bluuebunny/crossref_metadata_2025_split huggingface dataset:
The SMART needle
Authors: VUCEVIC M. , TEHAN B. , GAMLIN F. , BERRIDGE J. C. , BOYLAN M. 
Published: February 2007

SummaryCentral venous access is an essential part of patient management in many clinical settings. Traditionally this has been achieved by a blind, external landmark guided technique which may not correlate exactly with the location of the vessel. We have prospectively evaluated the SMART needle, a new Doppler ultrasound guided vascular access device, in 40patients, to evaluate whether it can improve on the standard technique. The SMART needle was easy to use and reliably distinguished between arterial and venous signals. No advantage was demonstrated in‘easy’internal jugular vein cannulations. Although ease of cannulation in difficult cases was subjectively improved, the differences in time to cannulation and number of passes between the groups failed to reach statistical significance and the complication rates were similar. However, the use of the SMART needle on two occasions enabled avoidance of carotid artery puncture by correctly distinguishing the artery from the vein, so that it may have a rôle in patients in whom difficult internal jugular venous cannulation is anticipated.
Circulating fluoride changes and hepatorenal function following sevoflurane anaesthesia
Authors: NEWMAN P. J. , QUINN A. C. , HALL G. M. , GROUNDS R. M. 
Published: February 2007

SummarySevoflurane, a new volatile inhalational agent, undergoes biotransformation to fluoride which is potentially nephrotoxic. We compared the effects of sevoflurane or isoflurane anaesthesia on hepatorenal function and serum fluoride concentrations in 50 ASA 1‐3patients undergoing major intra‐abdominal surgery. No patient developed renal or hepatic dysfunction. Mean (SEM) peak fluoride concentrations were 23.1 (1.5) μmol.l‐1for sevoflurane and 5.4 (0.4) μmol.l‐1 for isoflurane (p < 0.001). There was a significant correlation in the sevoflurane group between the total dose of agent (MAC h), the total fluoride production (r = 0 78, p = 0.0001) and peak fluoride concentration (r = 0.57, p = 0.003). There was no correlation between these variables in the isoflurane group.
Detection of cerebral hypoperfusion during cardiopulmonary bypass
Authors: ANDREWS P. J. D. , COLQUHOUN A. D. 
Published: February 2007

SummaryWe measured continuously cerebral venous oxyhaemoglobin saturation (Sjvo2) using a 4F fibreoptic catheter in 11 patients scheduled for elective myocardial revascularisation. The aims of this study were to assess the Oximetrix 3 computer and Opticath 40 cm catheter during moderate hypothermic cardiopulmonary bypass, and identify epochs of cerebral hypoperfusion (Sjvo2 < 54%). Radial artery pressure, brain electrical activity, arterial and cerebral venous oximetry (dual oximetry), end‐tidal CO2 and nasopharyngeal temperature were recorded continuously in each patient. Following in vivo calibration of 11 continuous Sjvo2 catheters and monitor, 57 simultaneous, paired recordings were additionally taken. The mean difference between the catheter Sjvo2 and the in vitro laboratory derived value was 0.34%, with a 95% confidence interval –3.2% to 2.4%. In 10 patients Sjvo2 decreased below normal at rewarming and myocardial reperfusion: mean lowest value 37%, range 19%–55%. Reduced Sjvo2 were associated with a decrease in perfusion pressure (r = 0.292, 80 DF, p = 7.7* 10‐3), and with an increase in nasopharyngeal temperature (r =–0.46, 115 DF, p = 2.7* 10‐7) after moderate hypothermia. The Oximetrix 3 computer and Opticath 40cm catheter provided reliable and accurate continuous monitoring of Sjvo2 during nonpulsatile cardiopulmonary bypass involving hypothermia with haemodilution and identified rewarming as the period of greatest risk of global cerebral hypoperfusion.
Haemothorax after attempted intercostal catheterisation
Authors: DANGOISSE M. , COLLINS S. , GLYNN C. J. 
Published: February 2007

SummaryA 30‐year‐old man with chronic abdominal pain was referred to the Pain Relief Unit after a course of unsuccessful diagnostic blocks and treatments. On admission, history, examination and clinical investigations were consistent with a large pleural effusion due to a recent attempt to catheterise the intercostal space. Pleural drainage confirmed the diagnosis of haemothorax. Percutaneous intercostal nerve blocks are usually considered as safe and simple and no‐one to our knowledge has reported such a complication.
A comparison of arterial lines and insertion techniques in critically ill patients
Authors: BEARDS S. C. , DOEDENS L. , JACKSON A. , LIPMAN J. 
Published: February 2007

