bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regurgitation and oesophageal rupture with cricoid pressure: a cActaver study
Authors: VANNER R. G. , PRYLE B. J. 
Published: February 2007

SummaryThe efficacy of cricoid pressure was studied in 10 adult cActavers. The oesophageal pressure that would result in regurgitation during measured values of cricoid pressure was determined. Oesophageal pressure, recorded by a 2 mm diameter oesophageal tube, was increased by oesophageal distension with saline, and incremental levels of cricoid force, 20, 30 and 40 Newtons, were applied with a cricoid yoke. With each 10 Newton increment of cricoid force there was a significant rise in the oesophageal pressure required to provoke regurgitation (p < 0.01). Thirty Newtons of cricoid force prevented regurgitation of saline in all cActavers with oesophageal pressures of up to 40 mmHg. Rupture of the oesophagus occurred in three cActavers: one at 30 and two at 40 Newtons of cricoid force, but there was no rupture at 20 Newtons of cricoid force. In the other seven cActavers oesophageal pressures were also studied with a 4.6mm diameter (14 FG) oesophageal tube, which did not reduce the efficacy of cricoid pressure in preventing regurgitation.
Continuous extradural infusion of lignocaine 0.75% vs bupivacaine 0.125% in primiparae: quality of analgesia and influence on labour
Authors: MILASZKIEWICZ R. , PAYNE N. , LOUGHNAN B. , BLACKETT A. , BARBER N. , CARLI F. 
Published: February 2007

SummaryWe studied 86 primiparous women with uncomplicated pregnancy and labour requesting extradural analgesia in labour. All the women were over 36 weeks of gestation with a cephalic‐presenting singleton fetus. The women were allocated randomly to two groups: group A, who received an extradural infusion of lignocaine 0.75%, after an initial dose of 10 ml of lignocaine 1.5%, and group B, who received an infusion of bupivacaine 0.125% after an initial dose of 10 ml of bupivacaine 0.25%. All the women had their labour actively managed. Assessment of analgesia during labour and delivery, and the requirements for additional top‐ups were noted, as were mode of delivery, requirement for oxytocic augmentation and incidence of fetal distress. Maternal and umbilical cord plasma concentrations of lignocaine were measured at delivery in 12 women receiving extradural lignocaine. There were no statistically significant differences between the two groups in terms of the mode of delivery, incidence of fetal distress, fetal heart rate abnormalities, or Apgar scores of the babies. Women in the bupivacaine group had a significantly better quality of analgesia during both the first and second stages of labour (p = 0.0005) and required fewer top‐ups than those in the lignocaine group. However, the requirement for oxytocin augmentation during the first and second stages of labour was significantly less in the lignocaine group (p = 0.004). Similarly, the duration of the second stage was shorter compared with the bupivacaine group. In spite of high plasma concentrations of lignocaine, no side effects were noted in either mothers or babies.
An assessment of an alternative method of internal jugular vein catheterisation
Authors: Latto I. P. , Hughes J. A. , Falconer R. J. 
Published: February 2007

SummaryThis study assessed a tried, but previously unpublished, method of internal jugular vein cannulation in 50 patients scheduled for elective cardiac surgery. The method involves using two landmarks: the larynx (thyroid and cricoid cartilages) together with the carotid artery (if it is palpable). The cricoid and thyroid cartilages were readily identifiable in 48 (96%) patients. The carotid artery was palpable in 45 (90%) patients, although some difficulty in palpation was recorded in 24 (48%) patients. There was a 98% success rate of venous cannulation. In 90% of cases the 21 gauge seeker needle entered the vein on the first or second attempt, and in 82% of cases the subsequent 18 gauge introducing needle entered the vein on the first attempt.
Phantom limb pain during labour
Authors: DUREJA G. P. , SANDHYA G. P. 
Published: February 2007

SummaryWe report the occurrence of severe phantom limb pain during labour. The patient, a 27‐year‐old, had had an above knee amputation performed 6 years earlier following a road traffic accident but had no previous history of phantom limb phenomena. However, during early labour, she complained of a severe phantom limb pain in her amputated leg; a continuous epidural block relieved her of the sensation and pain. The sensation did not return following delivery.
A comparison of propofol and methohexitone for dental chair anaesthesia in children
Authors: Ewah B. , Carr C. 
Published: February 2007

