bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osmolal excretion after open heart surgery
Authors: READ D. H. , MANNERS J. M. 
Published: February 2007

SummaryWater and osmolal balance was investigated during the peri‐operative period in twenty unselected adult patients presenting for open heart surgery. On the day before surgery the mean urine output was 1.13 litres/sq m/24 hours and osmolal output 430 mOs/sq m/24 hours.Using a haemodilution cardiopulmonary bypass technique, patients received 2.62 litres/sq m and 792 mOs/sq m in the operating room. The pattern of excretion of this water and solute load was identified. Patients were still in positive balance on the day following surgery despite a considerable diuresis, with solute retention exceeding water retention.
Intravenous lignocaine in dental anaesthesia
Authors: CLAYTON D. G. , ALLT‐GRAHAM J. 
Published: February 2007

SummaryThe prophylactic use of intravenous lignocaine 1.5 mg/kg given 1 minute prior to induction of anaesthesia has been shown to reduce significantly the incidence of dysrhythmias during dental anaesthesia, and reduce the rise in blood pressure associated with tracheal intubation.
Anaesthesia‐related surgical mortality
Authors: LUNN J. N. , HUNTER A. R. , SCOTT D. B. 
Published: February 2007

SummaryThis is the report of the second of two studies conducted by the Association of Anaesthetists of Great Britain and Ireland based on anonymous reports of deaths within 6 days of anaesthesia. One hundred and ninety‐seven detailed reports were received during 1981; 43% were found by assessors to have nothing to do with anaesthesia, 41% to be partly due to, and 16% totally due to anaesthesia. These figures confirm earlier results reported by the same system. It is important to have the opinion of the two clinicians (anaesthetist and surgeon) separately and not to ignore either in a study which attempts to identify aspects of clinical medicine which might be improved.
Choice reaction time
Authors: SCOTT W. A. C. , WHITWAM J. G. , WILKINSON R. T. 
Published: February 2007

SummaryPostoperative psychomotor performance changes were measured in three groups of thirteen subjects using a portable serial four‐choice reaction time apparatus. Anaesthesia consisted of either thiopentone, nitrous oxide and halothane (thiopentone subjects) or methohexitone and fentanyljnitrous oxide and incremental methohexitone (methohexitone subjects). Tests were performed on the day before operation and after 2, 4, 6, 8 and approximately 24 hours recovery on both groups of patients and at approximately the same times on nonoperated control patients. Control subjects' mean four‐choice reaction time decreased steadily with practice such that the difference between first and last tests was statistically significant. Mean four‐choice reaction times of thiopentone and methohexitone subjects increased from 515 to 550 ms and 552 to 600 ms respectively after 2 hours recovery. Subsequently four‐choice reaction times decreased in both groups although methohexitone subjects were still significantly slower than controls after 6 hours. Thiopentone subjects were slower than controls at 2, 4 and 8 hours recovery. There was no difference between the three groups of subjects after 24 hours recovery.
Epidural analgesia in labour and maternal posture
Authors: RICKFORD W. J. K. , REYNOLDS FELICITY 
Published: February 2007

SummaryThe effect of maternal position in the period immediately following epidural administration on analgesia and side effects was examined during labour. Patients were randomly allocated to two groups and were either turned from left to right lateral position within 5 minutes of bupivacaine administration (n = 35), or kept in the supine position, modified as appropriate, until pain relief or side effects indicated a change (n = 35). There was no significant difference between the two groups in onset or duration of analgesia, the need for supplements or in absorption of bupivacaine. Circulatory disturbances, all mild and transient, were seen in 14 patients (eight lateral, six supine). There was no significant difference betweeen the two groups either in the frequency of hypotension (four lateral, five supine) or of fetal heart deterioration (four lateral, three supine). However motor block occurred in 15 of the lateral group and five supine (p < 0.02). Such differences are not thought sufficient to counterbalance the potential circulatory disadvantage of the supine position.
Air aspirated from the venous system during total hip replacement
Authors: ANDERSEN K. H. 
Published: February 2007

