bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of isoflurane on a continuous infusion of mivacurium
Authors: DE MEY J. C. , FONCK K. , MAREELS K. , ROLLY G. 
Published: February 2007

SummarySixty surgical patients were studied to evaluate the neuromuscular effects of mivacurium 0.l5 mg.kg‐1 (2 × ED95)for tracheal intubation. After intubation the patients were randomly allocated to receive alfentanil with either propofol (starting with 9mg.kg‐1 h‐1, reducing to 6mg.kg‐1 h‐1 after 20min) or isoflurane (0.5% end‐tidal). In addition, all the patients were given a continuous infusion of mivacurium 10 μg.kg‐1 min‐1 after tracheal intubation which was adjusted to maintain 90% depression of T1. Following mivacurium 0.15 mg.kg‐1 T1 decreased below 25% in all but four patients. Mean (SD) percentage maximum block attainedwas 92.9% (12.5) after 309 (89)s. Tracheal intubation was completed 232 (155) s after administration of the relaxant and intubating conditions were graded as‘excellent’ or‘good’ in 56 patients. Although the mean (SD) mivacurium infusion rate for maintaining T1 at 10% was higher in the propofol group, 4.8 (2.1) compared with 4.4 (2.0) μg.kg‐1 min‐1 in the isoflurane group, this was not significantly different (p > 0.05). The mean (SD) recovery index was prolonged in the isoflurane patients, 757 (508)s, compared to those receiving propofol, 466 (219)s (p < 0.05).
Anaesthesia and adverse effects after intrathecal pethidine hydrochloride for urological surgery
Authors: GRACE D. , FEE J. P. H. 
Published: February 2007

SummaryAnaesthesia, postoperative analgesia and the incidence of adverse effects after intrathecal pethidine hydrochloride 0.50mg.kg‐1 and 0.75mg.kg‐1 were assessed and compared with a conventional technique using isobaric bupivacaine 13.75mg in patients undergoing transurethral resection of the prostate gland. Sensory and motor block were significantly shorter with both pethidine regimens than with bupivacaine (p < 0.001). Although sensory and motor block were shorter after pethidine 0.50mg.kg‐1 than after pethidine 0.75mg.kg‐1 the difference in duration was clinically insignificant. The incidence of incomplete motor block was significantly greater with pethidine 0.50mg.kg‐1 than with bupivacaine 13.75mg.kg‐1 (p < 0.01). Visual analogue pain scores recorded after the operation were low and were similar in the pethidine groups to those obtained with bupivacaine alone. Mean arterial blood pressure was significantly lower in both pethidine groups compared with the bupivacaine group between 30 and 240 min after intrathecal injection (p < 0.001). However, the within‐group reductions in blood pressure were within clinically acceptable limits. The incidences of nausea and emesis were low and emesis occurred in patients in the bupivacaine group only (p < 0.03). Pruritus was seen only in patients receiving pethidine. Intra‐operative sedation occurred more often in patients receiving both pethidine 0.50mg.kg‐1 and 0.75mg.kg‐1 compared with patients receiving bupivacaine (p < 0.04). Both pethidine regimens provided acceptable anaesthesia and there were no significant differences between the two regimens in quality of intra‐operative anaesthesia, incidence of adverse events or postoperative analgesia.
The accuracy of references in Anaesthesia
Authors: Asano M. , Mikawa K. , Nishina K. , Maekawa N. , Obara H. 
Published: February 2007

SummaryWe reviewed all the references quoted in Volume 45(1990) (n = 3967) and half the references quoted in Volume 49 (1994) (n = 2183) of Anaesthesia. The references were numbered sequentially and 100 references from each year were randomly selected. Citations of non‐journal articles were omitted leaving 197 citations for careful scrutiny. The authors’ names, article title, journal title, volume number, page numbers, and year were examined in each selected reference. A reference was deemed correct if each element of the citation was identical to its source. Of the references examined, 32% and 41% contained one or more errors in 1990 and 1994, respectively. The elements most likely to be inaccurate were, in descending order of frequency, article title, author, and page number. There was no significant difference in the error rate between the 2 years. It is the responsibility of contributors to ensure that all references are carefully checked.
Clinical characteristics of commonly used spinal needles
Authors: CARSON D. F. , SERPELL M. G. 
Published: February 2007

