bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidural morphine in the elderly
Authors: KLINCK J. R. , LINDOP M. J. 
Published: February 2007

SummaryThe effectiveness of epidurally administered morphine in the relief of pain after upper abdominal surgery was assessed in a controlled study involving 20 patients aged 61 to 78 years. Analgesia provided by epidural morphine was comparable to that obtained in matched patients given an intramuscular régime. The total dose required by the epidural route was less than one‐fifth that required intramuscularly, and sedation was correspondingly reduced. Postoperative respiratory mechanics, however, were not significantly improved and delayed respiratory depression was observed in one patient. It is concluded that in elderly patients undergoing upper abdominal surgery the risks related to the use of morphine by the epidural route outweigh the marginal advantages it may offer over conventional analgesic techniques.
Barbotage and spinal anaesthesia
Authors: NIGHTINGALE P. J. 
Published: February 2007

SummarySubarachnoid block was performed with 0.5% plain bupivacaine in 67 patients with patients in the lateral position and the table horizontal. Thirty‐six patients had a single injection while in the remaining 31 patients barbotage was used. Injection rates and aspiration rates were constant in both groups at 0.33 ml/second. Mean volumes of bupivacaine used in the two groups were 3.30 and 3.35 ml, respectively. The mean spread of analgesia after 30 minutes was 0.9 dermatomes higher in the group which received a single injection, and this was not statistically significant. The range of spread of analgesia was large in both groups, there was no correlation between spread of analgesia and volume of local anaesthetic used, and there was no correlation between age of patient and spread of analgesia in either group. Control of the level of analgesia during isobaric spinal block is difficult, and is not facilitated by barbotage.
Misconnexion of a cuffed ‘speaking’ tracheostomy tube
Authors: FENECK R. O. , SCOTT WENDY E. 
Published: February 2007

SummaryTracheal dilatation in a patient with a cuffed vocal‐aid plastic tracheostomy tube is described. Dilatation followed the inadvertent connexion of continuous flow oxygen, necessary for voice production, to the pilot tube of the tracheal cuff. A modification of the tube is described, and recommendations for future use of such tubes are discussed.
Mannitol, osmolality and steroids during renal transplantation
Authors: CHARTERS P. 
Published: February 2007

SummaryMannitol did not have an exaggerated effect on plasma potassium when administered to twelve patients undergoing renal transplantation. Unexpected rises in plasma osmolality, greater than those recorded after mannitol, were observed in two of the patients. In these two patients the osmolality changes were due to sudden hyperglycemia and followed methylprednisolone therapy (given for immunosuppression).It is suggested that under certain circumstances, such changes in osmolality may lead to a rise in plasma potassium comparable to the effect of mannitol. One of the two patients with the rise in glucose and osmolality did have a rise in plasma potassium.
Epidural analgesia and previous Caesarean section
Authors: UPPINGTON J. 
Published: February 2007

SummaryA series in which six cases of ruptured uterus occurred following previous lower segment Caesarean section, out of a total of 222 ‘trials of scar’, is presented, and the literature reviewed in an attempt to clarify the term ‘relative contra‐indication’ as applied to this clinical circumstance. The symptoms and signs of ruptured uterus likely to be blocked by an epidural, i.e. maternal tachycardia, scar tenderness and continuous lower abdominal pain, have been shown to be either unreliable (tachycardia and tenderness) or frequently not to occur at all (pain). When pain does occur it is not necessarily masked by an epidural. It is concluded that previous lower segment Caesarean section is not a contraindication to epidural analgesia in a subsequent labour provided certain conditions are fulfilled.
A new anaesthetic breathing system combining Mapleson A, D and E principles
Authors: HUMPHREY D. 
Published: February 2007

