bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pituitary apoplexy following cholecystectomy
Authors: YAHAGI N. , NISHIKAWA A. , MATSUI S. , KOMODA Y. , SAI Y. , AMAKATA Y. 
Published: February 2007

SummaryA case of pituitary apoplexy, which presented with hyperaesthesia in the distribution of the ophthalmic division of the left trigeminal nerve and a left sixth nerve palsy following cholecystectomy, is reported. Computed tomography and magnetic‐resonance imaging revealed a large intrasellar mass which extended laterally into the left cavernous sinus and showed evidence of old and recent haemorrhage within the tumour. This case demonstrates that patients who present with unusual neurological symptoms involving the cranial nerves after general anaesthesia, should undergo neurological and radiological investigations.
Magnetic resonance for the anaesthetist
Authors: MENON D. K. , PEDEN C. J. , HALL A. S. , SARGENTONI J. , WHITWAM J. G. 
Published: February 2007

SummaryAnaesthetists are being increasingly involved in magnetic resonance (MR) procedures, both in patient care and as a research tool. This paper outlines the physical basis of nuclear magnetic resonance and describes its application in magnetic resonance imaging and spectroscopy. Principles of magnet design and safety relevant to anaesthetic practice in a magnetic resonance environment are discussed and guidelines for anaesthetic practice suggested. Some recent clinical magnetic resonance studies of anaesthetic interest are reviewed.
Oxyhaemoglobin saturation following elective abdominal surgery in patients receiving continuous intravenous infusion or intramuscular morphine analgesia
Authors: Kluger M. T. , Owen H. , Watson D. , Ilsley A. H. , Baldwin A. M. , Fronsko R. R. L. , Plummer J. L. , Brose W. G. 
Published: February 2007

SummaryOxygen saturation was continuously measured using computerised pulse oximetry for 8 h overnight pre‐operatively and for the first 24 h postoperatively in 40 patients receiving intermittent intramuscular morphine or continuous infusion of morphine following elective upper abdominal surgery. The proportion of time with an oxygen saturation less than 94% was used as an index of de'saturation. Patients receiving continuous infusion analgesia received a larger morphine dose and achieved better analgesia than the intramuscular group. Postoperatively, the duration of desaturation increased 10‐fold over pre‐operative values, ‘intramuscular’ patients spending 39.0% (SD, 37.0%) and ‘continuous infusion’ patients 40.0% (SD, 37.5%) of the time below 94% saturation. Although newer therapies (e.g. epidural analgesia and patient‐controlled analgesia) are currently receiving greater attention, the sequelae of these more traditional analgesic techniques warrant further study.
Topical nonsteroidal anti‐inflammatory gel for the prevention of peripheral vein thrombophlebitis
Authors: PAYNE‐JAMES J. J. , BRAY M. J. , KAPADIA S. , RANA S. K. , MCSWIGGAN D. , SILK D. B. A. 
Published: February 2007

SummaryA double‐blind, randomised, placebo‐controlled study was undertaken to determine whether topical application of a nonsteroidal anti‐inflammatory gel to skin overlying peripheral vein cannula sites has a role in reducing the incidence or delaying the onset of peripheral vein thrombophlebitis. Fifty normal subjects had intravenous cannulae placed in right and left arms. Subjects were randomised to receive twice daily application of either active nonsteroidal anti‐inflammatory gel or placebo gel to each cannula site. Cannula sites were observed and signs and symptoms of inflammation recorded up to 108 h. If any site had signs extending beyond 2 cm then the cannula was removed. Cannula sites that had ‘active’ gel applied had half the incidence of marked signs at 108 h (44% vs 22%, p < 0.05). These results suggest that local application of topical nonsteroidal anti‐inflammatory gel to cannula sites may have a significant role to play in the prevention of peripheral vein thrombophlebitis.
Fentanyl‐prilocaine mixture for intravenous regional anaesthesia in patients undergoing surgery
Authors: PITKÄNEN M. T. , ROSENBERG P. H. , PERE P. J. , TUOMINEN M. K. , SEPPÄLÄ T. A. 
Published: February 2007

