bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic piroxicam as an adjunct to patient‐controlled analgesia with alfentanil for postoperative pain relief
Authors: VAN LANCKER P. , DEVULDER J. , ROLLY G. 
Published: February 2007

SummaryIn a double‐blind, placebo‐controlled study, the non‐steroidal anti‐inflammatory drug, piroxicam, in combination with alfentanil given in a patient‐controlled analgesia system, was compared with alfentanil alone given by the same route for analgesic effect, side effects and acute phase reaction over a 4‐day period following anterior cruciate ligament reconstruction of the knee. The patients receiving piroxicam had lower pain scores and consumed less alfentanil. There were no differences with regard to side effects between the two treatment groups, apart from significantly more sedation at 08.00 h on the first postoperative day in the non‐piroxicam group. Piroxicam did not influence either the levels of interleukin‐6 or the acute phase response to surgery.
Upper airway obstruction caused by acquired inhibitor to factor VIII
Authors: Joynt G. M. , Wickham N. W. R. , Young R. J. , Gomersall C. D. 
Published: February 2007

SummaryBleeding caused by inhibitors to factor VIII is a rare medical emergency requiring immediate specialist investigation and management. Urgent initiation of therapy with high dose factor VIII concentrates may be life saving. Successful management of acute upper airway obstruction from uncontrolled haemorrhage into the oropharyngeal tissues should be achieved with fibreoptic guided nasotracheal intubation.
The prognostic value of serial measurements of serum albumin concentration in patients admitted to an intensive care unit
Authors: McCLUSKEY A. , THOMAS A. N. , BOWLES B. J. M. , KISHEN R. 
Published: February 2007

SummaryThe prognostic value of serial measurements of serum albumin concentration during the first 72 h after admission to a general adult intensive care unit was retrospectively reviewed in 348 consecutive critically ill patients over a one year period. The accuracy of the admission APACHE II (Acute Physiology And Chronic Health Evaluation) score in correctly predicting patient outcome was compared with the serum albumin concentration measured at different times after intensive care unit admission. Multiple logistical regression analyses were performed to evaluate whether combining APACHE II and serum albumin into a unified risk index improved prognostic accuracy. Serum albumin concentration on admission was lower in non‐survivors than in survivors and decreased more rapidly in non‐survivors (p < 0.001). The admission serum albumin concentration was found to be an insensitive prognostic indicator. However, serum albumin measured after 24 h was as accurate as the admission APACHE II score in correctly classifying patients according to outcome. There was a good correlation between the admission APACHE II score and serum albumin measured after 24 h but not between the admission APACHE II and the admission serum albumin. Combining the APACHE II score and serial albumin concentrations into a unified risk of death equation did not improve the accuracy of outcome prediction.
Difficult intubation: thyromental distance and the atlanto‐occipital gap
Authors: FRERK C. M. , TILL C. B. W. , BRADLEY A. J. 
Published: February 2007

SummaryTen patients with a history of difficult intubation and 10 control patients were examined clinically and radiologically. It was shown that thyromental distance can be measured reliably clinically and further support is given to its usefulness as a predictor of difficult intubation. We were unable to demonstrate a conclusive link between thyromental distance and atlanto‐occipital or atlanto‐axial gaps. A review of X rays in other collections may add to the understanding of these factors in difficult intubation.
Effects of carbon dioxide insufflation for laparoscopic cholecystectomy on the respiratory system
Authors: PELOSI P. , FOTI G. , CEREDA M. , VICARDI P. , GATTINONI L. 
Published: February 2007