SummaryIn order to demonstrate the presence of air embolism during total hip replacement surgery six patients, chosen at random, were examined with an ultrasound probe placed over the right atrium. In five patients, the characteristic double cardiac sound coming from the ultrasound probe changed into an irregular rattling sound as the femoral cement started generating its maximum hardering heat. In two patients this change was also heard simultaneously with the insertion of the femoral prosthesis. In four patients in whom catheters were placed in the right atrium it was possible to aspirate a maximum of 3 ml air from the right atrium. During the cementation of acetabulum, no change in the signal, coming from the ultrasound probe, was registered.It is probable that air is formed in the venous system during the insertion and cementation of a femoral prosthesis. The resulting air embolism is presumed to be the cause of the massive, but generally very brief impairment of the central circulation and the lungs seen during a hip arthroplasty. In the case of patients undergoing anaesthesia with N20, the N20 should be removed before the cementation, it is also recommended that the right atrium be catheterised, in order to reduce the risk of this complication.
Electroconvulsive therapy and intracranial aneurysm
Authors: HUSUM B. , VESTER‐ANDERSEN T. , BUCHMANN G. , BOLWIG T. G. 
Published: February 2007

SummaryA 42‐year‐old normotensive woman developed a severe mental depression 6 months after an operation for intracranial aneurysm. The use of electroconvulsive therapy (ECT) was judged to be of vital importance. By concurrent administration of intravenous hydralazine and propranolol before induction of anaesthesia the normally occurring ECT‐induced blood pressure elevation was completely prevented, and the patient received a series of ten ECTs without complications.
Inhalation of ammonia vapour
Authors: O'KANE G. J. 
Published: February 2007

SummaryEight men were admitted to hospital following exposure to gaseous ammonia at a local factory. They were divided into three groups, according to their clinical condition. The clinical findings, chest radiographs and treatment are discussed. One case was very severely injured. His management is discussed in detail. He required mechanical ventilation, positive end expiratory pressure and tracheostomy.The toxic effects of ammonia gas are discussed. A review of the literature is included. It was concluded that ammonia is an extremely irritant gas. capable of producing severe damage to all levels of the respiratory tract which may result in clinical impairment of respiratory function, ranging from mild to fatal. Prolonged respiratory support may he required. Superinfection may cause a late deterioration in those severely affected.
Ranitidine as an antacid before elective Caesarean section
Authors: McAULEY D. M. , MOORE J. , McCAUGHEY W. , DONNELLY B. D. , DUNDEE J. W. 
Published: February 2007

SummaryIn a preliminary study, 20 women in labour received ranitidine 50 mg intravenously. No significant changes were seen in the height, frequency or amplitude of uterine contractions or in fetal heart rate or pattern. No neonatal problems attributable to ranitidine were found. Ranitidine crossed the placenta, the mean fetal‐maternal ratio being 0.9. Levels in the infants 12 hours following delivery were all very low. Ranitidine 150 mg orally was given to 80 healthy women undergoing elective Caesarean section at varying times from 75 to 510 minutes pre‐operatively. From 2 to 6 hours following ingestion, the pH of gastric contents was greater than 2.5 in all but one patient. The mean volume aspirated (8 ml) was significantly lower than in a control group receiving magnesium trisilicate (mean volume 30 ml). Neonatal assessment included Apgar scoring, neurobehavioural examination, feeding progress, measurement of acidity and culture of gastric aspirates. No significant differences between groups were found. Blood levels indicated that the oral drug is readily absorbed by the parturient and that a smaller proportion is transferred to the fetus, mean fetal‐maternal ratio at delivery being 0.38.
Isobaric bupivacaine and hyperbaric amethocaine for spinal analgesia
Authors: TATTERSALL M. P. 
Published: February 2007

SummaryA 15 mg dose of isobaric bupivacaine 0.5% solution for spinal analgesia was compared with a clinically indicated dose of hyperbaric amethocaine 1% solution (10–16 mg) in 123 patients undergoing orthopaedic, urological and general surgical procedures. The 63 patients who received bupivacaine had a more limited spread of analgesia, which lasted longer and was accompanied by less hypotension and fewer complications than those who received amethocaine.
Cold agglutinins and deep hypothermia
Authors: LEACH A. B. , VAN HASSELT G. L. , EDWARDS J. C. 
Published: February 2007

SummaryA case is reported of cardiac surgery under deep hypothermia in a child with cold agglutinins with a brief discussion of the significance of different types of cold agglutinins. The screening potential of routine cross‐matching for significant cold agglutinins is emphasised.
Portable ventilators under field conditions
Authors: HARRIES M. G. 
Published: February 2007