SummaryWe compared three arterial line insertion techniques and two types of arterial catheters in 69 critically ill patients. Use of the direct‐puncture technique (method A) was associated with a significantly higher failure rate (23%) than use of a catheter with a separate guide wire (method B,‘classical’Seldinger technique, p < 0.001) or a catheter with an integral guide wire (method C,‘modified’Seldinger technique, p < 0.02). Operators randomly allocated to using method A took significantly longer to perform the procedure than those using method C (p < 0.01), used significantly more catheters (p < 0.0001) and made significantly more punctures in achieving a successful insertion than those using either methods B (p < 0.001) or C (p < 0.001). Both catheter types B and C (polyurethane) were significantly less likely to block, thus requiring re‐insertion, than catheter type A (Teflon) (p < 0.02, p < 00 01 respectively). We recommend the use of a‘classical’Seldinger technique (method B) for arterial line insertion in critically ill patients and the use of a polyurethane catheter, in preference to Teflon, to maximise catheter life after insertion.
A comparison of thiopentone and propofol with respect to the incidence of postoperative shivering
Authors: Singh P. , Harwood R. , Cartwright D. P. , Crossley A. W. A. 
Published: February 2007

SummaryOne hundred patients (69 female) undergoing surgical excision of three or more wisdom teeth were randomly allocated to receive either thiopentone or propofol for induction of anaesthesia. Other than the induction agent, the anaesthetic regimen was standardised for all cases. All patients were observed for 15 min after entry into the recovery area to assess the presence and intensity of shivering. Twenty‐five patients in the thiopentone group (n = 50) and 11 patients in the propofol group shivered postoperatively (p < 0.005). There was no statistically significant difference in axillary temperature between shivering and non‐shivering patients. The use of propofol as an induction agent is associated with a lower incidence of postoperative shivering than thiopentone.
Effect of topical anaesthesia on the motor performance of vocal cords as assessed by tussometry
Authors: MAHAJAN R. P. , MURTY G. E. , SINGH P. , AITKENHEAD A. R. 
Published: February 2007

SummaryTussometry involves a continuous measurement of airflow produced by a cough manoeuvre displayed as an airflow‐time wave. There is a rapid rise to its peak (cough peak flow rate) and the time taken to reach the peak (peak velocity time) is determined by the laryngeal opening at the onset of cough. Cough peak flow and peak velocity time were measured in 10 healthy volunteers before and after topical anaesthesia of the larynx with lignocaine 100 mg sprayed under indirect laryngoscopy. Adequacy of anaesthesia was established by touching the cords deliberately with a fibreoptic laryngoscope. All subjects had excellent anaesthesia of the larynx. However, cough peak flow rate and peak velocity time remained unchanged following topical anaesthesia. We conclude that topical anaesthesia of the larynx does not impair the motor performance of the vocal cords during a voluntary cough.
Accuracy, alarm limits and rise times of 12 oxygen analysers
Authors: LAUBER R. , STEINER A. , ZBINDEN A. M. 
Published: February 2007

SummaryThe Comité Européen de Normalisation recently proposed a new standard for‘the particular requirements of oxygen monitors for medical use’. The feasibility of this proposed standard was tested in respect of (1) accuracy of alarm activation (2) accuracy of oxygen display value during both continuous and cyclical gas flows (3) rise time during rapid changes in oxygen concentration in the following 12 analysers: Datex Capnomac II and Servomex 570A (paramagnetic); Brüel & Kjaer 1304 (magnetoacoustic); Criticare Poet II, Multinex, Dräger Oxydig, Dräger PM 8030, Megamed 046A (part of the Megamed 700 ventilator), Ohmeda 5120, Spacelabs Multigas, Teledyne TED 200 (galvanic); Kontron OM 810 (polarographic). All the analysers tested displayed an oxygen reading which was within ±3 vol% of the actual oxygen concentrations of the test gases (15, 21, 40, 60 and 100 vol%). A cyclical pressure of between ‐1.5 to +8kPa did not affect the measured oxygen concentration as displayed by the Brüel & Kjaer 1304, Datex Capnomac II and Servomex 570A analysers. The remainder, however, showed, depending on their measuring principle, a display error of between ‐1 and +6vol%. After exposure to high pressure all the oximeters functioned normally. Some of the tested devices showed more than 2% of deviation between their alarm activation and the preset alarm limits. Only the Kontron OM 810, the Megamed 046A and the Spacelabs Multigas monitors satisfied the requirements at all the tested oxygen concentrations. The time required by the oxygen analyser to display the rise from 29 to 92vol% after a sudden change of concentration from 21 to 100 vol% O2 is defined as‘rise time’and must not, according to the Comité EuropéUen de Normalisation standard proposal, exceed the manufacturers’specification by more than a factor of 1.15. The Brüel & Kjaer and Poet II monitors did not comply with this requirement, although their rise times were among the shortest. We conclude that the recommended standards concerning accuracy are generally met during continuous gas flow. Some of the monitors tested failed to meet the required standard during cyclical flows and in the accuracy of their alarm response. These small deviations are, however, not likely to be clinically relevant.
Depth of epidural space in children
Authors: Hasan M. A. , Howard R. F. , Lloyd‐Thomas A. R. 
Published: February 2007