SummaryThe changes occurring in total respiratory system, lung and chest wall mechanics, lung volume and gas‐exchange during abdominal insufflation with carbon dioxide for laparoscopic cholecystectomy were studied. Using the technique of rapid airway occlusion during constant flow inflation together with an oesophageal balloon, we computed compliance and maximum resistance of the respiratory system, subsequently apportioning it into its lung and chest wall components. Maximum resistance of the respiratory system was further divided into airway resistance and the viscoelastic properties of the lung and the chest wall. In 10 patients (group 1), we measured respiratory system, lung and chest wall mechanics (compliance and resistance), functional residual capacity, end‐tidal carbon dioxide tension and oxygen saturation. In addition, arterial blood gas analysis and end‐tidal carbon dioxide tension were measured in a second group of 10 patients (group 2). Measurements, in both groups, were obtained in the reverse Trendelenburg position, at 15 min after the induction of anaesthesia, 5 min and 45 min after abdominal insufflation and at 15 min after abdominal deflation. Tidal volume, respiratory rate, inspiratory flow and the fraction of inspired oxygen were similar in both groups and maintained constant during the procedure. We found that abdominal carbon dioxide insufflation caused: a reduction in compliance of the respiratory system (both lung and chest wall components) and of functional residual capacity; a marked increase in the maximum resistance of the respiratory system (mainly due to increases in the viscoelastic properties of the lung and chest wall); no change in oxygenation, but an increase in the end‐tidal carbon dioxide tension (which was correlated closely with the arterial carbon dioxide tension). These changes were not affected by the duration of anaesthesia.
The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol
Authors: Wrench I. J. , Ward J. E. H. , Walder A. D. , Hobbs G. J. 
Published: February 2007

SummaryWe have studied the effect of combination antiemetic therapy (ondansetron and droperidol) with morphine delivered by patient‐controlled analgesia following major gynaecological surgery. Sixty patients were randomly allocated to one of three treatment regimens; ondansetron alone (4 mg bolus and 0.13 mg.ml‐1 in the morphine solution), droperidol alone (1.25 mg bolus and 0.05 mg.ml‐1 in the morphine solution), or both drugs in combination. For the first 12 postoperative hours, patients receiving combination therapy experienced significantly less nausea than those receiving single antiemetic therapy (p < 0.001). There was no difference between the regimens from 12 to 18 h. We conclude that a combination of ondansetron and droperidol added to morphine in a patient‐controlled analgesia system reduces postoperative nausea to a greater extent than treatment with either drug alone following major gynaecological surgery.
Effect of injection pressure on the success rate of peribulbar block
Authors: Gillart T. , Bazin J. E. , Deret C. , Aigouy L. , Schoeffler P. , Raynaud C. 
Published: February 2007

SummaryThe aim of this prospective double‐blind study was to evaluate the effect of the pressure on injection of local anaesthetic during peribulbar anaesthesia. Fifty patients scheduled for cataract surgery under peribulbar anaesthesia, with a two injection site technique, were randomly assigned to receive a mixture of 5ml of etidocaine 1%, 4ml of bupivacaine 0.5% and hyaluronidase SOW, injected under a constant pressure of either 140g.cm‐2 (group 1) or 250g.cm‐2 (group 2). After orbital compression, the degree of akinesia of the extra‐ocular and orbicular muscles was graded by clinical assessment. A significantly higher rate of satisfactory akinesia of the extra‐ocular muscles was found in group 2 (72% vs 28% in group 1) (p < 0.01). No significant relationship was found between the time taken to administer the anaesthetic mixture at constant pressure and the quality of the block.
Patients' experiences of patient‐controlled analgesia
Authors: TAYLOR N. M. , HALL G. M. , SALMON P. 
Published: February 2007

Summary We examined patients' experiences of patient‐controlled analgesia by the use of semistructured interviews in 26 patients shortly after discontinuation of the device. The opinions expressed by the patients were examined qualitatively to identify recurring themes in their experience of patient‐controlled analgesia. The areas of interest were analgesia, factors influencing whether the patient pressed the button or not, whether they felt in control and side effects. Negative as well as the expected positive evaluations were found. The negative evaluations reflected problems with nausea and vomiting and inadequate analgesia. No clear strategy for pressing, or not pressing, the button emerged and the principle of control by the patient over their pain relief was not considered important.‘The uncritical acceptance of expert‐driven questionnaires into clinical trial protocols will only diminish the importance of the patient's perspective.’
A comparison of the induction characteristics of sevoflurane and halothane in children
Authors: BLACK A. , SURY M. R. J. , HEMINGTON L. , HOWARD R. , MACKERSIE A. , HATCH D. J. 
Published: February 2007

