bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of diclofenac and ketorolac for postoperative analgesia following day‐case arthroscopy of the knee joint
Authors: MORROW B. C. , BUNTING H. , MILLIGAN K. R. 
Published: February 2007

SummarySeventy‐one patients presenting for day‐case arthroscopy were randomly allocated to receive either intramuscular diclofenac 75 mg or ketorolac 30 mg immediately after induction of anaesthesia. One hour after operation visual analogue pain scores were significantly lower in the ketorolac group compared with those receiving diclofenac. Pain scores at 2 and 4 h postoperatively were not significantly different between the two groups although six of those receiving diclofenac required opioid analgesia compared with only one in the ketorolac group. Discomfort in the operated knee was similar for both groups on the day following surgery, but pain from the intramuscular injection site was significantly greater in the diclofenac group. Intramuscular ketorolac 30 mg provided better postoperative analgesia and less pain at the injection site than diclofenac 75 mg.
Vecuronium block in the myasthenic patient
Authors: BARAKA A. , TAHA S. , YAZBECK V. , RIZKALLAH P. 
Published: February 2007

SummaryThe neuromuscular block of vecuronium was investigated in two myasthenic patients undergoing thymectomy. The first patient had no pre‐operative anticholinesterase therapy, the second patient was given pyridostigmine 60 mg 4 hourly, continued until the morning of surgery. In the two patients, neuromuscular block of vecuronium was monitored by electromyography. The results suggest that the neuromuscular block of vecuronium may be decreased by pre‐operative preparation of the myasthenic patient by pyridostigmine.
The Finapres 2300e finger cuff
Authors: JONES R. D. M. , KORNBERG J. P. , ROULSON C. J. , VISRAM A. R. , IRWIN M. G. 
Published: February 2007

SummaryBlood pressure measurements associated with malapplication of a finger cuff were compared with contemporaneous intra‐arterial pressure data in seven volunteers to determine the influence of cuff application on the accuracy of the Finapres 2300e. Systolic readings in all cuff positions differed from arterial line data by more than the recommended standard and tight and loose cuff applications under and over‐read respectively, in all subjects. The results show the Finapres to be sensitive to small degrees of finger cuff malapplication which contribute to the bias on direct arterial comparison and limit the reliability of the instrument in clinical practice.
A comparison of two systems for assessing cerebral venous oxyhaemoglobin saturation during cardiopulmonary bypass in humans
Authors: BROWN R. , WRIGHT G. , ROYSTON D. 
Published: February 2007

SummaryThe Somanetics Invos 3100 cerebral oximeter is a new noninvasive device which measures the regional oxygen saturation of haemoglobin within the cerebral microvasculature by infrared spectroscopy. It was used in nine patients undergoing elective cardiac surgery and its results were compared with measurements of jugular venous bulb saturations obtained by the Oximetrix Opticath oximetry system. The index value of jugular venous bulb saturation was obtained by analysis of jugular bulb blood in an 11282 cooximeter. The cerebral oximeter was less accurate and precise (standard deviation of difference 14.1%) than the Oximetrix system (standard deviation of the difference 2.65%) and also demonstrated a systematic error in bias unrelated to cerebral per fusion pressure. The cerebral oximeter may therefore be less useful than jugular venous bulb saturation in the clinical management of patients undergoing cardiopulmonary bypass.
An audit of extradural infusion analgesia in children using bupivacaine and diamorphine
Authors: Wilson P. T. J. , Lloyd‐Thomas A. R. 
Published: February 2007

SummaryOne hundred and fifty extradural infusions of diamorphine and bupivacaine after major surgery in children were audited over a 15 month period. The majority of the children (69%) were less than 5 years of age. Analgesia was assessed or selfrated as‘very good' in over 75% of patients. Urinary retention was seen in 11% of patients and pruritis in 10%. Respiratory depression requiring intervention was only seen in one patient–a premature infant of 39 weeks postconceptual age. Technical complications resulted in the early loss of 16.7% of the infusions. Although analgesia was good the complexity of the extradural infusion technique demanded significant medical and nursing time especially to overcome technical problems.
The influence of the H1 and H2 receptor antagonists, terfenadine and ranitidine on the hypotensive and gastric pH effects of the histamine releasing drugs, morphine and tubocurarine
Authors: TREUREN B. C. , GALLETLY D. C. , ROBINSON B. J. , SHORT T. G. , URE R. W. 
Published: February 2007

