bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case of malignant hyperthermia?
Authors: BROEKEMA A. A. , BOERSMA G. A. , HENNIS P. J. 
Published: February 2007

SummaryAn acute episode of a malignant hyperthermia‐like syndrome is described which occurred after suxamethonium and isoflurane anaesthesia in a 41‐year‐old healthy male patient undergoing a minor elective hand operation. Dantrolene therapy rapidly reversed the life‐threatening signs. Laboratory results appeared to confirm the suspicion of malignant hyperthermia. However, the in vitro contracture test, which was carried out according to the standards of the European Malignant Hyperthermia Group, was equivocal.
A low‐flow to‐and‐fro system
Authors: KADIM M. Y. , LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryThe insertion of a long deadspace tube between an anaesthetic breathing system and a ventilator produces only imperfect separation of the breathing system gas from the driving gas. This laboratory study has investigated different connecting tubes to establish the maximum tidal volume possible before ventilator gas contaminates the gas in a low‐flow to‐and‐fro system (fresh gas flow 1 litre/minute). A larger volume tube enables the use of larger tidal volumes, and plastic corrugated tubes are slightly better than black rubber corrugated tubes in this respect. The maximum tidal volume possible without contamination decreases as ventilatory rate increases, but the maximum minute volume is increased. A 22 mm plastic corrugated tube of internal volume 1.5 litres should be adequate for clinical use with the to‐and‐fro system described in this study at afresh gas flow of 1 litre/minute.
Evaluation of a small soda lime canister in a to‐and‐fro system
Authors: KADIM M. Y. , LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryThe main disadvantages of the to‐and‐fro system (the bulky canister and the progressive increase in apparatus deadspace) may be overcome by the use of a smaller canister. In this laboratory study, we have evaluated a 160 g canister in a low‐flow to‐and‐fro system (fresh gas flow 1 litre I minute). Two carbon dioxide productions of 150 and 200 ml/minute were simulated. The mean times to exhaustion, defined here as a 0.5 kPa rise in end‐tidal Pco2, were 112 and 79 minutes in the 150 and 200 ml/minute carbon dioxide groups respectively. Ventilation to normacapnia or hypocapnia did not affect the times to exhaustion. The soda lime absorbed 16 litres of carbon dioxide before exhaustion, and this was not affected by minute volume or carbon dioxide production. A small soda lime canister is suitable for carbon dioxide absorption in a low‐flow to‐and‐fro system for ventilated adults.
The effect of intravenous clonidine on the forearm circulation
Authors: CARABINE U. A. , WRIGHT P. M. C. , KEARNEY E. , HOWE J. P. , MOORE J. 
Published: February 2007

SummaryThe effect of two doses of clonidine on forearm blood flow was compared with an inert treatment using mercury strain gauge venous occlusive plethysmography. In the clonidine treated groups, forearm blood flow was unaffected in the resting state, but decreased sharply with tracheal intubation. In the saline group, blood flow increased with intubation. Forearm vascular resistance increased in the clonidine treated groups, but decreased in the saline group. These results suggest that clonidine has a peripheral action in anaesthetised normotensive individuals, and is not a purely centrally acting drug.
The effect of a priming epidural injection of adrenaline on epidural blockade with bupivacaine
Authors: BARANOWSKI A. P. , DEAN Y. , PITHER C. E. 
Published: February 2007

SummaryTwenty‐four patients receiving epidural anaesthesia were studied to test the hypothesis that 1:200 000 adrenaline administered into the epidural space 5 minutes before 20 ml bupivacaine 0.5% would improve nerve block and delay systemic absorption of the local anaesthetic. Group A/B received 20 ml adrenaline 1:200000 5 minutes before 20 ml bupivacaine 0.5%, group S/BA 20 ml saline followed by 20 ml bupivacaine 0.5% with 100 pg adrenaline, and group S/B saline 20 ml followed by 20 ml plain bupivacaine 0.5%. Mean maximum plasma concentrations of bupivacaine tended to be lower in the adrenaline groups. A delay in the time to peak plasma concentration of bupivacaine was noted in the A/B group; this indicated that priming with adrenaline may be effective at delaying early systemic uptake of the local anaesthetic. In both adrenaline groups a more prolonged epidural block and increased efficacy were noted, although this was only significant for the duration of block at T6 (p = 0.023) and duration of motor block at Bromage level 1 (p = 0.016) in group A/B. There seems little clinical advantage in administering adrenaline 5 minutes before bupivacaine.
Serious complications with dextran‐70 despite hapten prophylaxis
Authors: BERG E. M. , FASTING S. , SELLEVOLD O.F.M. 
Published: February 2007