Summary The induction characteristics of sevoflurane and halothane were compared in 81 children aged 6 months to 6 years. The mean time taken to achieve loss of eyelash reflex was significantly shorter with sevoflurane than with halothane (sevoflurane, mean time (SD) 1 min 41 s (35 s), halothane, mean time (SD) 2 min 17 s (43 s), t = 4.11, p = <0.01). The mean time taken to complete induction (to achieve steady spontaneous ventilation and small pupils with central gaze) was also shorter in children induced with sevoflurane (sevoflurane, mean time (SD) 3 min 58 s (1 min 8 s), halothane, mean time (SD) 4 min 50 s, (1 min 27s), t = 2.29, p = 0.027). Effects on heart rate, blood pressure and oxygen saturation during induction were similar for both agents. There were no major complications during induction with either halothane or sevoflurane.
A comparison of the effects of isoflurane and desflurane on the neuromuscular effects of mivacurium
Authors: KUMAR N. , MIRAKHUR R. K. , SYMINGTON M. J. , LOAN P. B. , CONNOLLY F. M. 
Published: February 2007

Summary The effects of 1 MAC of desflurane and isoflurane (in 66% nitrous oxide) on the potency and duration of action of mivacurium were studied in 80 patients. The ED95 of mivacurium was 86 μg.kg‐1 (74–100) and 88μg.kg‐1 (76–103) (mean and 95% confidence intervals) during anaesthesia with desflurane and isoflurane respectively. The onset and duration of recovery to 25, 75 and 90% of T1 (first response in the TOF) of 200 μg.kg‐1 of mivacurium were 1.4 (0.3) and 1.5 (0.3) min (mean and SD), 22 (4.9) and 19 (4.0), 29 (6.6) and 26 (5.8), and 32 (7.3) and 29 (6.6) min respectively. There was no significant difference in any of the variables between desflurane and isoflurane. It is concluded that the neuromuscular effects of mivacurium are similar during anaesthesia with 1 MAC of desflurane and isoflurane.
Creatinine and urea clearance during continuous veno‐venous haemofiltration in critically ill patients
Authors: BROCKLEHURST I. C. , THOMAS A. N. , KISHEN R. , GUY J. M. 
Published: February 2007

Summary Urea and creatinine clearances achieved using continuous veno‐venous haemofiltration were calculated in 16 critically ill patients, during 50 episodes of filtration. The effects of filter life and the volume of ultrafiltrate on these clearances were also evaluated. Clearances were calculated from urea and creatinine concentrations in blood and ultrafiltrate and the volume of ultrafiltrate produced. The overall mean (SD) urea clearance was 26.6 (6.0) ml.min‐1 and the overall creatinine clearance was 30.1 (6.3) ml.min‐1. The mean (SD) ultrafiltrate production was 29.6 (5.9)ml.min‐1. Creatinine clearance was significantly lower in, filters that failed within 24 h (filters < 24h 27.5 (6.3) ml. min 1, filters > 24 h 32.2 (5.5) ml.min‐1). The clerance of both solutes increased with increasing ulfrafiltrate volume (p < 0.001). We conclude that satisfactory clearance of urea and creatinine can be achieved using continuous two‐venous haemofiltration. Increases in ultrafiltrate production lead to similar increases in urea and creatinine clearance. Prolongation of filter life may improve creatinine clearance.
The practice of anaesthesia—a stressor for the middle‐aged?
Authors: SEELEY H. F. 
Published: February 2007

Summary Surveys conducted in the United Kingdom over the last few years have revealed decreased job satisfaction and increased anxiety and depression in both hospital specialists and general practitioners. Anaesthesia is perceived to be a stressful specialty and there is evidence, albeit patchy, that certain stress‐associated conditions are more common in anaesthetists. The ‘middle years’, seem to be a danger period. The analogy between the work of anaesthetists and airline pilots is often drawn and the principles underlying the assessment and maintenance of pilot competence could be adopted in anaesthesia. While outcome studies are numerous much less attention has been paid to the structure and process of anaesthtic practice. Models for studying these aspects have been developed for investigating stress in general practitioners and doctors in training. Even minor degrees of professional impairment may place patients at risk and an investigation into the effects of the specialty on those who practise it is justified.
The effect of pre‐incisional infiltration with lignocaine on postoperative pain after molar teeth extraction under general anaesthesia
Authors: Tordoff S. G. , Brossy M. , Rowbotham D. J. , James J. N. , James R. , Raphael J. H. 
Published: February 2007

