bluuebunny/crossref_metadata_2025_split huggingface dataset:
Grading of direct laryngoscopy A survey of current practice
Authors: Cohen A. M. , Fleming B. G. , Wace J. R. 
Published: February 2007

SummaryOne hundred and twenty anaesthetists (30 of each grade), from three separate regions, were interviewed as to how they recorded the appearance of laryngeal structures at direct laryngoscopy and about their knowledge of the commonly used numerical grading system. About two‐thirds of anaesthetists surveyed (69.2%) used the numerical grading system, but of these, over half could not identify a‘grade 2’laryngoscopic appearance correctly. Of anaesthetists who did not use the numerical method, over half could not correctly state the difference between a‘grade 2’and a‘grade 3’laryngoscopic appearance. Over 40% of anaesthetists stated incorrectly that the grading should be made on the initial view, even when laryngeal pressure had been needed. Junior anaesthetists were more likely to use the numerical method of recording. The results show that there is unacceptable uncertainty and inaccuracy in the use of the numerical grading system by users as well as non‐users, which makes the current routine clinical use of the numerical grading system unsatisfactory.
The physiology and pharmacology of postoperative nausea and vomiting
Authors: NAYLOR R. J. , INALL F. C. 
Published: February 2007

SummaryThe main function of emesis is to remove toxins from the body. The emetic response will also be triggered by cancer chemotherapy and radiotherapy or surgery under general anaesthesia. The mechanism of activation of the vomiting system is dependent on stimulation of gastrointestinal (mechanoreceptors and chemoreceptors) and/or central pathways which activate the chemoreceptor trigger zone in the area postrema. Postoperative emesis is activated by a range of factors before, during and after anaesthesia. The precise mechanism of action of any one of the influencing factors can only be speculated as there has been very little basic research into this area, due largely to the lack of an appropriate model for postoperative nausea and vomiting. The range of agents used in the prevention and treatment of emesis are effective to varying degrees, but some are associated with poor side effect profiles making them particularly unsuitable for prophylactic use. Newer antiemetics, which selectively antagonise 5‐HT3 receptors, have proved effective and well tolerated in the treatment of chemotherapy‐induced emesis and postoperative nausea and vomiting.
The oesophageal detector device
Authors: DONAHUE P. L. 
Published: February 2007

SummaryAccuracy, ease and speed of recognition of tracheal tube position were assessed using the oesophageal detector device in a series of 40 tests on 29 patients. A single blind method was used, with each paramedic performing a single test on each patient. The tests were randomly split between two groups consisting of those tests performed on the tracheal or oesophageal tube respectively. Of the 40 tests performed, 21 were on tracheal tubes and 19 on oesophageal tubes. Correct placement was diagnosed with 100% accuracy by the paramedics, none of whom had previously used the oesophageal detector device. Each paramedic also graded speed of recognition of position and ease of use of the device. Recognition of position was graded as instant in 37 out of 40 tests. Use of the oesophageal detector device by previously inexperienced paramedics has thus been shown to be accurate, rapid and easy to learn.
Differential lung ventilation as an alternative to one‐lung ventilation during thoracotomy
Authors: BARAKA A. 
Published: February 2007

SummaryInvestigation was carried out on three elderly patients undergoing thoracotomy. During one‐lung ventilation using a Robertshaw double‐lumen tube, the PaO2 decreased below 11·7 kPa despite ventilation of the dependent lung with 100% oxygen. Differential lung ventilation was then initiated by partial occlusion of the adapter limb to the nondependent lung, whilst maintaining unrestricted ventilation of the dependent lung. In the three patients, differential lung ventilation increased the PaO2 to 15–37.2 kPa. The increased Pao2 may be attributed to diffusion oxygenation via the partially inflated, nondependent lung. Differential lung ventilation can be used during thoracotomy whenever one‐lung ventilation is followed by hypoxaemia, despite adequate ventilation of the dependent lung with 100% oxygen.
The need for quality control in measurement of mixed venous oxygen saturation
Authors: BEARDS S. C. , EDWARDS J. D. , NIGHTINGALE P. 
Published: February 2007

