bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharyngeal teratoma
Authors: MORIARTY A. J. , McEWAN I. P. 
Published: February 2007

SummaryA 30‐week newborn patient presented with acute respiratory obstruction due to a large pharyngeal teratoma. At taryngoscopy no view of the larynx was obtained, and a tracheal tube was unintentionally passed blindly into the oesophagus. This relieved the obstruction by anterior displacement of the mass.
A comparison of keyed and non‐keyed vaporizer filling modes and volatile agent wastage
Authors: UNCLES D. R. 
Published: February 2007

SummaryTwo hundred and forty bottles of enflurane were collected after their contents had been emptied into vaporizers equipped with keyed or non‐keyed filling ports. The volume of agent remaining, the residual volume, was measured. There was a greater (p < 0.001) residual volume in ‘empty’ bottles which had been used to fill keyed compared with non‐keyed enflurane vaporizers. Five hundred and fifty two bottles of isoflurane were also collected after they had been used to fill keyed vaporizers. There was no significant difference between the residual volume remaining in bottles of isoflurane and enflurane used to fill keyed fillers; however, the difference was statistically significant if the residual volume was expressed as a proportion to the volume of agent contained in the full bottle. The results show that volatile anaesthetic agent wastage is increased by the use of keyed fillers. Isoflurane wastage caused by utilisation of keyed fillers could be reduced by a factor of 2.5 by supplying isoflurane in 250 ml rather than 100 ml bottles.
Evaluation of three portable suction devices
Authors: SIMON E. J. , DAVIDSON J. A. H. , BOOM S. J. 
Published: February 2007

SummaryThree portable suction devices were evaluated and compared with a wall‐mounted vacuum driven suction unit. The Repro‐med Res‐Q‐Vac, the Drager Sujector 2000 and the Laerdal suction unit were assessed by measuring the time taken to aspirate 140 ml of mock gastric contents. The respective times for each device, expressed as mean and (range) were 7.39 (4.3–10.4), 8.6 (7.8–9.4) and 11.4 (9.4–12.6) s. These compare favourably with the Ohmeda suction unit (7.27 (6.2–8.9)). Each type of device has advantages and disadvantages when factors such as size, power supply and portability are considered, and each will be the most suitable for a particular situation.
Propofol and Intralipid cause creaming of serum from critically ill patients
Authors: GEMPELER F. , ELSTON A. C. , THOMPSON S. P. , PARK G. R. 
Published: February 2007

SummaryThe aim of this in‐vitro study was to investigate the incidence of propofol agglutination with serum from critically ill patients. Serum (400 μl) from 58 critically ill patients and 30 healthy volunteers was incubated with 10 μl of either propofol, Intralipid 10% or Intralipid 20%. Control incubations contained serum only. At 24 h, the serum was examined macroscopically and microscopically for agglutination. Agglutination was seen with Intralipid 20% in serum from all critically ill patients and 13.3% of volunteers. Serum from 91.4% of critically ill patients was agglutinated with Intralipid 10% and only 3.3% of the healthy volunteers. In comparison, propofol produced agglutination in 74.1% of critically ill patients and in none of the serum from healthy volunteers (p < 0.05 propofol versus Intralipid 10%, p < 0.0001 propofol versus Intralipid 20%). No correlation was seen between agglutination and age, sex, APACHE II score or plasma concentration of acute phase proteins. However, agglutination of propofol and Intralipid 10% was more frequent (p < 0.001) in serum from patients with pulmonary disease, than in patients with normal lungs. The clinical implications of these in‐vitro findings are unclear and need further investigation.
Predictable nitrous oxide uptake enables simple oxygen uptake monitoring during low flow anaesthesia
Authors: BENGTSON J. P. , BENGTSSON A. , STENQVIST O. 
Published: February 2007

