bluuebunny/crossref_metadata_2025_split huggingface dataset:
Premedication with midazolam in children. Effect of intranasal, rectal and oral routes on plasma midazolam concentrations
Authors: Malinovsky J‐M. , Populaire C. , Cozian A. , Lepage J‐Y. , Lejus C. , Pinaud M. 
Published: February 2007

SummaryWe report a study performed to compare the time and plasma drug concentrations necessary to achieve a similar state of sedation after midazolam premedication given by various routes in children of 2–5 years old. Children were randomly allocated to one of three groups to receive midazolam 0.2mg.kg‐1 given intranasally, 0.5mg.kg‐1 given orally or 0.3mg.kg‐1 given rectally. Sedation was measured regularly until venepuncture was possible in a cooperative child. At this time, a first blood sample was taken to measure plasma concentration, followed by another 10 min later. Anaesthesia consisted of intravenous propofol supplemented with regional analgesia. At recovery from anaesthesia, a third blood sample was taken. Adequate sedation occurred sooner (7.7, SD 2.4 min) with intranasal than oral (12.5, SD 4.9 min) or rectal (16.3, SD 4.2 min) midazolam. The initial blood levels were lower when the drug was given by the alimentary routes despite higher doses (146, SD 51 ng.ml‐1 in 11.5, SD 3.9 min; 104, SD 34ng.ml‐1 in 21.6min; and 93, SD 63 ng.ml‐1 in 23.1, SD 3.5 min for the intra nasal, rectal and oral routes respectively). Duration of surgical procedures, and of propofol infusion, and recovery from anaesthesia was similar for the three groups. The only problem arose in a 30‐month‐old boy in the intranasal group who developed respiratory depression with a plasma midazolam concentration of 169 ng.ml‐1. Intranasal midazolam is an excellent alternative for rapid premedication provided that respiratory monitoring is used.
Molecular sieves: an alternative method of carbon dioxide removal which does not generate compound A during simulated low‐flow sevoflurane anaesthesia
Authors: FEE J. P. H. , MURRAY J. M. , LUNEY S. R. 
Published: February 2007

SummaryMolecular sieves are used in industry to 'scrub’ industrial gases. We examined, during simulated low‐flow closed system anaesthesia, (1) the carbon dioxide adsorbing potential of molecular sieves and (2) the reactivity of the sieves compared to soda lime using sevoflurane as an indicator. A low‐flow anaesthetic system containing 13X molecular sieves was connected to a model lung. End‐tidal concentrations of CO2 were measured continuously at an O‐2 flow of 800 ml.min‐1 and a CO2 flow of 200 ml.min‐1. In the second study, sevoflurane (FE'sevo 1.7%) was added to the system after which samples were taken from the inspiratory limb of the anaesthetic system. This experiment was performed both during carbon dioxide removal with soda lime and with the molecular sieves. The samples were stored in gas‐tight syringes and analysed by gas chromatography. The temperature of both absorbents was measured throughout the study. The molecular sieves adsorbed carbon dioxide (20 %) efficiently for a period of 5h. There was a gradual increase from the baseline of 4.4% to 4.5, 5.4, and 6.0% at 90, 180, and 300 min, respectively. When sevoflurane was added to the system, compound A was detected at the start of both experiments. However, when soda lime was used the concentrations of compound A increased 10‐fold after 2.5 h compared with baseline values. No increase in compound A was observed when molecular sieves were used for carbon dioxide removal. The highest mean (SD) temperature of the molecular sieves was 41.5 (3.2)° C. Molecular sieves are effective adsorbents of carbon dioxide when used in a simulated low‐flow, closed anaesthetic system. Compound A is not formed when sevoflurane is added to the system.
Lignocaine metabolite formation: an indicator for liver dysfunction and predictor of survival in surgical intensive care patients
Authors: SCHRÖTER J. , WANDEL C. , BÖHRER H. , SCHMIDT H. , BÖTTIGER B. W. , MARTIN E. 
Published: February 2007