SummaryThe effect of the addition of 0.1 mg or 0.2 mgfentanyl to 40 ml 0.5% prilocaine in intravenous regional anaesthesia of the arm was investigated in 37 patients in a randomised, double‐blind study. The characteristics of the sensory and motor block were studied. There was no difference in the speed of onset of analgesia in the groups (mean latency approximately 4 min in each group). However, significantly more patients in thefentanylO.2 mg group (7/12) had complete anaesthesia at 15 min than in the fentanyl 0.1 mg group (1/13) and the control group (2/12) (p < 0.05). There were no differences in the incidence of tourniquet pain immediately before cuff deflation (tourniquet time 45–87 min). After cuff deflation, in those patients who complained of wound pain within 30 min, on average the pain appeared later in the fentanyl 0.2 mg group (six patients, mean 14.3 min) than in the control group (eight patients, mean 9.4 min) (ns). In the fentanyl groups, the incidence of central nervous system side effects was greater than in the control group (fentanyl 0.1 mg 7/13 patients, fentanyl 0.2 mg 6/12 patients, control 1/12 patients) (p < 0.05). The plasma concentrations of prilocaine after cuff deflation were higher, in a dose‐dependent fashion, in the fentanyl groups than in the control group, but the concentrations of prilocaine and fentanyl did not correlate with the symptoms. Postoperative nausea occurred only in the patients who had received fentanyl.
Anaesthesia for cardiac surgery in children with nemaline myopathy
Authors: ASAI T. , FUJISE K. , UCHIDA M. 
Published: February 2007

SummaryNemaline myopathy is a rare congenital myopathy associated with skeletal deformities and respiratory complications. Three children with nemaline myopathy who underwent cardiac surgery are described where the heart rate decreased during induction of anaesthesia and body temperature increased during or after the surgery. The anaesthetic implications in the management of patients with nemaline myopathy are discussed.
Clinical evaluation of doxacurium chloride
Authors: Maddineni V. R. , Cooper R. , Stanley J. C. , Mirakhur R. K. , Clarke R. S. J. 
Published: February 2007

SummaryDoxacurium was administered to 50 adult patients for determination of potency (n = 10), onset and duration of clinical relaxation (n = 40). Cumulative dose‐response showed the ED95 to be 33.24 μg.kg−1 (95% confidence limits 27.4–39.3). Doxacurium 33 μg.kg−1 was then administered to four groups of 10 patients each who had anaesthesia maintained with either fentanyl‐droperidol or halothane and nerve stimulation carried out with single‐twitch stimulation at 0.1 Hz or train‐of‐four stimulation at 2 Hz every 12 s. The onset and duration showed wide individual variation. The mean (SD) times to occurrence of maximal block were 8.5 (4.6), 6.1 (1.9), 6.7 (1.8) and 4.7 (1.3) min in the single twitch‐fentanyl, train‐of‐four‐fentanyl, single twitch‐halothane and train‐of‐four‐halothane groups respectively, although it ranged from 3.4 to 13.1 min in individual patients. The mean (SD) durations of clinical relaxation (recovery of single twitch or first response in train‐of‐four to 25%) were 65 (22.8), 52 (21.7), 70 (33.4) and 72 (21.0) min respectively with individual values ranging from 31 to 103 min. Although halothane administration increased the duration of clinical relaxation and train‐of‐four stimulation accelerated the onset of effect, the changes due to these were not significant. There were no adverse effects on heart rate or indirectly measured arterial pressure.
Circulatory responses during electroconvulsive therapy
Authors: O'FLAHERTY D. , HUSAIN M. M. , MOORE M. , WOLFF T. R. , SILLS S. , GIESECKE A. H. 
Published: February 2007

SummaryElectroconvulsive therapy is usually accompanied by activation of the autonomic nervous system, which may be harmful in patients with cerebrovascular or ischaemic heart disease. We have compared this haemodynamic response in a series of 82 electroconvulsive treatments randomly assigned to receive either nitroglycerin 3 μg.kg−1, esmolol 2 mg.kg−1 or placebo. These drugs were given shortly after the suxamethonium and 2 min before the electroconvulsive therapy in all cases. Heart rate was significantly lower with esmolol 1 min after therapy as was blood pressure (systolic and diastolic). The pulse rate was higher following nitroglycerin than placebo, which in turn was higher than esmolol. The three groups did not differ with regard to seizure duration. The results demonstrate that esmolol is more effective than nitroglycerin in controlling the haemodynamic response to electroconvulsive therapy. With recent emphasis on stabilisation of heart rate in preference to blood pressure in at‐risk cardiac patients, our study suggests that, in the doses selected, esmolol is preferred to nitroglycerin to control the heart rate response to electroconvulsive therapy.
Changes in arterial blood pressure during traction of extra‐ocular muscles. A study in rabbits
Authors: KHURANA I. , KHURANA A. K. , SINGH P. I. , GOMBAR K. K. 
Published: February 2007