SummaryTwenty‐eight field rescue units using mechanical ventilators were questioned about the incidence of practical difficulties encountered with their equipment. Eleven (39%) had used the equipment in an emergency. Sixty‐one separate incidents were recorded, in 48 oxygen therapy alone was given but in 13 the equipment was used to ventilate the patients’ lungs. Seven units (25%) experienced some sort of practical difficulty. Six units complained of trouble with servicing, five of which were frustrated by delays with replacement oxygen cylinders.
Evaluation of a device for the measurement of the evoked tensions of the rectus abdominis muscle
Authors: GOUDSOUZIAN N. G. , WELCH J. 
Published: February 2007

SummaryA device was developed to measure the evoked tensions of the rectus abdominis muscle which consisted of a fluid‐filled reservoir wedged between the rectus abdominis muscle and a self‐retaining retractor. The evoked contractions of the rectus muscle were compared with that of the tibialis anterior muscle in twelve dogs anaesthetised with pentobarbitone. Significantly greater amounts of tubocurarine were required to depress the response to train‐of‐four stimuli and the twitch tensions of the rectus muscle than the tibialis. The tibialis recovered faster, spontaneously or after neostigmine, than the rectus in eight of the animals; the opposite occurred in the other four. The present device can be useful during surgery for the evaluation of abdominal muscle tension.
Rapid and safe withdrawal of intravenous papaveretum after prolonged continuous infusion
Authors: MORGAN R. J. M. 
Published: February 2007

SummaryA case is reported in which papaveretum was administered to a patient by continuous intravenous infusion for 60 days. Complete and rapid withdrawal of the narcotic analgesic at the end of that period, despite a massive established daily requirement, was relatively simple and apparently safe. Aspects of narcotic analgesic dependence as they pertain to the case are discussed and the prolonged administration of intravenous opiates with greater confidence by clinicians involved in the intensive therapy of similar patients is suggested.
Training in intensive care
Authors: HILLMAN K. , HINDS C. J. , WILLATTS SHEILA M. 
Published: February 2007

SummaryA questionnaire was sent to senior registrars in General Medicine and Anaesthesia enquiring into the amount of training they received in Intensive Therapy and their attitudes to this in the light of their expectations for a consultant post. The results suggest that training is inadequate and that trainees are dissatisfied with the current situation.
Unexplained haemoglobinuria associated with extracorporeal circulation
Authors: DHAMEE M. S. , DONAHUE R. J. , GANDHI S. K. 
Published: February 2007

SummaryHaemoglobinuria occurred within a few minutes of institution of extracorporeal circulation which is not a common phenomenon. A case report is presented and several possible causes of haemoglobinuria are discussed. The cause of early haemoglobinuria on ECC in this case remains unexplained.
Nitrous oxide sedation in dentistry
Authors: SHER A. M. , BRAUDE B. M. , CLEATON‐JONES P. E. , MOYES D. G. , MALLETT J. 
Published: February 2007

SummaryNitrous oxide concentrations (V/V) at the delivery Rotameters block, nasal mask, pharynx and venous blood, were compared. There was a dilution of approximately 50% of the delivered nitrous oxide at the nasal mask which was further reduced in the pharynx. Venous blood concentrations 10 minutes after inhalation of nitrous oxide were low but as would be calculated from pharyngeal concentrations. After 5 minutes of oxygenation venous blood nitrous oxide concentrations were still relatively high. A total of 92% of subjects experienced a satisfactory effect with 30% nitrous oxide or less in the pharynx.
Evaluation of a new fibre‐optic pulmonary artery catheter in intensive care
Authors: WESTON G. A. , LEDINGHAM I. McA. , DOUGLAS I. H. S. , MacARTHUR K. J. D. 
Published: February 2007

SummaryWe have assessed the performance of a new fibre‐optic pulmonary artery catheter for the measurement of mixed venous oxygen saturation. The results obtained from this catheter compare well with those using standard techniques. Other information from the catheter allows oxygen consumption to be easily calculated and again the results obtained agree closely with those measured using standard techniques.
Reduction of gastric acid secretion
Authors: YILDIZ F. , TRYBA M. , KUEHN K. , HAUSDOERFER J. 
Published: February 2007

