bluuebunny/crossref_metadata_2025_split huggingface dataset:
The uptake of enflurane during anaesthesia
Authors: DEVCHAND D. , CHAKRABARTI M. K. , LOCKWOOD G. G. 
Published: February 2007

SummaryThe uptake of enflurane at a constant end‐expired concentration of 2% in oxygen was studied in 38 patients, ASA 1 or 2, undergoing elective orthopaedic procedures. The anaesthetic was administered using a computer‐controlled closed circle system. Following an initial 4 min period during which the expired concentration of enflurane was established, the rate of uptake of enflurane showed a triexponential decline. The mean cumulative use of enflurane after 60min was 10.7ml, and after 120min was 18.4ml.
The effects of thiopentone and propofol on delayed hypersensitivity reactions
Authors: DEVLIN E. G. , CLARKE R. S. J. , MIRAKHUR R. K. , McNEILL T. A. 
Published: February 2007

SummaryThe effects of thiopentone and propofol on delayed hypersensitivity reactions and T lymphocyte proliferation were studied in nine healthy volunteers (five women and four men). Thiopentone 5 mg.kg‐1 and propofol 2.5mg kg‐1 were given as a 10 min infusion on two separate occasions. The volunteers were exposed to a skin multitest antigen before and after administration of the two agents and their skin reactions assessed. T lymphocyte responses were studied using phytohaemagglutinin (PHA)‐induced proliferation. Results showed that both drugs caused a significant depression of skin reactions in vivo but no depression in the T lymphocyte proliferation.
Intubating conditions following 1R CIS, 1′R CIS atracurium (51W89)
Authors: LITTLEJOHN I. H. , ABHAY K. , EL SAYED A. , BROOMHEAD C. J. , DUVALDESTIN P. , FLYNN P. J. 
Published: February 2007

Summary51W89 besylate, a new intermediate acting non‐depolarising muscle relaxant, consisting of a single stereo‐isomer of the commercial preparation of atracurium has been assessed in respect of intubating conditions during nitrous oxide‐propofol‐isoflurane anaesthesia. Intubating conditions at 2min were acceptable in 67% of patients following a dose of 0.1 mg.kg‐1 and in 90% of patients following a dose of 0.15 mg.kg‐1. Intubating conditions at 1.5 min were acceptable in 76% of patients following a dose of 0.2mg.kg‐1. In comparison, intubating conditions at 2min were acceptable in 95% of patients following 0.5mg.kg‐1 of atracurium. The intubating conditions at 2 min following a dose of 0.1 mg.kg‐1 51W89 besylate were significantly worse than the other three groups (p < 0.05); however, there was no significant differences between the scores in the other three groups. There was no clinical evidence of histamine release in the groups receiving 51W89 besylate compared to two out of the 19 patients who had cutaneous flushing following the administration of atracurium. Our results suggest that 51W89 besylate provides acceptable intubating conditions at 2 min following a dose of 0.15 mg.kg‐1 and may prove to be an acceptable alternative to atracurium if studies in progress confirm its greater cardiovascular stability and reduced propensity to release histamine than its parent compound.
Dose‐responses for edrophonium during antagonism of vecuronium block in young and older adult patients
Authors: McCARTHY G. J. , MIRAKHUR R. K. , MADDINENI V. R. , McCOY E. P. 
Published: February 2007

SummaryThe dose‐response relationship for edrophonium during antagonism of vecuronium‐induced neuromuscular blockade was studied in two groups of adult patients of mean (SD) age 35(10.0) years (n = 42) and 77 (5.4) years (n = 42) respectively. Neuromuscular block was monitored by recording the force of contraction of the adductor pollicis muscle following train‐of‐four stimulation. Six patients in each age group received 0.1, 0.3, 0.5, 0.7, 1.0, or 1.5mg.kg‐1 of edrophonium, or normal saline at 10% recovery of T1 (first response in the train‐of‐four) after a single dose of vecuronium 0.08mg.kg‐1. The train‐of‐four ratios were recorded continuously over the next 10 min and the values at 1 min intervals from 5min onwards were used to construct the dose‐response curves. The dose‐response curves showed no significant difference between the two age groups except at 10 min. The estimated dose of edrophonium required for attaining a train‐of‐four ratio of 0. 7 at 10 min was 0.9 and 1.3 mg.kg‐1 in the younger and older groups, respectively (p < 0.05).
Rate of‘onset’ and‘offset’ of four non‐depolarising neuromuscular blocking drugs
Authors: FELDMAN S. A. , WU X. , ENGLAND A. 
Published: February 2007

