bluuebunny/crossref_metadata_2025_split huggingface dataset:
A method of costing anaesthetic practice
Authors: BROADWAY P. J. , JONES J. G. 
Published: February 2007

SummaryThis paper identifies the main factors involved in the cost of elective general anaesthetic practice. The costs of anaesthesia were divided into overheads and running costs, which are sensitive to the duration of anaesthesia, and fixed costs which are incurred by each patient but are not sensitive to the duration of anaesthesia. The overhead costs consisted of salaries, capital equipment and maintenance costs. The overhead cost of a consultant anaesthetist combined with a technical assistant's salary, monitoring equipment and anaesthetic machine was estimated at £45.05.h‐1 (using 1993 salary scales and prices). The fixed costs of pre‐operative assessment and nursing care in recovery were the same for all patients, £20.60 per patient. For the majority of anaesthetics the combined cost of the anaesthetist, overheads and postoperative care was about 70% of the total cost, the remainder being the running costs which included drugs, anaesthetic gases, vapours, intravenous fluids, sterile equipment and other disposable items. Four sample anaesthetics were costed in two ways: both methods used the same overhead and fixed cost per patient but one added the cost of all the individual drugs and consumables used, whereas the other grouped these together using a charge sheet which can be computerised and used prospectively to cost anaesthesia. There was close agreement between the costs derived with the two methods. The cost of a 30min delay in the start of an operating session was £27.30 (anaesthetist, assistant and nurse salary (£9.50.h‐1)) which is more than the cost of 2h of propofol infusion anaesthesia. There was a difference between the estimated costs of an anaesthetic as calculated by management and by our analysis. The cost apportioned by management for assistants and recovery nurses’salaries was nearly £50.h‐1 and the cost for anaesthetic equipment maintenance and anaesthetic capital costs was nearly £20.h‐1. These management figures were considerably greater than our estimates of £19.14.h‐1 and £3.20.h‐1 respectively. We advocate the use of a charge sheet for providing an easy estimate of anaesthetic cost rather than relying on management estimates.
Differential effects of vecuronium on the thumb and great toe as measured by accelography and electromyography
Authors: Kitajima T. , Ishii K. , Kobayashi T. , Ogata H. 
Published: February 2007

SummaryWe evaluated possible differential effects of vecuronium on the thumb and great toe using two types of neuromuscular transmission monitor. Train‐of‐four stimuli were simultaneously applied to the ulnar nerve and tibial nerves using cutaneous electrodes. The responses were quantified with accelographs (thumb and left great toe) and an electromyograph (right great toe). Twenty ASA 1 or 2 patients received, by random allocation, one of two types of anaesthesia: neuroleptanaesthesia or sevoflurane‐based anaesthesia. With both techniques, the shortest time to maximum block after vecuronium 0.1 mg.kg ‐1 occurred in the thumb as measured by accelography. The average (SD) values with neuroleptanaesthesia were: 173(23) s for thumb using accelography; 220(16) s for great toe using accelography; 205(44) s for great toe using electromyography. The average (SD) valuefs) with sevoflurane‐based anaesthesia were: 137(15) for thumb using accelography; 179(21) for great toe using accelography; 153(23) for great toe using electromyography. The differences between the thumb and great toe were statistically significant during both types of anaesthesia when measured with the accelograph (p < 0.01). The time from completion of maximal block to 25% recovery of twitch height in the thumb was significantly longer than that of the great toe as measured by accelography during both types of anaesthesia (p < 0.05). In contrast, there were no statistically significant differences between time to maximum block and 25% recovery of twitch height of the thumb as measured by accelography compared to the values measured for the great toe using electromyography during either anaesthetic technique. The fastest recovery, therefore, was measured in the tibial nerve using accelography. The time to 25% spontaneous recovery after vecuronium 0.1 mg.kg‐1 during sevoflurane anaesthesia was significantly longer than that during neuroleptanaesthesia (p < 0.01).
Nathan Keep—William Morton's Salieri?
Authors: KEEP P. 
Published: February 2007

SummaryDr Nathan Cooky Keep (1800‐1875) was a Boston dentist and doctor who carried out pioneering work in both dentistry and anaesthesia. He worked with William Morton before the first public demonstration of ether anaesthesia, formed the world's first anaesthetic partnership with Morton but parted company with him and later opposed Morton's claim to be the sole inventor of ether anaesthesia.
Caesarean section in a patient with protein S deficiency
Authors: Fan S. Z. , Yeh M. , Tsay W. 
Published: February 2007