SummaryDextran is used clinically for plasma volume expansion, improvement of blood flow and thromboprophylaxis, but has been associated with untoward side effects. Immunoprophylaxis with dextran I (hapten), before the infusion of dextran‐70, has reduced the incidence of serious dextran‐induced anaphylactoid reactions. We report three cases of severe reactions occurring during anaesthesia in spite of immunoprophylaxis. One patient given dextran‐ 70 before Caesarean section had a mild reaction but gave birth to a child with serious brain damage. One patient with an extremely high titre of dextran‐reactive antibodies died from myocardial infarction and another patient recovered without sequelae. From our experience we conclude that dextran‐induced anaphylactoid reactions are still a serious problem despite immunoprophylaxis. Dextran‐70 should be avoided during pregnancy and should not be given during Caesarean section before delivery of the child. Even in the presence of immunological prophylaxis, vigilant observation of the patient is essential and resuscitation equipment must be available when starting a dextran infusion.
A ‘postspinal headache’ associated with incidental intracranial pathology
Authors: DUTTON D. A. 
Published: February 2007

SummaryA 28‐year‐old woman developed symptoms of raised intracranial pressure associated with an obstructive hydrocephalus following a spinal anaesthetic administered for a Kiellands rotation forceps delivery. A diagnosis of an unverified pineal body tumour was made after computerised axial tomography scanning and the symptoms were effectively treated by the insertion of a ventriculo‐peritoneal shunt. This unusual case demonstrates the importance of careful history taking and neurological examination where symptoms of postspinal headache persist.
Variable apparatus deadspace
Authors: SCOTT P. V. , JONES R. P. 
Published: February 2007

SummaryA variable apparatus deadspace was used to maintain normocapnia during artificial ventilation of the lungs in anaesthetised adults. End‐tidal carbon dioxide tension could be varied, if the need arose, within the range 4.0–5.2 kPa in both open and circle breathing systems when a fixed tidal volume of 12 ml.kg−1 and minute volume ventilation of 120 ml.kg−1.min−1 were employed.
Antireflux valves in intravenous opioid analgesia: are they necessary?
Authors: Turner G. A. , Murphy D. F. 
Published: February 2007

SummaryA study was conducted in patients receiving intravenous opioid analgesia to determine the incidence and degree of retrograde flow along the parallel gravity‐driven infusion line. From 1187 hours of observations retrograde flow was found in 2.5% of the total time. In 70% of these cases this was equivalent to less than 1 mg of pethidine and in 96% this was equivalent to less than 5 mg of pethidine. The need for routine use of antireflux valves during intravenous opioid analgesia is therefore questioned.
Postoperative pain control
Authors: Semple P. , Jackson I. J. B. 
Published: February 2007

SummaryA survey of postoperative analgesia in 195 anaesthetic departments in England and Wales was undertaken. The results showed that 64% of respondents were dissatisfied or very dissatisfied with the present situation. Large differences were demonstrated between what was regarded as the safest technique and what would form the ideal management of postoperative pain.
Double‐blind comparison of epidural diamorphine and intramuscular morphine after elective Caesarean section, with computerised analysis of continuous pulse oximetry
Authors: STEVENS J. D. , BRAITHWAITE P. , CORKE C. F. , MADEJ T. H. , WHEATLEY R. G. 
Published: February 2007

SummaryA randomised, double‐blind comparison of the efficacy, duration of action and side effects of two analgesic regimens following elective epidural Caesarean section is described. Patients received epidural diamorphine 3 mg or intramuscular morphine 10 mg in the immediate postoperative period. Time to next analgesia was longer after epidural diamorphine (11.0 hours) compared to intramuscular morphine (6.5 hours) (p < 0.05). In addition, a greater number of patients in the diamorphine group had a pain score < 2.5 cm at 5 hours (p < 0.05). However, more patients in the diamorphine group required catheterisation and suffered emetic sequelae, whereas more patients in the morphine group were sedated at 8 hours. Ten patients in each group had continuous pulse oximetry performed overnight after administration of the trial medications. Neither group demonstrated evidence of hypoxia.
The haemodynamic effects of bronchoscopy Comparison of propofol and thiopentone with and without alfentanil pretreatment
Authors: HILL A. J. , FENECK R. O. , UNDERWOOD S. M. , DAVIS M. E. , MARSH A. , BROMLEY L. 
Published: February 2007