SummaryA new simple anaesthetic breathing system is described which has been designed to incorporate into a single system advantages of Mapleson A, D and E type systems. Coaxial and non‐coaxial versions are available. The system can be used for adults, children or neonates and allows both spontaneous or controlled ventilation with low fresh gas flows at all times.As a Mapleson A system for spontaneous respiration a considerable saving of anaesthetic gases and vapours is achieved since, for adults, the new system requires a lower fresh gas flow even than that for the Magill. For children breathing spontaneously the system requires only one third of the fresh gas flow necessary for the Jackson Rees modification of Ay re's T‐piece. For controlled ventilation the system behaves as a modified Mapleson D/E (Bain type) system with the advantage of predictable CO2 tensions and good humidification. The system is safe, simple in design and operation, and is easily sterilized. Further it offers low resistance to expiration and facilitates scavenging at all times which, with low anaesthetic gas flows, permits complete theatre pollution control.Its potential application in academic and rural environments and major advantages over the circle absorber system are discussed.
Dose‐response relationships for infusions of Althesin or methohexitone
Authors: SEAR J. W. , PHILLIPS K. C. , ANDREWS C. J. H. , PRYS‐ROBERTS C. 
Published: February 2007

SummaryA technique is described for the determination of equipotent rates of infusion of intravenous hypnotic agents. Two end points have been defined; the rates needed to suppress the initial response to the surgical incision in 50% (ED50) and 95% (ED95) of patients receiving continuous infusion anaesthesia to supplement 67% nitrous oxide in oxygen. For patients aged 20–60 years, and premedicated with morphine 0.15 mg/kg intramuscularly, the ED50 values for Althesin (as alphaxalone) and methohexitone by infusion were 13.7 and 48.8 μg/kg/minute respectively. The ED95 values were 18.1 and 75.9 μg/kg/minute. For patients of a similar age premedicated with diazepam 10 mg orally, the ED50 values for Althesin and methohexitone were 18.5 and 66.0 μg/kgjminute respectively; while the ED95 values were 24.2 and 80.8μg/kg/minute.
Epidural versus intramuscular fentanyl
Authors: JUSTINS D. M. , KNOTT CHRISTINE , LUTHMAN JUDITH , REYNOLDS FELICITY 
Published: February 2007

SummaryIn a randomised double blind trial, 36 patients in the first stage of labour received either epidural or intramuscular fentanyl at the same time as the epidural test dose of bupivacaine. Analgesia was more rapid in onset and more complete in the epidural fentanyl group. Supplementary doses of bupivacaine were required within the first hour in 62% of the intramuscular fentanyl group compared with only 16% in the epidural group. Plasma fentanyl concentrations showed wide interindividual variation, but after epidural fentanyl the peak occurred earlier. There was no correlation between analgesia and plasma fentanyl concentration, and epidural fentanyl produced superior analgesia but a systemic contribution to this effect cannot be ruled out.
Pneumothorax in the neonatal period
Authors: JONES R. M. , RUTTER N. , COOPER A. C. , PULLAN C. R. 
Published: February 2007

SummaryThe incidence of pneumothorax in the neonatal period is reviewed. Most infants who developed a pneumothorax were undergoing intermittent positive pressure ventilation. The most common underlying pathology associated with pneumothorax was idiopathic respiratory distress syndrome. This was the only condition in which a pneumothorax occurred in spontaneously breathing patients. The development of a pneumothorax was not significantly related to gestational age, birth weight, high ventilator inflation pressure, maximum fractional inspired oxygen concentration or the method of delivery. Evidence is presented to suggest that the development of a pneumothorax is not primarily a complication of ventilation but is due to the more severe pulmonary pathology of infants who require ventilatory assistance. Whatever the mechanism, prompt diagnosis and treatment mean that this common complication does not necessarily increase mortality.
Circulation, respiration and serotonin levels in carcinoid patients during neurolept anaesthesia
Authors: TÖRNEBRANDT K. , NOBIN A. , ERICSSON M. , THOMSON D. 
Published: February 2007

SummaryRelease of hormones peri‐operatively in patients with metastatic carcinoids may lead to severe circulatory and respiratory disturbances. Fourteen patients with liver metastases were studied during 16 operations with a modified neurolept anaesthesia in order to evaluate the central haemodynamic and respiratory functions as well as plasma serotonin levels. The premedication in five patients was supplemented with levopromazine. During the 11 operations performed on patients not pretreated with levopromazine, no major significant fluctuations in circulatory or respiratory functions were recorded although big variations in serotonin plasma levels were measured. In the patients treated with levopromazine, however, significant changes were observed in heart rate, mean pulmonary artery pressure, cardiac index, and left and right ventricular stroke work especially during flushing episodes. However, these changes did not correlate with the changes in plasma serotonin levels. Modified neurolept anaesthesia without levopromazine pretreatment combined with careful monitoring seems to be a safe procedure for carcinoid patients. Using this type of anaesthetic procedure only one major complication occurred in connexion with 16 major operations and then in the postoperative period.
Unilateral cold neck
Authors: WATSON B. G. 
Published: February 2007

