bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atracurium recovery: prediction of safe reversal times with edrophonium
Authors: CASHMAN J. N. , JONES R. M. , ADAMS A. P. 
Published: February 2007

SummaryThe time to safe return of neuromuscular function after atracurium 0.3 mg/kg intravenously was assessed in 24 patients in whom anaesthesia was maintained with halothane 0.5%. Safe reversal (recovery to a T4 ratio > 05), after this dose of atracurium, could only be reliably and rapidly (< 2 minutes) achieved with edrophonium if a period greater than 30 minutes elapsed since administration of the relaxant. This coincides with the appearance of four recognisable twitches if a train‐of‐four pattern of nerve stimulation is used. Thus, if no monitoring equipment is available, at least half‐an‐hour should elapse after administration of atracurium in a moderate dose (e.g. 0.3 mg/kg) before rapid and reliable reversal can be anticipated. Four twitches in a train‐of‐four should be recognisable, if a nerve stimulator is available.
Intravenous enalaprilat and autonomic reflexes
Authors: MURPHY J. D. , VAUGHAN R. S. , ROSEN M. 
Published: February 2007

SummaryThirty healthy patients, who were to undergo surgery which required tracheal intubation, were given an intravenous injection of enalaprilat (either 0.5 mg, 1 mg, 2 mg or 4 mg; six patients, for each dose) or normal saline 17 minutes before induction of anaesthesia with thiopentone 3–5 mg/kg, and suxamethonium 1.5 mg/kg. Postural manoeuvres were performed 5 minutes before and 6, 11 and 16 minutes after enalaprilat or saline. Complete inhibition of angiotensin converting enzyme occurred with all doses of enalaprilat, which allowed the four different treatment groups to be considered as one large treated group. The mean arterial pressure was almost unchanged during the postural manoeuvres; the heart rate increased, mostly similarly (by approximately 10%) in both groups. Mean arterial pressure in the recumbent position decreased over the 17 minutes before induction in the enalaprilat group, and increased slightly in the control group (treated mean, −5.0%; controls mean, 1.8%; difference, −6.8%; 95% confidence intervals of difference, −2.3 to −11.3%, p < 0.01). This difference was again seen after induction (treated, − 8.0%; controls, 7.7%; confidence intervals of difference, −0.6 to −31%) and for a 5‐minute period shortly after tracheal intubation. The increases in mean arterial pressure produced by intubation itself were similar in both groups (treated, + 36%; controls, +35%; 95% confidence intervals of difference, −16% to +18%). Changes in heart rate after induction were also similar in both groups. It is concluded that intravenous enalaprilat acted as a hypotensive agent with a sparing effect on autonomic reflexes, both before and after induction of anaesthesia.
The effects of secondary transport on critically ill patients
Authors: RIDLEY S. , CARTER R. 
Published: February 2007

SummaryThis study examined the effect of secondary transport on critically ill patients and the effectiveness of a regionally based intensive care service. Four hundred and ninety‐jive patients were studied retrospectively over a 2‐year period. Eighty‐two were transferred from peripheral hospitals in a mobile intensive care unit while the remaining 413 were admitted directly to the intensive therapy unit at the Western Infirmary, Glasgow. The severity of illness in both groups was assessed using the APA CHE II scoring system. The transferred group were scored before and after the journey, while the directly admitted group were scored only on admission. The results show that the transferred patients exhibited a consistent cardiorespiratory response to transport irrespective of their severity of illness, and that the mortality in both groups of patients in the intensive therapy unit was not significantly different. The results also suggest that in the transferred group, the outcome is not only dependent on the severity of illness but also on other factors, such as the hospital from which the patient was referred and the duration of the pretransfer admission.
Paul Sudeck—his contribution to anaesthesia
Authors: HOWAT D. D. C. 
Published: February 2007

SummaryPaul Sudeck is not generally recognised as a pioneer in anaesthesia, although he is well known for the atrophy of bone named after him. However, he not only championed the use of ether as a safe anaesthetic agent, described a method of ether analgesia for outpatient surgery and devised an inhaler for its administration, but also reintroduced nitrous oxide into Germany and invented possibly the first circle carbon dioxide absorption system with an optional attachment for continuous positive pressure respiration.
Controlled‐release morphine in cancer pain
Authors: HOSKIN P. J. , POULAIN P. , HANKS G. W. 
Published: February 2007