SummaryMorphine and tubocurarine may release histamine by direct mast cell degranulation which may result in systemic effects such as cutaneous flushing, local wheal and flare formation and hypotension. This randomised, double‐blind study examined whether pre‐operative combined oral terfenadine (60 mg) and ranitidine (150 mg) attenuates the reduction in blood pressure and cutaneous flushing after the administration of tubocurarine and morphine in 60 patients undergoing elective gynaecological surgery. In addition, investigation was made of whether tubocurarine and morphine cause a significant decrease in gastric pH in comparison to the nonhistamine‐releasing agents fentanyl and vecuronium. Patients were randomly assigned to one of three groups receiving either pre‐operative terfenadine and ranitidine and intra‐operative tubocurarine and morphine (group A); pre‐operative placebo and intra‐operative tubocurarine and morphine (group B); pre‐operative placebo and intra‐operative fentanyl and vecuronium (group C). Compared to group B, group A had less hypotension and tachycardia but no significant decrease in cutaneous flushing immediately following morphine and tubocurarine (p > 0.05). There were no significant differences in haemodynamic changes between the groups A and C. In those patients not pretreated with terfenadine and ranitidine (groups B and C), gastric pH decreased between 5 and 10 min following bolus administration of morphine and tubocurarine (group B), whereas patients receiving fentanyl and vecuronium (group C) had an increase in gastric pH. This suggests that histamine release following administration of morphine and tubocurarine is sufficient to increase gastric acidity. These results indicate that for routine prophylaxis of high risk patients and for patients who have had a previous anaesthetic anaphylactoid reaction, oral premedication with the newer H1 and H2 receptor antagonists may be useful. Furthermore, systemic liberation of histamine may cause a significant decrease in gastric pH with the attendant risk of aspiration pneumonitis.
Creatinine and 51Cr‐EDTA clearance after liver transplantation
Authors: BURNS A. M. , HUE D. P. , WRAIGHT E. P. , PARK G. R. 
Published: February 2007

SummaryWe have compared glomerular filtration rate measured by creatinine clearance with that measured by 51Cr‐EDTA clearance after liver transplantation. Fourteen pairs of values were obtained from seven patients on the first and second days after operation. There were wide discrepancies between the values for glomerular filtration rate measured by the two methods, with a regression co‐efficient of 0.43 (p = 0.12). Both methods assume a steady state, with no change of extracellular fluid volume or in the rates of exchange between physiological compartments, that does not apply in the immediate period after operation. The results show the difficulties of using clearance techniques to assess renal function after major surgery. Since drug therapy may be based on these measurements, we suggest that in this group of patients isolated clearance values should not be used.
Intra‐arterial versus intravenous regional analgesia for hand surgery
Authors: KOSCIELNIAK‐NIELSEN Z. J. , HORN A. 
Published: February 2007

SummaryTwenty‐six adult patients participated in this study of intra‐arterial and intravenous regional analgesia. The radial or the brachial artery was cannulated in patients randomised to receive intra‐arterial regional analgesia and a hand vein was cannulated in patients randomised to receive intravenous regional analgesia, with a 22‐G cannula. A double cuffed tourniquet and Esmarch's bandage were used. Lignocaine 0.5%, (1.5 mg.kg−1 intra‐arterially, and 3.0 mg.kg−1 intravenously) was injected over 3 min. There were two failures (one in each group). Intra‐arterial injection of lignocaine was more painful than intravenous injection. Onset and offset of analgesia, surgical and tourniquet pain scores, motor blockade, and bruising after cannulations were similar. Surgical conditions were good in all patients having intra‐arterial regional analgesia, fair and poor in five having intravenous regional analgesia (ns). Three of the intravenous regional analgesia patients had transient adverse affects after tourniquet release (ns). No permanent sequelae of cannulations were observed. It is concluded that intra‐arterial regional analgesia with lignocaine 0.5%, 1.5 mg.kg−1 has similar onset, offset, quality, failure rate and patient acceptance, as intravenous regional analgesia with lignocaine 0.5%, 3.0 mg.kg−1.
A preliminary assessment of epidural chloroprocaine for day procedures
Authors: ALLEN R. W. , FEE J.P.H. , MOORE J. 
Published: February 2007