SummaryProtein S is a nonenzymatic and vitamin K‐dependent cofactor of activated protein C. Without protein S, the anticoagulant function of protein C is almost depleted and thrombotic events occur. We report a parturient with hereditary protein S deficiency in whom the risk of thromboembolism was further complicated by pregnancy and who required emergency Caesarean section for fetal distress.
Transcervical endometrial resection syndrome
Authors: McSwiney M. , Myatt J. , Hargreaves M. 
Published: February 2007

SummaryDuring transcervical endometrial resection the uterine cavity is irrigated under pressure with 1.5% glycine solution. This solution may be absorbed, with consequent fluid and electrolyte shifts. Plasma sodium concentration was analysed in 21 women undergoing transcervical endometrial resection and decreased in every case. In five cases this decrease was > 10mmol.l‐1. Hyponatraemia is a potential risk with this procedure.
The effects of 2% lignocaine gel on incidence of retching with the use of the laryngeal mask airway
Authors: Chan S. T. , Tham C. S. 
Published: February 2007

SummaryThis randomised, single‐blind study investigated the incidence of retching during emergence from general anaesthesia with a laryngeal mask airway in place. Eighty four patients, ASA grade 1 and 2, aged 15 to 60 years, were randomly divided into two groups. Each patient received fentanyl 1 μg.kg‐1 and propofol 2mg.kg‐1for induction. A laryngeal mask airway was then inserted and the patient breathed spontaneously on a nitrous oxide‐oxygen mixture with isoflurane. Lubafax gel was the lubricant in the control group and 2% lignocaine gel was used in the test group. The patients were allowed to wake up at the end of surgery with the laryngeal mark airway in place while a blinded observer observed for retching. The age, sex, weight and duration of surgery were similar in both groups. The test group had a significantly lower incidence of retching on emergence from general anaesthesia with the laryngeal mask airway in place (p < 0.005, Chi‐squared test).
Metabolic gas exchange during different surgical procedures
Authors: LIND L. 
Published: February 2007

SummarySurgery performed during general anaesthesia has been shown to induce an increase in oxygen consumption. It is postulated that this response might be influenced by the surgical procedure performed. Metabolic gas exchange was continuously measured by indirect calorimetry for 30min in 45 patients undergoing four different surgical procedures during general anaesthesia with propofol/fentanyl/vecuronium as follows: elective laparotomy (n = 13); emergency laparotomy (n = 10); elective knee joint arthroscopy (n = 10); gynaecological laparoscopy (n = 12). A significant increase in oxygen consumption occurred in all the groups within 5min of skin incision. The greatest increase was seen in those undergoing elective laparotomy (+13%, p < 0.001 at 15min), with similar smaller increases in the other three groups (+6 to + 7%, p < 0.05). Surgery induced an increase in systolic blood pressure in all four groups, being most pronounced in the elective laparotomy group (+47% 15min after skin incision, p < 0.001). These patients also experienced a significant rise in heart rate (+14%, p < 0.01 at 15min). Carbon dioxide production increased both in the laparoscopy patients (+9%, p < 0.05) and, transiently, in the elective laparotomy group (+6% at 15min, p < 0.01), but decreased in the other two groups (‐7 to ‐15%, p < 0.05). Surgery induced a parallel increase in both oxygen consumption and systolic blood pressure in all types of operations, although the magnitude varied. Continuous measurement of metabolic gas exchange may provide an additional method of evaluating the metabolic response to different types of surgery.
Prolonged tracheal intubation in an infant with tracheomalacia secondary to a vascular ring
Authors: Reah G. , Entress A. 
Published: February 2007

SummaryWe report a case in which the trachea of a 3‐week‐old infant with a double aortic arch and secondary tracheomalacia was intubated for nearly 10 months prior to tracheal surgery. Postoperatively no complications relating to surgery or intubation were seen.
The effect of cardiac output on the onset of neuromuscular block by vecuronium
Authors: Iwasaki H. , Igarashi M. , Yamauchi M. , Namiki A. 
Published: February 2007