SummaryNineteen patients with pain from advanced cancer stabilised on oral 4‐hourly aqueous morphine who were to be converted to twice daily controlled‐release morphine tablets (MST Continus) completed this study. Patients were randomised to receive either their usual 4‐hourly morphine dose or placebo with the first dose of MST tablets. There were no significant differences between the treatment groups in ratings of pain intensity, pain relief or side effects, or in any of the measured pharmacokinetic parameters. No patients in the placebo group experienced any breakthrough pain, and nursing staff were unable to identify which patients had received the active dose of morphine elixir. We conclude that there is no need for a loading dose when aqueous morphine is changed to MST tablets.
Chlormethiazole sedation for critically ill patients in renal failure
Authors: GRAY P. A. , PARK G. R. 
Published: February 2007

SummaryChlormethiazole infusions were used successfully to provide night sedation for 10–19 nights in three patients with renal failure managed by continuous veno‐venous haemofiltration with dialysis. Fluid overload has accompanied the use of this drug previously because of its low concentration. The ability to remove large amounts of fluid during haemofiltration dialysis proved to be effective in preventing this. All three patients had impaired liver function and showed evidence of chlormethiazole accumulation after 4–6 days. The combination of progressive reduction in dose and daily withdrawal of infusions prevented a major problem. Acceptance of this technique by the patients was high. Chlormethiazole may be a useful addition to the drugs available to provide sedation in well defined clinical circumstances.
Admissions to the intensive care unit after complications of anaesthetic techniques over 10 years
Authors: COOPER A. L. , LEIGH J. M. , TRING I. C. 
Published: February 2007

SummaryFifty‐three patients were admitted in a 5‐year period to the intensive care unit as a result of a complication of an anaesthetic technique. These patients represented 1 in 1543 anaesthetics carried out in the District in the period and 2.0% of all admissions to the intensive care unit. The mortality rate was 17%. The complication was considered to be wholly or partially avoidable in 14 instances (26%). Five of these subjects died and two had a residual neurological deficit.
An unusual case of symptomatic hypoglycaemia in a child
Authors: LONG T. M. W. 
Published: February 2007

SummaryAn unusual case of pre‐operative, symptomatic hypoglycaemia in an otherwise fit, well developed 6‐year‐old boy is reported, and highlights the unpredictable effect of pre‐operative starvation on children admitted on the day of surgery. The presentation and incidence of hypoglycaemia before operation in children is also reviewed.
Obliteration of the axillary artery after axillary block
Authors: OTT B. , NEUBERGER L. , FREY H. P. 
Published: February 2007

SummaryA case of total obliteration of the axillary artery after axillary block is presented. This resulted from an accidental intramural injection of local anaesthetic (mepivacaine 1%, 40ml, with adrenaline 1:200 000). Axillary block was performed using the loss of resistance technique with a blunt needle (45° bevel). The diagnosis was made by paplation of the peripheral pluse and by comparison between the skin temperatures of each arm. The thrombosed part of the artery was successfully reconstructed with an autologous saphenous vein graft.
Epidural anaesthesia and thrombocytopenia
Authors: HEW‐WING P. , ROLBIN S. H. , HEW E. , AMATO D. 
Published: February 2007

SummaryA case is presented of a mother with unanticipated profound thrombocytopenia who received a continuous epidural anaesthetic for labour. No neurological sequelae or excessive bleeding occurred. It is clear, after a review of the literature, that more information is needed to define the lower limits of platelet count at which it is safe to proceed with epidural anaesthesia.
Epidural versus general anaesthesia for elective Caesarean section Effect on Apgar score and acid‐base status of the newborn
Authors: Evans C. M. , Murphy J. F. , Gray O. P. , Rosen M. 
Published: February 2007