SummaryA significant reflex fall in mean arterial blood pressure from baseline values was observed during extra‐ocular muscle traction in rabbits. This effect could be abolished only by retrobulbar block (afferent pathway block) and not by vagotomy, intravenous atropine or glvcopyrronium, suggesting that it is distinct from, and independent of, the oculocardiac reflex. We suggest that these reflex changes in blood pressure be known as the ‘oculodepressor reflex’.
Forces applied during laryngoscopy and their relationship with patient characteristics
Authors: BUCX M. J. L. , VAN GEEL R. T. M. , SCHECK P. A. E. , STIJNEN T. , ERDMANN W. 
Published: February 2007

SummaryThe relationships between patients' height, weight, age, body mass index, gender and presence of maxillary incisors and a series of laryngoscopic factors have been studied. These included the duration of laryngoscopy, maximally applied force, mean applied force and the integral of force over time. There was a positive correlation between height and weight and laryngoscopic factors. Sex and age also showed a positive correlation but these could be explained by differences in height, weight and the presence of maxillary incisors. This latter factor was the dominant patient characteristic influencing the measured laryngoscopic factors. Use of these laryngoscopic factors as a measure of difficulty of laryngoscopy is discussed.
An automated system for testing the accuracy of patient‐controlled analgesia devices
Authors: HAWKINS D. J. , ROBERTS D. R. D. , ILSLEY A. H. , PLUMMER J. L. , OWEN H. 
Published: February 2007

SummaryA system was developed to test the accuracy of patient‐controlled analgesia devices in situations simulating clinical use. Bolus requests are made automatically at predetermined intervals, and the infusate delivered is measured and recorded without the need for operator presence. To ensure clinical relevance, the bolus request times used in this study corresponded to a pattern typical of those requested by patients on the ward. Graseby, Abbott Provider 5500 and IVAC patient‐controlled analgesia devices were tested and found to deliver reasonably accurately over a 24 h period. However, when an infusion was started in an unprimed system or after a period of no bolus requests in a bolus‐only mode the Graseby and IVAC machines under‐delivered. This system provides a means of testing patient‐controlled analgesia devices operating in any delivery mode.
Profound hypotension following intravenous codeine phosphate
Authors: PARKE T. J. , NANDI P. R. , BIRD K. J. , JEWKES D. A. 
Published: February 2007

SummaryThree adults are described who developed life‐threatening hypotension following intravenous codeine phosphate. It is recommended that codeine phosphate should not be given intravenously to adults.
Plasma concentrations of flumazenil during liver transplantation
Authors: Park G. R. , Podkowik B. I. , Hoffmann‐La F. 
Published: February 2007

SummarySix patients were given flumazenil (1 mg) during the anhepatic period of liver transplantation. We found higher mean plasma flumazenil concentrations during the anhepatic period than occurred in patients with hepatic cirrhosis. It was only possible to measure plasma flumazenil concentrations in four patients after revascularisation of the donor liver. Of these, elimination half‐lives could be calculated in only three patients (normal in one and prolonged in two). In these two patients the elimination half‐lives were prolonged to the same extent as in patients with fulminant hepatic failure. The changes during the anhepatic period occur because the liver contributes to the central volume of distribution. After revascularisation of the donor organ the prolonged half‐lives indicate that transplanted livers may not recover normal metabolic functions immediately.
Day case laparoscopy
Authors: Goodwin A. P. L. , Rowe W. L. , Ogg T. W. 
Published: February 2007

SummaryForty women undergoing day case laparoscopy were randomly allocated to receive either an inhalational or total intravenous anaesthetic. All patients breathed spontaneously through a Brain laryngeal mask. There were no clinically significant cardiovascular or respiratory differences between the two techniques. No episodes of clinical aspiration occurred and there were no peri‐operative arrhythmias. We conclude that spontaneous respiration with a laryngeal mask is a safe and effective method of anaesthesia for laparoscopy provided certain guidelines are followed.
Comparison of digital blood pressure, plethysmography, and the modified Allen's test as means of evaluating the collateral circulation to the hand
Authors: Fuhrman T. M. , Reilley T. E. , Pippin W. D. 
Published: February 2007