SummaryThe haemodynamic response to bronchoscopy under general anaesthesia was investigated. Forty patients were allocated at random to receive either thiopentone or propofol; half the patients in each group received in addition 18 μg/kg of alfentanil one minute before induction of anaesthesia. The heart rate, noninvasive blood pressure and Holter ECG was monitored in all patients. Significant increases in heart rate (p < 0.05), systolic and diastolic arterial pressures (p < 0.01) occurred in the thiopentone only group, following bronchoscopy. Systolic and diastolic arterial pressure decreased in patients receiving thiopentone plus alfentanil, following induction of anaesthesia and laryngoscopy (p < 0.05). No significant haemodynamic changes were seen in either of the groups which received propofol. ST segment changes on subsequent Holter analysis were seen in four patients, but there were no significant differences between the groups. Anaesthesia with propofol alone provides adequate haemodynamic stability for bronchoscopy and the addition of alfentanil is superfluous.
An unusual cause of obstructive emphysema
Authors: BUIST R. J. 
Published: February 2007

SummaryA 6‐month‐old child presented with a history, physical signs and radiographic findings suggestive of the presence of a foreign body in the tracheobronchial tree. However, further investigation revealed extrinsic compression of the left main bronchus by a grossly enlarged left atrium. Treatment of the patient's heart failure resulted in resolution of the signs. Anomalous origin of the left coronary artery was found to be the cause.
A comparison of APACHE II and a clinical sickness score
Authors: SINCLAIR J. R , MAGEE P. T. , GOULD T. H. , COLLINS C. H. 
Published: February 2007

SummaryThe aim of this study was to compare the predictive power of a simple illness severity score (Clinical Sickness Score) to that of APACHE II in a District General Hospital intensive therapy unit. A prospective comparison was carried out on 97 consecutive adult patients whose severity of illness was scored one hour after admission using both the Clinical Sickness Score and APACHE II. Intensive Therapy Unit and hospital outcomes were recorded for each patient. The Clinical Sickness Score and APACHE II identified survivors and nonsurvivors with similar power (p < 0.001). There was a highly significant correlation between the two scoring systems for hospital survivors and nonsurvivors together (r = 0.5418, r2= 0.28, p = < 0.0001) and for hospital survivors alone (r = 0.6102, r2= 0.37, p = 0.0001). Correlation for hospital nonsurvivors was not significant (r = 0.1629, r2= 0.027, p = 0.3134). The positive predictive values of APACHE II were between 5% and 10% more sensitive than the Clinical Sickness Score for hospital outcome. Admission Clinical Sickness Score and APACHE II scores had similar predictive power in this study.
Propofol in short gynaecological procedures
Authors: SANDERS L. D. , CLYBURN P. A. , ROSEN M. , ROBINSON J. O. 
Published: February 2007

Summary Recovery was assessed over 48 hours after anaesthesia with propofol or thiopentone as sole anaesthetic agent in 36 unpremedicated gynaecological patients. Immediate recovery, as measured by the Steward scale, was shown to be quicker for the patients given propofol. At one hour postoperatively the thiopentone group showed impaired visual‐motor coordination on the aiming test (p < 0.01) and dexterity task (p < 0.05), and a slowing of reaction time (p < 0.01). Patients given propofol showed only an increase in reaction time (p < 0.05). By 2 hours the thiopentone group showed impairment only in the aiming task (p < 0.05). No further significant impairment was detected at 4, 24 or 48 hours. However, patients reported symptoms throughout the 48 hours indicative of residual drug effects. There was a substantial practice effect with some tests which may have obscured impairment. It can be argued therefore that the better recovery profile after propofol is still evident at 24 hours.
Anaesthesia for a patient with giant axonal neuropathy
Authors: MITCHELL A. , MOSKOVITS P. E. 
Published: February 2007

SummaryGiant axonal neuropathy is a generalised disorder of cytoplasmic intermediate filaments which particularly involves the peripheral and central nervous systems. In this paper we describe a child with giant axonal neuropathy and discuss the anaesthetic management in the light of the pathology and physiology of the condition.
Resedation after bolus administration of midazolam to an infant and its reversal by flumazenil
Authors: COLLINS S. , CARTER J. A. 
Published: February 2007