SummaryThe important features which determine the ease of use of spinal needles include rapid detection of cerebrospinal fluid, minimal delay before injection and low resistance to injection of local anaesthetic. We investigated these three parameters among the following 11 spinal needles: Becton‐Dickinson 22 G, 25 G and 27 G Whitacre, 25 G and 27 G Quincke; B. Braun Spinocan 22 G, 25 G and 26 G Quincke; Vygon 25 G Whitacre, Portex 26 G Pencil Point and the 24 G Sprotte. Three needles of each type were tested using an artificial cerebrospinal fluid model maintained at body temperature and at two hydrostatic pressures of 12 and 50 cm of water. The Becton Dickinson 27 G Whitacre has an immediate detection time at both pressure heights, a reasonably short‘ready to inject’ time and relatively low resistance to injection, which, together with a reported low rate of postdural puncture headache, would indicate that it is the most appropriate for spinal anaesthesia. The 25 G Whitacre types would be the next most suitable to use.
Safelon—a new device to reduce needle‐stick injuries during intravenous cannulation
Authors: WATTERS J. , MacCALLUM R. , MAURICE S. , ROBERTSON C. 
Published: February 2007

SummaryA prospective evaluation was performed to assess the efficacy and ease of use of a novel self‐sheathing intravenous cannula with needle protection device (Safelon). Use of the device did not require significant change to the normal cannulation technique. Blood splashes during insertion and the risk of needle‐stick injury were reduced.
The estimation of inspired isoflurane concentration in a low‐flow system
Authors: GOWRIE‐MOHAN S. , CHAKRABARTI M. K. , LOCKWOOD G. G. 
Published: February 2007

SummaryWe have examined the predictability of inspired isoflurane concentration during low‐flow anaesthesia using a to‐and‐fro breathing system. Twenty one adult patients requiring mechanical ventilation of the lungs during surgery took part in this study. Using a fresh gas flow of 2 l.min‐1, the ratio of inspired isoflurane concentration to isoflurane vaporizer setting was found to be approximately 4/5th after 5 min of anaesthesia. The ratio was maintained throughout the procedure, except for a few minutes following each change in vaporizer setting.
Severe airway management problems during insertion of a cuffed oesophageal stent
Authors: Langham B. T. , McLaren I. M. 
Published: February 2007

SummaryA 68‐year‐old man underwent a general anaesthetic for insertion of an oesophageal stent for a tracheo‐oesophageal fistula. The authors report the management of severe airway problems caused by the insertion of the stent and discuss the use of a double lumen tube in this situation.
The use of protective gloves, the incidence of ampoule injury and the prevalence of hand laceration amongst anaesthetic personnel
Authors: Parker M. R. J. 
Published: February 2007

SummaryIn a study of 97 anaesthetic sessions, the incidence of hand laceration secondary to opening glass ampoules was 6% and the prevalence of visible old hand laceration 26%. The wearing of gloves for procedures likely to cause contamination by human secretions ranged from 35–86%, Overall there was no statistically significant difference in glove wearing habits of trainees and consultants. In the presence of a visible laceration, glove wearing by trainees increased and was significantly higher than that practiced by consultants. There were at least 90 procedures performed in 97 sessions during which an anaesthetist risked contaminating a visible laceration. It appears that the occupational risk of contracting a blood‐borne viral infection is still unnecessarily increased by anaesthetists not wearing protective gloves for all procedures in which contamination may occur.
A prospective study of anaesthesia for quinsy tonsillectomy
Authors: FAGAN J. J. , JAMES M. F. M. 
Published: February 2007

SummaryA prospective study of 50 adult quinsy tonsillectomy anaesthetics was performed. There were no significant anaesthetic or surgical complications and the mean intra‐operative blood loss was 176 ml. The Mallampati score did not correlate with the Cormack and Lehane glottic view and there were no difficult intubations. Pre‐operative trismus resolved completely during induction in 77.4% of cases. We concluded that the Mallampati grading system is not applicable in quinsies and in cases with palatopharyngeal arch distortion, that trismus in quinsies is due to muscle spasm and resolves completely during induction in most cases and that pre‐anaesthetic drainage of the abscess together with rehydration and antibiotics are important contributing factors to safe anaesthesia for quinsy.
The effect of different end‐tidal volatile agent and carbon dioxide concentrations upon the incidence of postoperative shivering
Authors: HARWOOD R. J. , SINGH P. , CARTWRIGHT D. P. , CROSSLEY A. W. A. 
Published: February 2007