SummaryA case is reported of survival following accidental cannulation of the innominate artery during cardiopulmonary bypass. Coldness of the right side of the neck was noticed during cooling of the patient and is a useful new sign of misplacement of the aortic cannula. Confirmation of miscannulation of first the innominate then the left common carotid artery was obtained by palpation of the neck pulses during total cardiopulmonary bypass using a pulsatile pump.
Quinine overdose Prevention of visual damage by stellate ganglion block
Authors: BOSCOE M. J. , CALVER D. M. , KEYTE C. , AYRES J. G. 
Published: February 2007

SummaryA case of quinine poisoning is described. Stellate ganglion block was performed immediately on the basis of the clinical history of visual disturbance without waiting for physical signs to develop. There was no residual field defect despite the presence of toxic levels of the drug. It is suggested that stellate ganglion block may prevent development of visual field defects.
Increased cortisol excretion in chronic pain
Authors: DPhil R.A. Moore , Evans P.J.D. , FIMLS R.F. Smith , FFARCS J.W. Lloyd 
Published: February 2007

Summary Urine samples were collected from 67 patients attending a Regional Pain Unit for treatment of chronic pain. Patients treated with steroids or with any signs or symptoms of Cushing's syndrome were excluded. The urine Cortisol/ creatinine ratio was subsequently measured. Values for the urine Cortisol/creatinine ratio were elevated in 31% of the patients, and grossly elevated in some. These patients could not be differentiated from those with normal ratios on the basis of pain or mood scores, cause of pain or drug therapy; they tended to have pain of shorter duration. Possible interpretations of these results are discussed.
Anaesthesia in the morbidly obese
Authors: BUCKLEY F. P. , ROBINSON N. B. , SIMONOWITZ D. A. , DELLINGER E. P. 
Published: February 2007

SummarySeventy morbidly obese patients presented for upper abdominal surgery; 17% had pre‐existing cardiovascular disease and 23% pre‐existing respiratory disease. Twenty‐eight patients received general anaesthesia, plus narcotic analgesia postoperatively, and 42 general anaesthesia plus thoracic epidural analgesia intra‐ and postoperatively. Aspects of anaesthetic management are discussed and compared with previous similar reports. Doses of local anaesthetic for induction of epidural analgesia were less than those for the non‐obese but doses of local anaesthetic for maintenance of epidural analgesia were similar to those in non‐obese patients. Patients who had thoracic epidural analgesia required less volatile anaesthesia than the group who had general anaesthesia and narcotic analgesics. Postoperative respiratory complications were more common in patients with pre‐existing cardiovascular and respiratory disease, and occurred less frequently in patients who had thoracic epidural analgesia.
Oculocardiac reflex from the empty orbit
Authors: KERR W. J. , VANCE J. P. 
Published: February 2007

SummaryTwo cases of profound bradycardia (one progressing to asystole) during orbital surgery where the relevant eye had been removed years earlier are reported. Cessation of stimulation was followed by recovery of heart rate. Intravenous atropine prevented further bradycardia.
Midazolam—does it cause resedation?
Authors: Ruiz K. , Asbury A.J. , Thornton J.A. 
Published: February 2007

SummaryThe objective of this double blind study was to compare the sedation following the intravenous injections of midazolam in three dose levels (0.07, 0.10 and 0.15 mg/kg), and to assess the time taken after each dose to return to street fitness.Recovery was monitored by measurement of reaction time. The mean results for each dose were compared against placebo and each other using the Student's t‐test. All doses gave a significant (p < 0.05) lengthening of reaction time compared to placebo. The two highest doses gave similar results when compared to 0.07 mg/kg. but not when compared to each other. Reaction times always returned to control values within 3 hours of injection. The Deletion of Ps test was also employed. A significant correlation was found between the results of reaction time testing and the Deletion of Ps test.
Day‐case anaesthesia for termination of pregnancy
Authors: OGG T. W. , JENNINGS R. A. , MORRISON C. G. 
Published: February 2007

