bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of speed of injection on induction with propofol A comparison with etomidate
Authors: GILLIES G. W. A. , LEES N. W. 
Published: February 2007

SummaryOne hundred and eighty female patients received either propofol 2.5 mg/kg or etomidate 0.3 mg/kg injected over 20, 40 or 80 seconds for induction of anaesthesia after premedication with temazepam 20 mg. The mean induction times for both etomidate and propofol were significantly reduced with increasing speed of injection. The mean induction times for etomidate were significantly less than propofol at the slower rates of injection. At each speed of injection, the decrease in systolic, mean and diustolic arterial blood pressures with etomidate were less than with propofol. The decrease in systolic blood pressure was not significantly affected by injection speed for either drug. Apnoea occurred significantly more frequently with propofol than with etomidate at each speed of injection and the incidence of apnoea greater than 60 seconds with propofol was significantly higher when injected over 20 seconds than 80 seconds. The incidence of pain on injection was unaffected by injection speed, for either drug. The incidence of myoclonus and (or) hypertonus was significantly higher following etomidate.
Cardiovascular instability following bolus dose of etomidate
Authors: McGRADY E. M. , WRIGHT I. H. 
Published: February 2007

SummaryA patient with alveolar proteinosis develqed unexpected cardiovascular instability after broncho‐alveolar lavage. He had received two bolus doses of etomidate within an 18‐hour period. Serum cortisol concentrations were low and hydrocortisone replacement therapy was necessary to restore arterial pressure. Implications for management of critically ill patients who receive bolus doses of etomidate are discussed.
The oesophageal detector device
Authors: WILLIAMS K. N. , NUNN J. F. 
Published: February 2007

SummaryMisplacement of a tracheal tube in the oesophagus remains a significant cause of mortality and morbidity in anaesthesia, despite decades of effort aimed at prevention, or perhaps more importantly, detection, of such an event. We have evaluated a cheap, simple and quick device which relies mainly on the reflation or otherwise of an Ellick's evacuator applied to the supposed ‘tracheal’ tube. Identical tracheal tubes were passed into the trachea and oesophagus of 100 patients; the left and right position in the mouth was chosen at random. The test was conducted by a second anaesthetist, not present at intubation, and unaware of which tube was in the trachea. There were no false positive results and the correct deduction of which was the tracheal tube was reached in 100 tests using this device. Its use is recommended for widespread evaluation as a valuable adjunct to existing methods of detecting misplacement.
The Malawi anaesthetic machine
Authors: FENTON P. M. 
Published: February 2007

SummaryOne year's experience with a new type of oxygen concentrator and anaesthetic machine, designed for anaesthesia in developing countries, is presented. The apparatus, its performance and problems are described and the author's suggested modijications to improve the original design are outlined. The apparatus, with these changes, represents a signifcant advance in oxygen availability for hospitals in developing countries as well as improving the anaesthetic capabilities.
Serious morbidity attributable to anaesthesia Considerations for prevention
Authors: Pedersen T. , Johansen S. H. 
Published: February 2007

SummaryThe types and frequency of complications attributable solely to anaesthesia, and which caused serious morbidity and substantial negative outcome, were examined in a prospective study of 7306 anaesthetics, The analysis demonstrated that severe complications and mortality attributable to anaesthesia occurred in 0.59% (1:170) and 0.04% (1:2500) of patients respectively. The data suggest that‘high‐risk'patients are more likely to be affected by errors and a substantial negative outcome than more healthy patients. We judged one‐third of the anaesthesia‐related morbidity to be preventable. Anaesthetists are faced with an increasing number of patients who are at high risk, and who undergo increasingly extensive surgical interventions. Concomitant with the increasing complexity of care and increasing demands on the anaesthetists may be an expected increase in the incidence of errors. Recognition of the importance of human factors in morbidity and mortality attributable to anaesthesia is a necessary jrst step.
A double‐blind comparison of epidural ketamine and diamorphine for postoperative analgesia
Authors: PEAT S. J. , BRAS P. , HANNA M. H. 
Published: February 2007