SummaryFormation of the lignocaine metabolite monoethyl‐glycine‐xylidide (MEGX) by hepatic cytochrome P450 enzymes is a new method for evaluating liver function. The purpose of this study was to compare MEGX formation with other liver function parameters in surgical intensive care unit patients. The study included 29 critically ill patients who had been admitted to the unit for more than 3 days with a median APACHE III score‐predicted mortality > 30%. On day 4, lignocaine was given intravenously at a dose of 1 mg.kg‐1 over 2 min and MEGX formation was measured 15 min later. Eighty‐nine percent of the patients had MEGX values below 90μg.l‐1 indicating impaired liver function. Eleven patients died, 18 patients survived. The group of patients with fatal outcome had significantly lower MEGX values (median: 23μg.l‐1) than the group of survivors (median: 53μg.l‐1, p < 0.01). Bilirubin values were elevated in the non‐survivor group (median: 2.8mg.dl‐1) compared to the survivors (median: 0.9mg.dl‐1, p < 0.05). There was no significant difference between the two groups in the other liver function tests. We conclude from our results that the MEGX test can be considered an indicator for hepatic dysfunction and predictor of survival in critically ill patients.
A microprocessor based photoplethysmograph for use in clinical practice
Authors: WRIGHT I. P. , GRIFFITHS M. , CHILDS C. 
Published: February 2007

SummaryA microprocessor‐based system of photoplethysmography and its use in measuring skin blood flow is described. The system was designed specifically for use over long periods and for the analysis of the output to be handled by a personal computer. The photoplethysmograph described in this paper is shown to be a qualitative method for assessment of changes in peripheral skin blood flow. There is potential for use of this instrument in a variety of clinical conditions.
Effects of magnesium sulphate on suxamethonium‐induced complications during rapid‐sequence induction of anaesthesia
Authors: STACEY M. R. W. , BARCLAY K. , ASAI T. , VAUGHAN R. S. 
Published: February 2007

SummaryTwenty patients were studied in a double‐blind manner to investigate whether magnesium sulphate, when given during a rapid‐sequence induction of anaesthesia, lessens the side effects caused by suxamethonium. Patients were randomly allocated to two groups; equal volumes of either magnesium sulphate (40 mg.kg‐1) or saline were given during rapid‐sequence induction of anaesthesia, after thiopentone but before the administration of suxamethonium (1.5 mg.kg‐1). The changes in the serum potassium concentration, the degree of muscle fasciculations and the presence of postoperative myalgia were recorded. The mean serum potassium concentration increased by 0.08 mmol.l‐1 in the magnesium group and by 0.1 mmol.l‐1 in the control group at 2 min after injection of suxamethonium; in neither group was there a significant increase from baseline values. The systolic blood pressure and heart rate increased in both groups after tracheal intubation. The incidence of fasciculations was significantly lower in the magnesium group. Magnesium did not clinically prolong muscle relaxation. There was no difference between the groups in the incidence of myalgia after surgery (one patient in each group). Since no significant increase in the serum potassium concentration was demonstrated, no assessment could be made of the effect of magnesium sulphate on the serum potassium concentration after administration of suxamethonium.
Assessment of recovery following day‐case arthroscopy
Authors: GUPTA A. , KULLANDER M. , EKBERG K. , LENNMARKEN C. 
Published: February 2007

SummaryFifty healthy patients, aged 15–45 years, undergoing day‐case arthroscopy, participated in a study to assess aspects of recovery and mood. Psychomotor tests, including the p‐deletion test and the Trieger dot test, were performed pre‐operatively and mood was measured using the mood adjective checklist. Anaesthesia in all patients was induced with propofol and a laryngeal mask airway was inserted immediately. All patients received alfentanil as the intra‐operative analgesic. The patients were randomly allocated to receive one of two different regimens for maintenance of anaesthesia: propofol group—maintenance with an infusion of propofol 10 mg.kg‐1.h‐1for 15 min followed by 6 mg. kg‐1.h‐1 and nitrous oxide and oxygen (bolus doses of propofol were given if anaesthesia was deemed to be light); isoflurane group—maintenance with isoflurane (inspired concentration 0.5–2.0%) in nitrous oxide and oxygen. Postoperatively, psychomotor tests were repeated every 30 min and mood was measured after 2 h and 24 h. Psychomotor recovery was quicker in the isoflurane group than the propofol group and had returned to baseline values in the isoflurane group by 60 min. The time to discharge was similar in both groups as was the incidence of side effects. There was no difference in mood scores between the groups either at the time of discharge or at 24 h. We conclude that psychomotor recovery is somewhat quicker when isoflurane‐based anaesthesia is used for day‐case arthroscopy, but other factors, including time to awakening, mood and time to discharge are similar for both techniques.
Comparison of the reinforced laryngeal mask airway and tracheal intubation for nasal surgery
Authors: Williams P. J. , Thompsett C. , Bailey P. M. 
Published: February 2007