SummaryCimetidine 10 mg/kg orally was given at varying times from 60 to 240 minutes pre‐operatively to 100 healthy children between the ages of 6 months and 14 years. Cimetidine proved to be most effective when given between 120 and 180 minutes before the induction of anaesthesia. All patients in this group had a gastric pH of more than 2.5 and the mean volume aspirated was also significantly lower than that in the control group. The average peak blood concentration after 10 mg/kg oral cimetidine in four healthy children was 3.25 μg/ml (range 1.20‐4.80) and occurred 75 minutes after administration (range 60‐120 minutes). In these patients the mean (SD) hay‐life of cimetidine was 138 (18) minutes. The reduction of gastric juice volume and acidity produced by 10 mg/kg oral cimetidine given 120—180 minutes prior to induction of anaesthesia has important clinical implications.
Visceral injuries following external cardiac massage
Authors: BARROWCLIFFE M. P. 
Published: February 2007

SummaryThis case report describes a patient who sustained a laceration of the hepatic artery during external cardiac massage, a complication which has not previously been reported. The spleen was also damaged. The importance of recognising complications such as haemorrhage from injured abdominal viscera is emphasised and the literature relating to these injuries is briefly reviewed.
Continuous monitoring of blood Po2 in extracorporeal systems
Authors: CLAREMONT D. J. , PAGDIN T. M. , WALTON N. 
Published: February 2007

SummaryThe technique of intermittent sampling of blood during extracorporeal circulation and in vitro analysis to establish that the blood‐gas status of the patient is within acceptable limits has drawbacks which may be overcome by continuous monitoring. An evaluation of an oxygen monitoring system and a comparison with a blood gas analyser have been performed.Blood of known PO2 was circulated at 15°, 25° and 37°C in an extracorporeal system and the monitor readings and results from samples analysed on a blood gas analyser were compared with calculated partial pressures. There was no significant difference between the calculated value and the monitor readings but the blood gas analyser results were significantly lower (p < 0.01) than the calculated values of the tonometered blood. The reasons for this difference and the potential clinical advantages of continuous monitoring are discussed.
Barrier pressure and muscle relaxants
Authors: HUNT P. C. W. , COTTON B. R. , SMITH G. 
Published: February 2007

SummaryThe effects of pancuronium and vecuronium on the lower oesophageal sphincter pressure were studied in 24 healthy patients anaesthetised with 0.5% halothane in nitrous oxide and oxygen. Following pancuronium 0.1 mg/kg intravenously, there was a significant increase in barrier pressure from a control value of 2.0 (SEM 0.14) kPa to 3.0 (SEM 0.27) kPa 1 minute after injection (p < 0.05). This increase was sustained throughout the 15 minute period of recording and was accompanied by a significant increase in heart rate (p < 0.001). Following administration of vecuronium 0.1 mg/kg intravenously there was an initial modest, though not significant increase in barrier pressure. This increase was significant (p < 0.05) at 15 minutes. There were no cardiovascular changes following vecuronium.
The effect of nitrous oxide on cerebral electrical activity
Authors: WILLIAMS D. J. M. , MORGAN R. J. M. , SEBEL P. S. , MAYNARD D. E. 
Published: February 2007

SummaryRecordings of cerebral electrical activity produced by the cerebral function analysing monitor (CFAM) were obtained from nine healthy volunteers breathing increasing concentrations of N2O in O2. Concentrations of 30 and 50% N2O produced significant reductions in CFAM trace amplitude. Withdrawal of N2O resulted in an increase in amplitude with an initial increase above the control level. There were no consistent changes in the frequency distribution of the weighted electroencephalographic signal with increasing concentrations of N2O.
Midazolam and diazepam in ketamine anaesthesia
Authors: CARTWRIGHT P. D. , PINGEL S. M. 
Published: February 2007

SummaryMidazolam 0.07 mg/kg was compared with diazepam 0.12 mg/kg intravenously as an adjuvant to ketamine anaesthesia in healthy patients undergoing minor gynaecological operations of less than 15 minutes duration. The occurrence of induction and emergence sequelae, and patient acceptance of the technique was assessed by means of a questionnaire. The incidence of unpleasant dreams was 6.7% with midazolam and 26.7% with diazepam. There was no significant difference in any other sequelae. Overall patient acceptance was high at 96.7%.
Anaesthesia and severe skin disease
Authors: SMITH G. B. , SHRIBMAN A. J. 
Published: February 2007