SummaryAn investigation was undertaken to assess the use of a total intravenous anaesthetic technique offentanyl and methohexilonc for outpatient vaginal termination of pregnancy. When compared with a technique offentanyl, methohexitone, nitrous oxide and trichloroethylene the total intravenous method caused snifter recovery, minimal side‐effects and no cardiovascular depression. However, both anaesthetic techniques produced significant postoperative reduction of memory for new facts when compared with a control group receiving no general anaesthesia. There is a need to continue the search for anaesthetic methods appropriate for day cases.
Postoperative analgesia provided by morphine infusion in children
Authors: BRAY R. J. 
Published: February 2007

SummaryA technique is described for using morphine by continuous infusion to relieve postoperative pain in children between the ages of 1 year and 15 years. The pain relief produced by the infusion was found to be significantly better than that produced by intramuscular injections of morphine given as required in 20 children after major surgery.
The MIE Carden ventilator
Authors: FLETCHER I. R. , CARDEN E. , HEALY T. E. J. , POOLE T. R. 
Published: February 2007

SummaryThe Carden ventilator is described and assessed when used in adult and paediatric modes against lest lungs with varying compliance and airways resistance. The ventilator proved to have limited ability to compensate for changes in test lung compliance and resistance. Repeated confirmation of tidal volume is mandatory, but the Carden combines simplicity with flexibility of design and may prove useful as a theatre ventilator.
Intramuscular and oral midazolam. Some factors influencing uptake
Authors: Hildebrand P.J. , Elwood R.J. , McClean E. , Dundee J.W. 
Published: February 2007

SummaryIntramuscular midazolam is better absorbed than when given orally. Addition of hyaluronida.se to the injection significantly increases uptake but causes a high incidence of pain at the injection site. Concurrent administration of oral midazolam and metoclopramide does not increase its uptake.
Neurological complications following aortic surgery
Authors: COSTELLO T. G. , FISHER A. 
Published: February 2007

SummaryA case of spinal cord ischaemia developing in a man aged 70 years following thoracic aortic surgery is reported. In contrast, two further cases associated with surgery for resection of coarctation of the aorta are described, in a younger age group. A review of the literature reveals a small but increasing incidence of reports of spinal cord complications following varied types of surgery; the anatomy of the blood supply to the spinal cord is reviewed and recommendations are made for the appropriate conduct of anaesthesia and surgery in patients at risk.
Atypical ventricular tachycardia (torsade de pointes)
Authors: ALEXANDER M. G. , POTGIETER P. D. 
Published: February 2007

SummaryTorsade de pointes is an atypical or variant ventricular tachycardia. We report a case of atypical ventricular tachycardia (torsade de pointes) in a patient with severe obstructive lung disease which occurred following surgery. The factors that may precipitate this dysrhythmia often occur in the postoperative period. The correct diagnosis is vital as the treatment for this dysrhythmia differs markedly from the treatment for the more common ventricular tachycardia.
Epidural analgesia and forceps delivery: laying a bogey
Authors: Bailey P.W. , Howard F.A. 
Published: February 2007

SummaryThe spontaneous and operative delivery rates on a labour ward are compared in the years before and after the initiation of m epidural analgesia service. An epidural rate of 27% of all deliveries in the first year is the only influence affecting an otherwise almost steady obstetric background. Despite this major impact, the changes in operative delivery rates are small and fail to reach statistical significance, although the decrease in spontaneous deliveries is significant. In later years the epidural rate rose to involve 7.2% of primiparae and 26% of multiparae, yet the pattern of deliveries tended to return toward the pre‐epidural picture.
Postoperative dreaming
Authors: JAGO R. H. , RESTALL J. 
Published: February 2007

SummaryThe incidence of postoperative dreaming following the use of morphine and pentazocine as premedicants in an otherwise standard anaesthetic sequence is compared in healthy volunteers. No statistically significant difference was demonstrated between the two drugs. The causes of psychotomimetic problems in the postoperative period and the difficulty of precise definition of hallucinaltions are discussed.
Coronary artery spasm during non‐cardiac surgical procedure
Authors: BRIARD C. , CORIAT P. , COMMIN P. , CHOLLET A. , MENASCHE P. , ECHTER E. 
Published: February 2007