SummaryThere is evidence that onset time and potency of non‐depolarising neuromuscular blocking drugs are related. The relationship between onset time and rate of recovery has not been investigated. In this study, using the isolated forearm technique, the onset time of four different non‐depolarising drugs have been compared with their recovery times. It has been demonstrated that there is a strong relationship between these parameters. It is proposed that the relationship between onset time and offset time suggests a common mechanism that influences both events and that this may also explain the relationship between potency and the rate of onset.
Haemodynamic effects of tracheally administered adrenaline in anaesthetised patients
Authors: KESTIN I. G. , McCRIRRICK A. B. 
Published: February 2007

SummaryTen patients undergoing arterial surgery in the leg received a combined general anaesthetic, which included muscle relaxation and intubation of the trachea, and a regional anaesthetic using a lumbar extradural catheter. The radial arterial pressure was measured. Adrenaline 0.1 μg.kg‐1 was administered intravenously and the heart rate, arterial pressure and oxygen saturation were recorded every 15 s for l0min. Adrenaline in 5 ml of saline was given into the trachea at 10 min intervals. The first was saline only, and successive injections contained 0.5 μg.kg‐1, 1 μg.kg‐1, 2 μg.kg‐1, and 3 μg.kg‐1 of adrenaline. The mean maximum rise in systolic arterial pressure after adrenaline given intravenously was 30 (SD 11) mmHg, and 15 (SD 16) mmHg after the maximum dose of adrenaline given into the trachea (p < 0.05). The mean systolic arterial pressure was significantly increased between 45 s and 4.5 min after the adrenaline given intravenously, and 2 min after adrenaline given into the trachea. Of seven patients who received adrenaline 3 μg.kg‐1 into the trachea, six had no noticeable effect and in the other patient, the increase in arterial pressure was less than 90% of the maximum rise after the adrenaline. We conclude that adrenaline given into the trachea is unreliable in humans with very large doses necessary in some patients to produce a clinically useful haemodynamic effect.
Prolonged interval jet ventilation
Authors: CONACHER I. D. 
Published: February 2007

SummaryThe initial clinical experience of using a technique of prolonged interval jet ventilation is reported. Periodic pulses, of from three to nine breaths, were delivered in rapid sequence from a jet ventilator during one‐lung ventilation. The expiration phase was free to atmosphere, without added artificial expiratory assist or resistance, and of from 30 to 50 s duration before delivery of the next pulse of jet ventilation. The aim of the technique was to evaluate during anaesthesia the practicalities of securing a prolonged period during which intrathoracic pressure is low and hence optimal for venous return and deflation of pathological pulmonary regions with long time constants. The system used is flexible enough to allow for conventional positive pressure techniques to be applied if necessary. As the gas delivery was of oxygen of high concentration, episodes of hypoxaemia were minimal in this group of high risk patients and due to technical rather than physiological causes. The delivery of a minute volume adequate to prevent hypercapnia was not always possible and the technique may be contraindicated in those conditions in which a raised carbon dioxide concentration is disadvantageous.
Effect of demand frequency on lockout period
Authors: MILNER A. R. , HARWOOD R. J. , MILLARD J. , BOGOD D. G. , CURRAN J. P. 
Published: February 2007

SummaryAn Abbott Provider 5500 Patient Controlled Analgesia machine was noticed to have developed a prolonged lockout period when frequent analgesic demands were being made. This study tested five other machines and demonstrated that the duration of the lockout period was influenced by the frequency of analgesic demands. This finding could have clinical implications and we recommend that the duration of the lockout period should be specifically examined during the testing of patient‐controlled machines.
Propofol and postanaesthetic shivering
Authors: Cheong K. F. , Low T. C. 
Published: February 2007

