bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstetric epidural test doses
Authors: PRINCE G. , MCGREGOR D. 
Published: February 2007

SummaryA number of obstetric fatalities related to epidural anaesthesia have been reported recently. In each case catheter or needle misplacement had resulted in a lethal intrathecal or intravascular injection. In this review these cases and a number of other similar but nonfatal reports are examined. In many cases, essential safety checks such as the aspiration test and the test dose had not been performed before the epidural injection, but in others one or both of these tests had been used and had failed to predict the complication. Safety test failures generally occurred because ineffective tests were used or because effective tests were inadequately interpreted. This is not surprising because although textbooks recommend a bewildering variety of test doses, they seldom give precise details as to how they should be conducted. A detailed test dose protocol is recommended, which will safely warn of epidural catheter and needle misplacement in the most effective manner possible. If the protocol is used, accidental subarachnoid and intravascular injections can be reduced to a minimum, but they will still occur. It is emphasised that these complications should not cause fatalities if trained personnel and adequate resuscitation facilities are available.
Intravenous anaesthesia with propofol and alfentanil. The influence of age and weight
Authors: Hilton P. , Dev V.J. , Major E. 
Published: February 2007

SummarySixty healthy patients undergoing body surface surgery were anaesthetised with continuous infusions of propofol (200 μ/kg/minute) and alfentanil (0.25 μ/kg/minute). Additional bolus doses of propofol (20 mg) were given if movement occurred. The incidence of patient movement in response to skin incision was significantly less in patients over 45 years of age than in those below 45 years (p < 0.05). Maintenance dosage of propofol sufficient to abolish movement decreased with increasing age (p < 0.001). Systolic blood pressure decreased in most patients over the first 10 minutes of anaesthesia and the magnitude of this decrease increased with age (p < 0.0001). These parameters did not correlate strongly with body weight. Dose requirements of propofol are not the same for patients of all ages and strongly suggest that young and old patients should not he treated as a homogeneous group, either for investigative or clinical purposes.
Treatment of near drowning—a review of 130 cases
Authors: Simcock A.D. 
Published: February 2007

SummaryThis paper reviews the management and clinical course of patients after rescue from near drowning. Those with adequate ventilation on arrival at hospital had an excellent prognosis. The prognosis of those patients with inadequate ventilation, or who have suffered cardiac arrest, depends on rapid assessment and the institution of vigorous resuscitative measures. The medical management of all types of patients is reviewed in detail. the results tabulated and complications discussed.
Ventilatory effects of propofol during induction of anaesthesia
Authors: TAYLOR M. B. , GROUNDS R. M. , MULROONEY P. D. , MORGAN M. 
Published: February 2007

SummaryThe ventilatory effects of induction of anaesthesia with either propofol 2.5 mg/kg or thiopentone 4.0 mg/kg have been observed in patients premedicated with either atropine alone or papaveretum and hyoscine. Induction of anaesthesia with propofol was accompanied by a greater degree of ventilatory depression which was of longer duration than following thiopentone. The effect was accentuated by the opioid premedication.
Management of a glomus jugulare tumour with internal carotid artery involvement
Authors: BRAUDE B. M. , HOCKMAN R. , McINTOSH W. A. , HAGEN D. 
Published: February 2007

SummaryA previously healthy 40–year‐old female presentedfor surgical resection of a large glomus jugulare tumour with extensive involvement of the carotid siphon and intracranial extension. Conduct of anaesthesia with specijic reference to cerebral protection is discussed. A combination of induced hypothermia, barbiturate therapy, normotension, normocarbia and prior clamping of the distal internal carotid artery was chosen. The role of barbiturates as a therapeutic intervention is debated.
Pretreatment with opioids
Authors: Dundee J. W. , Halliday N. J. , Mcmurray T. J. , Harper K. W. 
Published: February 2007

SummaryPretreatment with small doses of fentanyl (fO0 jig) or alfentanil (300 pg) was found significantly to reduce the induction dose of thiopentone. Fentany 150 μp and alfentanil 150 pg also signifcantly reduced the onset time and increased the consistency of action of midazolam. Respiratory depression was not a problem when 50 pg fentanyl or 150 pg alfentanil were used.
Amiodarone, phaeochromocytoma and cardiomyopathy
Authors: Solares G. , Ramos F. , Martin‐Duran R. , SAN‐Jose J. M. , Buitrago M. 
Published: February 2007