SummarySixty patients (47 female) undergoing surgical excision of three or more wisdom teeth were randomly allocated into three groups with differing end‐tidal carbon dioxide and volatile agent concentrations during maintenance of anaesthesia. The anaesthetic techniques employed were identical in all other respects. All patients were observed for 10 min after arrival in the recovery area to assess the presence and severity of shivering, axillary temperature and oxygen saturation. There were no significant differences in axillary temperatures between groups or between shivering and non‐shivering patients, although there was a significant difference (p = 0.001) in duration of anaesthesia between shivering and non‐shivering patients. There was no significant difference between groups with respect to the incidence of shivering (p = 0.96)
An evaluation of the Universal PAC and Oxford Miniature Vaporizers for paediatric field anaesthesia
Authors: CRAIG G. R. , BERRY C. B. , YEATS M. J. 
Published: February 2007

SummaryA laboratory study has demonstrated that the Universal PAC and Oxford Miniature Vaporizers can be used for paediatric anaesthesia in drawover mode at varying ambient temperatures. Changes in tidal volume have minimal effect on the delivered concentration of halothane from either vaporizer but varying ambient temperature significantly affects the output of the Oxford Miniature Vaporizer. The Oxford performs well in continuous flow mode, which is of particular use for T‐piece anaesthesia, whereas the Universal PAC does not perform adequately in this way.
Case reports Toxic epidermal necrolysis with adult respiratory distress syndrome
Authors: Wallis C. , McClymont W. 
Published: February 2007

SummaryA severe case of drug‐induced toxic epidermal necrolysis is described in which the adult respiratory distress syndrome developed, requiring a prolonged period of mechanical ventilation and intensive care. The importance of early transfer to the intensive care unit for monitoring and prompt treatment of complications of this rare condition is emphasised.
An assessment of morphine requirement after wisdom tooth extraction under general anaesthesia
Authors: Tighe K. E. , Gillan G. , Korczak P. K. J. , Crossley A. W. A. 
Published: February 2007

SummaryThe use of morphine delivered by a patient‐controlled analgesia system was studied in 20 patients who had undergone surgical extraction of three or four wisdom teeth as inpatients. Whilst 64.3% of the patient requests were made in the first 8 postoperative hours, use of the system continued throughout the night in the majority of patients. The implications for analgesic regimens in day‐case surgery are discussed.
What changes drug metabolism in critically ill patients?—II Serum inhibits the metabolism of midazolam in human microsomes
Authors: PARK G. R. , MILLER E. , NAVAPURKAR V. 
Published: February 2007

SummarySerum samples from fire critically ill patients were incubated with microsomes prepared from three human livers. The activity of cytochrome P450 3A4 was assessed by measuring the disappearance of midazolam and the appearance of 1‐hydroxy midazolam in the incubates. Significant inhibition of the ability of this enzyme to metabolise midazolam was seen. This occurred in incubates containing serum samples from critically ill patients and not in those containing serum from two normal volunteers. The mechanism of this inhibition is unknown, but several possibilities are discussed.
Re‐establishment of paralysis using mivacurium following apparent full recovery from mivacurium‐induced neuromuscular block
Authors: KOPMAN A. F. , MALLHI M. U. , NEUMAN G. G. , JUSTO M. D. 
Published: February 2007

SummaryRecent published data suggest that despite apparently satisfactory recovery from nondepolarising block (train‐of‐four ratios in excess of 0.90), even very small doses of additional relaxant may re‐establish significant paralysis. We sought to verify this observation and quantify its magnitude. Twelve adult patients were studied under nitrous oxide‐propofol‐opioid anaesthesia and neuromuscular block was monitored electromyographically. Train‐of‐four stimuli were delivered to the ulnar nerve every 20s throughout the period of observation. After baseline stabilisation, an initial bolus of mivacurium 25 μg.kg‐1 was administered and the twitch depression noted. When the twitch was stable for two consecutive stimuli, a second bolus, calculated to produce approximately 90% twitch depression, was administered. Recovery was then allowed to proceed spontaneously until the train‐of‐four ratio reached 0.95. At that time a second 25 μg.kg ‐1 dose was administered and the effect on twitch height recorded. Using the slope for the log‐dose/logit dose‐response relationship of mivacurium (5.5), it was possible to estimate any change in the ED50 of mivacurium. The control ED50 of mivacurium (calculated from the initial dose of mivacurium) averaged 43 μg.kg‐1. When the same dose of drug was given at 95% recovery of the train‐of‐four ratio, the ED50 was reduced to 19 μg.kg ‐1 (p < 0.0001). Hence, there remains a considerable reduction in the neuromuscular margin of safety even at a train‐of‐four ratio of 0.95.
Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia
Authors: Brimacombe J. 
Published: February 2007