SummaryTwenty patients who had abdominal hysterectomy under general anaesthesia were randomly assigned to receive either epidural ketamine (30 mg), or epidural diamorphine (5 mg) peri‐operatively and on first request for analgesia. Failure to obtain satisfactory analgesia with one of the agents was treated by epidural administration of the other. Pain was assessed by an independent observer, and by the patient using a visual analogue scale. The mean (SD) pain score on recovery from general anaesthesia, on a scale of 0–4, was 2.9 (1.2) for the ketamine group and 1.0 (1.0) for the diamorphine group (p < 0.01). The mean (SD) time to first request for analgesia was 272 (206) and 72 (41) minutes in the diamorphine and ketamine groups respectively (p < 0.01). All patients in the diamorphine group obtained adequate analgesia, but all patients in the ketamine group were changed to epidural diamorphine. Epidural ketamine does not appear to be a suficiently effective alternative to epidural diamorphine for routine use in postoperative pain.
Postspinal headache in young and elderly patients
Authors: RASMUSSEN B. S. , BLOM L. , HANSEN P. , MIKKELSEN S. S. 
Published: February 2007

SummaryIn two randomised, double‐blind studies of elderly patients with a mean age of 68.9 (range 21–88) years and young patients, mean age 29.4 (range 20–40) years, the effect of needle size on the incidence of postspinal headache was compared. The two needle groups, 20‐ and 25‐gauge, were comparable in both studies with regard to number, sex, age and type of surgery. The incidence of postspinal headache in young patients was 27.6% when a 20‐gauge needle was used and 12.6% with a 25‐gauge needle. There was no significant dzzerence in either the incidence of headache in the elderly patients (10.8% and 7.8%, respectively) or between the sexes. It is concluded that it does not matter if a 20‐ or a 25‐gauge needle is used for spinal analgesia in elderly patients with regard to postspinal headache, but if spinal analgesia is indicated in young patients a fine needle is preferred.
A comparison between open‐end (single hole) and closed‐end (three lateral holes) epidural catheters
Authors: MICHAEL S. , RICHMOND M. N. , BIRKS R. J. S. 
Published: February 2007

SummaryA randomised, single‐blind study was conducted on 802 parturient women who required epidural analgesia, to compare open‐end (single hole) with closed‐end (three lateral holes) epidural catheters. The complication rate after catheter insertion was not statistically drferent between the two groups, but the number of unsatisfactory blocks was significantfy higher in the open‐end group (p < 0.001). The closed‐end catheters were easier and less painful to place, but gave a higher incidence of bloody taps. The open‐end catheters caused sensory blockade to be more frequently unilateral and more frequently missed sensory segments. This resulted in a significantly higher number of open‐end catheters that required replacement (p < 0.001). Open‐end catheters despite their theoretical advantages in the detection of intravenous and subarachnoid placement caused an unacceptably high incidence of unsatisfactory sensory blockade.
Giant false aneurysm of the subclavian artery
Authors: HUDDY S. P. J. , McEWAN A. , SABBAT J. , PARKER D. J. 
Published: February 2007

SummaryA false aneurysm with a diameter of 15 cm developed in the wall of the subclavian artery after attempted internal jugular cannulation. This potentially lethal complication, its diagnosis and treatment are described.
Fluid deprivation before operation
Authors: AGARWAL A. , CHARI P. , SINGH H. 
Published: February 2007

SummaryThe effect of oral fluids before operation, followed by intramuscular morphine, on gastric volume and pH was examined in 150 elective surgical patients, ASA physical status 1 and 2, who were randomly assigned to one of the three groups of 50 each. Group 1 (control) continued their overnight fast; patients in Groups 2 and 3 received 150 ml water 2 hours before the scheduled time of surgery. Patients in Group 3 received intramuscular morphine 0.15 mg/kg and promethazine 0.5 mg/kg one hour before operation. The residual gastric volume was obtained by suction and its volume and pH measured immediately after induction of anaesthesia. Statistically significant (p < 0.05) decrease in residual gastric volume was observed in Groups 2 and 3 as compared to Group 1. However, the difference between these two groups was not statistically significant. There was no statistically significant difference in pH among the three groups. Overnight fluid fasting is not justified in elective surgical patients. Morphine can be safely given one hour before surgery in patients who have received water (150 ml) 2 hours before operation.
The Brain laryngeal mask airway An alternative to emergency tracheal intubation
Authors: CALDER I. , ORDMAN A. J. , JACKOWSKI A. , CROCKARD H. A. 
Published: February 2007