SummaryWe have studied the depth of epidural space in 586 children who had lumbar epidural block as part of their anaesthetic management. The mean depth of epidural space in neonates was I cm (SD 0.2, range 0.4–1.5 cm). The depth of epidural space in older infants and children correlated significantly with age and weight with regression equations of depth (cm) = 1 + 0.15 × age (years) and depth (cm) = 0.8 + 0.05 × weight (kg) respectively.
Waiting in pain
Authors: DAVIES H. T. O. , CROMBIE I. K. , MACRAE W. A. 
Published: February 2007

SummaryPatients with chronic pain may benefit from referral to a pain specialist. This study describes the delay between referral and first appointment of 3386 new referrals seen in ten outpatient pain clinics between 1990 and 1992. We then assess the follow‐up patterns of the pain clinics and how these relate to waiting times. Patients wait in pain for long periods before being seen in a pain clinic. In 1992 about half of patients waited more than 3 months for an appointment at a teaching hospital pain clinic; and half waited 9 weeks or longer to be seen at a district general hospital pain clinic. In many clinics the situation is worsening. Pain clinics differ widely in their patient follow‐up, with patients averaging more than twice as many visits in some clinics than others. Clinic practice on reappointing patients largely determines the number of new referrals who can be accepted for management, and hence affects waiting lists. Thus our data suggest that pain clinics themselves can help reduce waiting times, by changing the extent and nature of patient follow‐up. Ultimately, however, additional consultant sessions may be needed to enable pain clinics to meet the increasing demands placed on them.
Curare modification of suxamethonium blockade
Authors: HOOD J. R. , CAMPKIN N. T. A. , FELDMAN S. A. 
Published: February 2007

SummaryTubocurare (0.125 mg.kg‐1 or 0.25 mg.kg‐1) was injected 10 s before 1 mg.kg‐1 suxamethonium in patients anaesthetised with enflurane 1–1.5%. Measurement of electromyographic response was recorded using a 0.2 Hz train‐of‐four every 20 s. The modified blocks were slower in onset, of lesser intensity, and of shorter duration than that of suxamethonium alone, but were much closer to those of suxamethonium than of tubocurare. However, the train‐of‐four fade observed during onset of the modified blocks were similar to that of their tubocurare controls and significantly different from the suxamethonium group. We conclude that effective amounts of tubocurare are present in the neuromuscular junction within the 30 s following intravenous injection of the drugs, and this affects the onset of action of the suxamethonium block. The presence of train‐of‐four fade during a predominantly agonist block is difficult to explain on the basis of diminished acetylcholine release and a postsynaptic site of action of suxamethonium.
Use of a guide wire and a ureteral dilator as an aid to awake fibreoptic intubation
Authors: TELFORD R. J. , SEARLE J. F. , BOADEN R. W. , BAIER F. 
Published: February 2007

SummaryWe describe the successful use of a guide wire and ureteral dilator to pass a tracheal tube into the trachea through the mouth in an awake, sedated patient when attempts to pass a larger tube over an Olympus LFI fibreoptic bronchoscope were unsuccessful. Since the ureteral and renal dilators are available in a variety of sizes, if too large a tube is inadvertently mounted on the instrument this technique allows an appropriate sized tube to be inserted without the need to re‐endoscope the patient.
Severe pain in both legs after spinal anaesthesia with hyperbaric 5% lignocaine solution
Authors: SJÖSTRÖMand S. , BLÄSS J. 
Published: February 2007