SummaryElective Caesarean section deliveries over a 5‐year period were studied to compare the effect of epidural block with general anaesthesia on the condition of the infant at birth. The Apgar score and umbilical arterial acid‐base status were used as determinants of the latter. Epidural block was used in 139 (22.8%) mothers while 471 (77.2%) were performed under general anaesthesia. No babies in the epidural group were severely depressed (Apgar < 4), compared with 6.2% in the general anaesthesia group. Only 4.3% of the epidural sections were moderately depressed (Apgar 4–6), compared with 15.4% of the others. These differences remained highly significant when infants of less than 2500 g were excluded, and when matched groups were compared. Mean umbilical arterial pH was similar within the two groups (pH 7.28), and was not consistent with asphyxia in almost 90% of the depressed infants. The findings suggest that general anaesthesia, rather than asphyxia or aortocaval compression, is responsible for most of the depressed infants born by elective Caesarean section. This may involve over 20% of babies delivered in this manner, so greater use of epidural block for elective Caesarean section is recommended. Further investigations are required to improve results with general anaesthesia.
The influence of patient characteristics on the requirements for postoperative analgesia
Authors: BURNS J. W. , HODSMAN N. B. A. , McLINTOCK T. T. C. , GILLIES G. W. A. , KENNY G. N. C. , McARDLE C. S. 
Published: February 2007

SummaryThe requirements for analgesia after upper abdominal surgery were evaluated in 100 patients who received morphine by way of a patient‐controlled analgesia system. Hourly and cumulative 24‐hour requirements were analysed for possible correlations with patient characteristics and for the patterns of consumption throughout the 24‐hour study period. The level of pain relief was assessed by linear analogue pain scores at 4–6 hours and 24 hours. Male patients (n = 46) required significantly more morphine than female patients (n = 54) to achieve similar levels of pain relief (p < 0.05). There was an inverse correlation between age and morphine consumption in both males and females (r = ‐ 0.684, p < 0.00005 and r = ‐ 0.502, p < 0.00005 respectively). No correlation was found between morphine consumption and patient weight. The pattern of hourly morphine consumption appeared to follow a diurnal rhythm, with peak times of demand at 0900 and 2000 hours. The variations in requirements for analgesia among patients and with time of day should be taken into account when a regimen for postoperative analgesia is prescribed.
Variables of patient‐controlled analgesia 1. bolus size
Authors: OWEN H. , PLUMMER J. L. , ARMSTRONG I. , MATHER L. E. , COUSINS M. J. 
Published: February 2007

SummaryThe efficacy of a range of demand doses of morphine for patient‐controlled analgesia was studied. Patients who self–administered the smallest dose (0.5 mg) were frequently unable to achieve good pain control; patients who received the largest dose (2 mg) had a high incidence of ventilatory depression. A dose of 1 mg was the best increment under the conditions of this study but the relationship between increment and lockout interval requires consideration.
Efficacy of lignocaine in the suppression of the intra‐ocular pressure response to suxamethonium and tracheal intubation
Authors: GROVER V. K. , LATA K. , SHARMA S. , KAUSHIK S. , GUPTA A. 
Published: February 2007

SummaryThe effect of lignocaine pretreatment on the intra‐ocular pressure response to suxamethonium and tracheal intubation was studied in 80 adult patients, divided randomly into four groups of 20 each. These groups received respectively normal saline (10 ml), lignocaine 1 mg/kg, 1.5 mg/kg and 2 mg/kg as pretreatment, in a double blind manner, one minute before anaesthetic induction with thiopentone and suxamethonium 1.5 mg/kg. Lignocaine pretreatment caused a signijicant decrease in intra‐ocular pressure. Suxamethonium caused a significant increase, but lignocaine pretreatment in doses of 1.5 mg/kg and 2 mg/kg effectively kept the postsuxamethonium pressure below control values. Tracheal intubation further aggravated the postsuxamethonium increase in intra‐ocular pressure. Lignocaine, in doses of 1.5 mg/g and 2 mg/kg also effectively kept the postintubation pressure values below control levels. Lignocaine, in dose of 1 mg/kg, only partially attenuated the postsuxamethonium and postintubation increase in intra‐ocular pressure. In conclusion, lignocaine pretreatment, in a dose of 1.5 mg/kg, offers protection against suxamethonium‐ and tracheal‐intubation initiated increases in intra‐ocular pressure, without causing any signijicant decrease in arterial pressure.
Acute thyroid crisis on induction of anaesthesia
Authors: BENNETT M. H. , WAINWRIGHT A. P. 
Published: February 2007