SummaryFifty healthy children presenting for outpatient exodontia received either propofol or methohexitone for induction. Anaesthesia was maintained in both groups using 50% oxygen in nitrous oxide and 1–2% halothane. Those receiving methohexitone maintained a significantly higher mean arterial pressure and heart rate than the propofol group. Nine percent of patients in the propofol group developed ventricular arrhythmias, compared to 32% in the methohexitone group.
The level of neuromuscular block needed to suppress diaphragmatic movement during tracheal suction in patients with raised intracranial pressure: a study with vecuronium and atracurium
Authors: WERBA A. , KLEZL M. , SCHRAMM W. , LANGENECKER S. , MULLER C. , GOSCH M. , SPISS C. K. 
Published: February 2007

SummaryThe effects of tracheobronchial suction before and after neuromuscular blockade with vecuronium (0.12 mg.kg−1; ED95 X 2; group A) and atracurium (0.4 mg.kg−1; ED95 X 2; group B) on intracranial pressure were studied in 18 neurosurgical patients with a Glasgow Coma Scale < 7. Despite adequate sedation, moderate to severe diaphragmatic movements (bucking and coughing) in response to carinal stimulation with significant increases in intracranial pressure (A: 18 SD 7 to 24 SD 8 mmHg; B: 19 SD 7 to 27 SD 5 mmHg) and subsequent decreases in cerebral perfusion pressure (group A: 69 SD 11 to 63 SD 8 mmHg; group B: 63 SD 11 to 59 SD 17 mmHg) could be observed without muscle relaxation. After a bolus dose of vecuronium or atracurium, profound neuromuscular paralysis quantified by the post‐tetanic count, was observed after an onset time of 253 SD 72 s (vecuronium) and 159 SD 54 s (atracurium). Slight diaphragmatic movements could be elicited in only two patients in group A and in two patients in group B during tracheal suction; intracranial pressure (group A: 20 SD 8 to 20 SD 8 mmHg; group B: 19 SD 7 to 19 SD 7 mmHg) and cerebral perfusion pressure (group A: 65 SD 13 to 65 SD 13 mmHg; group B: 66 SD 12 to 65 SD 11 mmHg) remained unchanged. When coordinating respiratory therapy in neurosurgical intensive care patients, profound neuromuscular block, quantified by a post‐tetanic count of at least 5 for vecuronium and 1 for atracurium, it is necessary to rule out any impact of diaphragmatic movement on intracranial pressure. Repeated neurological evaluation was not inhibited when utilising an intermittent bolus‐dose regimen.
A comparison of percutaneous and perconjunctival routes of administration of peri‐ocular anaesthesia for day case cataract surgery
Authors: Sweeney E.J. , Barber K. , Prosser J.A. 
Published: February 2007

SummaryThis study of 100 day case patients having cataract surgery under local anaesthesia compared patient acceptance of two peri‐ocular techniques; a transcutaneous method and a transconjunctival method. A significant difference was found in relation to the pain felt on injection such that all peri‐ocular blocks at our unit are now done via the perconjunctival route.
Hyperthermia associated with 3,4‐methylenedioxyethamphetamine (‘Eve’)
Authors: TEHAN B. , HARDERN R. , BODENHAM A. 
Published: February 2007

SummaryA patient was admitted with hyperthermia, muscle rigidity, rhabdomyolysis and disseminated intravascular coagulation. He was initially thought to have taken 3,4‐methylenedioxymethamphetamine (MDMA, ‘Ecstasy’), but subsequent toxicology revealed the presence of 3,4‐methylenedioxyethamphetamine (MDEA, ‘Eve’), its sister drug, in his blood. Subsequent in vitro testing for malignant hyperthermia proved to be negative.
Severe bronchospasm during epidural anaesthesia
Authors: WANG C. Y. , ONG G. S. Y. 
Published: February 2007