SummaryThe laryngeal mask airway was used to resuscitate a patient in whom direct and fibreoptic laryngoscopy were impossible because of cervical pathology and pulmonary oedema. The laryngeal mask airway may be an alternative to tracheal intubation in emergency resuscitation.
The nature of pre‐operative anxiety
Authors: McCleane G. J. , Cooper R. 
Published: February 2007

SummaryIn a study of 247 patients who had general anaesthesia for dental procedures, the incidence of individual anxieties was noted using a questionnaire completed by the patient. The most common anxieties related to the period before transfer to the operating theatre, intra‐operative awareness and postoperative pain. These anxieties were present in over half the patients questioned. The follow‐up questionnaire was completed by 207 patients in order to indicate which anxieties they would expect to have if they needed anaesthesia in the future. All anxieties were less frequent than found before operation.
Pre‐induction behaviour of children A review of placebo‐controlled trials of sedatives
Authors: MORGAN‐HUGHES J. O. , BANGHAM J. A. 
Published: February 2007

SummaryPlacebo‐controlled trials of sedative premedication in children are reviewed in an attempt to determine which drugs have been shown to reduce the frequency with which children cry or appear apprehensive. Small samples and inappropriate statistical methods limit the value of many of the studies. Most of the drugs tested will, in sufficient dose, increase the proportion of children who are asleep. Only intramuscular opioid analgesics, either alone or in combination with other drugs, have been shown repeatedly to increase the frequency of calm behaviour in those who are awake. There is some evidence, however, that intramuscular placebo controls have a lower frequency of calm behaviour than oral placebo controls.
Flumazenil in the outpatient A study following midazolam as sedation for upper gastrointestinal endoscopy
Authors: ANDREWS P. J. D. , WRIGHT D. J. , LAMONT M. C. 
Published: February 2007

SummaryFifty outpatients who underwent upper gastrointestinal endoscopy under midazolam sedation were allocated randomly into two equal groups of 25 in this double‐blind study. After the endoscopy, and 30 minutes after administration of the sedative, patients in one group received flumazenil 0.5 mg; those in the other group received a similar volume of vehicle only. Assessments of memory function, psychomotor performance and coordination were carried out and these were repeated 3.5 hours later. Flumazenil produced a significant improvement (p < 0.0001) immediately but no difference could be detected between flumazenil and placebo at 3.5 hours. However, patients in the flumazenil group reported, by means of linear analogue scales, a subjective feeling of alertness at the time of discharge, which was greater than that reported by those in the placebo group (p < 0.005).
Variables of patient‐controlled analgesia. 3: test of an infusion‐demand system using alfentanil
Authors: OWEN H. , BROSE W. G. , PLUMMER J. L. , MATHER L. E. 
Published: February 2007

SummaryPatient‐controlled infusion‐demand analgesia was studied using alfentanil. We were unable to identify an optimal dose and administration rate; doses required range from 100 to 900 μg alfentanil. The mean concentration of alfentanil in blood associated with return of pain (i.e. immediately before demand) was 58 ng/ml on day 1 and 37 ng/ml on day 2. This difference was despite similar drug consumption on both days.
Guillain–Barré syndrome mimicking brainstem death
Authors: COAD N. R. , BYRNE A. J. 
Published: February 2007

SummaryThere must be a defined, predisposing condition to fulfil the criteria of brainstem death in the UK. A patient presented recently in coma and with absent brainstem reflexes, but no diagnosis was initially obvious. A subsequent diagnosis of Guillain–Barré syndrome was made, and the patient made a full recovery.
Internal jugular catheterisation Case report of a potentially fatal hazard
Authors: POWELL H. , BEECHEY A. P. G. 
Published: February 2007

SummaryA case is presented of acute life‐threatening haemorrhage caused by laceration of the subclavian artery as a result of attempted cannulation of the internal jugular vein. This sequence of events has not been reported previously, and probably resulted from use of a cannula‐over‐needle system.
Rate‐responsive pacemakers and anaesthesia A consideration of possible implications
Authors: ANDERSEN C. , MADSEN G. M. 
Published: February 2007