SummaryThe anaesthetic management of a patient with a phaeochromocytoma and cardiomyopathy is described. The control of dysrhythmias was the major problem. Ventricular dysrhythmias were treated with lignocaine, and intravenous amiodarone was used to control the supraventricular rhythm disturbances.
Local complications following intravenous benzodiazepines in the dorsum of the hand. A comparison between midazolam and Diazemuls in sedation for dentistry
Authors: Margary J. J. , Rosenbaum N.L. , Partridge M. , Shankar S. 
Published: February 2007

SummaryTwo hundred patients requiring sedation for minor oral surgery were randomly allocated to receive either midazolam or diazepam as Diazemuls intravenously through a 23‐gauge indwelling needle in the dorsum of the hand. The site of injection was inspected at 7 days and 14 days post injection and assessed for pain, tenderness, redness, induration, painless thrombosis, and thromhophlebitis. The mean dose administered was 0.119 mg/kg of midazolam and 0.298 mg/kg of Diazemuls. At 7 days there was no significant difference in venous complications. At the 14 day follow up, the midazolam group had a significantly greater incidence of tenderness and redness (p < 0.001 and p < 0.05 respectively using Chi squared test). The incidence of thrombophlebitis in the midazolam group was 2% at 7 days and 1% at 14 days, the corresponding figures in those given Diazemuls being none und 1% respectively. We conclude that the dorsum of the hand is a satisfactory site of injection for administration of these drugs. The higher incidence of minor complications at 14 days following midazolam was offset by its more reliable amnesic properties.
Multiple complications after internal jugular vein catheterisation
Authors: GAMULIN Z. , BRÜCKNER J.‐C. , FORSTER A. , SIMONET F. , ROUGE J.‐C. 
Published: February 2007

SummaryWe report a case of a young female who developed multiple life threatening complications after a single internal jugular vein catheterisation. They consisted of pleural misplacement of the catheter. massive haemorrhage with cardiovascular collapse following catheter removal, and development of arteriovenous fistula, diagnosed 18 months later.
The prevention of renal impairment in patients undergoing orthotopic liver grafting by infusion of low dose dopamine
Authors: POLSON R. J. , PARK G. R. , LINDOP M. J. , FARMAN J. V. , CALNE R.Y. , WILLIAMS R. 
Published: February 2007

SummaryAdministration of low dose dopamine (2.0 μg/kg/minute) begun before surgery in patients undergoing liver transplantation decreases the incidence of postoperative renal impairment. Thirty‐four consecutive patients in the Cambridge/King's College Hospital liver transplantation series were studied. Nineteen patients (21 transplant operations) received prophylactic low dose dopamine throughout the operative and early postoperative period, while 15 patients (15 transplant operations) received dopamine only when clinically indicated for incipient renal failure or as an inotropic agent. In the prophylactic dopamine group, only two transplant operations (9.5%) were complicated by renal impairment, whereas in the other group, 10 patients (67%) developed renal impairment (p = 0.001); of these, four developed acute renal failure (27%). Comparison of seven pairs of patients, matched for age, sex, diagnosis, operative blood loss and operative hypotension (one group receiving dopamine, the other not), revealed a significantly higher urine output in the first 24 hours and creatinine clearance 24—48 hours after surgery (p < 0.05) in those treated prophylactically. In view of these findings, we would recommend that consideration be given to the prophylactic use of dopamine in patients undergoing orthotopic liver transplantation.
Continuous display of plasma potassium during cardiac surgery
Authors: DRAKE H. F. , TREASURE T. , SMITH B. 
Published: February 2007

SummaryWe have evaluated the use of an intravascular ion‐selective electrode for continuous plasma potassium monitoring in patients during and after cardiac surgery. Potassium estimations from the indwelling electrode provided a rapid and sensitive, but only moderately reliable, indicator of potassium as confirmed by blood samples. Several significant changes in the plasma potassium were found to occur in the period studied and using this continuous monitor, the precise time course of these changes was recorded.
A prospective study of 200 consecutive twin deliveries
Authors: CRAWFORD J. S. 
Published: February 2007