SummaryA case of severe bronchospasm occurring during epidural anaesthesia in a patient undergoing Caesarean section is described. The aetiology of the bronchospasm may have been related to sympathetic nervous blockade allowing unopposed parasympathetically mediated bronchoconstriction.
An evaluation of anaesthetic loss from a closed breathing system
Authors: LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryWe present the results of a laboratory study of the loss of isoflurane from a to‐and‐fro system, ventilated with oxygen, using a standard ventilator connected to the system via a long corrugated tube (the trunk) in place of the reservoir bag. No conventional fresh gas supply is used and isoflurane is injected as a liquid directly into the soda lime canister. The loss of isoflurane from the system due to mixing in the trunk was generally less than that lost by absorption into rubber and plastic system components. Glass syringes used for injection of liquid isoflurane were found to be a potential source of much greater leaks. The results showed that a to‐and‐fro system ventilated with oxygen via an open trunk functions as a virtually completely closed anaesthetic breathing system.
Histamine release following atracurium in the elderly
Authors: SHORTEN G. D. , GOUDSOUZIAN N. G. , ALI H. H. 
Published: February 2007

SummaryA study was performed to evaluate histamine release, as well as potential cardiovascular and cutaneous sequelae, following bolus administration of atracurium in elderly patients. In 15 patients, using a radioenzymatic technique, plasma histamine concentrations were measured in venous blood samples obtained before and after induction of anaesthesia with thiopentone and at 2 and 5 min after administration of atracurium (0.6 mg.kg−1) over 30 s. Blood pressure and pulse rate were measured noninvasivefy and cutaneous changes sought and compared with those seen in 12 similar patients who received vecuronium (0.1 mg.kg−1). Our findings indicate that the histamine releasing property of atracurium in elderly patients is greater than that in children, similar to that in adolescents and less than that in nonelderly adults. The decreases in blood pressure following atracurium and vecuronium in elderly patients are similar.
The effect of residual receptor occupancy on sensitivity to repeated vecuronium
Authors: CAMPKIN N. T. A. , HOOD J. R. , FAUVEL N. J. , FELDMAN S. A. 
Published: February 2007

SummaryCumulative dose‐response curves were obtained for vecuronium in 10 patients anaesthetised with thiopentone, enflurane and nitrous oxide using adductor pollicis mechanomyography. Five patients received vecuronium systemically, which was repeated at 100% twitch recovery to obtain initial and repeat curves. Another five patients received 0.3 mg vecuronium into an isolated forearm and at 100% recovery of this arm received vecuronium systemically to obtain simultaneous dose‐response curves in both the previously isolated and nonisolated arms. There was no significant difference between the calculated ED50 obtained after initial systemic administration [16.2 (1.7) μg.kg−1], after recovery in the previously isolated arm [14.8 (2.0) μg.kg−1] and simultaneously in the nonisolated arm [16.1 (2.9) μg.kg−1]. The ED50 obtained after repeated systemic administration was significantly reduced [8.2 (2.9) μ.kg−1]. These results suggest that the reduction in ED50 at 100% twitch recovery from systemic vecuronium is not due to residual drug at the biophase/receptor but to drug persisting in the plasma.
The management of anaesthesia for Caesarean section in a patient with paroxysmal ventricular tachycardia
Authors: FIELD L. M. , BARTON F. L. 
Published: February 2007

SummaryWe describe the successful management of general anaesthesia for Caesarean section in a patient with poorly controlled paroxysmal ventricular tachycardia of pregnancy. The use of alfentanil before laryngoscopy and tracheal extubation ensured cardiostability without compromising maternal or fetal wellbeing. General anaesthesia allows prompt cardioversion. We believe that in the presence of a life‐threatening unstable cardiac rhythm this consideration outweighs any theoretical advantage of regional blockade.
The additional work of breathing imposed by Mapleson A systems
Authors: OOI R. , PATTISON J. , Soni N. 
Published: February 2007

SummaryThe additional work attributable to breathing through five Mapleson A anaesthetic breathing systems (Magill, Lack, Parallel Lack, Humphrey ADE and Enclosed Magill) was studied using a lung model. With all five systems, the additional work was found to be a function of fresh gas flow, respiratory flow as well as system geometry. Within the range of fresh gas flow and respiratory flows studied, the additional work ranged between 80 mJ.1−1 and 182 mJ.1−1. Expiratory work was always greater than the inspiratory workload, increasing fresh gas inflow into the system increases expiratory work, both resistive and elastic components. The Magill system posed the least work expenditure. The values for the additional work obtained with the lung model were of the same order of magnitude when measurements were taken in volunteers.
A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery
Authors: Bennett M. W. R. , Shah M. V. , Bembridge J. L. 
Published: February 2007