SummaryA 4‐month‐old infant was sedated with bolus doses of midazolam, and after initial apparent complete arousal, became unresponsive and hypotonic. Administration of flumazenil enabled differentiation of a residual drug effect from an intracerebral event.
The laryngeal mask airway in children
Authors: Rowbottom S. J. , Simpson D. L. , Grubb D. 
Published: February 2007

SummaryClinical and fibreoptic assessment of the positioning of the laryngeal mask airway was performed in 100 children. Clinical observation indicated a patent airway in 98% and severe airway obstruction in 2% of cases. Perfect positioning, as judged by fibreoptic laryngoscopy, was found in 49% and the epiglottis was within the mask in 49%. Fibreoptic evidence of partial airway obstruction in 17%, was not detected clinically.
Colloid solutions in the critically ill
Authors: STOCKWELL M. A. , SCOTT A. , DAY A. , RILEY B. , SONI N. 
Published: February 2007

SummaryAll patients admitted to an Intensive Care Unit were assigned randomly to one of two groups, A and B. Group A received colloid volume replacement as 4.5% albumin whilst group B received a synthetic colloid, polygeline. This study describes the changes in serum albumin concentration in survivors and nonsurvivors in the two groups during their stay in the Intensive Care Unit. The incidences of renal failure and pulmonary oedema were also assessed. Serum albumin concentration decreased in all nonsurvivors. In survivors the serum albumin concentration decreased to a greater extent in the synthetic colloid group than in the albumin group. Despite the differences in serum albumin concentration there were no significant differences between the groups in the incidences of pulmonary oedema or renal failure.
Response to the Valsalva manoeuvre after spinal anaesthesia
Authors: MACFIE A. G. , BRIMACOMBE J. 
Published: February 2007

SummaryThe waveform from a Criticare 504 pulse oximeter was recorded during the performance of a standard Valsalva manoeuvre in 20 patients before and after spinal anaesthesia. The pulse oximeter waveform showed changes typical of the expected heart rate and pulse volume changes seen in each phase of the Valsalva manoeuvre. There were no significant changes in the typical pulse volume changes of the Valsalva manoeuvre after spinal anaesthesia, which achieved a sensory block ranging in upper extent from T3‐T12. There was, however, a significant delay in recovery of the pulse volume in phase 4 of the Valsalva manoeuvre after spinal anaesthesia from a mean (SD) of 3.1 (0.9) s to 6.2 (3.1) s (p < 0.05). There was also a significant reduction in reflex bradycardia seen in phase 4. However, this was found only at 5, 10 and 15 min after spinal anaesthesia and was not associated with a significant change in Valsalva ratio or maximum‐to‐minimum rate ratio. The study confirms that the normal response to a standard Valsalva manoeuvre is suppressed only mildly during spinal anaesthesia in normovolaemic fit patients.
The response times during anaesthesia of pulse oximeters measuring oxygen saturations during hypoxaemic events
Authors: BROOME I. J. , HARRIS R. W. , REILLY C. S. 
Published: February 2007

SummaryEpisodes of desaturation were recorded simultaneously by computer from two Ohmeda Biox 3700 pulse oximeters, one with an ear and one with a finger probe, on patients undergoing anaesthesia. Over a period of 6 months, 28 episodes of desaturation were detected. Analysis of the recordings showed the mean minimum saturations recorded for ear and finger probes were 86.3% and 83.5% respectively (p < 0.01). The mean delay for finger compared to ear pulse oximetry was 4.4 s (p < 0.01). Analysis at different saturation levels showed finger probe responses to be significantly slower than ear probe responses at saturations equal to and above 91% (p < 0.05). At saturation levels of 90% or less no significant difference in probe response times were found.
Effect of fentanyl on the circulatory responses to orotracheal fibreoptic intubation
Authors: SMITH J. E. , KING M. J. , YANNY H. F. , POTTINGER K. A. , POMIRSKA M. B. 
Published: February 2007

SummaryThe effectiveness of fentanyl in attenuating the pressor and heart rate response to orotracheal fibreoptic intubation under general anaesthesia was assessed in 60 healthy patients undergoing elective surgery. Patients were randomly assigned to receive either fibreoptic intubation with or without fentanyl 6μg.kg−1 or traditional Macintosh intubation with fentanyl 6μg.kg−1. A standardised general anaesthetic was administered which included temazepam premedication, thiopentone, atracurium, oxygen, nitrous oxide and isoflurane. The pressor response to fibreoptic intubation was suppressed in those patients who received fentanyl and was similar to that seen in the Macintosh‐fentanyl group of patients. The heart rate response to fibreoptic intubation was also significantly reduced in the patients who received fentanyl, but, in contrast, was still significantly greater than that in the Macintosh‐fentanyi group. Fentanyl 6μg.kg−1 appears to have a useful place in attenuating the cardiovascular effects of fibreoptic intubation under general anaesthesia.
Finger blood content, light transmission, and pulse oximetry errors
Authors: CRAFT T. M. , LAWSON R. A. , YOUNG J. D. 
Published: February 2007