SummaryA prospective study of consecutive series of 200 twin pregnancies has provided some definitive and some tentative conclusions. It has been shown that in any attempt to assess the value of form of clinical management, cases in which nuchal cord was present in either twin must be disregarded and that attention must be paid to the techniques of analgesia/anaesthesia provided for delivery. There is strong suggestion that the provision of an epidural for either Caesarean section or vaginal delivery is markedly beneficial to the second twin. There is also evidence to suggest that when vaginal delivery is conducted under an epidural, the acid‐base status of the second twin is very likely to be as good as, or better than, that of its sibling, where as that is most unlikely to be so among cases delivered without an epidural. Further benefit is conferred upon both twins if the bearing‐down reflex is abolished. Attention is drawn to an apparently increasing frequency of abdominal delivery of the second twin following vaginal delivery of the first and to the consequent demand which this must make upon anaesthetic cover.
The effect of pregnancy on pulmonary nitrogen washout
Authors: BYRNE F. , ODURO‐DOMINAH A. , KIPLING R. 
Published: February 2007

Summary Pre‐oxygenation times were studied in 30 fit pregnant women during the course of their pregnancy. The mothers were studied in the supine position with a left lateral tilt and breathing through a standard Magill system with an oxygen flow rate of 8 litres/minute. Between 13–26 weeks gestation and 26–42 weeks the times needed to achieve an end‐tidal nitrogen of 2% were 104 seconds (SD 30) and 80 seconds (SD 20), respectively. A control group of young women of similar age and weight needed 130 seconds (SD 30) to achieve the same end‐tidal nitrogen concentration. A gas‐tight mask was found to be essential to achieve effective denitrogenation (end‐tidal nitrogen concentration of 2%).
Anaphylactoid reaction to alcuronium
Authors: PUSEY J. M. , CHARLTON S.M. , SKINNER J. B. , ASSEM E. S. K. 
Published: February 2007

SummaryA 67‐year‐old woman suffered cardiovascular collapse during induction of anaesthesia. This was later shown to be anaphylactic in origin; the causative agent was alcuronium. In vitro testing showed a highly specific sensitivity to alcuronium with minimal cross‐reactivity. Future anaesthesia with decreased risk was thereby assured. The clinical nature of this reaction and a review of the literature implicate the cardiovascular system as the principal target in this type of reaction to alcuronium and suggest that the heart is directly involved.
Respiratory depression after intrathecal opioids
Authors: KRANTZ T. , CHRISTENSEN C. B. 
Published: February 2007

SummaryMorphine 20 mg and pethidine 50 mg were accidentally injected intrathecally in a patient who had received large doses of opioids epidurally for cancer pain and who had shown tolerance to their effects. The well established tolerance to spinal opioids did not protect the patient against a moderate degree of respiratory depression. Morphine concentrations 6.5 hours after the morphine injection were 103 500 ng/ml and 52 ng/ml in cerebrospinal fluid and serum, respectively.
Unilateral pulmonary oedema/atelectasis in the lateral decubitus position
Authors: BARAKA A. , MOGHRABI R. , YAZIGI A. 
Published: February 2007

SummaryAn obese male patient developed hypoxia, hyercarbia and radiological signs of pulmonary oedemal atelectasis in the dependent lung after surgery in the lateral decubitus position. This appears to have been due to ventilation‐perfusion mismatch, although other factors were considered. The patient recovered following 36 hours of intermittent positive pressure ventilation of the lungs.
Explosive anaesthetic agents. A regional survey on the use of ether and cyclopropane
Authors: Konarzewski W. H. , Richards G. , Thomson S. , Nash D.G. 
Published: February 2007

SummaryA total of 156 consultant anaesthetists in the North East Thames Regional Health Authority were circulated with a questionnaire on their personal use of ether and cyclopropane and their attitudes towards restriction or withdrawal of these agents; 144 completed questionnaires were received (92% response). Four anaesthetists (3%) claimed to use ether regularly at least once a month and 27 anaesthetists (19%) fell that their anaesthetic practice would suffer if ether were withdrawn. Cyclopropane had 62 regular users (43%) and 65 anaesthetists (45%) felt that their practice would suffer if it were withdrawn. Ninety‐two anaesthetists (64%) were prepared to confine their use of explosive agents to either the anaesthetic room or the operating room; of these, three‐quarters favoured the anaesthetic room. There were few notable differences in the pattern of use of explosive agents between anaesthetists with more than 21 years in the specialty and those with less than 21 years.
Evoked potentials following diazepam or fentanyl
Authors: Loughnan B. L. , Sebel P. S. , Thomas D. , Rutherfoord C. F. 
Published: February 2007