SummaryTwenty patients, scheduled for minor gynaecological surgery, were studied. Anaesthesia was induced with propofol and maintained with oxygen, nitrous oxide and enflurane. Patients were randomly allocated to two groups: group 1 were given alfentanil 0.2 mg; group 2 were given morphine 5 mg. The rate of gastric emptying was measured indirectly by the paracetamol absorption technique. The results showed that morphine caused greater delay in gastric emptying compared with alfentanil (p < 0.05). The observed effect on gastric emptying rate may potentially affect the risk of peri‐operative regurgitation and aspiration. This study provides further evidence that in short day‐case procedures, when oral medication may be required postoperatively, alfentanil may be preferable to morphine as an intra‐operative opioid.
Continuous regional analgesia in comparison with intravenous opioid administration for routine postoperative pain control
Authors: Schug S. A. , Fry R. A. 
Published: February 2007

SummaryThis study compares retrospectively the postoperative analgesia provided via intravenous opioids with continuous regional techniques (interpleural and epidural infusions) administered as a clinical routine by an anaesthesia‐based Acute Pain Service. In 2630 patients no severe complications resulting in morbidity or mortality occurred; the rate of potentially serious complications was in the 0.5% range and comparable between the techniques. A detailed analysis of a randomised subsample of 340 patients revealed better analgesia at rest and better compliance with physiotherapy under continuous regional analgesia. Techniques of continuous regional analgesia also resulted in fewer incidents of desaturation and fewer side effects. Patient satisfaction with these techniques was higher than with intravenous opioid administration. In conclusion, continuous regional analgesia in a routine clinical setting is comparable to intravenous opioid administration with regard to safety, but results in significantly better analgesia with fewer side effects.
A comparison of 25 G and 27 G Whitacre needles for Caesarean section
Authors: SMITH E. A. , THORBURN J. , DUCKWORTH R. A. , REID J. A. 
Published: February 2007

SummarySpinal needles with a pencil‐point tip and those of a finer gauge are known to be associated with a lower incidence of postdural puncture headache. This study set out to determine if fine pencil‐point needles were acceptably easy to use in routine clinical practice. Two hundred and twelve women undergoing elective Caesarean section were randomly allocated to receive a subarachnoid block using either a 25 G or 27G Whitacre needle. Factors determining ease of needle use, adequacy of block, incidence of postdural puncture headache, backache and neurological sequelae were assessed. Successful intrathecal injection was achieved in all patients in the 25 G group. Using the 27 G needle, the anaesthetist failed to reach the subarachnoid space in eight patients of which seven subsequently had a successful intrathecal injection with a larger needle. These failures were attributed to excessive needle flexibility which was the only significant difference in ease of use between the 25G and 27G needles. In the 25G group, there was one severe postdural puncture headache which required an epidural blood patch and three mild headaches which resolved spontaneously. There were no postdural puncture headaches in the 27 G group. We conclude that the final choice of needle is a compromise between the ease of use and lower failure rate of the 25 G needle and the, as yet unproven, possibility of a lower incidence of postdural puncture headache with the 27 G needle.
Administration of rocuronium (Org 9426) by continuous infusion and its reversibility with anticholinesterases
Authors: McCOY E.P. , MIRAKHUR R.K. , MADDINENI V.R. , LOAN P.B. , CONNOLLY F. 
Published: February 2007

SummaryThe use of rocuronium (Org 9426) as a single bolus followed by an infusion was assessed in 50 patients under anaesthesia with nitrous oxide‐oxygen and halothane. Neuromuscular block was monitored using train‐of‐four stimulation and recording the force of contraction of the adductor pollicis muscle. Rocuronium was administered in an initial bolus dose of 0.45 mg.kg‐1 followed by an infusion adjusted manually to maintain the T1, the first response in the train‐of‐four, at 10% of control. Following cessation of rocuronium infusion the patients were either allowed to recover spontaneously (n = 10) or were given neostigmine 50μg.kg‐1 or edrophonium 1 mg.kg‐1 at 10 or 25% recovery of the T1 (n = 10 for each group). Adequate antagonism was defined as attaining a sustained train‐of‐four ratio of 0.7. Rocuronium requirements showed marked variation among individual patients but were relatively constant in individual patients. The mean (SD) time to attain stable infusion rates was 17.4 (10.9) min. The mean (SD) requirement of rocuronium for steady state 90% block of T1 was 572 (190) μg.kg‐1.h‐1 (range 242–1104 μg.kg‐1.h‐1). The mean (SD) time to attain a train‐of‐four ratio of 0.7 in the group allowed to recover spontaneously was 36.1 (7.3) min. This interval was 7.5 (1.9), 9.3 (7.0), 4.6 (1.9) and 1.9 (0.9) min respectively in the groups receiving neostigmine at T1 of 10%, edrophonium at T1 of 10%, neostigmine at T1 of 25% and edrophonium at T1 of 25%. The antagonism was significantly faster in those reversed at 25% (p < 0.05). Three patients in the group receiving edrophonium at T1 of 10% and one in the group receiving neostigmine at T1 of 25% failed to attain a train‐of‐four ratio of 0.7. It is concluded that rocuronium can be administered as a continuous infusion for stable neuromuscular block. Neostigmine may be a more reliable antagonist of deep block, whereas edrophonium is advantageous when there is a greater spontaneous recovery.
Neuromuscular blockade of the fetus with pancuronium or pipecuronium for intra‐uterine procedures
Authors: FAN S. Z. , SUSETLO L. , TSAI M. C. 
Published: February 2007