SummaryA relationship between cardiac output and the onset time of neuromuscular blockade administered into a peripheral vein was evaluated in 41 adult patients. Anaethesia was induced with midazolam and fentanyl and maintained with intermittent doses of fentanyl and 66% nitrous oxide in oxygen. After immobilisation of the forearm in a splint, the ulnar nerve in the other arm was stimulated supramaximally every 10 s and the adduction force of the thumb was recorded. The times from administration of vecuronium 0.08mg.kg‐1 to first and 95% depression of twitch response was 82.4(18.0) s and 191.7(33.5) s (mean, SD), respectively. A significant correlation between cardiac index and the onset time of blockade was observed. This study demonstrated that the rapidity of the onset of paralysis in the adductor pollicis muscle after vecuronium injection into a peripheral vein is clearly related to cardiac output.
The quality of breathing and capnography during laryngeal mask and facemask ventilation
Authors: IVENS D. , VERBORGH C. , THI H. PHAN , CAMU F. 
Published: February 2007

SummaryClinical measures of ventilation and the relationship between arterial and end‐tidal carbon dioxide tensions were studied during inhalational anaesthesia in 18 patients using a laryngeal mask airway or a facemask. Tidal volumes were similar in both groups but expired minute volume, respiratory rate and physiological deadspace ventilation were significantly increased in the facemask group. Both end‐tidal and arterial carbon dioxide tensions were higher in the laryngeal mask group. Mean arterial to end‐tidal carbon dioxide tension differences ranged from 0.13 to 4.13kPa in the facemask group and from 0–1.73kPa with the laryngeal mask airway. Pooled data analysis revealed a better correlation between arterial and end‐tidal carbon dioxide tensions during laryngeal mask ventilation as compared to facemask breathing. With both techniques the arterial to end‐tidal carbon dioxide tension difference was related to respiratory rate and physiological deadspace ventilation. Estimation of arterial carbon dioxide partial pressure by monitoring end‐tidal carbon dioxide tension is more reliable with the laryngeal mask airway than during facemask breathing, in particular at small tidal volumes.
Skin tethering after dilatational percutaneous tracheostomy
Authors: Whittet H. B. , Commins D. J. , Waldmann C. S. 
Published: February 2007

SummaryPercutaneous tracheostomy is increasingly preferred for patients in the Intensive Care Unit. It is a convenient method with a low incidence of complications. Skin tethering has not previously been emphasized as a complication of this technique and, although primarily cosmetic, may result in significant morbidity.
Skin–epidural distance in children
Authors: Bösenberg A. T. , Gouws E. 
Published: February 2007

SummaryThe skin–epidural distance was measured in 274 children to assess the usefulness of 1 mm .kg–1 as a guideline. Children aged between 2 days and 16 years, weighing between 2 and 43 kg were investigated. Lumbar epidurals were performed under general anaesthesia using a midline approach in the L3‐4 interspace with the patient in the left lateral position. Good correlation between skin‐epidural distance and age and weight was demonstrated. No statistical difference was shown when plotting the best fit regression line: skin‐epidural distance (mm) = 0.8 weight (kg) + 3.93 (R2= 0.74) and its 95% confidence limits and skin‐epidural distance (mm) = weight (kg) for children between 6 months and 10 years. Poor correlation was noted below 6 months (n = 22) and over 10 years (n = 19). No dural puncture or bloody tap occurred. One mm. kg‐1 body weight was shown to be a useful guideline for children between 6 months and 10 years of age.
A comparison of diclofenac with ketorolac for pain relief after knee arthroscopy
Authors: Dennis A. R. , Leeson‐Payne C. G. , Hobbs G. J. 
Published: February 2007

SummaryWe performed a double‐blind controlled trial to compare the analgesic effect of two nonsteroidal anti‐inflammatory drugs. We compared rectal diclofenac 100 mg given 1 h before induction of anaesthesia with intravenous ketorolac 10 mg given immediately before anaesthesia in 40 patients undergoing arthroscopy of the knee as day cases. A visual analogue scale was used to assess pain prior to discharge. Pain, analgesic consumption, sleep disturbance and restriction of activities were recorded by telephone enquiry 24 h after surgery. There was no difference in the pain parameters, sleep disturbance, or restriction of activity between groups. We suggest that ketorolac 10 mg intravenously and diclofenac 100 mg rectally provide comparable postoperative analgesia in the first 24 h after arthroscopy of the knee.
Comparative study of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis
Authors: HERREGODS L. , FOUBERT L. , MOERMAN A. , FRANÇOIS K. , ROLLY G. 
Published: February 2007