SummaryThe effects of fentanyl or diazepam on somatosensory, visual and brainstem auditory evoked potentials were studied in 13 healthy patients scheduled for elective surgery. Following control recordings of evoked potentials, either diazepam 20 mg or fentanyl 200 μg was administered intravenously. Evoked potentials were then recorded twice in the subsequent hour. No significant changes occurred in the latency or amplitude of somatosensory, visual or brainstem auditory evoked potentials. Although dose‐related changes in evoked potential latencies and amplitudes have been demonstrated with both the inhalational and intravenous anaesthetics, these changes did not occur with diazepam or fentanyl used alone. An anaesthetic technique based on these two drugs would be suitable when intra‐operative evoked potential monitoring is required to assess ischaemia and preservation of evoked responses.
Premedication for day case surgery
Authors: RAYBOULD D. , BRADSHAW E. G. 
Published: February 2007

SummaryA double‐blind, between‐patient trial was used to assess midazolam 7.5 and 15 mg as oral premedication for day case surgery. Midazolam 7.5 mg did not produce significant anxiolysis or sedation in comparison to placebo as measured by patient self‐assessment linear analogue scales and observer scores. Midazolam 15 mg caused significant anxiolysis and sedation pre‐operatively but also at 2 hours following awakening. Psychomotor performance assessed by digital‐symbol substitution tests was significantly impaired by midazolam, in both doses, throughout the period of investigation. Midazolam 15 mg orally provides good premedication but the prolonged effects make it unsuitable for short‐stay patients.
Memory of cardiac anaesthesia
Authors: GOLDMANN L. , SHAH M. V. , HEBDEN M. W. 
Published: February 2007

SummaryThirty patients scheduled for elective cardiopulmonary bypass surgery were interviewed pre‐operatively and postoperatively to assess changes in their emotional state and recollections, both aware and unaware, of intra‐operative events. A random selection of patients heard a prerecorded audio tape towards the end of bypass after they were rewarmed to 37°C. The tape contained suggestions for patients to touch their chin during the postoperative interview, to remember three sentences and to recover quickly. The interviewers were blind to the experimental condition. The experimental group touched their chins significantly more often than the control group (p = 0.015). Sentence recognition did not reach significance and this may be due to the small numbers and low salience of the stimuli. Seven patients (23%) recalled intra‐operative events, five with the aid of hypnosis. Three reports (10%) were corroborated. Pre‐operative medication (p < 0.01) and postoperative anxiety (p < 0.05) were significant predictors of those patients who reported recall.
Cardiovascular collapse following epidural anaesthesia for Caesarean section in a patient with aortic incompetence
Authors: ALDERSON J. D. 
Published: February 2007

SummaryA death following epidural anaesthesia for Caesarean section in a patient with aortic incompetence and pre‐eclampsia is described. Possible hazards of epidural anaesthesia in aortic incompetence are described and it is suggested that reduction of total peripheral resistance is contraindicated in such patients.
A comparison of propofol and methohexitone as induction agents for day case isoflurane anaesthesia
Authors: O'TOOLE D. P. , MILLIGAN K. R. , HOWE J. P. , McCOLLUM J. S. C. , DUNDEE J. W. 
Published: February 2007

SummaryThe induction and recovery characteristics of equivalent doses of propofol and methohexitone were compared in 50 patients undergoing day case isoflurane anaesthesia. Propofol induction was smoother but was associated with greater cardiorespiratory depression. Both the speed and quality of recovery were superior with propofol compared with methohexitone.
The effect of sufentanil on the cardiovascular responses to tracheal intubation
Authors: KAY B. , NOLAN D. , MAYALL R. , HEALY T. E. J. 
Published: February 2007