SummaryThe collateral circulation to the hand was evaluated on 70 hands of healthy volunteers. Comparisons were made between the results of the modified Allen's test alone and the Allen's test combined with either plethysmography or digital blood pressure. The modified Allen's test requires patient cooperation and the results can be subjective. Plethysmography does not require patient cooperation and produces a signal that varies directly with flow; however, this is not a quantifiable signal. Digital blood pressure (measured by the 2300 Finapres noninvasive blood pressure monitor, Ohmeda, Englewood, CO, USA) also requires no patient cooperation. The values produced are of clinical value and reproducible. Both the plethysmograph and digital blood pressure monitors were able to demonstrate the dominant arterial vessel of the hand. The digital blood pressure monitor produces an objective recordable numerical value, an accepted clinical parameter, and it does not require patient cooperation. The use of a digital blood pressure monitor may prove to be an acceptable alternative to the traditional Allen's test.
Catecholamine response to laryngoscopy and intubation
Authors: CHRÆMMER‐JØRGENSEN B. , HERTEL S. , STRØM J. , HØILUND‐CARLSEN P. F. , BJERRE‐JEPSEN K. 
Published: February 2007

SummaryThe haemodynamic response and changes in plasma catecholamine concentrations associated with laryngoscopy and tracheal intubation were compared during anaesthesia employing three strictly standardised techniques with commonly used drug combinations. Thirty‐six patients were investigated consecutively resulting in 12 patients in each of three study groups. Anaesthesia was induced with thiopentone 5 mg.kg−1 (group 1), fentanyl 6 ng.kg−1 with thiopentone 5 mg.kg−1 (group 2). or midazolam 0.2 mg.kg−1 with fentanyl 6 ug.kg−1 (group 3). Undesirable changes in haemodynamic effects and an elevation of plasma catecholamine concentrations during laryngoscopy and intubation occurred in group 1. Heart rate and mean arterial pressure increased significantly (34% and 23% respectively). Noradrenaline concentration increased by a maximum of 147%. The addition of fentanyl (groups 2 and 3) attenuated the adverse haemodynamic response and elevation of plasma catecholamine concentrations; heart rate and mean arterial pressure did not differ from pre‐intubation values and plasma catecholamine concentrations decreased steadily. Substitution of thiopentone by midazolam in combination with fentanyl abolished the adverse haemodynamic response and modified the increase in plasma catecholamine concentrations. ‘High‐dose’ opioid anaesthesia is not necessary to produce optimal conditions during laryngoscopy and intubation.
Cardiovascular effects of fibreoptic oral intubation
Authors: SCHAEFER H.‐G. , MARSCH S. C. U. , STREBEL S. P. , DREWE J. 
Published: February 2007

SummaryThe cardiovascular response to fibreoptic oral intubation under total intravenous anaesthesia with propofol or a balanced volatile technique with thiopentone I enflurane was compared in 50 patients of physical status ASA 1 and 2 who were scheduled for elective ear, nose and throat surgery. Patients were randomly assigned to receive propofol or enflurane. There was no significant difference between the two anaesthetic techniques in haemodynamic profile either before, during or after fibreoptic intubation (the study design was adequate to detect a 20% difference with > 90% statistical power), in incidence of postoperative sore throat or in lime taken for intubation. In no patient did the oxygen saturation decrease to below 95% or the CO2 tension exceed 5.8 kPa.
Are electrocardiogram changes the first sign of impending peri‐operative pneumothorax?
Authors: BOTZ G. , BROCK‐UTNE J. G. 
Published: February 2007

SummaryA patient in the right lateral position underwent left nephrectomy, after which he was placed supine for insertion of an arteriovenous fistula. All haemodynamic and respiratory values, including peak inspiratory pressure, were within normal limits and unchanged from baseline measurements. However, following the position change we noted that the amplitude of the electrocardiogram complexes were dramatically reduced. Our differential diagnosis included the possibility of a pneumothorax, which was subsequently confirmed by both physical examination and chest X ray. A chest drain was planned to be inserted at the end of the surgery, but 25 min after the electrocardiogram changes were noted, the patient's vital signs suddenly deteriorated. Emergency treatment for pneumothorax was instituted with good effect. The diagnostic use of the electrocardiogram and the treatment of this intra‐operative pneumothorax are discussed.
The use of a checklist for anaesthetic machines
Authors: BARTHRAM C. , MCCLYMONT W. 
Published: February 2007