SummaryThyroid crisis on induction of anaesthesia was treated with dantrolene, because of a mistaken diagnosis of malignant hyperthermia. There was immediate improvement after dantrolene with reduction in muscle rigidity, mental confusion and pyrexia. High circulating T4 has an effect on calcium flux across the sarcoplasmic reticulum and dantrolene may inhibit this pathological mechanism. We suggest the same dosage regimen as is used in the treatment of malignant hyperthermia.
Automatic control of arterial pressure after cardiac surgery Evaluation of a microcomputer‐based control system using glyceryl trinitrate and sodium nitroprusside
Authors: COLVIN J. R. , KENNY G. N. C. 
Published: February 2007

SummaryArterial hypertension after cardiac surgery is common and is associated with increased morbidity. Glyceryl trinitrate may be a more suitable agent for control of hypertension than sodium nitroprusside. We have developed a closed–loop system for the Atari 1040 ST microcomputer to control arterial pressure by the simultaneous infusion of two vasodilators under computer control. Use of this system with glyceryl trinitrate and sodium nitroprusside in 24 patients who required vasodilators after cardiopulmonary bypass, revealed that hypertension was controlled by glyceryl trinitrate alone in 14 of the patients and 10 required supplementary sodium nitroprusside. The results suggest that glyceryl trinitrate is a suitable agent for control of hypertension after cardiac surgery in the majority of patients. They also show that a sizeable minority required additional sodium nitroprusside, and that an automated‘dual pump’ system is a satisfactory method of administering two vasodilators in this way.
Postoperative absorption of controlled‐release morphine sulphate
Authors: LEW J.K.L. , MOBLEY K. A. , ACHOLA K. J. , HORNE M. , SMITH G. 
Published: February 2007

SummaryThe absorption of morphine sulphate in a controlled‐release formulation was studied in 12 patients who had undergone unilateral inguinal hernia repair under a light general anaesthetic and ilio‐inguinal block. Serum morphine concentrations were measured serially and gastric emptying was assessed by measurement of paracetamol absorption. Three patients had delayed gastric emptying and impaired morphine absorption in the immediate postoperative period. Four hours later, there was a significant reduction in gastric emptying in eight patients who had normal paracetamol and morphine absorption in the immediate postoperative period.
Cardiovascular responses to flumazenil‐induced arousal after arterial surgery
Authors: FISHER G. C. , HUTTON P. 
Published: February 2007

SummaryPatients who underwent peripheral arterial surgery had anaesthesia maintained with an infusion of midazolam. They were allowed either to recover spontaneously or to have the effects of midazolam reversed by flumazenil at the end of surgery. This study demonstrated that the cardiovascular responses to arousal using flumazenil are no dqferent from those seen when the patient is allowed to recover in the normal way. This result has obvious advantages for clinical practice but the dangers of resedation must not be forgotten.
Instability of the tracheal tube in neonates
Authors: ROOPCHAND R. , ROOPNARINESINGH S. , RAMSEWAK S. 
Published: February 2007

SummaryA postmortem study of the degree of displacement of the tracheal tube was performed on 13 neonates of varying birthweights. There was significant movement of the tube on flexion and extension of the neck, and on opening the infant's mouth. Our findings lend support to certain techniques of tracheal tube placement; the ultimate aim is to position it accurately.
Angiotensin II in the management of excision of phaeochromocytoma
Authors: SOMMERVILLE K. J. , MCKELLAR J. B. M. 
Published: February 2007

SummaryThe management of a patient with an unusual combination of anaesthetic problems, namely phaeochromocytoma and difficult intubation is described. Angiotensin II is discussed in the management of hypotension after excision of the tumour.
Postdural puncture headache A comparison between 26‐ and 29‐gauge needles in young patients
Authors: Flaatten H. , Rodt S.Å. , Vamnes J. , Rosland J. , Wisborg T. , Koller M.E. 
Published: February 2007

SummaryThe incidence of postdural puncture headache after spinal anaesthesia with two types of 26‐ and 29‐gauge needles was investigated in 149 patients less than 30 years old. Ten patients, (6.7%), six men and four women, developed typical symptoms of postdural puncture headache, while six (4.0%) developed headache of other origin. There were no headaches in the 29‐gauge group. Spinal anaesthesia in four patients (8%) was impossible to perform with the 29‐gauge needle. By using the latter, spinal anaesthesia can be given to young adults with little risk of postdural puncture headache.
Comparison of the effects of famotidine and ranitidine on gastric secretion in patients undergoing elective surgery
Authors: ESCOLANO F. , CASTAÑO J. , PARES N. , BISBE E. , MONTERDE J. 
Published: February 2007