SummaryWe investigated the variability of arterial, mixed venous and peripheral venous oxygen saturation readings in three co‐oximeters in regular use on two Intensive Care Units. Over a 2‐week period, 96 readings were obtained from each of the following machines; two AVL 912 co‐oxylite co‐oximeters (Machines A and B, Biomedical Instruments, Graz, Austria) and one IL‐282 (Machine C, Instrumentation Laboratories, Lexington, MA, USA). The coefficient of variation in the arterial oxygen saturations was extremely small on all three machines (<0.43%). The coefficient of variation in the mixed venous samples, however, ranged from 1.96 to 4.61% on machine A, and from 2.73 to 4.71% on machine B, but only from 0.17 to 1.47% on machine C. The variation in mixed venous saturations obtained from a single blood sample repeatedly analysed on machines A and B was large enough to influence clinical management.
Blood pressure measurement using oscillometric finger cuffs in children and young adults
Authors: LYEW M. A. , JAMIESON J. W. 
Published: February 2007

SummaryArterial blood pressure measurements (y) obtained from forefinger cuffs were compared with standard arm cuff readings (x) in 41 anaesthetised children and young adults. Mean (SD) differences between cuff measurements were –0.21 (9.15), –1.56 (10.2) and 1.23 (9.12) mmHg for the systolic, mean and diastolic pressures respectively. The correlation for systolic blood pressures (r = 0.85, y = 0.99x + 0.58, sy, x= 9.15) was better than that for mean or diastolic pressures. Oscillometric finger cuffs are suitable for monitoring the systolic blood pressure in children and young adults during general anaesthesia.
Spinal cord compression immediately following, but unrelated to, epidural analgesia
Authors: MILLS G. H. , HOWELL S. J. L. , RICHMOND M. N. 
Published: February 2007

SummaryA patient developed spinal cord compression following epidural analgesia. The diagnosis was made difficult by the presence of epidural analgesia, although the compression was not in fact related to the analgesic technique employed. This case highlights the need for close observation of patients in whom epidural analgesia is, or has recently been, employed and the need to consider alternative reasons for neurological deficit.
Elevated porphyrins following propofol anaesthesia in acute intermittent porphyria
Authors: ELCOCK D. , NORRIS A. 
Published: February 2007

SummaryA patient with acute intermittent porphyria was anaesthetised with propofol for a minor orthopaedic procedure. Postoperative urinary porphyrins were markedly raised compared to pre‐operative values, although the patient remained clinically well. Caution should continue to be exercised when propofol is used in patients with acute porphyrias.
Phakomorphic glaucoma—an unusual cause of postoperative vomiting
Authors: GUPTA S. , CHARI P. , BALA I. , MURALIDHAR J. 
Published: February 2007

SummaryA 60‐year‐old female patient receiving epidural buprenorphine for postoperative analgesia developed intractable nausea and vomiting not responding to antiemetics. Ophthalmic consultation for congestion of the left eye was sought and the patient was diagnosed as having phakomorphic glaucoma. Extracapsular extraction of the left lens was performed after primary anti‐oedema measures. Glaucoma as a cause of intractable postoperative nausea and vomiting should be considered in susceptible patients.
Noise pollution in the anaesthetic and intensive care environment
Authors: KAM P. C. A. , KAM A. C. , THOMPSON J. F. 
Published: February 2007

SummaryNoise in the operating theatre, recovery room and intensive care unit is above internationally recommended levels. The psychological and physiological effects of noise are reviewed. Equipment and conversation among the staff are major sources of noise in these areas. Equipment design, modification of nursing care procedures, and increased awareness of noise created by the staff may be effective in reducing noise pollution in these areas.
The effect of clonidine on intra‐operative requirements of fentanyl during combined epidural/general anaesthesia
Authors: Murga G. , Samsó E. , Valles J. , Casanovas P. , Puig M. M. 
Published: February 2007

SummaryThe study evaluates the analgesic effects of epidural clonidine in patients undergoing abdominal hysterectomy under combined epidural/general anaesthesia. Forty ASA 1–2 patients were divided into two groups who received epidurally either clonidine 300 μg (group 1) or placebo (group 2). Anaesthesia was maintained with oxygen/nitrous oxide, a midazolam infusion, vecuronium, and boluses of fentanyl 100 μg administered as needed to maintain cardiovascular stability. The mean (SD) intra‐operative fentanyl requirements were 2.05 (0.18) and 3.66 (0.3) μg.kg‐1.h‐1 for groups 1 and 2 respectively (p < 0.001). Patients in Group 1 had a lower heart rate after tracheal intubation and surgical incision (p < 0.02). In the recovery room, pain intensity was lower in group 1 (p < 0.003) and the mean (SD) time until analgesia request was jincreased from 48.5 (8.4) min in group 2 to 235.7 (33.2) min in group 1 (p < 0.001). Our results demonstrate that epidural clonidine produces decreased fentanyl requirements, improved cardiovascular stability, reduced pain intensity and effective postoperative analgesia in the recovery room.
Age‐dependent haematological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of halothane and nitrous oxide
Authors: PERIĆ M. , PETROVEČKI M. , MARUŠIĆ M. 
Published: February 2007