SummaryA patient is presented who developed severe pain in both legs, that began 5 h after a spinal anaesthetic with lignocaine 5% in dextrose 7.5%, but lasted for less than 24 h.
A modification of the Bain system for ambient air‐oxygen inhalation
Authors: SHRESTHA B. M. , TWEED W. A. , BASNYAT N. B. , LEKHAK B. D. 
Published: February 2007

SummaryIn developing countries like Nepal, anaesthetic compressed gases, especially nitrous oxide, are expensive and in short supply and anaesthetic techniques must equally use oxygen and volatile anaesthetics sparingly. We have designed a non‐rebreathing anaesthetic system which meets these requirements. An Ambu‐E anaesthetic valve and self‐inflating Ambu bag connected to a Bain system form a non‐rebreathing system which uses ambient air to supplement a mixture of low flow oxygen and halothane. Over 100 patients have been anaesthetised with this system using a balanced anaesthetic technique. The oxygen flow was 2 l.min‐1 and the average halothane consumption was 8 ml.h‐1. The average inspired oxygen concentration was 34%, and the air: oxygen dilution ratio was 5:1. A graphical analysis of gas flow predicts that the system is almost 100% efficient, in that almost all of the oxygen and halothane will enter the alveoli. Our experience confirms that this is a safe, simple and economical method for inhalation anaesthesia. We recommend it for locations where anaesthetic machines and mechanical ventilators are lacking, and where medical oxygen is in short supply.
Late presentation of tracheo‐oesophageal fistula
Authors: TEASDALE A. R. , NIELSEN M. S. 
Published: February 2007

SummaryWe report a 6‐year‐old boy with an H‐type tracheo‐oesophageal fistula, previously undiagnosed, which presented initially as asthma and became apparent only after tracheal intubation.
The effect of insufflation leaks in long‐term ventilation. Waking and sleeping transcutaneous gas tensions in ventilator‐dependent patients with an uncuffed tracheostomy tube
Authors: Watt J.W.H. , Fraser M.H. 
Published: February 2007

SummaryTranscutaneous blood gases were recorded for 60 min when awake and asleep in 10 ventilator‐dependent patients with high tetraplegia who used a pressure‐limited ventilator and uncuffed tracheostomy tube. The mean arterial oxygen tension awake was 16.0 kPa compared with 15.2 kPa when asleep; the mean arterial carbon dioxide tension awake was 3.2 kPa, compared with 3.9 kPa when asleep. The oxygen tensions in each patient during the awake and sleep states were not significantly different between the two states, but during sleep the carbon dioxide tension was significantly greater.
Improving the induction characteristics of methohexitone
Authors: Raphael J. H. , Bexton M. D. R. 
Published: February 2007

SummaryA double‐blind, randomised, controlled study was undertaken to investigate the effects on injection pain and excitatory phenomena of adding thiopentone to methohexitone. One hundred and twenty unpremedicated, day‐case patients received one of four induction regimens: unmodified 1% methohexitone, or a mixture of 2.5% thiopentone and 1% methohexitone in ratios of 1:1, 1:3 or 1:9 by volume. The addition of one part of thiopentone to three parts of methohexitone produced a mixture which significantly reduced the occurrence of pain and discomfort compared with methohexitone alone from 67% to 13% (p < 0.01) and reduced the occurrence of excitatory effects from 50% to 13% (p < 0.01).
A new laryngeal mask prototype
Authors: BRAIN A. I. J. , VERGHESE C. , STRUBE P. , BRIMACOMBE J. 
Published: February 2007

SummaryA new prototype laryngeal mask airway is described which incorporates a second mask to isolate the upper oesophagus and a second dorsal cuff to increase the seal against the glottis. We have made a within‐patient comparison of seal pressures between the prototype and standard laryngeal mask airway in 20 patients, and determined if the prototype facilitates functional isolation of the glottis and upper oesophagus. Leak pressure was found to be significantly higher for the prototype and equalled or exceeded 5.0kPa in all patients (p < 0.001). The prototype laryngeal mask airway provided functional isolation in all patients as judged by leak and placement of a gastric tube via the oesophageal mask. Ease of insertion and incidence of pharyngeal morbidity appeared similar to the standard laryngeal mask, but were not formally tested. The prototype laryngeal mask airway exhibits potentially useful new features which justify further evaluation and development.
The effect of pre‐operative oral fluids on morbidity following anaesthesia for minor surgery
Authors: Gilbert S. S. , Easy W. R. , Fitch W. W. 
Published: February 2007