SummaryAirway maintenance and protection during anaesthesia and recovery provided by the reinforced laryngeal mask airway was compared with the sequential use of a tracheal tube followed by the Guedel airway in 66 patients having anaesthesia for nasal surgery. One patient was withdrawn from the laryngeal mask group because the airway was difficult to position. All patients had an oropharyngeal pack inserted and Moffett's solution instilled into the nasal cavities. At the end of surgery the nasal cavities were packed. During operation airway maintenance was good and airway protection was equally effective in both groups. Contamination of the lower airway occurred in only five patients. During recovery from anaesthesia the laryngeal mask and Guedel airway were well tolerated by most patients, but only the mask laryngeal provided an unobstructed airway in all patients. The laryngeal mask protects the larynx from contamination during and after operation until the return of the patient's own protective reflexes.
Metoclopramide and prochlorperazine do not decrease propofol hypnotic requirements
Authors: Ali P. B. , Graham S. G. 
Published: February 2007

SummaryOne hundred patients scheduled for minor surgery were given either saline, metoclopramide 0.1 mg.kg‐1 or 0.2 mg.kg‐1, or prochlorperazine 0.1 mg.kg‐1 or 0.2 mg.kg‐1 before induction of anaesthesia with a fixed rate infusion of propofol. Neither metoclopramide nor prochlorperazine reduced the induction dose of propofol. The possibility that these agents increased the induction dose could not be excluded.
The neuromuscular blocking effects of vecuronium during sevoflurane, halothane and balanced anaesthesia in children
Authors: TAIVAINEN T. , MERETOJA O. A. 
Published: February 2007

SummaryForty‐five children aged 5–12 years were randomly allocated to receive 1.0 MAC of sevoflurane or halothane, or balanced anaesthesia with propofol and alfentanil. The ulnar nerve was stimulated every 20 s supramaximally with a train‐of‐four pattern and adductor pollicis electromyography was recorded. A cumulative log‐probit dose‐response curve of vecuronium was established. Thereafter, spontaneous recovery of neuromuscular function was monitored until complete. Effective doses of vecuronium were lowest in the sevoflurane group and greatest during balanced anaesthesia; for 50% neuromuscular blockade these were 13.3%μg.kg‐1, 21.8 μg.kg‐1and 36.6 μg.kg‐1during sevoflurane, halothane and balanced anaesthesia, respectively, p < 0.05. Recovery of neuromuscular function was slower during sevoflurane than during halothane or balanced anaesthesia. Sevoflurane potentiated vecuronium more than halothane; when compared to balanced anaesthesia the dose requirements of vecuronium were reduced by approximately 60% and 40%, respectively.
Relief of tension subcutaneous emphysema using a large bore subcutaneous drain
Authors: Kelly M. C. , McGuigan J. A. , Allen R. W. 
Published: February 2007

SummaryWe report a case of subcutaneous emphysema following multiple attempts to cannulate both subclavian veins for pacemaker insertion. Initial bilateral pneumothoraces were complicated by subcutaneous emphysema which became so severe that respiration and cardiac output became seriously impaired. The insertion of a single large bore subcutaneous drain produced a dramatic improvement. The aetiology, complications and management of tension subcutaneous emphysema are discussed.
Local anaesthesia for cannulation
Authors: DENNIS A. R. , LEESON‐PAYNE C. G. , LANGHAM B. T. , AITKENHEAD A. R. 
Published: February 2007

SummaryA questionnaire study was undertaken to assess the influence of recently published, simple and conclusive research on the practice of anaesthetists in four centres. The research had clearly demonstrated the benefit of subcutaneous infiltration of local anaesthetic in reducing the pain of intravenous cannulation. Of the 81% who responded, 71% were aware of the research; 43% of these anaesthetists had altered their clinical practice as a result of the research and 73% used local anaesthesia for cannulae of 18 gauge or less, compared with only 46% of those who were unaware of the research. Practice comparisons were made between centres and grades of anaesthetist. Senior house officers were significantly less likely to be aware of the research than other grades. Anomalies were identified between the apparent awareness of the research and routine practice agreeing with the study findings. The value of research and the incorporation of clinical findings into everyday practice is discussed.
Epidural infusion of alfentanil or diamorphine with bupivacaine in labour—a dose finding study
Authors: HILL D. A. , McCARTHY G. , BALI I. M. 
Published: February 2007