SummaryAnaesthetic staff chronically exposed to high occupational concentrations of halothane and nitrous oxide were tested for numerous haematological and cellular function parameters at the peak of the working season and after 3 weeks vacation. The analysis of data was performed to compare differences in subjects younger and older than the age of 40 years, respectively when compared with normal controls. The analysis revealed a higher recovery of erythrocyte’count in the blood of older staff, and stronger disturbance of leucocyte formation in younger staff. In contrast, monocytes appeared to be more stable in the younger staff as were the T and B lymphocyte counts. After stimulation with PHA, Con A and PWM mitogens, lymphocytes from the older age group incorporated a significantly higher amount of tritiated thymidine, but stimulation indices did not differ. Natural killer cell numbers appeared equally affected; natural killer cell activity was unaffected, but there was an increase in activity in the younger staff after the vacation. Serum immunoglobulin concentrations tended to be more affected in older individuals at the peak of the working season.
Cardiac tamponade in an infant
Authors: CHERNG Y‐G. , CHENG Y‐J. , CHEN T‐G. , WANG C‐M. , LIU C‐C. 
Published: February 2007

SummaryA 2994g infant suffered cardiac tamponade from an infusion of total parenteral nutrition through an indwelling central venous catheter. The infant survived as a result of early diagnosis and aggressive therapeutic intervention. Cardiac tamponade secondary to central venous catheterisation is rare, but potentially lethal. Possible mechanisms are direct puncture by the catheter tip, or osmotic injury from the use of hypertonic solutions. To avoid this complication, the catheter tip should be prevented from entering the right atrium and its position should be checked periodically by chest X ray. Cardiac tamponade should be considered in any patient with a central venous catheter whose clinical condition deteriorates suddenly. Diagnostic or therapeutic pericardiocentesis should be employed as the first measure and time should not be wasted on other diagnostic procedures.
Traumatic pneumomyelogram
Authors: DAY C. J. E. , NOLAN J. P. , TARVER D. 
Published: February 2007

SummaryA 70‐year‐old man sustained a severe head injury following a fall downstairs, which resulted in him being found in a head down position. In the accident and emergency department he was noted to have subarachnoid air on a lateral cervical spine radiograph. This drew attention to the presence of fractures in the middle cranial fossa and nitrous oxide was immediately discontinued. The presence of a traumatic pneumomyelogram implies a base of skull or middle cranial fossa fracture, and is almost certainly associated with intracranial subarachnoid air. Early recognition of the condition, and cessation of nitrous oxide, is essential to prevent dangerous increases in intracranial pressure secondary to the diffusion of gas into the air filled cavity.
A trial of pre‐emptive analgesia
Authors: Mansfield M. , Meikle R. , Miller C. 
Published: February 2007

SummaryThe influence of timing of administration of peroperative alfentanil on pain and analgesic requirements after surgery was studied in 60 patients undergoing total abdominal hysterectomy with or without bilateral salpingo‐oophorectomy. Thirty patients received alfentanil 7.5μg.kg‐1 on induction of anaesthesia, followed by alfentanil 7.5μg.kg‐1 90s before surgical incision (group A). Thirty control patients received alfentanil 15μg.kg‐1, 10 min after abdominal incision (group B). In addition, 10min after surgical incision both groups received morphine 0.2mg.kg‐1, given over a 10min period. The visual analogue scores (median, interquartile range) for pain 24 h after operation were 28.5 mm (11.25–47.0) in group A and 21.0 mm (10.5–47.5)in group B, p = 0.76. There were no differences in visual analogue scores at intermediate times. Morphine consumption in the first 24 h after surgery (median, interquartile range) was 53.5mg (37.25–60.0) in group A and 52.0mg (39.75–71.0) in group B, p = 0.52. We conclude that postoperative morphine consumption and pain scores are no different when alfentanil 15μg.kg‐1 is given before or after skin incision for abdominal hysterectomy.
Sensitivity to second dose of mivacurium
Authors: FELDMAN S. A. , HOOD J. R. , CAMPKIN N. T. A. , REHM S. 
Published: February 2007