SummaryPostoperative morbidity and serum osmolality were studied in 46 patients who were encouraged to drink water until 3h pre‐operatively and 49 receiving the normal fasting regimen prior to minor surgery. There was significantly less thirst in the postoperative period in those patients allowed to drink and subjectively better recovery than after previous anaesthesia. There was no morbidity from ingestion of up to 11 of water 2.5h pre‐operatively. Although there was only a moderate improvement in postoperative recovery we feel that allowing patients to drink water pre‐operatively improves patient comfort, especially since patients may have to fast for much longer than guidelines recommend, simply because of the traditional organisation of operating lists.
An assessment of the consistency of ASA physical status classification allocation
Authors: HAYNES S. R. , LAWLER P. G. P. 
Published: February 2007

SummaryThe American Society of Anesthesiologists’(ASA) Physical Status Classification was tested for consistency of use by anaesthetists. A postal questionnaire was sent to 113 anaesthetists of varying experience working in the Northern Region of England. They were asked to allot ASA grades to 10 hypothetical patients. Ninety‐seven (85.8%) responded to two mailings. In no case was there complete agreement on ASA grade, and in only one case were responses restricted to two of the five possible grades. In one case there was a significant difference in answers between anaesthetists with the FRCA (or equivalent) qualification, and those without. So much variation was observed between individual anaesthetist's assessments when describing common clinical problems that the ASA grade alone cannot be considered to satisfactorily describe the physical status of a patient.
Lower limb nerve blocks in children using unsheathed needles and a nerve stimulator
Authors: BÖSENBERG A. T. 
Published: February 2007

SummaryThe use of unsheathed non‐insulated needles and a nerve stimulator as an aid to peripheral nerve blockade in children has received little attention in the literature. In order to assess the value of such a technique, a study was performed in children presenting for lower limb surgery with no contraindication to femoral and/or sciatic nerve block. Four hundred and eleven children, mean age 4.25 (SD 3.8) years and mean weight 16.8 (SD 9.4) kg, received a total of 883 peripheral nerve blocks: 419 femoral nerve blocks and 464 sciatic nerve blocks. One hundred and twenty six children were below one year of age. The current required to stimulate the more superficial femoral nerve ranged from 0.5‐1.0 mA whilst for the deeper sciatic nerve ranged from 1.2–2.0 mA. Staff in training, with little or no experience of the technique, successfully performed 223 nerve blocks in 114 patients under the author's guidance. The overall success rate was 98%, the failures occurring early in the series.
Difficult tracheal extubation in a patient with an unsuspected congenital subglottic stenosis
Authors: Asai T. 
Published: February 2007

SummaryA case is described of difficulty in advancing a tracheal tube and subsequent difficult extubation in an asymptomatic patient. The origin of this complication was an unsuspected subglottic stenosis, and a subsequent experiment showed how the relatively large folds of the cuff of an armoured tracheal tube could become caught on a narrow section of airway.
Intra‐operative tracheal obstruction by tumour fragments
Authors: Tzabar Y. 
Published: February 2007

SummaryA patient underwent oesophageal dilatation for invasive secondary carcinoma. During the course of the procedure, ventilation of the patient's lungs became impossible due to total tracheal obstruction. A rigid bronchoscopy was performed and the cause was found to be fragments of tumour that had broken off and were behaving like a ball‐valve in the trachea and right main bronchus.
Continuous monitoring of irrigating fluid absorption during transurethral surgery
Authors: HAHN R. G. , LARSSON H. , RIBBE T. 
Published: February 2007

SummaryWe have designed an automatic detector system for noninvasive monitoring of irrigating fluid absorption during transurethral resection of the prostate. Ethanol, which is used as a tracer for the fluid, is measured in the expired breath of the patient. The breath ethanol monitor can be used both in the awake patient and during general anaesthesia. A lap‐top computer controls the monitor and calculates the fluid absorption 1–3 times per min and uses the pattern of ethanol changes to indicate whether the fluid is being taken by the intra‐ and/or extravascular route. The monitor has been used in routine operations for one year. The interpretation of absorption routes was checked by control methods or by evaluation of the postoperative breath‐ethanol curve. We found the indicated absorption to be correct in all resections with absorption large enough for the monitor to present an interpretation.