SummarySixty ASA grade 1 unpremedicated patients scheduled for minor elective surgery were randomly allocated to receive general anaesthesia consisting of either propofol‐nitrous oxide in oxygen or a conventional technique of thiopentone–isoflurane–nitrous oxide–oxygen. Baseline axillary temperature readings, duration of operation and intra‐operative decrease in axillary temperature were similar in both groups. The patients who received propofol—nitrous oxide—oxygen anaesthesia had a significantly lower incidence of postanaesthetic shivering than the control group. A propofol‐nitrous oxide‐oxygen technique may be preferable when postanaesthetic shivering is deemed undesirable.
Ineffective analgesia after extradural tramadol hydrochloride in patients undergoing total knee replacement
Authors: Grace D. , Fee J. P. H. 
Published: February 2007

SummaryPostoperative analgesia after two extradural tramadol regimens was compared with that obtained using a standard extradural morphine regimen in patients undergoing total knee replacement. Extradural anaesthesia with light general anaesthesia was used. Patients received extradurally either: tramadol 50mg by bolus injection followed by infusion (5mg.h‐1 for 12 h and 2.5mg.h‐1 for a further 12 h) (group T50), tramadol 100 mg by bolus injection followed by infusion (10 mg.h‐1 for 12 h and 5mg.h‐1 for a further 12 h) (group T100) or morphine sulphate 2 mg by bolus injection followed by infusion (0.2 mg.h‐1 for 12 h and at 0.1 mg.h‐1 for a further 12 h) (group M). Analgesia was allocated according to a controlled double‐blind design. Visual analogue pain scores were markedly poorer (p < 0.05) and patient‐controlled analgesic consumption was significantly greater (p < 0.01) in the two tramadol groups when compared with the morphine group. The study was discontinued after recruitment of 12 patients, as analgesia was deemed inadequate in those receiving tramadol extradurally. However, further study of this drug may be warranted to examine its effectiveness where postoperative pain is expected to be less severe, and to assess the effect of larger extradural doses and of co‐administration of tramadol and morphine by this route.
The antiemetic effectiveness of droperidol during morphine patient‐controlled analgesia
Authors: Roberts C. J. , Millar J. M. , Goat V. A. 
Published: February 2007

SummaryThis prospective, double‐blind study examined the antiemetic effectiveness of the addition of droperidol to a morphine solution for use in patient‐controlled analgesia in a group of 50 patients undergoing elective lumbar laminectomy. The addition of 20 mg droperidol to 120 mg morphine in 60 ml saline given by a Baxter‘Infusor’ patient‐controlled analgesia device reduced the incidence of vomiting as compared to the addition of sodium chloride from 42.8% to 12.5% (p = 0.028) and of nausea from 71.4% to 29.2% (p = 0.005). The proportion of patients requiring rescue antiemetic therapy was reduced from 47.6% to 16.7% (p = 0.025) and the time interval to the first use of rescue antiemetic agent was significantly prolonged (p = 0.029). The use of droperidol was associated with an increased degree of sedation during the first 12 h after operation.
Does dead space ventilation always alleviate hypocapnia?
Authors: WATT J. W. H. , DEVINE A. 
Published: February 2007

Summary Long‐term tracheostomy‐ventilated patients have better speech with a cuffless tracheostomy tube and a large tidal volume. Moderate day time hyperventilation from a pressure‐limited ventilator is necessary in these patients to avoid hypoxia during sleep due to the variable insufflation leak. This study sought to confirm whether a dead space of 3 ml.kg‐1 could help to provide normocapnic hyperventilation during waking time without causing hypercapnia and hypoxaemia during sleep. Transcutaneous blood gas studies were performed on 11 patients with high tetraplegia undergoing pressure‐limited pulmonary ventilation with room air. Recordings were made for 120 min each when awake and asleep, with and without dead space. The mean derived arterial P CO2without the dead space was 2.95 kPa awake and 3.21 kPa asleep, whilst the corresponding tensions with dead space were 3.39 kPa and 3.79 kPa. These small increases associated with the dead space, both awake and asleep, were statistically significant. There was a statistically, though not clinically significant decrease in oxygen tension when the patients without dead space went to sleep. The fact that the carbon dioxide tension was higher during sleep when dead space was in situ indicates that, despite the insufflation leak in these patients, there is significant rebreathing back through the dead space. Amelioration of hypocapnia during waking and sleeping is achievable using a dead space extension in these patients.
A fibreoptic laryngoscope for paediatric anaesthesia
Authors: WRIGLEY S. R. , BLACK A. E. , SIDHU V. S. 
Published: February 2007