SummaryTwenty‐five patients underwent epidural anaesthesia with a new formulation of chloroprocaine 3% (1.0–1.5 ml. 10 cm body height−1) for a variety of day procedures. The mean (range) duration of surgery was 17 (5–35) min. The mean (range) time taken to establish maximal block was 16 (15–21) min and the mean (range) time to ambulation was 78 (55–95) min after administration of chloroprocaine. Twenty‐three patients experienced a decrease in systolic arterial blood pressure of up to 15% of baseline values with another two decreasing by up to 25%. Two patients complained of severe backache immediately after operation and a further 16 and four patients reported mild or moderate backache respectively. Operating conditions were excellent in all but one patient and 23 patients said they would be happy to have the same anaesthetic again.
Noninvasive blood pressure measurements with single and twin‐hose systems—do mixtures matter?
Authors: AMOORE J. N. , SCOTT D. H. T. 
Published: February 2007

SummaryNoninvasive blood pressure monitors which use twin‐ and single‐hose cuffs complicate the movement of patients between bed spaces with different cuff‐hose systems. We assessed, using a commercially available noninvasive blood pressure monitor function analyser, the use of single‐hose cuffs coupled via a Y‐piece adaptor to the twin‐hose of noninvasive monitors designed for use with twin‐hose cuffs. Assessments were made at three simulated pressures (200/150 mmHg, 120/80 mmHg, and 60/30 mmHg) and at normal and weak arterial pulsations. The use of a single‐hose cuff attached with the Y‐piece adaptor did not adversely affect the performance of the monitors.
The effectiveness of pre‐operative advice to stop smoking: a prospective controlled trial
Authors: Munday I. T. , Desai P. M. , Marshall C. A. , Jones R. M. , Phillips M.‐L. , Rosen M. 
Published: February 2007

SummaryPatients who smoke cigarettes suffer increased postoperative morbidity. A prospective, controlled trial was designed to evaluate the effectiveness of written pre‐operative advice to stop smoking before admission for elective surgery and to record the duration of abstinence immediately before the operation. Although the advice was ineffective in persuading patients to stop smoking, it was associated with a reduction in the amount of tobacco consumed. Nicotine and carbon monoxide have important short‐term adverse effects but 15% of all patients continued to smoke within an hour of surgery. If patients are unable to give up cigarette smoking completely, it is still worthwhile stopping on admission to hospital.
A comparison of the 2% and 1% formulations of propofol during anaesthesia for craniotomy
Authors: DEWANDRE J. , VAN BOS R. , VAN HEMELRIJCK J. , VAN AKEN H. 
Published: February 2007

SummaryThis study investigated the pharmacodynamic and pharmacokinetic equivalence of 1% and 2% propofol emulsions when used for total intravenous anaesthesia for intracranial surgery. The same infusion rate (6.7 mg.kg‐1.h‐1) of the two preparations was administered. Induction doses, recovery times, and haemodynamic profiles were identical. Similar propofol concentration profiles were produced and total body clearance of propofol was identical. Both preparations were associated with a similar incidence of injection pain but neither resulted in venous thrombosis or thrombophlebitis at 24 h. Plasma triglyceride concentrations were significantly higher with the 1% solution, but there were no differences in cholesterol concentrations. The 1% and 2% emulsions appeared to be pharmacologically equivalent with similar minor effects on arterial blood pressure and heart rate. Two percent propofol may be preferable to the 1% solution for maintenance of anaesthesia in patients in whom a large lipid load might be considered undesirable.
The effects of Entonox and epidural analgesia on arterial oxygen saturation of women in labour
Authors: ARFEEN Z. , ARMSTRONG P. J. , WHITFIELD A. 
Published: February 2007

SummaryThe arterial oxygen saturation of 40 mothers in the first stage of labour was monitored using pulse oximetry. Half the mothers received epidural analgesia and the rest inhaled Entonox for pain relief. Eight mothers in the Entonox group and six in the epidural group had at least one episode of significant hypoxia (saturation < 90%). There was little difference in the number of hypoxic episodes experienced by either group (29 in the Entonox and 21 in the epidural) although their mean duration and severity was greater in the Entonox group. Women in labour who inhale Entonox have an appreciable incidence of arterial desaturation. Epidural analgesia reduces the severity of hypoxic episodes although it does not eliminate them.
A comparison of postoperative analgesia following spinal or epidural anaesthesia for Caesarean section
Authors: Lam F. Y. , Broome I. J. , Matthews P. J. 
Published: February 2007

