fluid at the outlet of the system reached a maximum temperature of 37.8°C (37.4°C) after 6 min at a flow of 400 ml.min−1. At flows higher than 1150 ml.min−1 (priming with 12°C tap water: 800 ml.min−1), the system slowed down to flows of 700 to 1000 ml.min−1 in order to maintain an adequate temperature. We conclude, that the Rapid Infusion System is a valuable tool for situations where a rapid but controlled replacement with warmed blood at rates up to at least 1100 ml.min−1 is needed. The use of large bore intravenous catheters and avoiding additional resistors such as standard 3‐way stopcocks is highly recommended.
A multiple dose comparison of combinations of ibuprofen and codeine and paracetamol, codeine and caffeine after third molar surgery
Authors: MCQUAY H. J. , CARROLL D. , GUEST P. , JUNIPER R. P. , MOORE R. A. 
Published: February 2007

SummaryIn a randomised, double‐blind, double‐dummy, multiple dose, crossover study in 30 patients we compared an ibuprofen/codeine combination (400 mg ibuprofen/25.6 mg codeine phosphate) with a paracetamol/codeine/caffeine combination (1 g paracetamol/ 16 mg codeine phosphate/60 mg caffeine) for pain relief over 6 days after two‐stage bilateral lower third molar removal. The ibuprofen combination produced significantly greater analgesia than the paracetamol combination, both on single‐dose analysis of the first and second days and on multiple‐dose measures for days 1, 2, 3 and 4. The mean incidence of adverse effects over the 6 days was 20% for both combinations. This trial design (crossover with multiple dosing in outpatients) is a sensitive way of testing for analgesia, and is potentially more predictive of adverse effect problems than single‐dose studies. It confirms that multiple dosing may show increased efficacy.
Patient‐controlled sedation using propofol in day surgery
Authors: GRATTIDGE P. 
Published: February 2007

SummaryPatient‐controlled sedation using propofol was studied in 30 unselected patients aged 26–72 years undergoing day case general surgical or orthopaedic procedures under local or regional anaesthesia. Using a fixed propofol dose of 0.7mg.kg −1 body weight, the technique provided anxiolysis and sedation with few side effects and a high degree of patient satisfaction. Increasing age was significantly correlated with a deeper maximum level of sedation (p < 0.001), indicating a need for a lower bolus dose in the higher age groups. Interpatient variability in propofol requirement was reflected in the lack of significant correlation between propofol dose and procedure duration (p = 0.095) and patient age (p = 6.72).