SummaryThe uptake rate of oxygen and nitrous oxide were studied during low flow anaesthesia with enflurane or isoflurane in nitrous oxide with either spontaneous or controlled ventilation. The excess gas flow and composition were analysed. The nitrous oxide uptake rate was in agreement with Severinghaus’formula V̇N20 1000.t‐0.5. The composition of excess gas was predictable and the following formula for oxygen uptake could be derived: V̇O2=V̇fgO2 ‐0.45 (V̇fgN2O ‐(kg: 70.1000.t‐0.5)) where oxygen uptake rate (V̇O2, ml.min‐1) equals oxygen fresh gas flow (V̇fgO2) minus 0.45 times the difference between the fresh gas flow of nitrous oxide (V̇fgN2O), ml.min‐1 and estimated uptake of nitrous oxide. The equation assumes constant inspired gas concentrations of 30% oxygen and 65–70% nitrous oxide. The oxygen uptake rates calculated from this formula were in good agreement with measured uptake rates. Thus, continuous monitoring of oxygen uptake rates is possible by using only reliable flowmeters and analysis of inspried oxygen concentration.
Thyroid storm as a cause of loss of consciousness following anaesthesia for emergency Caesarean section
Authors: PUGH S. , LALWANI K. , AWAL A. 
Published: February 2007

SummaryA previously undiagnosed thyrotoxic patient was anaesthetised for an emergency Caesarean section. The recovery period was complicated by an acute thyroid crisis resulting in loss of consciousness following an apparently normal recovery from general anaesthesia.
Studies in postoperative sequelae. Nausea and vomiting—still a problem
Authors: Quinn A. C. , Brown J. H. , Wallace P. G. , Asbury A. J. 
Published: February 2007

SummaryWe collected data on postoperative nausea and vomiting from 3850 patients aged 11–91 years. Thirty‐seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. Of the general anaesthetic patients reporting nausea, 72.2% were women, and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 74.0% were women and again the mean age was lower (p < 0.001). Of the local anaesthetic patients reporting nausea, 62.0% were women and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 68.1% were women and again the mean age was lower (p < 0.001). Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).
The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes
Authors: MURPHY P. J. , ERSKINE R. , LANGTON J. A. 
Published: February 2007

SummaryThis investigation studied the effect of two intravenous benzodiazepines and the specific reversal agent, flumazenil, on the sensitivity of upper airway reflexes. In a blinded, randomised, crossover study, we have investigated the effect of a single dose of diazepam (‘Diazemuls’) (0.2 mg.kg‐1) and midazolam (0.07 mg.kg‐1), both given intravenously on the sensitivity of upper airway reflexes in eight male volunteers. Reflex sensitivity was assessed by identification of reflex glottic closure in response to a threshold concentration of inhaled ammonia vapour. Both diazepam and midazolam produced significant depression of upper airway reflex sensitivity. This was maximum with both drugs within 10 min of administration, but baseline sensitivity was regained within 60 min. Flumazenil (300 μg) administered 10 min after midazolam, resulted in significant reversal of the upper airway reflex sensitivity depression.
Efficacy of epidurally administered sufentanil versus bupivacaine during thoracic surgery
Authors: DER LELY F. HAAK‐VAN , VAN KLEEF J. W. , DER VEER B. J. GESINK‐VAN , BURM A. G. L. , BOVILL J. G. 
Published: February 2007

SummaryThe efficacy of thoracic epidural sufentanil 50 μg was compared with bupivacaine 0.5% with adrenaline 5 μg.ml‐1 (dose 40 mg) or saline, in 30 patients (n = 10 in each group) undergoing lateral thoracotomy. Sufentanil, bupivacaine or saline was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg‐1 and thiopentone 2–5 mg.kg‐1. Anaesthesia was maintained with nitrous oxide 66% and halothane 0.3%. Supplementary sufentanil 25 μg was given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre‐operative value, whenever heart rate exceeded 90 beat. Min‐1 in the absence of hypovolaemia, or when other autonomic or somatic signs occurred. Fewer patients in the epidural sufentanil (n = 4, p < 0.005) and bupivacaine (n = 1, p < 0.001) groups required supplementary sufentanil compared to the placebo group, in which all patients needed supplementary sufentanil, but there was no statistical difference between the sufentanil and bupivacaine groups. One or more hypotensive episodes occurred in five patients in the sufentanil group, in all patients in the bupivacaine group and in no patient in the placebo group, and the differences were significant (p < 0.02).
An intra‐operative comparison of lumbar with thoracic epidural sufentanil for thoracotomy
Authors: DER LELY F. HAAK‐VAN , VAN KLEEF J. W. , BURM A. G. L. , BOVILL J. G. 
Published: February 2007