SummaryThe use of the Association of Anaesthetists of Great Britain and Ireland checklist for anaesthetic machines, based on an oxygen analyser, was surveyed over a 5‐week period in a teaching hospital. Fifty‐five completed checklists were analysed; no problems developed during anaesthesia which were missed by the checklist. The mean time taken to complete the checklist for one machine was 8.9 min with a range of 5 to 19 min; for two consecutive machines it was 18.25 min with a range of 10 to 30 min. The most frequent faults detected were the poor reliability of some oxygen analysers, absent ventilator disconnection alarms, and absent oxygen supply failure alarms on some older machines. Faults were found in 60% of the machines checked; 18% of these were deemed to be serious.
A comparison of the performance of two types of infusion device
Authors: O'KELLY S. W. , EDWARDS J. C. 
Published: February 2007

SummaryThe delivery performance of two types of infusion pump, the IVAC 711 series syringe driver and the IVAC 531 series drop‐counter, was examined by measuring the output of 16 pumps. We found that despite careful attention to the setting up of all apparatus, the IVAC 711 series syringe drivers had a significant lag phase before output matched the set rate, and that this lag phase was more pronounced at low rates of infusion. This was not the case with the IVAC 531 series which delivered the set rate from the outset. We suggest, that when the timing and rate of an infusion of drug is important from the outset and when these types of pump are being used, that either the syringe driver pump is primed by a brief period of high rate infusion vented by a three‐way tap or that a drop‐counter pump is used.
Diclofenac for analgesia after Caesarean section
Authors: Bush D. J. , Lyons G. , Macdonald R. 
Published: February 2007

SummaryThe analgesic efficacy of a single intramuscular dose of 75 mg diclofenac given after elective Caesarean section was studied in 50 women in a double‐blind randomised manner using a patient‐controlled analgesia system. The mean 18 h papavaretum consumption of the placebo group was significantly greater (91.4 mg compared to 61.4 mg). Subjective experience of pain and observed sedation were significantly greater in the control group up to 6 h after operation.
A study into the incidence of methaemoglobinaemia after ‘three‐in‐one’ block with prilocaine
Authors: Bellamy M. C. , Hopkins P. M. , Halsall P. J. , Ellis F. R. 
Published: February 2007

SummaryA 34‐year‐old female patient developed methaemoglobinaemia following a femoral nerve block using prilocaine. The concentrations of methaemoglobin in the blood of the next eight patients receiving this block were assayed, and found to be significantly increased above baseline concentrations, but very significantly less than the concentration in the patient with symptomatic methaemoglobinaemia. Pulse oximetry was of value in making the diagnosis.
Intermittent positive pressure ventilation through a laryngeal mask airway
Authors: Graziotti P.J. 
Published: February 2007

SummaryA nasogastric tube was used to aspirate air insufflated into the stomach during intermittent positive pressure ventilation through a laryngeal mask airway and a tracheal tube. No difference was found in the amount aspirated between patients with a tracheal tube, a laryngeal mask airway with the nasogastric tube closed or a laryngeal mask airway with the nasogastric tube open, when the nasogastric tube was aspirated at 15 min intervals for the first hour of anaesthesia.
The management of tracheal rupture using bilateral bronchial intubation
Authors: MITCHELL J.B. , WARD P.M. 
Published: February 2007

SummaryThe management of a patient who required positive pressure ventilation following pharyngolaryngo‐oesophagectomy during which tracheal injury was sustained is described. Ventilation with a tracheal tube resulted in a massive pneumoperitoneum. Bilateral bronchial intubation was employed with success.
The rebreathing characteristics of the Hudson oxygen mask
Authors: CAMPKIN N.T.A. , OOI R.G. , SONI N.C. 
Published: February 2007

SummaryA lung model was used to study the effect of varying minute ventilation, oxygen flow and inspiratory: expiratory ratio on the rebreathing chracteristics of the Hudson oxygen mask. The onset of rebreathing was detected using two different sets of criteria; those defined by Kain et al. and Humphrey. The onset of rebreathing was also quantified in terms of the inspired volume of carbon dioxide and increases in deadspace. The magnitude of rebreathing was increased by reducing oxygen inflow and increasing minute ventilation. Variation in I:E ratio between 1:1 and 1:4 had little effect on rebreathing. Using the clinical criteria of Kain et al, the onset of rebreathing was detected when oxygen inflow/minute ventilation ratio was reduced below 0.78 on average. With the other criterion, rebreathing occurred when the ratio was 0.46.