SummaryThe sensitivity of patients to a second dose of mivacurium has been studied following complete recovery of the twitch response after > 95% neuromuscular block produced by a systemic bolus of the drug. In further experiments we have excluded one arm from the effect of a systemic bolus ED95 dose of mivacurium for 100 s so as to obtain two different levels of neuromuscular block in the two arms of the same patient. Upon recovery from the block in the paralysed arm the dose response of both arms to a second dose of mivacurium was studied in order to investigate the effect of the amount and duration of block upon second dose sensitivity. An approximately 50% diminution in the ED95 dose requirement of mivacurium was found following complete recovery from an ED95 dose in spite of the rapid plasma clearance of this drug. A similar increase in sensitivity was observed in the arm that had been excluded for 100 s from the peak effect of the drug. It was concluded that the second dose sensitivity was not due to a receptor effect or to residual drug in plasma.
An assessment of a blood warmer for high and low flows
Authors: JOHNSON A. L. M. , MORGAN M. 
Published: February 2007

SummaryThe Level 1 warmer (H‐250 model) with its new disposable set (D‐60HL) was found to be effective in warming fluids at flows between 1 and 500 ml.min‐1 or fluids at room temperature, and between 5 and 100 ml.min‐1 for fluids at 4–5°C.
Angiotensinamide in the treatment of probable anaphylaxis to succinylated gelatin (Gelofusine)
Authors: McKINNON R. P. , SINCLAIR C. J. 
Published: February 2007

SummaryA patient undergoing anaesthesia for coronary artery bypass surgery developed a probable anaphylactic reaction to succinylated gelatin (Gelofusine). The principal feature of the reaction was one of cardiovascular depression. An infusion of the angiotensin analogue, angiotensinamide was successful in the treatment of the reaction and allowed completion of the surgery.
The application of Read Codes to anaesthesia
Authors: BANKS I. C. 
Published: February 2007

SummaryThe Anaesthetic Specialty Working Group of the Clinical Terms Project is creating a set of terms for anaesthesia. These terms can be used to describe the activities of an anaesthetist, and are designed for use in computerised systems such as automated anaesthetic record‐keeping systems. These terms will be coded as Read Codes, and will be introduced to the National Health Service in 1994. The method for, and the reasoning behind the creation of these terms, is discussed below. The way that these terms can be used in the field of anaesthesia is outlined.
Teaching fibreoptic intubation
Authors: Hartley M. , Morris S. , Vaughan R. S. 
Published: February 2007

SummaryA technique for teaching fibreoptic orotracheal intubation in patients under general anaesthesia is described and evaluated. A standard general anaesthetic was administered to 60 patients presenting for elective gynaecological surgery. Patients were randomly assigned to receive either alfentanil 10 μg. Kg−1 or a placebo, and to be intubated either by a consultant experienced in the use of the fibreoptic bronchoscope or by an inexperienced trainee under instruction. Heart rate, arterial pressure and oxygen saturation were monitored continuously. The time to achieve tracheal intubation in the trainee group was significantly prolonged (p < 0.001), but no patient developed arterial desaturation. The hypertensive response to fibreoptic intubation was suppresed in those patients who received alfentanil (p < 0.001). The increase in heart rate was not suppressed, but was attenuated when these patients were compared with those who had received the placebo (p < 0.001). Alfentanil 10μ.kg−1 minimises the haemodynamic response when teaching fibreoptic orotracheal intubation under general anaesthesia.
Facial sensory evoked muscle potentials during labour
Authors: ANDREWS P. J. D. , ACKERMAN W. E. , JUNEJA M. J. , VOGEL R. 
Published: February 2007