SummaryPostoperative analgesia, using a patient‐controlled analgesia system, was studied in 32 women after elective Caesarean section performed under either spinal or epidural anaesthesia. Patients who had spinal anaesthesia had significantly higher pain scores and morphine consumption during the first 4 h postoperatively than patients who had epidural anaesthesia. This situation was reversed between 4 to 8 h postoperatively with patients who had had epidurals having significantly higher pain scores despite higher morphine consumption. After 8 h there was little difference in pain scores or morphine use between the two groups. Total morphine consumption in the first 24 h postoperatively was not significantly different between the two groups.
The EMLA patch—a new type of local anaesthetic application for dermal analgesia in children
Authors: Nilsson A. , Boman I. , Wallin B. , Rotstein A. 
Published: February 2007

SummaryThe skin application of EMLA cream under a Tegaderm dressing was compared in children with a new combined dressing/local anaesthetic patch—the EMLA patch. The analgesic effect during venepuncture was assessed using a visual analogue scale (patients) and a verbal rating scale (investigator). Skin adhesiveness and incidence of local skin reactions with the two types of application were also studied. The study was designed as an open randomised trial with two parallel groups. Sixty children, aged between 5 and 15 years were evaluated. After a minimum application time of 60 min an intravenous cannula was inserted. There was no difference in analgesia as assessed by the patients or the investigators. Mild discomfort at removal of the occlusive dressing/patch was observed in a few patients, but there was no difference in the adhesiveness of the Tegaderm dressing and the EMLA patch. Only mild local skin reactions (with paleness in the anaesthetised skin area) were observed in both groups. It was concluded that both the EMLA patch and the Tegaderm/EMLA cream dressing provide effective dermal analgesia for venepuncture with a 0.8 mm (outer diameter) cannula. The two types of application were indistinguishable but the ease of application of the patch is a distinct advantage.
Reducing smoking
Authors: HUGHES J. A. , SANDERS L. D. , DUNNE J. A. , TARPEY J. , VICKERS M. D. 
Published: February 2007

SummaryIn a double‐blind randomised trial, 122 female smokers undergoing elective surgery were allocated to receive one of two prerecorded messages while fully anaesthetised. The active message was designed to encourage them to give up smoking whilst the control message was the same voice counting numbers. No patient could recall hearing the tape. Patients were asked about their postoperative smoking behaviour one month later. Significantly more of those who had received the active tape had stopped or reduced their smoking (p < 0.01). This would suggest a level of preconscious processing of information.
Anaphylactic/anaphylactoid reactions to anaesthetic and associated agents Skin prick tests in aetiological diagnosis
Authors: PEPYS J. , PEPYS E. O. , BALDO B. A. , WHITWAM J. G. 
Published: February 2007

SummaryFifty‐one patients were referred in one year (1992) for investigation of immediate type anaphylactic/anaphylactoid reactions during anaesthesia. Skin prick tests were made with 23 anaesthetic and associated agents in the concentrations used clinically. Definite or probable causes were identified by immediate type wealing reactions, supported by the clinical history in 36 of the 46 in whom a diagnosis of anaphylaxis was made. These comprised mainly the neuromuscular relaxants, chiefly suxamethonium (18); atracurium (6); gallamine (2); one each alcuronium; pancuronium; vecuronium and tubocurarine, as well as alfentanil (1); Gelofusine (2); cefuroxime (1) and latex (2). The materials for performing the skin prick test are readily available and it can be very helpful in making important aetiological diagnoses.
Motor signs of wakefulness during general anaesthesia with propofol, isoflurane and flunitrazepam/fentanyl and midlatency auditory evoked potentials
Authors: SCHWENDER D. , FABER‐ZÜLLIG E. , KLASING S. , PÖPPEL E. , PETER K. 
Published: February 2007