SummaryThe effects of sufentanil 0.5 or 1 μg/kg, given intravenously after induction of anaesthesia, on the cardiovascular responses to tracheal intubation were examined in a controlled, randomised, double‐blind investigation. The control group of patients exhibited significant rises in arteriat blood pressure and heart rate for 4 minutes after tracheal intubation. Heart rate exceeded 100 beats/minute and systolic pressure increased by over 20% in every patient. All patients moved or breathed within 10 minutes of the administration of suxamethonium. Sufentanil 0.5 μg|kg prevented increases in the me an values of heart rate and arterial blood pressure, although increases were observed in five patients. Significant falls in the mean values of heart rate and arterial pressure occurred from 4 minutes after intubation until observations ended 15 minutes after induction of anaesthesia. Two patients moved or breathed during this time, although movement in response to nerve stimulation occurred in all patients 10 minutes after administration of suxamethonium. Sufentanil 1 μg/kg was effective in suppressing a rise in heart rate or arterial pressure in every patient. Significant falls in these variables occurred from 2 minutes after tracheal intubation onwards. No patient moved or breathed for 15 minutes after induction of anaesthesia, although neuromuscular transmission was present 10 minutes after giving suxamethonium in each case.
Prolonged and biphasic respiratory depression following epidural buprenorphine
Authors: JENSEN F. MOLKE , JENSEN N.‐H. , HOLK I. K. , RAVNBORG M. 
Published: February 2007

SummaryVentilatory sensitivity to carbon dioxide was measured in six healthy volunteers before, and at various times up to 20 hours after, administration of epidural buprenorphine 0.15 mg with a modified Read rebreathing technique. The carbon dioxide response curves were depressed in a time‐dependent, prolonged and biphasic manner. Significant depression was seen in the intercept values at an end tidal carbon dioxide of 7.2 kPa. for mouth occlusion pressure (p < 0.01), tidal volume (p < 0.05) and minute ventilation (p < 0.05). A significant reduction of slope was obtained only for minute ventilation. Linear regression of respiratory rate changes during carbon dioxide stimulation, did not reach statistical significance. In conclusion, these data indicate that epidural buprenorphine, despite a high lipid solubility, causes respiratory depression to the same extent as epidural morphine. Surveillance of patients who receive epidural buprenorphine for postoperative pain relief is necessary.
Difficult tracheal intubation: a retrospective study
Authors: SAMSOON G. L. T. , YOUNG J. R. B. 
Published: February 2007

SummaryThis is a retrospective study of patients whose tracheas were impossible to intubate on a previous occasion. There is a correlation between the degree of difficulty and the anatomy of the oropharynx in the same patient. The study was initially on obstetric patients but was extended to nonobstetric surgical patients in order to increase the number of cases investigated. The incidence of failed intubations in the obstetric group over a 3‐year period was seven out of 1980 cases, whereas in the surgical group the results were six out of 13 380 patients. Any screening test which adds to our ability to predict difficulty in intubation must be welcomed, as failure to intubate can potentially lead to fatality.
Awareness under anaesthesia due to a defective gas‐loaded regulator
Authors: PURI G. D. , GEORGE M. A. , SINGH H. , BATRA Y. K. 
Published: February 2007

SummaryAwareness under anaesthesia occurred in two patients due to a defect in an anaesthesic machine, which caused an inadequate supply of nitrous oxide. A defective fail‐safe gas‐loaded regulator was found to have caused communication between the pipelines for oxygen and nitrous oxide. This resulted in oxygen flow through the nitrous oxide flowmeter. A simple test to detect this type of defect is suggested.
Assessment of alfentanil by intravenous infusion as long‐term sedation in intensive care
Authors: Cohen A.T. , Kelly D.R. 
Published: February 2007

SummaryThe use of an alfentanil infusion for sedation of critically ill patients in intensive care was investigated in 16 patients who were entered consecutively into the study. The mean duration of stay was 8 days. Supplements of Diazemuls and muscle relaxants were administered if required. The success of the technique was judged by nursing and medical staff and, in particular, the wakefulness of patients was noted. No patient could recall events that occurred during their infusion. An outline protocol is described.
Suxamethonium apnoea in a 4‐month‐old twin
Authors: MEHTA Y. , HOLE P. 
Published: February 2007

SummaryA case of one infant of twins who developed suxamethonium apnoea is described. Investigation of the family revealed him to be homozygous for atypical cholinesterase while the other twin was normal. Tissue HLA and blood typing indicated the twins to be identical.