SummaryIntentional normovolaemic haemodilution is a blood saving technique which can be performed when major blood loss is expected. Severe coronary artery disease and particularly left main stenosis are considered a contraindication for intentional normovolaemic haemodilution. The effects and complications of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis scheduled for coronary artery bypass grafting were evaluated. Patients were randomly allocated to two groups: group A (n = 15) underwent limited intentional normovolaemic haemodilution to a haematocrit of 34%; group B(n = 15), no intentional normovolaemic haemodilution was performed. In both groups succinyl‐linked gelatin was used to maintain normovolaemia. Haemodynamic parameters were kept as constant as possible. In group A, a mean (SD) volume of 785 (250) ml of blood was withdrawn [range 500–1200 ml]. ST segment changes occurred on the ECG in three patients in each group. There were no statistically significant differences for frequency, maximum deflection and duration of ST‐segment changes. Limited intentional normovolaemic haemodilution can be performed safely in patients with left main coronary artery stenosis. In this study it was not associated with increased frequency, severity or duration of ST‐segment changes, or with arrhythmias or haemodynamic instability.
The effect of a cervical collar on the tidal volume of anaesthetised adult patients
Authors: DODD F. M. , SIMON E. , McKEOWN D. , PATRICK M. R. 
Published: February 2007

SummarySemi‐rigid cervical collars may be used to assist the stabilisation of the cervical spine during transport in patients suffering from major trauma. We have attempted to evaluate the effect of one such collar on airway patency in the presence of depressed airway reflexes. Thirty‐eight patients undergoing anaesthesia via facemask with spontaneous ventilation were studied. Tidal volume was measured with the airway in three different positions, both with and without a collar. The collar made no statistically significant difference to tidal volume in any position. Changing support of the airway increased tidal volume both with and without the collar. Patients fitted with an incorrectly sized collar may develop upper airway obstruction in the presence of impaired consciousness. Experience should be gained in the correct fitting of semi‐rigid collars.
Lessons from in vitro testing of spinal needles
Authors: LYONS G. , LESSER P. , BEMBRIDGE M. 
Published: February 2007

SummaryIn vitro testing of spinal needles is intended to identify a best buy, but such tests are not necessarily good indicators of clinical performance and some bench tests appear to conflict with mock clinical assessments. Discrepancies can be explained by examining the role of the hub. The Visual Probability Test, which assesses the needle as a complete unit, would appear to be more useful than the more complex measurements of shaft flow. Not all needle manufacturers use the same gauge, creating confusion when comparisons are made. Packaging frequently fails to give adequate information. Changes in hub design could permit earlier identification of dural puncture.
Cerebral oximetry: a useful monitor during carotid artery surgery
Authors: DUNCAN L. A. , RUCKLEY C. V. , WILDSMITH J. A. W. 
Published: February 2007

SummaryCerebral oximetry was evaluated as a monitor of oxygenation during carotid endarterectomy in 22patients. The oximeter was a reliable continuous monitor, identifying changes in cerebral oxygenation during episodes of hypotension and after arterial occlusion. Changes in oxygenation correlated well with the surgical assessment of backbleeding after arterial clamping, but less well with other methods which are used to make a decision on insertion of an arterial shunt. There was no correlation between internal carotid artery stump pressure and change in cerebral oxygenation after application of the arterial cross clamp. However, cerebral oxygenation correlated weakly with the change in middle cerebral artery velocity as measured by transcranial Doppler ultrasonography (r = 0.49, p < 0.02).
SCOTI—a new device for identification of tracheal intubation
Authors: MURRAY D. , WARD M. E. , SEAR J. W. 
Published: February 2007

SummaryA new lightweight device for the detection of placement of a tracheal tube in the trachea or oesophagus is described. The device utilises a sonic technique detecting resonating frequencies in an open (trachea) or closed (oesophagus) structure. Evaluation of the device in a clinical environment is described and it has been shown to be capable of verifying the correct placement of the tracheal tube in the trachea in 98% of patients studied. Further evaluation of this intubating aid appears justified.
Resistance, reverse flow and opening pressure of unidirectional valves
Authors: LEIBUNDGUT D. , ZBINDEN A. M. 
Published: February 2007