SummaryAn analysis of 1500 laryngeal mask airway uses by one anaesthetist using the standard insertion technique was conducted to determine successful insertion rates, position by fibreoptic laryngoscopy, complication rates and whether there is a long‐term learning curve. The correlation between laryngeal mask airway placement and modified Mallampati grade was also determined. The first time insertion rate was 95.5% with an overall failure rate after three attempts of 0.4%. One hundred and fifteen patients were Mallampati III or IV. All failed placements were Mallampati I or II. Problems occurred in 94 patients (6.27%), but oxygen saturation decreased below 90% on only ten occasions and below 80% on one occasion. There were no episodes of regurgitation. The vocal cords were visible from the mask aperture bars in 97.1%. Comparison of insertion rates, fibreoptic position and complications for the first and second 750 insertions provides evidence for a‘long’term learning curve. These data could he used as a guide for‘optimal’or expected successful laryngeal mask airway insertion rates in adults undergoing routine anaesthesia.
The effect of extradural ketamine on onset time and sensory block in extradural anaesthesia with bupivacaine
Authors: Yanli Y. , Eren A. 
Published: February 2007

SummaryIn a randomised, double blind study of 30 patients, we have compared two regimens for extradural anaesthesia: 20 ml bupivacaine 0.5%, 25mg (0.5ml) ketamine, 1 in 200 000 adrenaline; and 20 ml bupivacaine 0.5%, 0.5 ml 0.9% saline, 1 in 200 000 adrenaline. The main outcome measures were onset time to acceptable bilateral anaesthesia and postoperative analgesic duration. The time to onset of anaesthesia was reduced by 8 min in the bupivacaine‐ketamine group compared with the bupivacaine alone group. In addition, the anaesthetic levels were two segments higher in the bupivacaine‐ketamine group (T7 versus T9). Side effects were similar in both groups and there was no significant difference in postoperative analgesic requirements between the two groups. The addition of ketamine to bupivacaine given epidurally appears to be useful in the reduction of onset time to blockade.
Enhancement of pressor response to ephedrine following clonidine medication
Authors: TANAKA M. , NISHIKAWA T. 
Published: February 2007

SummaryWe studied pressor responses and changes in plasma catecholamine concentrations following two consecutive doses of ephedrine 0.1 mg.kg‐1 with (n = 20) and without (n = 20) clonidine 5 μg.kg‐1 premedication in patients presenting for a variety of major surgical procedures under general anaesthesia. Arterial blood pressure and heart rate were measured at 1 min intervals for 10 min, and plasma catecholamines were measured before and 3 min after each dose of ephedrine. Mean blood pressure changes from the baseline values were greater in the clonidine than in the control group 3–8 min and 4–9 min following the first and the second doses of ephedrine, respectively (p < 0.05). Plasma catecholamine concentrations tended to be lower in the clonidine group throughout the study. The augmented pressor response to ephedrine in clonidine‐treated patients can be attributed to enhanced cardiovascular response rather than clonidine‐induced accumulation and subsequent increased release of catecholamine.
Evaluation of two electrochemical monitors for measurement of inhaled nitric oxide
Authors: STRAUSS J. M. , KROHN S. , SüMPELMANN R. , SCHRöDER D. , BARNERT R. 
Published: February 2007