SummaryThe efficacy of thoracic epidural sufentanil 50 μg was compared with lumbar epidural sufentanil 50 μg in 30 patients (n = 15 in each group) undergoing lateral thoracotomy. Sufentanil was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg‐1 and thiopentone 2–5 mg.kg‐1 intravenously. Anaesthesia, nitrous oxide 66%, halothane 0.3% and sufentanil 25 μg intravenously were given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre‐operative value and heart rate exceeded 90 beat.min‐1 in the absence of hypovolaemia, or when other autonomic or somatic signs were seen. Four patients in the thoracic epidural group and five in the lumbar epidural group needed supplementary sufentanil. Six patients in the thoracic epidural group and three in the lumbar epidural group each had a single hypotensive episode. Lumbar and thoracic epidural sufentanil are equally effective in contributing to intra‐operative analgesia for lateral thoracotomy.
Intra‐operative blood glucose measurements
Authors: SMITH E. A. , KILPATRICK E. S. 
Published: February 2007

SummaryVariations in haematocrit are known to affect the accuracy of reagent strip tests for glucose. We have investigated 10 patients during cardiopulmonary bypass, where intra‐operative decreases in haematocrit occur. Whole blood glucose concentrations were measured on five occasions at 30 min intervals during the procedure using the Glucometer II, One Touch II and Reflolux II meters as well as a reference instrument (YSI Model 23AM). Haematocrits were recorded simultaneously. Overall, for every 10% fall in haematocrit, Glucometer II measurements rose by 22% (r = 0.74, p < 0.00001), One Touch II measurements fell by 3% (r = 0.44, p < 0.002) and the Reflolux II measurements showed no significant variation. The One Touch II showed closer agreement to the reference (mean bias 0.3 mmol.l‐1 (95% between +0.86 and –0.26)) than the Reflolux II (bias 1.58 (+3.40 to –0.24)) or the Glucometer II (bias 3.25 (+6.18 to 0.32)). Thus, depending on the meter used, spuriously large intraoperative changes in blood glucose may seem to arise where patient haematocrit varies.
Response to suxamethonium during propofol‐fentanyl‐N2O/O2 anaesthesia in a patient with active myasthenia gravis receiving long‐term anticholinesterase therapy
Authors: VANLINTHOUT L. E. H. , ROBERTSON E. N. , BOOIJ L.H.D.J. 
Published: February 2007

SummaryWe describe the effect of repeated suxamethonium doses during propofol‐fentanyl‐N2O/O2 anaesthesia in a 29‐year‐old woman with active myasthenia gravis receiving chronic pyridostigmine therapy. Despite adequate pre‐operative pseudocholinesterase activity, suxamethonium resistance occurred. Neither bradycardia nor residual neuromuscular block were seen after repeated doses of suxamethonium.
Recovery from pre‐operative sedation with clonidine—brain stem auditory evoked response
Authors: Kumar A. , Tandon O. P. , Bhattacharya A. , Bose S. , Kundra P. 
Published: February 2007

SummaryIn a randomised double‐blind study, 34 elderly patients (ASA grades 1–2) underwent elective intra‐ocular surgery. Patients were allocated randomly to two groups to receive oral clonidine 300 μg or oral diazepam 10 mg 2h before surgery. Facial block and retrobulbar block were given at 2 h after premedication. Anaesthetic recovery was assessed using a clinical recovery score (at 0, 30, 60 and 120 min after arrival in the recovery room) and brain stem auditory evoked potential responses (BAER) (immediately after operation and at 120 min after operation). In both the groups the clinical recovery scores decreased significantly at 30 and 60 min following recovery (p < 0.01). At 120 min this score returned to the pre‐operative value in the clonidine group, but in the diazepam group there was a significant difference between the 2 h value and pre‐operative value (p < 0.05). In the clonidine group there was no significant rise in the interpeak latencies and absolute peak latencies of brain stem auditory evoked responses recorded immediately after operation and 120 min after operation. In the diazepam group, there was a significant rise in the interpeak latencies immediately after operation and 120 min after operation and a rise in absolute peak latencies (p < 0.05) immediately after operation. In the clonidine group there was a reduction (p < 0.05) in amplitude of wave V at immediately after operation. We conclude that clonidine 300 μg orally before surgery does not delay recovery.
Single dose intravenous ondansetron in the prevention of postoperative nausea and vomiting
Authors: PEARMAN M. H. 
Published: February 2007