SummaryBased on a new preliminary standard of the‘Comité Européen de Normalisation’, the following unidirectional valves were tested with regard to resistance, opening pressure, reverse flow and dislocation: the Dräger inspiratory and expiratory valves, the Engström inspiratory valve, the Ohmeda valve, the Siemens Ventilator 710 inspiratory and expiratory valves, the Siemens Ventilator 900C unidirectional valve of the absorber and the Megamed 700 inspiratory and expiratory valves of the circle system 219 (Megamed 700 CS 219). The following valves fulfilled all Comité Européen de Normalisation requirements: Dräger inspiratory and expiratory valves, Siemens 900 absorber valve and Megamed 700 CS 219 inspiratory valve. The Siemens 710 valve and the Megamed 700 CS 219 expiratory valve did not meet the requirements for flow resistance. The Ohmeda and Siemens 710 valves and the Engström inspiratory valve did not fulfil the Comité Européen de Normalisation requirements for reverse flow. In addition, the Engström inspiratory valve did not comply with the dislocation test. The requirements for the opening pressure were met by all the valves tested. Valves with the disc in a horizontal position achieved better results than those with the disc in a vertical position. These measurements, showing the differences in the performance of various types of valves confirm the feasibility of the standards proposal.
Cardiovascular and catecholamine response to surgery in brain‐dead organ donors
Authors: FITZGERALD R. D. , DECHTYAR I. , TEMPL E. , FRIDRICH P. , LACKNER F. X. 
Published: February 2007

SummaryEleven brain‐dead organ donors were studied during surgery. Plasma levels of adrenaline and noradrenaline were measured before and after skin incision, upon sternotomy and 15, 30 and 45min thereafter. Haemodynamic changes were measured continuously throughout the observation period. Blood pressure and heart rate increased after skin incision, remained high at sternotomy then decreased towards the end of the observation period in six of the 11 patients. Plasma catecholamines increased promptly with the onset of surgical stimuli. We conclude that surgical stress can evoke an excessive rise of plasma adrenaline and noradrenaline and thus could impair allograft function.
The output of an‘empty’ Tec 3 vaporizer
Authors: GRAHAM S. G. , SZAFRANSKI J. , BLAND D. , LANGTON J. A. 
Published: February 2007

SummaryThe output of 30 Tec 3 vaporizers (halothane, enflurane and isoflurane) was studied, starting at the point where no liquid was visible in the content window. At 6l.min‐1 and 1% v/v initial output, consistent delivery was on average maintained for in excess of 90 (range 55–120) min. Thereafter, output declined rapidly. At the flows and concentrations studied there is a significant reserve in the vaporizing chamber, but it is likely that when higher flows and concentrations are used this reserve may be substantially reduced.
Analgesia following day‐case knee arthroscopy—the effect of piroxicam with or without bupivacaine infiltration
Authors: Morrow B. C. , Milligan K. R. , Murthy B.V.S. 
Published: February 2007

SummarySixty patients presenting for day‐case arthroscopy of the knee under general anaesthesia were studied. Patients were randomly allocated to receive, in addition to intramuscular piroxicam 20mg, either bupivacaine 0.25% 20 ml applied locally to the knee at the end of the procedure (n = 30) or no further intra‐operative analgesia (n = 30). Visual analogue pain scores were significantly lower at 1,2 and 4 h postoperatively in the bupivacaine group (p < 0.05). A higher proportion of patients in the piroxicam‐only group required supplemental analgesia before discharge from hospital. The combination of piroxicam and bupivacaine provided superior analgesia to piroxicam alone.
Utilisation of the pre‐operative ECG
Authors: CALLAGHAN L. C. , EDWARDS N. D. , REILLY C. S. 
Published: February 2007

SummaryThe utilisation of the pre‐operative ECG in patients undergoing routine surgery was investigated in 354 adult patients over a 2‐week period. Sixty‐four percent of patients had an ECG pre‐operatively. An ECG was not performed in 17% of patients who, current hospital policy suggests, should have had one. In contrast, an ECG was performed in 33% of patients who, hospital policy suggests, have no need of one (all of which were normal), which represented 18% of the total number of pre‐operative ECGs performed. In 62% of patients with known cardiac disease, and 44% of patients with strong risk factors for ischaemic heart disease (in the absence of known disease) the ECG was abnormal. This compares with only 7% of patients aged over 50 with no risk factors in whom the ECG was abnormal. These findings suggest that there is room for improvement in the utilisation of the pre‐operative ECG, which may have cost implications.