SummaryA new generation of pacemakers has been developed in recent years which adjust the pacing rate according to changes in physiological variables. The selected parameters are affected during physical activity that involves an increased heart rate in healthy humans. The variables include body movements, QT interval, breathing, temperature, myocardial contractility, oxygen saturation and changes in blood pH which may be influenced during general anaesthesia, and can lead to unphysiological, high, pacing rates. It is important to be familiar with the pacemaker and its functions before administration of anaesthesia in order to prevent complications. Rate‐responsive pacemakers in such situations should be programmed to exclude the rate‐responsive function.
Acupuncture anaesthesia Observations on its use for removal of thyroid adenomata and influence on recovery and morbidity in a Chinese hospital
Authors: Kho H. G. , van Egmond J. , Zhuang C. F. , Lin G. F. , Zhang G. L. 
Published: February 2007

SummaryAcupuncture anaesthesia, supplemented by small doses of pethidine, was evaluated in 20 patients who had surgery for removal of a thyroid adenoma. There were significant increases in mean arterial pressure and respiratory rate during surgery, but no significant change in heart rate. The mean dose of pethidine given during surgery was 45 mg (SD 8.9). Postoperative recovery was rapid and complication free. Acupuncture anaesthesia did not provide complete analgesia, but was safe and preferable to general anaesthesia where there was a shortage of facilities.
Cholinesterase deficiency and the Churg–Strauss syndrome
Authors: TAYLOR B. L. , WHITTAKER M. , HEERDEN V. VAN , BRITTEN J. 
Published: February 2007

SummaryWe report two patients with the Churg–Strauss syndrome who were found to have decreased cholinesterase activity despite normal phenotypes. Suspicion of abnormal sensitivity to suxamethonium in the first case was raised after prolonged paralysis under anaesthesia. The findings in the second were incidental during the course of intensive care treatment. Both patients received immunosuppressive therapy. Differentiation between the effects of this and the disease process itself cannot be established.
Sprotte needle for intrathecal anaesthesia for Caesarean section: incidence of postdural puncture headache
Authors: CESARINI M. , TORRIELLI R. , LAHAYE F. , MENE J. M. , CABIRO C. 
Published: February 2007

SummaryCaesarean section was performed under spinal anaesthesia in 55 women using a 25‐gauge diamond‐tipped needle and in a further 55 mothers with a 24‐gauge Sprotte needle. Eight patients (14.5%) developed a headache in the former group, five of whom required a blood patch. There were no headaches reported in the Sprotte group.
Effects of famotidine and cimetidine on plasma levels of epidurally administered lignocaine
Authors: KISHIKAWA K. , NAMIKI A. , MIYASHITA K. , SAITOH K. 
Published: February 2007

SummaryThe effects of two H2‐receptor antagonists, famotidine and cimetidine, on the plasma levels of epidurally administered lignocaine were studied. Group A (n = 20) received famotidine 20 mg orally the night before surgery and 20 mg intramuscularly 60 minutes before induction of anaesthesia. Group B (n = 15) received cimetidine 200 mg orally the night before the surgery and 400 mg orally 60 minutes before the anaesthetic induction. Group C (n = 20) received neither famotidine nor cimetidine and served as controls. Twelve millilitres of 2.0% lignocaine with adrenaline 1:200 000 was injected into the epidural space in all patients, after the establishment of general anaesthesia with nitrous oxide, oxygen, and enflurane (0.3–0.5%). The patients who received cimetidine showed significantly higher plasma concentrations of lignocaine compared with either group A or group C at all investigation times (p < 0.01). The mean peak plasma concentrations were 2.4 (SEM 0.1), 3.2 (SEM 0.2) and 2.3 (SEM 0.1) μg/ml in group A, B, and C, respectively. This study suggests that famotidine is preferable to cimetidine for control of gastric acidity before the use of lignocaine as the epidural anaesthetic.
Intravenous diclofenac sodium Does its administration before operation suppress postoperative pain?
Authors: Campbell W. I. , Kendrick R. 
Published: February 2007