Summary In a double‐blind, placebo‐controlled investigation, we studied the effects of pre‐operative inferior alveolar nerve blockade and local anaesthetic intra‐oral infiltration upon postoperative pain following third molar teeth extraction under general anaesthesia. Thirty six patients (12 male), mean (range) age 25.7 (18–40) years received an injection of 2% lignocaine 2 ml with 1:200 000 adrenaline around the inferior alveolar nerve and tissues adjacent to the third molar tooth on one side and of normal saline 2 ml in a similar fashion to the other side. We measured the pain on each side of the mandible on the 1st, 4th and 11th days after surgery using a visual analogue scale. The visual analogue pain score on the lignocaine and saline sides were 25/100 and 26/100 on day 1, 23/100 and 22/100 on day 4 and 0/100 and 1/100 on day 11. This study has a power of 80% to detect differences at the 5% level of significance of 11/100 on days 1 and 4 and 7/100 on day 11. We found no significant difference in the visual analogue scores between the lignocaine side and the saline side at any stage after the procedure.
Postoperative pain in children
Authors: Goddard J. M. , Pickup S. E. 
Published: February 2007

Summary An audit project was designed to assess and improve the provision of postoperative analgesia in a children's hospital. Pain assessment for all children and analgesia standards for our institution were introduced prior to data collection. Data were collected on consecutive samples of 316 and 325 children undergoing surgery as inpatients during 10‐week periods. Change was initiated between the two periods in response to our findings; our action plan involved education, changes to documentation, the widespread use of diclofenac in children over 2 years of age and recommendations far the prescription of analgesia. The initial prescription of analgesia increased from 95% to 98% (p = 0.019), administration of analgesia to children experiencing bad or severe pain increased from 57% to 71% (p = 0.032) and the number of children experiencing severe pain reduced from 17% to 11% (p = 0,050). Application of audit, by a clinical nurse specialist, enabled us to achieve and demonstrate improvements in the prescription, administration and effectiveness of postoperative analgesia.
The effect of four different surgical prone positions on cardiovascular parameters in healthy volunteers
Authors: WADSWORTH R. , ANDERTON J. M. , VOHRA A. 
Published: February 2007

Summary Twenty healthy volunteers were placed in four different surgical prone positions: on pillows, on an evacuatable mattress, on pelvic props and in the knee—chest position. The normal supine position was used as a control for the measurement of cardiovascular parameters. Mean arterial pressure was measured by automated oscillotonometry. Transthoracic electrical bioimpedance was used to measure cardiac output and heart rate. Cardiac index and total vascular resistance index were derived from these data. No significant changes in heart rate or mean arterial pressure occurred when the volunteers were moved from the supine position to any of the four prone positions or when returned to the supine position again. Cardiac index decreased significantly on going from the supine to the knee—chest position (20%) and onto the props (17%) but not onto the evacuatable mattress (11%) or the pillows (3%).
Changes in tracheal tube position during laparoscopic cholecystectomy
Authors: INADA T. , UESUGI F. , KAWACHI S. , TAKUBO K. 
Published: February 2007

Summary The distance from the carina to the tip of the tracheal tube was measured with a fibreoptic bronchoscope in 21 consecutive patients undergoing elective laparoscopic cholecystectomy. After placement of an Eschmann tracheal tube with a printed intubation guide mark at the vocal cords, the distance was 28 (15) [5–54]mm (mean (SD) [range]). The tube was then repositioned so that the distance was 34 (3) [30–40]mm from tip of the tube to the carina. After creation of pneumoperitoneum, the distance was significantly decreased to 26 (5) [17–35] mm (p < 0.005), which was not significantly altered by subsequent moving of the patient to the reverse Trendelenburg and left lateral tilt position. The maximum distance of tube migration was 8 (4) [0–15]mm. Four out of 21 patients would have been at risk of bronchial intubation after pneumoperitoneum if the tube had not been repositioned. Placement of the tube according to the guide mark is not recommended for laparoscopic cholecystectomy.
The effect on the heart of hypoxaemia in patients with severe coronary artery disease
Authors: SMITH H. L. , SAPSFORD D. J. , DELANEY M. E. , JONES J. G. 
Published: February 2007

SummaryThe aim of the study was to examine the effect of spontaneous nocturnal hypoxaemia on myocardial ischaemia in patients with severe coronary artery disease. This was a prospective study of continuously measured oxygen saturation and ECG overnight in patients prior to coronary artery bypass graft surgery. Fifteen patients with angiographically proved coronary artery disease were studied between October 1992 and September 1993. All patients had episodes of hypoxaemia with oxygen saturation < 94% and eight of the 15 patients had episodes where oxygen saturation < 85%. An episode was defined as a period of hypoxaemia not less than 2.5min in duration, the longest total duration of hypoxaemia in one patient being 355 min. Twelve of the 15 patients showed a drop in ST segment of 1 mm or more lasting from 5–700 min. The hypoxaemic and ischaemic episodes apparently occurred at random. No causal relationship could be shown between hypoxaemia and ischaemia.
Anaesthesia and the QT interval in humans
Authors: MICHALOUDIS D. , FRAIDAKIS O. , LEFAKI T. , DEDE I. , KANAKOUDES F. , ASKITOPOULOU H. , POLLARD B. J. 
Published: February 2007