SummaryInhaled in low concentrations, nitric oxide (NO) acts as a potent pulmonary vasodilator, but when inhaled in high concentrations NO and its metabolite NO2 are potentially toxic molecules. Thus, an accurate and reproducible measurement of both NO and NO2 is necessary, and changes in NO concentration need to be detected instantly to avoid lung damage (high concentrations) or failure of NO therapy (low concentrations; unnoticed interruption of NO supply). We investigated two electrochemical NO monitors (Sensor Stik 4586 and Dräger PAC II)for accuracy and time constants. Both provided accurate and reproducible results at different NO concentrations. Known NO concentrations (standards: 10, 50, 75ppm) were detected within a 3% tolerance, and acceptable time constants were seen when NO concentration was abruptly increased from zero to 50 ppm. The display read the final value within 60s with the Sensor Stik and lls with the Dräger PAC II. Significant differences were seen when the NO concentration was rapidly reduced from 50 ppm to zero. The Sensor Stik took more than 2 h to reach zero, whereas the PAC II took 60s.
Cricoid pressure: are two hands better than one?
Authors: COOK T. M. 
Published: February 2007

SummaryOne hundred and twenty patients were studied to compare the view of the larynx at laryngoscopy with one ‐ or two‐handed cricoid pressure applied. A blinded crossover technique was employed. When the grade of laryngeal view achieved with either type of cricoid pressure was compared using a 4‐point scale there was no significant difference. However, when the views were compared with greater discrimination the laryngeal view achieved with one‐handed cricoid pressure was significantly better than that seen with two‐handed cricoid pressure. There was no significant difference between the groups in the need for a gum elastic bougie to facilitate intubation. A two‐handed technique has been advocated to improve intubation conditions when cricoid pressure is required. It has several disadvantages, its efficacy has not been proven and this study suggests it does not improve the view at laryngoscopy. Two‐handed cricoid pressure should no longer be advocated unless an advantage over one‐handed cricoid pressure can be shown.
Acid aspiration prophylaxis for emergency Caesarean section
Authors: STUART J. C. , KAN A. F. , ROWBOTTOM S. J. , YAU G. , GIN T. 
Published: February 2007

SummaryOver a 3.5 year period, 384 patients requiring emergency Caesarean section under general anaesthesia received at random one of six acid aspiration prophylaxis regimens as soon as the decision was made for surgery. In the first phase of the study, sodium citrate administered orally 0.3 M, 30 ml (group C, n = 120) was compared with metoclopramide 10 mg administered intravenously and sodium citrate (group MC, n = 65). In the second phase, all patients received sodium citrate, and either intravenous administration of ranitidine 50 mg (group RC, n = 50), omeprazole 40 mg (group OC, n = 50), ranitidine 50 mg with metoclopramide 10 mg (group RMC, n = 50) or omeprazole 40 mg with metoclopramide 10 mg (group OMC, n = 49). Gastric contents were aspirated using a 16 FG Salem sump tube and acidity measured with a pH meter. Non‐parametric tests were used for comparisons. There was no difference in gastric volume or pH between groups C and MC, or among OC, RC, OMC and RMC. After pooling the data, median (range) gastric volume in groups C and MC (55(0–360) ml) was greater than in groups OMC and RMC (40(3–270) ml, p < 0.05). Median (range) pH was lower in groups C and MC (4.97(0.76–6.99)) than in groups OC, RC, OMC and RMC (5.76(1.11–7.5), p < 0.001). The proportion of patients with pH < 3.5 and volume > 25 ml in the C and MC groups (43/185) was greater than that in the OC, RC, OMC and RMC groups (18/199, p < 0.001). Ranitidine and omeprazole administered intravenously were equally effective adjuncts to sodium citrate in reducing gastric acidity for emergency Caesarean section. Compared with sodium citrate alone, the addition of either ranitidine, omeprazole or metoclopramide alone did not reduce gastric volume while small reductions in gastric volume were seen with the addition of metoclopramide and either ranitidine or omeprazole.
The addition of tenoxicam to prilocaine for intravenous regional anaesthesia
Authors: JONES N. C. , PUGH S. C. 
Published: February 2007

SummaryThe analgesic effects of tenoxicam 20 mg added to prilocaine in a standard Bier's block (group 2) was studied in 45 patients who had their Colles’fractures reduced under intravenous regional anaesthesia, and compared both to a control group (group 1), and to a group who received a standard Bier's block combined with the same dose of tenoxicam given intravenously into the contralateral arm (group 3). Patients in group 2 obtained significantly better analgesia than group 1, as judged by a longer time before first additional analgesia was required (p < 0.05), less total analgesic consumption (p < 0.01), and lower pain scores (p < 0.01). These benefits were not obtained by patients in group 3.