SummaryFollowing induction of epidural analgesia with 0.375% bupivacaine, 120 healthy parturients were randomly assigned in a double blind fashion to one of eight infusion groups. All received 8ml.h‐1 of0.125% bupivacaine either alone (control group), or with alfentanil at 133, 266 or 400μg.h‐1 (groups A1‐A3) or with diamorphine at 133, 266, 400 or 533μg.h1 (groups D1‐D4). Significantly longer top‐up intervals were achieved with the two highest doses of both alfentanil and diamorphine when compared with bupivacaine alone (p<0.01), making the minimum effective doses 266 μg.h‐1 of alfentanil and 400 ng.h‐1 of diamorphine. Perineal analgesia was better in all the opioid groups compared with the control group (p < 0.05). The intensity of motor block was greater in the control group (p < 0.05). The incidence of pruritus did not differ between groups. The highest dose of diamorphine caused significantly more nausea. No significant neonatal side‐effects were demonstrated.
Evaluation of the influence of movement on saturation readings from pulse oximeters
Authors: PLUMMER J. L. , ZAKARIA A. Z. , ILSLEY A. H. , FRONSKO R. R. L. , OWEN H. 
Published: February 2007

SummaryThis study aimed to develop a protocol for assessing the influence of movement on oxyhaemoglobin saturation readings from pulse oximeters. Thirty‐six volunteers took part in the study. In each volunteer, each hand was monitored by both a Nellcor N200 oximeter using a disposable probe and by a Datex Satlite DS103 oximeter using a clip‐on finger probe. Volunteers made five standardised movements during which output was recorded from all four oximeters. All movements were associated with apparent decreases in oxyhaemoglobin saturation which were statistically significant for two movements with the Nellcor equipment and for four movements with the Datex equipment. Movement was associated with increases in the magnitude of pulse amplitude, but this was not quantitatively associated with magnitude of artefactual changes in saturation. Use of this standardised movement protocol allows quantification of movement artefact from pulse oximeters and should facilitate the development of equipment less affected by movement.
Facilitation of laryngeal mask insertion
Authors: Stoneham M. D. , Bree S. E. , Sneyd J. R. 
Published: February 2007

SummaryThe effects of pretreatment with lignocaine administered intravenously on the insertion of the laryngeal mask airway were investigated in 80 unpremedicated, ASA 1 or 2, adult day‐case patients in a randomised, double‐blind, placebo‐controlled trial. Patients received either intravenous lignocaine 1.5mg.kg‐1 or an equivalent volume of sodium chloride 0.9%. Induction of anaesthesia was achieved with propofol given via a syringe driver at a fixed rate of 600ml.h‐1 until the patient dropped a weighted syringe. No opioid or sedative drugs were given prior to induction. Pain on injection of propofol was recorded. Jaw opening, ease of insertion of the laryngeal mask, coughing, gagging and airway patency were all scored on three‐point scales immediately after mask insertion. If insertion failed, anaesthesia was deepened by gentle manual ventilation for 1 min with nitrous oxide/oxygen/2% enflurane and insertion re‐attempted. This cycle was continued until success was achieved and the number of such cycles recorded. There were no differences between the lignocaine and control groups with respect to induction dose of propofol, degree of jaw opening, or amount of gagging. Laryngeal mask insertion was facilitated by pretreatment with lignocaine administered intravenously, without an alteration in induction dose of propofol (p < 0.05). Coughing and airway obstruction were both significantly reduced by pretreatment with lignocaine, as was the incidence of failure of insertion requiring deepening of anaesthesia (p < 0.05).
Anaesthesia for a patient with tracheobronchomegaly (Mounier‐Kuhn syndrome)
Authors: Bourne T. M. , Raphael J. H. , Tordoff S. G. 
Published: February 2007

SummaryTracheobronchomegaly is a rare condition in which anaesthetic experience is limited. Patients with tracheobronchomegaly are at risk of large airway collapse and obstruction, aspiration pneumonitis and tracheal trauma following airway instrumentation. We describe our anaesthetic technique and problems encountered during nephrectomy in a patient with this condition.
Comparison of direct blood pressure measurement at the radial and dorsalis pedis arteries during surgery in the horizontal and reverse Trendelenburg positions
Authors: Parry T. , Hirsch N. , Fauvel N. 
Published: February 2007