SummaryThe changes in light emitting diode current necessary to maintain a constant level of light incident upon a photodetector were measured in 20 volunteers at the two wavelengths employed by pulse oximeters. Three states of finger blood content were assessed; exsanguinated, hyperaemic, and normal. The changes in light emitting diode current with changes in finger blood content were small and are not thought to represent a significant source of error in saturation as measured by pulse oximetry.
Malignant hyperthermia
Authors: HARRISON G. G. , ISAACS H. 
Published: February 2007

SummaryThis paper reports previously unpublished accounts of the deaths in 1915 and 1919 of two members of the same family during general anaesthesia. The deaths were subsequently ascribed to a‘hereditary susceptibility to chloroform. Contemporary evidence is presented which suggests that these deaths were among the very earliest examples of malignant hyperthermia to be described.
Epidural infusion of bupivacaine and diamorphine for postoperative analgesia
Authors: Hobbs G. J. , Roberts F. L. 
Published: February 2007

SummaryAn audit of postoperative epidural analgesia in a District General Hospital is presented. Three hundred and forty‐eight patients received epidural infusions of a bupivacaine and diamorphine mixture, and were managed on general surgical wards using a standard protocol of observations and instructions. Good analgesia was achieved in 339 (97%) patients. Respiratory depression, defined as a respiratory rate of eight breaths.min−1 or less, occurred in 22 (6%) patients, was of gradual onset, and was simply and successfully managed without morbidity. There were no respiratory arrests. Other complications, and the significance of catheter insertion level are discussed.
Pipecuronium versus high dose vecuronium
Authors: HARROP‐GRIFFITHS W. , FAUVEL N. , PLUMLEY M. , FELDMAN S. 
Published: February 2007

SummaryThe onset time and tendency to cumulation of pipecuronium and high‐dose vecuronium were studied during nitrous oxide anaesthesia supplemented with isoflurane. Pipecuronium 0.06 mg·kg−1 had a similar duration of action to vecuronium 0.015 mg·kg−1 (42 vs 49 min). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p < 0.01). The use of pipecuronium was associated with marked cumulation.
Cause of death after critical illness
Authors: RIDLEY S. , PURDIE J. 
Published: February 2007

SummaryThis study reports the causes of death after discharge following treatment of life‐threatening illness on an Intensive Therapy Unit. Details of survivors discharged between June 1985 and December 1988 were sent to the Registrar General for Scotland who subsequently issued copies of death certificates of those patients who had died between discharge and 1 January 1990. The results show that the commonest causes of death after discharge were malignancy and respiratory failure, although there is wide variation in the post‐discharge mortality rates for different diagnostic categories. The admission diagnoses were identical to, or contributed to, the causes of death in 64% of patients who died after discharge. Eighty‐five percent of patients who died from the same condition which prompted admission did so within a year following discharge, but after 2 years no deaths were attributed to the admission diagnosis.
Torsade de pointes and long QT syndrome following major blood transfusion
Authors: KULKARNI P. , BHATTACHARYA S. , PETROS A. J. 
Published: February 2007

SummaryWe report a rare complication following transfusion of a large volume of blood in an adult patient. An electrophysiological disturbance of the cardiac cycle with prolongation of the QT interval developed, which was followed by recurrent episodes of torsade de pointes, a unique form of ventricular tachycardia. The most likely cause of this acquired long QT syndrome was hypomagnesaemia secondary to massive blood transfusion. Treatment with a magnesium infusion restored the QT interval to normal and temporary ventricular pacing prevented further ventricular arrhythmias.
Anaesthesia in a patient with Noonan's syndrome and cardiomyopathy
Authors: CAMPBELL A. M. , BOUSFIELD J. D. 
Published: February 2007

SummaryA 5‐year‐old girl with Noonan's syndrome and a hypertrophic cardiomyopathy presented for myelography and subsequently, laminectomy. The anaesthetic management of the patient is described and the potential problems of the facial, cardiovascular and skeletal abnormalities associated with the condition are discussed.