SummaryA case of coronary artery spasm during a non‐cardiac surgical procedure is presented. Two paroxysmal episodes of ST segment elevation in lead 11 and aVF without changes in V5 developed during general anaesthesia. These changes were not preceded by increases in heart rate or arterial pressure. The second episode was associated with a ventricular bigeminal rhythm. This case demonstrates the importance of monitoring several leads in patients likely to develop per operative spasm of the coronary arteries. Intravenous nitroglycerin was effective in treating the second episode of coronary artery spasm. However, this episode occurred in spite of nitroglycerin administered intravenously at a rate of 0.25 μg/kg min.
Unilateral computerised tomography guided coeliac plexus block: a technique for pain relief
Authors: Filshie Jacqueline , Golding S. , Robbie D.S. , Husband Janet E. 
Published: February 2007

SummaryTwelve patients have undergone unilateral coeliac plexus block using needle localisation by computed tomography and the technique is described. Computed tomography has the advantage that the needle route to the coeliac axis can be accurately planned, avoiding damage to other organs. In this study nine out of twelve patients had significant pain relief. Most success was achieved in patients with carcinoma of the pancreas.
Ventilatory response to morphine in young and old subjects
Authors: ARUNASALAM K. , DAVENPORT H. T. , PAINTER S. , JONES J. G. 
Published: February 2007

SummaryThe effects of intravenous morphine (10 mg/70 kg body weight) on ventilation in two groups of subjects, young (age 28–37 years) and old (age 65–82 years) were studied prior to elective surgery. There was no significant difference between the two groups in minute ventilation, ventilatory frequency and end‐tidal carbon dioxide before morphine administration. In both groups there was a significant depression of ventilation and elevation of end tidal carbon dioxide tension 20 minutes after intravenous morphine. There was no significant difference between the two groups in the response of these variables to morphine. However, in the older group seven out of thirteen subjects showed frequent periods of apnoea or periodic breathing whereas three of the young subjects had these phenomena at much less frequent intervals. Respiratory depression after morphine is similar in old and young patienls but old patienls have more change in ventilatory control.
Epidural analgesia following thoracic surgery
Authors: CONACHER I. D. , PAES M. L. , JACOBSON L. , PHILLIPS P. D. , HEAVISIDE D. W. 
Published: February 2007

SummaryThe use of thoracic epidurals for postoperative pain relief in 58 patients following thoracic surgery is reviewed. Epidural catheters were inserted at the end of the operative procedure and it was planned that analgesia was to be maintained with a continuous infusion of bupivacaine. In those patients with evidence of successful neurological blockade there was a high incidence of adverse effects. Hypotension occurred in nearly 80% of patients and inadequate analgesia necessitating intramuscular opiates in 30%. The results suggest that the method adopted is unsuitable for some patients who have undergone major pulmonary surgery, although it has proved a useful adjuvant for pain relief in patients who have had other intrathoracic operations.
Evaluation of Spirolog I volume meter
Authors: CHAKRABARTI M. K. , LOH L. 
Published: February 2007

SummaryA volume meter (Dräger Spirolog I) is evaluated for clinical use. It works on the principle of a constant temperature anemometer and displays tidal volume, minute volume and frequency. It was found that the volume recorded was hardly affected by oxygen concentration, humidity or temperature but was affected by high concentrations of nitrous oxide and during the operation of diathermy.
Sedation for local anaesthesia. Comparison of intravenous midazolam and diazepam
Authors: Dixon J. , Power S.J. , Grundy E.M. , Lumley Jean , Morgan M. 
Published: February 2007

SummaryIntravenous midazolam and diazepam have been compared as sedatives during surgery performed under local anaesthesia. Satisfactory conditions were produced by both drugs. No difference was detected in the rate of recovery, but a highly significant greater degree of amnesia followed the use of midazolam.
Contamination of hypodermic needles in anaesthetic practice
Authors: CLARKE T. N. S. , HUMAN R. P. 
Published: February 2007

SummaryThe study was undertaken to define and compare the incidence of bacterial contamination on opening three different types of hypodermic needle package. Four user groups were studied (anaesthetists, intensive care nurses, operating department assistants and medical laboratory scientific officers). Bacterial contamination was shown to occur and to be related to the type of needle packaging, the ratio of contamination incidence being similar in all four user groups. The results emphasize the importance of a careful opening technique when using sterile packaged hypodermic needles.