SummaryThe differences in simultaneous arterial pressure measurements from the radial and dorsalis pedis arteries were studied in anaesthetised adult patients in either the horizontal or reverse Trendelenburg position. Significantly higher pressures were measured from the dorsalis pedis artery than from the radial artery in both positions, even allowing for the hydrostatic effect on the dorsalis pedis arterial pressure in the non‐horizontal group. If the dorsalis pedis artery is to be used to measure direct arterial blood pressure, we recommend that readings be compared with an arm sphygmomanometer to avoid potentially dangerous hypotension being missed.
A survey of obstetric patients who refuse regional anaesthesia
Authors: Gajraj N. M. , Sharma S. K. , Souter A. J. , Pole Y. , Sidawi J. E. 
Published: February 2007

SummaryOne hundred obstetric patients presenting for elective surgery who had refused regional anaesthesia were interviewed just prior to entering the operating room. In each case, the reason for refusing a regional technique was recorded. The most frequent reasons given were fear of backache (33%) and fear of the needle (28%). Anaesthetists should be aware of patients’ concerns and be able to discuss the relevant issues.
Delayed amniotic fluid embolism following Caesarean section under spinal anaesthesia
Authors: Margarson M. P. 
Published: February 2007

SummaryA case of amniotic fluid embolus is described with an acute onset occurring 90 min after surgical delivery in a mildly pre‐eclamptic primigravida undergoing Caesarean section for a breech presentation. Severe disseminated intravascular coagulation and massive postpartum haemorrhage were corrected and she went on to make a full recovery. The pathophysiology of amniotic fluid embolism is discussed and new diagnostic tests are reviewed. It is suggested that in this patient an amniotic fluid collection in dilated uterine veins was mobilised as venous tone returned following the offset of spinal anaesthesia and sympathetic blockade.
Peri‐operative assessment of glomerular permeability
Authors: De Gaudio A. R. , Piazza E. , Barneschi M. G. , Ginanni R. , Martinelli P. , Novelli G. P. 
Published: February 2007

SummarySurgical trauma may provoke an increase in glomerular permeability. Microalbuminuria is a subclinical increase in urinary albumin ranging from 20 to 300 mg.l‐1. This cannot be measured with routine laboratory tests and is estimated by radioimmunoassay. It has been proposed that microalbuminuria, an expression of increased glomerular permeability, serves to reflect a generalised increase in systemic vascular permeability. In this study the degree of microalbuminuria (expressed as microalbuminuria/creatinine ratio to correct for dilutional changes) has been measured in two groups of patients undergoing either videolaparoscopic surgery (group A) or conventional, open, abdominal surgery (group B). The anaesthetic technique was standardised and the duration of surgery similar in the two groups. A significant increase (p < 0.01) in the microalbuminuria I urinary creatinine ratio occurred in patients undergoing open abdominal surgery (group B). This alteration appeared 2 h after surgery but had disappeared 24 h after the end of the operation. During surgery, there was a direct relationship between glomerular permeability and the severity of the surgical insult.
Correct positioning of the epiglottis for application of the Brain laryngeal mask airway
Authors: Fukutome T. 
Published: February 2007

SummaryPositioning of the epiglottis when the Brain laryngeal mask airway is in place was studied in 20 adult patients, using a new technique of insertion. The laryngeal mask was inserted when the anterior displacement of the mandible extended the epiglottis, thereby the providing an excellent airway in all patients. In 10 out of these 20 patients, the conventional technique of insertion revealed an incomplete extension of the epiglottis, and inadequate opening of the laryngeal inlet. It was concluded that the anterior displacement of the mandible during insertion of the laryngeal mask enhances the opening of the larynx, the result being an excellent airway.
Inhalation anaesthesia at the extremes of age: geriatric anaesthesia
Authors: CONZEN P. , PETER K. 
Published: February 2007

SummaryNo single anaesthetic technique is superior for all elderly patients, although the prognosis is improved if minor surgical procedures are performed with local anaesthesia rather than with general or major regional anaesthesia. If general anaesthesia is required, which specific inhalation anaesthetic can improve the prognosis of the geriatric patient? The low solubility of desflurane and its resistance to biodegradation would seem to recommend its use in the geriatric patient. However, these theoretical advantages remain to be adequately documented.