SummaryAuditory evoked potentials have been used as an indicator of awareness. In the present study we combined epidural analgesia with three techniques of general anaesthesia. Motor signs of intra‐operative wakefulness were documented and assessed along with cardiovascular changes and with midlatency auditory evoked potentials. Thirty patients undergoing elective laparotomy were studied as follows: first continuous epidural analgesia was used in all patients to block painful sensation to the level of T5. Intravenous general anaesthesia was induced with propofol (2.5 mg.kg‐1 b.w., group 1, n = 10), thiopentone (5 mg.kg‐1 b.w., group 2, n = 10) or etomidate (0.2 mg.kg‐1 b.w., group 3, n = 10) and maintained with a propofol (3–5 mg.kg‐1, group 1), isoflurane (0.4‐0.8 Vol%, group 2), flunitrazepam and fentanyl (0.005 mg.kg‐1 b.w.) bolus injection every 20 to 30 s (group 3). Heart rate and arterial pressure were recorded continuously. Purposeful movements of the limbs, eye‐opening or other movements as well as coughing were documented as motor signs of intra‐operative wakefulness. Auditory evoked potentials were recorded in the awake state, after induction and during maintenance of general anaesthesia. Motor signs of intra‐operative wakefulness occurred statistically significantly more often in the patients of the flunitrazepam/fentanyl group than in those of the propofol and isoflurane group. There was no correlation between wakefulness and cardiocirculatory parameters. In the awake patients midlatency auditory evoked potentials had high peak to peak amplitudes and a periodic waveform. After induction of general anaesthesia with propofol, thiopentone and etomidate as well as during maintenance of general anaesthesia with propofol and isoflurane, midlatency auditory evoked potentials were severely attenuated or abolished. In contrast, during maintenance of general anaesthesia with flunitrazepam/fentanyl midlatency auditory evoked potentials reestablished high peak to peak amplitudes. The persistence of midlatency auditory evoked potentials coincides with a high incidence of motor signs of wakefulness. During the combination of regional and general anaesthesia, isoflurane and propofol seem to provide better suppression of motor signs of wakefulness than the intermittent bolus injection of flunitrazepam/fentanyl.
The subjective effects of low‐dose propofol A double‐blind study to evaluate dimensions of sedation and consciousness with low‐dose propofol
Authors: WHITEHEAD C. , SANDERS L. D. , OLDROYD G. , HAYNES T. K. , MARSHALL R. W. , ROSEN M. , ROBINSON J. O. 
Published: February 2007

SummaryIn this study the subjective effects (sedation and mood) of subanaesthetic doses of propofol were examined in 28 healthy male volunteers. A computer model was used to predict the infusion profiles necessary to obtain steady state propofol plasma concentrations of0.3μg.ml‐1, 0.6 μg.ml‐1, 0.9 μg.ml‐1. Objective measures of sedation from saccadic eye movement and choice reaction time gave significant dose responses at each level but a battery of psychometric tests failed to show dose‐related subjective responses. Of particular note in the subjective data is the lack of a difference between groups or even of a consistent trend within the data. This suggests that a low concentration of propofol in plasma does not induce euphoria or a sense of well‐being. The anecdotal evidence available for mood changes with propofol therefore remains unsubstantiated.
The effect of oral omeprazole on the disposition of lignocaine
Authors: NOBLE D. W. , BANNISTER J. , LAMONT M. , ANDERSSON T. , SCOTT D. B. 
Published: February 2007

SummaryThe effects of the gastric antisecretory drug, omeprazole, on the disposition of lignocaine were studied in 10 healthy male volunteers in a double‐blind, randomised, placebo‐controlled, two‐period crossover trial. Omeprazole 40 mg or placebo was taken daily for one week before administration of lignocaine 1 mg.kg‐1 (3.7 μmol.kg‐1) given intravenously over 10 min. Venous concentrations of lignocaine and its metabolite monoethylglycinexylidine were measured in plasma with reversed phase liquid chromatography. The mean (95% CI) areas under the curve at infinity for lignocaine after pretreatment with omeprazole or placebo were 6.67 (4.90–8.45) μmol.h.l‐1 and 6.14 (5.05‐7.23) μmol.h.l‐1, respectively (p = 0.44). The respective areas for monoethylglycinexylidine were 1.85 (1.25‐2.45) μmol.h.l‐1 and 1.79 (1.44‐2.14) μmol.h.r‐1 (p = 0.78). Similarly, omeprazole had no significant effect on the half‐lives of lignocaine or methylglycinexylidine.
Nitric oxide: basic science and clinical applications
Authors: KAM P. C. A. , GOVENDER G. 
Published: February 2007

SummaryNitric oxide is now considered an important endogenous mediator for neurotransmission, vasodilatation, nerve function and immune defence. Improved understanding of the physiology and pharmacology of nitric oxide could lead to important applications especially in the treatment of septic shock and pulmonary hypertension or vasoconstriction.