SummaryA technique for the use of the Olympus LF‐P as an aid to tracheal intubation, via the oral route, in 40 anaesthetised, spontaneously breathing children is described. The technique was completely successful in 30 (75%) of the children. Complications occurred in the remaining ten (25%); two developed laryngospasm and in seven the fibrescope flipped out of the trachea during the initial passage of the tracheal tube over the fibrescope. In one child the wrong tracheal tube was initially chosen. The two children who developed laryngospasm and three of the children in whom the fibrescope flipped out of the trachea required conventional laryngoscopy and tracheal intubation. Whilst this technique allowed for training in the use of the LF‐P in paediatric anaesthesia there were a number of complications.
Oxygen therapy reduces postoperative tachycardia
Authors: Stausholm K. , Kehlet H. , Rosenberg J. 
Published: February 2007

SummaryConcomitant hypoxaemia and tachycardia in the postoperative period is unfavourable for the myocardium. Since hypoxaemia per se may be involved in the pathogenesis of postoperative tachycardia, we have studied the effect of oxygen therapy on tachycardia in 12 patients randomly allocated to blinded air or oxygen byfacemask on the second or third day after major surgery. Inclusion criteria were arterial hypoxaemia (oxygen saturation ≤ 92%) and increased heart rate (> 90 beat.min‐1). Each patient responded similarly to oxygen therapy: an increase in arterial oxygen saturation and a decrease in heart rate (p < 0.002). Thus, postoperative supplementary oxygen has a positive effect on the cardiac oxygen delivery and demand balance.
Effect of general anaesthesia and surgery on neutrophil function
Authors: KHAN F. A. , KAMAL R. S. , MITHANI C. H. , KHURSHID M. 
Published: February 2007

SummaryThe effects of general anaesthesia and surgical trauma on neutrophil function were studied in 60 female ASA 1 and 2 patients undergoing anaesthesia for gynaecological surgery. Patients were divided into three groups depending on the degree of trauma and duration of surgery. Group 1 (n = 15) were patients for dilatation and curettage (minor surgical trauma) and were given 2% halothane. Group 2 (n = 30) had laparoscopic surgery (moderate surgical trauma) and received either 0.5% halothane or 1% enflurane. Group 3 (n= 15) were those having hysterectomy (major surgical trauma) and received 0.5% halothane for a longer duration. Venous samples were taken 30 min before anaesthesia (control value), 10 min after induction of anaesthesia, 10 min after the start of surgery, 30 min after the end of anaesthesia and 24 h later. Phagocytic index, nitroblue tetrazolium reduction test, total leucocyte count, and differential leucocyte counts were performed on each sample. Data were analysed by paired t‐test to compare findings in the same patient and by unpaired t‐test for differences between groups. Anaesthesia with halothane 0 5% to 2% caused a dose‐related depressant effect on leucocyte function which reversed. Enflurane 1% on the other hand caused significantly greater depression of leucocyte function compared with 0.5% halothane which persisted during the recovery period and recovered on the first postoperative day. Total leucocyte counts also showed a fivefold increase in the major surgery groups.
Anaesthesia for Caesarean section in a patient with Klippel‐Feil syndrome
Authors: Dresner M. R. , Maclean A. R. 
Published: February 2007

SummaryA 34‐year‐old woman with severe kyphoscoliosis, an immobile cervical spine, and short stature due to the Klippel‐Feil syndrome presented for elective Caesarean section. She expressed a strong desire to remain awake during the procedure. We chose a technique using a spinal microcatheter to provide spinal anaesthesia on the basis that incremental control of the dose of bupivacaine would reduce the risk of‘high’ block. Awake inspection of the larynx was performed as a precaution in the event of respiratory embarrassment. A total of 6.25 mg heavy bupivacaine, 7.5 mg plain bupivacaine, and 10 μg fentanyl were administered over 20 min. This provided anaesthesia up to T5 without significant effects on respiratory or cardiovascular function. The patient was successfully delivered of a healthy boy.
Paravertebral blockade
Authors: Lönnqvist P. A. , MacKenzie J. , Soni A. K. , Conacher I. D. 
Published: February 2007