SummaryProlongation of the QT interval may cause potentially hazardous arrhythmias. The effects on the QT interval (QTc, corrected for heart rate) of isoflurane and halothane followed by vecuronium have been investigated during induction of anaesthesia in 51 patients. All patients were ASA 1 or 2, without cardiovascular problems or electrolyte abnormalities and were not receiving medication. Midazolam 0.08mg.kg‐1 was administered intramuscularly for premedication. Anaesthesia was induced with either isoflurane (n = 26) or halothane (n = 25), and the inspired concentration increased to reach an end‐tidal concentration of 2.5% to 3%. Recordings of ECG, heart rate, systolic and diastolic arterial pressure were obtained at the following times: prior to induction of anaesthesia; 1 min and 3 min after a stable end‐tidal concentration had been reached; 1 min and 3 min following vecuronium administration, at the time of tracheal intubation and 1 min and 3 min later. Halothane significantly shortened QTc (p < 0.05 to p < 0.001), in contrast to isoflurane which prolonged it (p < 0.01). The heart rate decreased (p < 0.01 to p< 0.001) after induction of anaesthesia with halothane and returned to pre‐induction values after tracheal intubation. In contrast, heart rate increased after induction with isoflurane and increased further after laryngoscopy and tracheal intubation (p < 0.001). In the isoflurane group, ST depression was noticed in seven patients and nodal rhythm in two, while in the halothane group seven patients developed nodal rhythm and, in two patients, ventricular ectopics were recorded. There were no sequelae. In both groups, systolic and diastolic arterial pressure decreased after induction of anaesthesia (p < 0.01 to p < 0.001), increasing again after intubation.
Tropisetron and metoclopramide in the prevention of postoperative nausea and vomiting
Authors: ALI‐MELKKILÄ T. , KANTO J. , KATEVUO R. 
Published: February 2007

SummaryOne hundred and twenty patients undergoing elective ophthalmic surgery under general anaesthesia were investigated in a randomised, double‐blind, parallel group study of postoperative nausea and vomiting. Patients received tropisetron 0.1 mg.kg–1, metoclopramide 0.25mg.kg–1 or placebo given at the end of anaesthesia. In comparison with placebo, tropisetron significantly reduced the degree of nausea (p< 0.01), whereas metoclopramide reduced both nausea (p < 0.05) and vomiting (p < 0.05). There were no statistically significant differences between the two active agents in their efficacy to postoperative nausea and vomiting. The patients in the placebo group required rescue antiemesis more often in the postanaesthesia care unit. Our results suggest that tropisetron may not be suitable as a routine, primary therapy for the prevention of postoperative nausea and vomiting.
Measuring rebreathing in spontaneous ventilation A new lung model
Authors: COOK L. B. , WATT S. , PEACHEY G. , CHAKRABARTI M. K. 
Published: February 2007

SummaryThe performance of breathing systems is tested by means of physical lung models. We describe a new lung model, allowing direct measurement of the dead space/tidal volume ratios produced by any breathing system at different fresh gas flows. The model allows a range of different patterns of spontaneous respiration to be studied. Although rebreathing is measured by capnography, the design ensures that the results are unaffected by changes in carbon dioxide inflow, or even calibration drift in the capnograph.
Circle systems with a coaxial inspiratory limb
Authors: COOK L. B. , CHAKRABARTI M. K. 
Published: February 2007

SummaryA laboratory study of a new circle system is presented. The inspiratory limb encloses a coaxial tube, delivering fresh gas close to the patient, immediately upstream of the inspiratory one‐way valve. The system is more efficient than the non‐coaxial system and allows the expiratory valve to be situated conveniently at the canister end of the expiratory limb. A disadvantage of low flow anaesthesia is the sluggish response of the system to changes in vapour or oxygen concentrations in the fresh gas flow. This is markedly improved by the new system. The advantages of the system are largely independent of respiratory pattern.