SummaryA review of the anaesthetic management of severe skin disease is presented. Erythroderma, urticaria pigmentosa, hereditary angioedema, epidermolysis bullosa, pemphigus, pemphigoid, the Stevens‐Johnson syndrome, Behcet's syndrome, scleroderma, Ehlers‐Danlos syndrome and congenital anhidrotic ectodermal defect are discussed.
The Macintosh laryngoscope
Authors: JEPHCOTT A. 
Published: February 2007

SummaryIt is 40 years since Sir Robert Macintosh discovered the principle of indirect elevation of the epiglottis and developed the laryngoscope which bears his name. The author celebrates the anniversary of this revolution in intubation with some notes on the early commercial history of the instrument and a description of a Longworth version made about 1945.
Plasma catecholamine concentrations
Authors: TAYLOR S. , ACHOLA K. , SMITH G. 
Published: February 2007

SummaryPlasma catecholamine concentrations were measured in 19 patients allocated randomly to receive submucous infiltration with 4 ml of either 0.5% lignocaine with adrenaline 1:200 000 or prilocaine 0.5% with octapressin 0.03 iu per ml. Venous blood samples were obtained before and at 2, 5, and 10 minutes following infiltration. Plasma adrenaline increased from 0.35 to 1.72 p mol/ml at 2 minutes infiltration with the former solution whilst there was little change in plasma noradrenaline concentration. No similar peak in adrenaline concentration occurred after infiltration with prilocaine/octapressin solutions but with both solutions there was a small increase in plasma noradrenaline and adrenaline concentrations 10 minutes after infiltration, at the time of surgical stimulation.
Magnesium trisilicate mixture BP
Authors: CRAWFORD J. S. , POTTER S. R. 
Published: February 2007

SummaryStudy of samples of magnesium trisilicate mixture BP obtained commercially has shown that redistribution of the mixture into a reasonably well‐dispersed suspension becomes increasingly difficult the longer the mixture is stored. This process of compacting is hastened in response to an increase of environmental temperature. It is possibly for this reason that to administer the mixture at some time later than shortly after it has been prepared contravenes the recommendation of the British National Formulary, that‘it should be recently prepared.’These findings were reflected in the contrast between gastric aspirates obtained from anaesthetised patients who had received the commercially‐obtained antacids and those whose antacid had been prepared by the hospital pharmacy. There was a higher incidence of patients‘at risk’because of aspirates with pH value < 3.0 in the former group. Among the latter group of 131 patients, only one was found to have been‘at risk’. The importance of administering a final dose of antacid within the 15‐minute period before induction of anaesthesia is emphasised. The results of assays of the magnesium concentration in the gastric aspirates varied widely, and bore no systematic relationship to the total dose of antacid administered, the time elapsing since the last dose was given, or the pH value of the same aspirate.
The analgesic effect of a low dose of alfentanil
Authors: BLACK T. E. , KAY B. , HEALY T. E. J. 
Published: February 2007

SummaryThe effect of a single small dose of alfentanil (6 μg/kg) on postoperative pain was compared with saline using a double blind study. Pain was assessed using a linear analogue scale und shown to decrease at 2, 5 and 10 minutes after injection of alfentanil (p < 0.01). The Pe'co2 was increased at 2 and 15 minutes (p < 0.05) and 5 and 10 minutes (p < 0.01) after injection of alfentanil. There were no changes in pain or Pe'co2 in the control group throughout the study. Intravenous alfentanil given to patients in pain provides quick effective analgesia for a short period of time, but respiratory depression may occur.
Isobaric bupivacaine for spinal anaesthesia in acute war injuries
Authors: BION J. F. 
Published: February 2007

SummaryTwenty nine patients with acute war injuries of the lower limbs or perineum were anaesthetised with intrathecal bupivacaine. Eleven patients (38%) were shocked on arrival with systolic arterial blood pressures less than 90 mmHg; in three the blood pressure was unrecordable. All patients were resuscitated and ready for surgery within 30 minutes of arrival at the field hospital. Hypotension occurred two minutes after injection of bupivacaine in three of the eleven shocked patients, but was corrected with fluids and metaraminol without difficulty. Patients with a fever were found to be less likely to develop hypotension. The early onset of hypotension and the necessity for a head‐down tilt gives bupivacaine a significant advantage over hyperbaric agents, and the technique can be recommended.