SummaryIntravenous diclofenac sodium was evaluated in a double‐blind randomised trial relative to intramuscular diclofenac, intravenous fentanyl, and intramuscular placebo in 160 patients undergoing extraction of impacted lower third molar teeth. The test drug was administered before operation in an attempt to alleviate postoperative pain. A 10‐cm visual analogue scale was used to assess pain at 30 minutes and one day after surgery, if the patients stayed overnight. Patients who received intravenous diclofenac had significantly less pain than the other groups 30 minutes after operation. They also had significantly less pain one day after surgery than the placebo or opioid groups, but not less than the intramuscular diclofenac group. Capillary bleeding time, in comparison with placebo, was significantly prolonged after the use of intramuscular diclofenac, and a similar but nonsignificant trend was observed in the intravenous diclofenac group. No problems were encountered with excessive bleeding in any group.
Intrathecal anaesthesia for day‐care surgery A retrospective study of 160 cases using 25‐ and 26‐gauge spinal needles
Authors: Sarma V. J. , Boström U. 
Published: February 2007

SummaryThe records of 160 day‐care surgical patients who received intrathecal anaesthesia were reviewed. No major complications were recorded. The incidence of postspinal headache after puncture with a 25‐gauge spinal needle was nearly four times more frequent compared to a 26‐gauge needle. The occurrence of postspinal headache in patients over the age of 45 years was significantly less frequent (p < 0.05) than in younger patients. Intrathecal anaesthesia was acceptable to 91% of outpatients in this group.
Acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom
Authors: Tordoff S. G. , Sweeney B. P. 
Published: February 2007

SummaryThe choice of drugs for acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom was determined by questionnaire. The results are compared with a similar survey of anaesthetic departments 5 years ago. The prescription of sodium citrate and the H2 receptor antagonist ranitidine has superseded that of Mist, magnesium trisilicate.
Accidents, near accidents and complications during anaesthesia A retrospective analysis of a 10‐year period in a teaching hospital
Authors: CHOPRA V. , BOVILL J. G. , SPIERDIJK J. 
Published: February 2007

SummaryA retrospective analysis is presented of all reports of faults, accidents, near accidents and complications associated with anaesthesia in one hospital from 1978 to 1987. 113074 anaesthetics were administered in that period, of which 97496 were for noncardiac procedures. There were 148 reports; 39 were of dental damage. Peri‐operative cardiac arrests during noncardiac surgery were reported 29 times. Sixteen of these were fatal. Anaesthesia was thought to have played an important role in 13 cardiac arrests (1 per 7500 anaesthetics) and six were not successfully resuscitated (1 per 16 250 anaesthetics). There were 12 reports of postoperative peripheral neuropathies (1 per 9422 anaesthetics). Failure to check, lack of vigilance and inattention or carelessness were the most frequently associated factors with the rest of the reports.
Local anaesthesia for eye surgery The peri‐ocular technique
Authors: FRY R. A. , HENDERSON J. 
Published: February 2007

SummaryA technique of peri‐ocular infiltration of local anaesthetic for eye surgery is described. The ease of administration of this form of local blockade is highlighted and its low propensity for complication compared with retrobulbar blockade. The involvement of anaesthetists in the performance of local anaesthesia for ophthalmic surgery that utilises this technique is encouraged.
Cardiac arrest after isoflurane anaesthesia in a patient with Duchenne's muscular dystrophy
Authors: CHALKIADIS G. A. , BRANCH K. G. 
Published: February 2007

SummaryAn 8‐year‐old boy known to have Duchenne's muscular dystrophy suffered a cardiac arrest 10 minutes after he regained consciousness after isoflurane anaesthesia for an orchidopexy procedure. Resuscitation was successful 2 hours after the star of external cardiac compression and after correction of hyperkalaemia and the administration of dantrolene. He later developed myoglobinuria, elevated creatine kinase and a metabolic and respiratory acidosis. He demonstrated a delayed increase in rectal temperature.
Effect of metoprolol and diazepam on pre‐operative anxiety
Authors: Jakobsen C.‐J. , Blom L. , Brondbjerg M. , Lenler‐Petersen P. 
Published: February 2007

SummaryA double‐blind study of 98 patients who underwent elective hysterectomy or orthopaedic surgery was conducted to evaluate the effect of metoprolol or placebo combined with diazepam given 1–3 hours before surgery. Evaluation was by anaesthetists and by visual analogue scoring by the patients. The anaesthetists found that patients who received metoprolol were significantly less anxious (p < 0.005) and better sedated (p < 0.001) before induction of anaesthesia. The patients who received metoprolol found themselves more calm compared with placebo patients. Arterial blood pressure and heart rate were reduced by metoprolol compared to placebo. Metoprolol may be a valuable drug for premedication.