SummaryFetal movement during intra‐uterine fetal therapy makes these procedures technically more dificult and increases the likelihood of trauma to the fetus. Pancuronium or pipecuronium were used in a randomised study to temporarily arrest movement in 16 fetuses undergoing intra‐uterine procedures. Under ultrasound guidance, pancuronium or pipecuronium 0.2 mg.kg−1 was injected into the fetal gluteal region. Fetal movements ceased within 4.6 ± 2.3 min in the pancuronium group and 4.5 ± 2.8 min in the pipecuronium group and returned by 115±26 min in the pancuronium group and 121 ± 3 2 min in the pipecuronium group. No adverse effects of the relaxant were observed in the mothers. There bvas no evidence of soft tissue, nerve or muscle damage at the fetal injection site after delivery. Both muscle relaxants provided a safer method for diagnostic and therapeutic procedures. However, four cases in the pancuronium group (50%) developed a fetal tachycardia, and two cases in the same group showed loss of beat‐to‐beat variability. Pipecuronium appeared to be more suitable for intra‐uterine procedures.
Prolonged high frequency jet ventilation and milrinone therapy following modified Fontan procedure
Authors: McBRIDE W. T. , McMURRAY T. J. 
Published: February 2007

SummaryAn 11‐year‐old boy who underwent a modified Fontan procedure required surgical re‐exploration the next day. Profound cardiogenic shock developed and he required high frequency jet ventilation and milrinone therapy for 15 days. After 11 days of high frequency jet ventilation he developed a tracheal mucous plug leading to a hypoxic cardiac arrest from which he was successfully resuscitated.
Teaching fibreoptic intubation in anaesthetised patients
Authors: Schaefer H. G. , Marsch S.C.U. , Keller H. L. , Strebel S. , Anselmi L. , Drewe J. 
Published: February 2007

SummaryOne hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. The time (SEM) to achieve successful intubation was statistically different for fibreoptic and rigid intubation (77.2 (5.1) s vs 17.7 (1.6) s, p < 0.01). The time to achieve successful rigid laryngoscopic intubation remained constant over the ten intubations, whereas time required for fibreoptic intubation decreases significantly (p < 0.01). The learning objectives (fibreoptic intubation times in 60 s or less and with 90% or greater success rate on the first intubation attempt) were met by all residents. The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptive or rigid intubations. The study was designed to detect a difference of 10% in means (assuming β= 0.05 and 0.2). The incidence of postoperative sore throat, dysphagia or hoarsensess was similar in both groups. We conclude that routine fibreoptic orotracheal intubation in ASA grades 1 and 2 surgical patients is justifiable for teaching this valuable technique. since it increases clinical exposure to fibreoptic intubation, which should be learned and mastered by all anaesthetic residents by completion of their residency.
The incidence and severity of postoperative nausea and vomiting in patients exposed to positive intra‐operative suggestions
Authors: Williams A. R. , Hind M. , Sweeney B. P. 
Published: February 2007

SummaryIn a double‐blind study, the effects of positive intra‐operative suggestions on the incidence and severity of postoperative nausea and vomiting were studied in 60 patients randomly selected to undergo routine major gynaecological surgery. Patients who received positive suggestions suffered significantly less nausea and vomiting in the 24 h after surgery.