SummaryPostoperative nausea and vomiting continues to pose problems for surgical patients. Three studies were undertaken to evaluate the efficacy and safety of prophylactic intravenous ondansetron in male and female patients undergoing outpatient surgery. Studies 1 and 2 included a total of 1169 female patients scheduled to undergo surgery on a day case basis. In study 3, 468 male patients scheduled for outpatient surgery were enrolled. Patients received ondansetron or placebo prior to induction of anaesthesia. Efficacy and safety data were collected for 24 h postoperatively. Studies 1 and 2, individually, revealed that ondansetron 4 mg and 8 mg were significantly (p ≤ 0.05) better than placebo at preventing emesis. A combined analysis showed that the 4 mg and 8 mg doses were significantly (p ≤ 0.05) better than ondansetron 1 mg at preventing emesis, while 8 mg was not statistically different from 4 mg. Therefore, 4 mg was chosen as the optimal dose. In study 3, ondansetron 4 mg was significantly (p ≤ 0.001) more effective than placebo in preventing emesis in males. There were no differences between treatment groups with respect to vital signs, laboratory values, or adverse events. Intravenous ondansetron is safe and effective at preventing postoperative nausea and vomiting in male and female patients undergoing day case surgery.
Impact of postoperative nausea and vomiting in the surgical setting
Authors: HIRSCH J. 
Published: February 2007

SummaryPostoperative nausea and vomiting is one of the most common complications of inpatient and day case surgical procedures. In a climate where total cost of an illness is becoming increasingly important, postoperative nausea and vomiting is a major contributor to direct and indirect costs for both the hospital and patient. In patient terms, the impact of increased recovery room stays and extra nursing time required by PONV patients has been estimated to range from 96–576 more surgical procedures which may be performed in an‘average’day case surgery centre. Postoperative nausea and vomiting is perceived by patients to account for equal or more debilitation than surgery itself and may cause them to lose wages due to absence from work. Reducing the incidence of nausea and vomiting and its associated problems may therefore provide opportunities to improve patient care, decrease the size of waiting lists and improve utilisation of scarce healthcare resources.
An impaled neck
Authors: BULLINGHAM A. , HAMPSON‐EVANS D. , PALAZZO M. 
Published: February 2007

SummaryWe describe the management of a patient impaled through the lower submandibular area by the top spike of some iron railings which immobilised his jaw and blocked access to the trachea. The Fire Brigade used specialised equipment to cut out a section of the railings so that the patient could be transported to hospital. Awake fibreoptic intubation was used to gain access to the patient's airway before induction of anaesthesia.
Peri‐operative effect of major gastrointestinal surgery on serum magnesium
Authors: Sanchez‐Capuchino A. , McConachie I. 
Published: February 2007

SummaryThis study investigates the changes in serum magnesium levels after major gastrointestinal surgery and evaluates if Plasma‐Lyte 148 used as maintenance fluid influences these changes in the peri‐operative period. Thirty patients presenting for procedures ranging from anterior rectal resection to thoraco ‐abdominal cardio‐oesophagectomy were randomly allocated into two groups, one of which received compound sodium lactate solution as the maintenance crystalloid during the intra‐ and postoperative period, and the other Plasma‐Lyte 148, a magnesium‐containing crystalloid solution. Serum magnesium levels were measured pre‐operatively, in the immediate recovery period and 24 h postoperatively. The results showed a statistically significant (p < 0.05) reduction in the magnesium levels in both groups. The reduction was less marked in the Plasma‐Lyte group but this did not achieve statistical significance (p > 0.05) compared with the compound sodium lactate group.
Survival after intensive care
Authors: RIDLEY S. , PLENDERLEITH L. 
Published: February 2007

SummaryThe life expectancy for survivors of critical illness has not been reported in the United Kingdom. The aim of this study was to compare the long‐term survival of intensive care patients with that of an age and sex‐matched population. All patients admitted to a general intensive therapy unit over 4 years (n = 1168) were included in the study. Details of the survivors were forwarded to the Registrar General for Scotland, who then issued copies of death certificates as the survivors died. The survival curve of patients discharged from the intensive therapy unit was significantly different from that of the normal population. The risk of dying in the first year after discharge was 3.4 times higher (95% confidence intervals 2.7–4.2) than that in the normal population. It is not until the start of the fourth year after discharge that the probability of death matched that of the normal population.
The polyurethane nasotracheal tube
Authors: WRIGHT C. J. , FRERK C. M. , PADFIELD A. , RYAN M. M. , SMITH G. B. 
Published: February 2007