SummaryA randomised double‐blind comparison of oral famotidine and ranitidine given 2 hours before induction, on gastric secretion (volume and pH) was carried out on 93 patients undergoing elective surgery. Gastric contents were aspirated immediately after tracheal intubation. Famotidine significantly reduced the gastric volume, compared with the other groups, including ranitidine. Both famotidine and ranitidine significantly elevated gastric pH towards neutral, compared with the other groups. There was no significant difference between ranitidine and famotidine in respect of the pH. The patients premedicated with famotidine and ranitidine were well protected against Mendelson's syndrome, whereas 38% of patients from the other groups remained at risk.
Penetrating craniocerebral airgun injury
Authors: WRIGHT P. J. , MURRAY R. J. 
Published: February 2007

SummaryLow velocity cerebral missile injuries inflicted by air guns frequently cause little primary neurological damage, but the patient often suffers severe later deterioration which has been classified as a type of ‘talk and die’ head injury. The anaesthetic management of a penetrating air rifle missile injury using an infusion of propofol is described.
Characteristics of the Pharmaseal continuous flushing device
Authors: McKINNEY M. S. , ORR I. A. 
Published: February 2007

SummaryPharmaseal continuous flushing devices were tested with regard to flow characteristics into simulated arterial and venous pressure systems. Two driving pressures were used and it was found that variation in driving pressure made a significant difference to the flow, while arterial or venous pressure made no significant difference. The flow devices had a wide variation although they were all of the same type. The fluid volume delivered was in the region of 100 ml in a 24‐hour period.
Neostigmine after spontaneous recovery from neuromuscular blockade
Authors: GOLDHILL D. R. , WAINWRIGHT A. P. , STUART C. S. , FLYNN P. J. 
Published: February 2007

SummaryThe effect of neostigmine on neuromuscular function was examined after spontaneous recovery from an atracurium‐induced neuromuscular blockade, which reached a train‐of‐four ratio of either 0.5 or 0.9. Two doses of neostigmine 2.5 mg were given 5 minutes apart. Neuromuscular recovery was assessed with train‐of‐four and tetanic stimuli. The first dose of neostigmine antagonised the neuromuscular blockade. The second dose diminished tetanic height and increased tetanic fade. The train‐of‐four measured mechanically was adversely affected to a small degree, but when measured with the electromyograph no significant change occurred. Neostigmine may adversely affect neuromuscular function after spontaneous recovery from a non‐depolarising block. This is unlikely with a single modest dose and any effects are probably short‐lived.
Cerebral effects of anaesthesia and hypothermia
Authors: STEPHAN H. , SONNTAG H. , LANGE H. , RIEKE H. 
Published: February 2007

SummaryCerebral blood flow, cerebral oxygen and glucose consumption, and cerebral lactate and pyruvate release were measured; spectral analysis of the EEG was recorded in 10 male patients who had coronary artery bypass surgery. The measurements were taken to evaluate the effects of fentanyl–midazolam anaesthesia during normothermia and during hypothermic nonpulsatile cardiopulmonary bypass at 26°C venous blood temperature, when a temperature‐corrected Paco2‐value of 5.3 kPa was maintained. Anaesthesia with fentanyl 7 μg/kg and midazolam 200 μg/kg as induction doses, followed by infusions of fentanyl 0.15 μg/kg/minute and midazolam 3 μg/kg/minute, was characterised by a decrease in fast‐wave activity and an increase in high‐amplitude, slow‐wave activity in the EEG. There was also a decrease in cerebral blood flow (38%), oxygen consumption (22%) and glucose consumption (25%), while lactate and pyruvate production remained unchanged. Hypothermia of 26°C venous blood temperature suppressed EEG almost completely and decreased oxygen and glucose consumption by a further 61% and 54%, respectively, with no changes in lactate and pyruvate production while cerebral blood flow increased by 145%. These results show that the effects of fentanyl–midazolam anaesthesia on cerebral metabolism are enhanced during hypothermic cardiopulmonary bypass while the influence of anaesthesia on cerebral blood flow is overshadowed by the practice of a temperature‐corrected acid‐base management.