SummaryWe prospectively studied the relationship between upper facial sensory‐evoked muscle potential amplitude, uterine contraction amplitude and heart rate in 20 healthy parturients during the first stage of labour. Monitoring began when minimal pain was reported and continued until severe pain occurred and extradural analgesia was established. Pain intensity was assessed by each patient using a 10 cm visual analogue score. Heart rate was recorded using a pulse oximeter. Sensory evoked muscle potential was derived from frontalis biopotentials that were rectified, integrated and digitised by an Anaesthesia and Brain activity Monitor (Datex, Helsinki, Finland). An additional signal filter was included in the pre‐amplifier to improve the signal‐to‐noise ratio. The rms amplitude of successive 10 s samples of sensory evoked muscle potential, as well as heart rate and the output from an external tocotransducer, were then graphically displayed to allow assessment of temporal relationships. The data were assessed using correlation analysis and hypergeometric probability distribution. Before extradural analgesia (mean pain score 7.5 cm, SD 1.5cm) a significant relationship was demonstrated between sensory evoked muscle potential and uterine contraction, p < 0.001). No constant relationship was seen between heart rate and uterine contraction. Following extradural analgesia (mean pain scores of 2.1 cm, SD 1.3 cm) a variable relationship between sensory evoked muscle potential and uterine contraction amplitude, and heart rate and uterine contraction, was recorded. A continuous display of the relationship between filtered sensory evoked muscle potentials of the frontalis muscle and uterine contraction may, in the future, permit an objective assessment of the adequacy of analgesia following extradural analgesia for the pain of labour.
Double burst stimulation for monitoring neuromuscular blockade for tracheal intubation
Authors: JAIN A. K. , SHARMA P. K. , BHATTACHARYA A. 
Published: February 2007

SummaryResponses to double burst stimulation were palpated every 15s after intravenous administration of vecuronium 0.2mg.kg‐1 in 60 adult patients under anaesthesia. Intubating conditions and neuromuscular responses to tracheal intubation were assessed at disappearance of one or both palpable responses to double burst stimulation in groups of 30 patients randomly divided, although in group A patients, tracheal intubation could be performed at disappearance of one palpable response to double burst stimulation; 27 out of 30 patients (90%) had mild to moderate bucking on intubation. In this group, only five patients (16.66%) had good intubating conditions. In group B, where tracheal intubation was attempted at disappearance of both palpable responses, intubating conditions were good in 28 out of 30 patients (93.33%) and there was no response to tracheal intubation in 26 out of 30 patients (86.66%). Palpation of evoked response to double burst stimulation can be used to predict intubating conditions and neuromuscular response to tracheal intubation with nondepolarising muscle relaxants such as vecuronium.
Massive lingual swelling following palatoplasty
Authors: CHAN M. T. V. , CHAN M. S. H. , MUI K. S. Y. , HO B. P. Y. 
Published: February 2007

SummaryWe report a case of upper airway obstruction as a result of delayed massive lingual swelling following routine cleft palate repair in an otherwise healthy 12‐month‐old girl. We believe that ischaemia and venous congestion were the causes of macroglossia, after prolonged use of the Digman Dott tongue retractor. In any difficult and lengthy repair, we recommend the prophylactic insertion of a nasopharyngeal airway under direct vision by the surgeons after surgery to prevent potential upper airway obstruction.
Anaesthetic considerations in a patient with Fraser syndrome
Authors: JAGTAP S. R. , MALDE A. D. , PANTVAIDYA S. H. 
Published: February 2007

SummaryA 16‐year‐old girl with Fraser syndrome underwent abdominal hysterectomy under general anaesthesia. She had multiple congenital anomalies which included a cardiac defect and airway abnormalities. Intubation difficulties were circumvented by the retrograde technique of placement of the tracheal tube.
An evaluation of a new percutaneous tracheostomy kit
Authors: CALDICOTT L. D. , OLDROYD G. J. , BODENHAM A. R. 
Published: February 2007

SummaryThe Portex percutaneous trachestomy kit incorporates guidewire dilating forceps which pass over a guidewire and perform rapid dilatation. These forceps have curved jaws which are designed to reduce possible damage to the lateral and posterior walls of the trachea. The guidewire dilating forceps are first opened in front of the trachea to dilate the pretracheal tissues and then opened in the trachea to dilate the anterior tracheal wall. A tracheostomy tube is then passed over the guidewire and into the trachea. The procedure was rapid and successful in all 20 patients, with no serious complications. Mean time to perform tracheostomy was 4.9min (range 90s–15min). Overall, the Portex percutaneous tracheostomy kit worked well and proved a rapid and acceptable method for performing percutaneous tracheostomy.