SummaryThe failure rate and complications were studied prospectively in 367 paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1%; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1.1%; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.
The relationship between anaesthetic uptake and cardiac output
Authors: WATT S. J. , COOK L. B. , OHRI S. , LOCKWOOD G. G. 
Published: February 2007

Summary The hypothesis that anaesthetic uptake during maintenance of anaesthesia is related to cardiac output was tested on 21 patients undergoing cardiac surgery. Using a computer‐controlled closed breathing system, enflurane was administered to maintain an end‐expired concentration of 1%. Cardiac output was measured by thermodilution using a pulmonary artery catheter. A clear qualitative but not quantitative relationship was demonstrated. Changes in anaesthetic requirements at a constant end‐expired concentration are a better guide to changes in cardiac output than changes in end‐expired carbon dioxide with constant ventilation in patients undergoing cardiac surgery.
The effect of epidural blockade on gastric intramucosal pH in the peri‐operative period
Authors: SUTCLIFFE N. P. , MOSTAFA S. M. , GANNON J. , HARPER S. J. 
Published: February 2007

SummaryPatients undergoing major surgery are at risk of developing gut ischaemia and multiple organ failure. The gastric tonometer provides a relatively non‐invasive method of assessing the adequacy of gut blood flow. Patients who develop repeated episodes of splanchnic ischaemia in the postoperative period, as evidenced by a low gastric intramucosal pH, have a higher mortality than those who do not. This randomised, controlled study was conducted to assess the effect of epidural blockade with bupivacaine on gastric intramucosal pH measurements in patients undergoing major surgery. A significantly lower proportion of patients with epidural blockade developed gastric intramucosal pH values < 7.32 postoperatively compared to controls (3/15 versus 13/16, p < 0.001). The significance of these results is discussed.
Learning fibreoptic skills in ear, nose and throat clinics
Authors: Burke L. P. , Osborn N. A. , Smith J. E. , Reid A. P. 
Published: February 2007

SummaryWe have compared the progress of anaesthetists taught fibreoptic techniques on awake patients in ear, nose and throat clinics with that of anaesthetists taught by traditional methods. Twelve anaesthetists participated in the study and were randomly allocated to the ear, nose and throat group or to the traditional training group. Each individual in the ear, nose and throat group attended the outpatient clinic and performed ten nasendoscopies on awake patients, whose upper airway had been anaesthetised with cocaine, under the supervision of an ear, nose and throat surgeon. Each individual in the traditional group performed ten nasendoscopies on anaesthetised oral surgery inpatients under the supervision of an anaesthetist. To assess the effectiveness of the two training methods, each anaesthetist in each group then attempted ten fibreoptic nasotracheal intubations on anaesthetised oral surgery patients. There was no significant difference between either the success rates or mean successful tracheoscopy times between the two groups. Nasendoscopy training in the ear, nose and throat clinic appears to be a good way of learning fibreoptic skills, which can then be readily applied to fibreoptic tracheal intubation in anaesthetic practice.
Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness
Authors: DAVIES F. W. , MANTZARIDIS H. , KENNY G. N. C. , FISHER A. C. 
Published: February 2007

SummaryWe have investigated the relationship between changes in the middle latency auditory evoked potentials during alternating periods of consciousness and unconsciousness produced by propofol infusion combined with spinal anaesthesia for total knee replacement. Eleven patients completed the study, of whom two had recollection of events after the onset of the anaesthetic. There were no significant differences in heart rate or systolic arterial pressure between any conscious and unconscious period. With the first change from consciousness to unconsciousness, latencies of Na, Pa and Nb increased from mean (SD) starting values of 20.0 (1.4), 31.7 (1.0) and 42.8 (1.6)ms to 22.5 (2.0), 39.3 (2.1) and 57.8 (4.4)ms, respectively. During successive transitions from unconsciousness to consciousness, awake latencies were slightly higher than those of baseline awake, whereas anaesthetised latencies were similar to the ones obtained during the first period of unconsciousness. The consistent changes demonstrated, suggest that the auditory evoked potentials could represent a reliable indicator of potential awareness during anaesthesia.