SummaryAn uncuffed nasotracheal tube for use in minor maxillofacial surgery has been developed using polyurethane. The suitability of this tube as an alternative to the existing soft red rubber and harder polyvinyl chloride materials has been assessed at four centres during anaesthesia for routine oral surgery. The tube was found to be satisfactory.
Munchausen's syndrome
Authors: BAKER C. E. , MAJOR E. 
Published: February 2007

SummaryWe present a variant of Munchausen's syndrome not previously described in which acute severe asthma is the presenting complaint. The clinical presentation is so extreme that the patient has received artificial ventilation on several occasions despite having had normal arterial blood gas values. The patient appears to be able to mimic the signs of severe respiratory distress by means of a protracted Valsalva manoeuvre, and all signs of acute asthma instantaneously disappear with sedation. Because of the chronic‘asthma’, and the frequent dramatic acute episodes, the patient successfully claims invalidity benefit, and has done so for many years.
Forces acting on the maxillary incisor teeth during laryngoscopy using the Macintosh laryngoscope
Authors: BUCX M. J. L. , SNIJDERS C. J. , VAN GEEL R. T. M. , ROBERS C. , VAN DE GIESSEN H. , ERDMANN W. , STIJNEN T. 
Published: February 2007

SummaryWe determined the forces on the maxillary incisors during routine laryngoscopy in 65 adult patients. The forces were measured by a strain gauge based sensor positioned between the handle and the blade of the laryngoscope. The mean maximal force acting on the maxillary incisors was 49 N. In patients without maxillary incisors, the force acting on the gums was significantly lower at 21N (p < 0.001). These results suggest that, despite traditional advice to the contrary, a levering movement of the laryngoscope, using the maxillary incisors (or gums) as a fulcrum, is common practice. Biomechanical analysis revealed that, although levering is not the preferred movement, it is an efficient way of bringing the glottis into view. These results may have implications for future laryngoscope design.
A comparison of the effect on gastric emptying of either enflurane or propofol given during maintenance of anaesthesia for minor surgery
Authors: BENNETT M. W. R. , BEMBRIDGE J. L. , SHAH M. V. 
Published: February 2007

SummaryTwenty patients scheduled for minor gynaecological surgery were studied. Anaesthesia was induced with propofol and maintained either with enflurane/oxygen/nitrous oxide or propofol/oxygen/nitrous oxide. The rate of gastric emptying was measured indirectly by the paracetamol absorption model. The results showed that there was no significant difference in gastric emptying rate between the two groups. Recovery in the propofol group was more rapid in that paracetamol ingestion occurred earlier in the recovery period compared with the enflurane group.
Intensive care management of multiple‐organ dysfunction due to falciparum malaria in a married couple
Authors: GRACE D. , LA VERY G. G. , JACKSON P. , CANAVAN D. A. , FEE J. P. H. 
Published: February 2007

SummaryA married couple presented simultaneously with malignant tertian malaria and rapidly developed septicaemia and severe multiple‐system organ failure. Despite schizonticidal treatment and multisystem support in intensive care the husband died. The selection of chemoprophylactic agents for this couple was not ideal and the duration of therapy before exposure to risk was inadequate. Severe infection with plasmodium falciparum is life‐threatening and requires early diagnosis. It is best managed in an intensive care unit where continuous assessment may enable rapid detection of clinical deterioration and allow appropriate treatment to be instituted. The diagnosis should be considered in symptomatic patients who have travelled through areas where malaria is endemic. Recognised guidelines for the prescription of malarial chemoprophylaxis should be followed to ensure adequate protection.
Difficult intubation following thoracic trauma
Authors: GROVES J. , EDWARDS N. , HOOD G. 
Published: February 2007

SummaryA previously fit 20‐year‐old man presented with a large haemothorax following a stab wound to the left chest. Pre‐operative airway assessment indicated that tracheal intubation would be routine. On induction of anaesthesia, visualisation of the larynx proved impossible because of soft tissue swelling. Successful intubation was eventually achieved with the aid of a gum elastic bougie. At operation, the patient's common carotid artery was found to have been perforated close to its origin on the aorta. The patient made an uneventful recovery.