bluuebunny/crossref_metadata_2025_split huggingface dataset:
Migration of thoracic epidural catheters
Authors: MOURISSE J. , GIELEN M. J. M. , HASENBOS M. A. W. M. , HEYSTRATEN F. M. J. 
Published: February 2007

SummaryMigration of thoracic epidural catheters was evaluated in 25 patients by three methods either after placement of the catheter or immediately after surgery. The first method was the determination of the depth of the catheter from the skin, the second the determination of the level of sensory blockade which resulted from a test dose of a local anesthetic agent, while the third consisted of radiological visualisation of the catheter tip in the epidural space with radiopaque dye. The evaluations were repeated on the third or fourth day after operation. We observed an inward movement of the catheter in 56% of the patients instead of the expected outward movement. This inward movemenl was accompanied by a higher level of sensory blockade. No relationship with radiological visualisation was found.
Sodium bicarbonate as a single dose antacid in obstetric anaesthesia
Authors: Mathews H.M.L. , Moore J. 
Published: February 2007

SummaryGastric pH and volumes were measured in 84 women who had general anaesthesia for emergency Caesarean section. Forty‐eight received only 20 ml 8.4% sodium bicarbonate immediately before induction of anaesthesia and 36 ranitidine 150 mg 6‐hourly during labour in combination with NaHCO3. Gastric pH was less than 2.5 in four women who received only bicarbonate. All aspirates from the ranitidine plus bicarbonate group had a pH greater than 2.5. Mean volumes of gastric content aspirated were 87 (SD 87.4) and 60 (SD 46.3) ml for the bicarbonate alone and bicarbonate plus rantidine series respectively. These differences were not significant. Twenty millilitres of 8.4% NaHCO3 cannot be recommended as a single dose antacid for emergency Caesarean section. Ranitidine plus bicarbonate is considered a reliable antacid regimen to ensure elevation of gastric pH to safe levels.
Asystole with convulsion following a subanaesthetic dose of propofol plus fentanyl
Authors: DORRINGTON K. L. 
Published: February 2007

SummaryA case is presented in which asystole and convulsions occurred after an attempted induction of anaesthesia with propofol and fentanyl. The case suggests that a history of syncope may be associated with unusual susceptibility to the bradycardic effects of propofol.
A computer‐controlled anaesthetic gas mixer
Authors: BOADEN R. W. , HUTTON P. , MONK C. 
Published: February 2007

SummaryThe theory and construction of a prototype computer‐controlled gas mixer and flow regulator are described. The device is capable of controlling and mixing flows of oxygen, nitrous oxide and air. The accuracy and repeatability of the device is very high under given conditions, and its performance is quantified. The flow rate and oxygen concentration are selected from a microcomputer and the control program is written in BASIC. Possible improvements to the system are discussed as are uses in both clinical and research work.
Temazepam or midazolam for night sedation. A double‐blind study
Authors: Irjala J. , Kanto J. , Salonen M. 
Published: February 2007

SummaryThe effects of oral temazepam (20 mg), oral midazolam (15 mg) and a placebo were compared for night sedation on the evening prior to surgery in a double‐blind study. Patients in the placebo group had significantly worse sleep than those in the temazepam (p = 0.004) or midazolam groups (p = 0.04). There was no significant difference between the two drug groups, nor between the residual effects of the three treatments. Temazepam appears to be somewhat more effective than the ultrashort‐acting midazolam in pre‐operative transient insomnia.
The subdural space: the third place to go astray
Authors: REYNOLDS F. , SPEEDY H. M. 
Published: February 2007

SummarySubdural placement of the tip of the Tuohy needle or epidural catheter may account for many unexpected complications of attempted epidural blockade, for example ‘unexplained’ headache, false‐negative aspiration test down needle or catheter, false‐negative test dose, unilateral block, delayed total spinal and neurological sequelae, as well as profound block of delayed onset that is characteristic of subdural blockade. Cases are reported in support of this hypothesis.
Cardiovascular response to insertion of Brain's laryngeal mask
Authors: HICKEY S. , CAMERON A. E. , ASBURY A. J. 
Published: February 2007

SummaryThis study was designed to investigate the cardiovascular effects related to insertion of the Brain laryngeal mask airway and to compare these effects with those after insertion of a Guedel oral airway. Arterial pressure and heart rate in 100 patients were measured using an Ohmeda 2300 Finapres arterial pressure monitor. Arterial pressure decreased significantly (p < 0.001) and heart rate increased significantly (p < 0.001) after induction of anaesthesia with 2.5 mg/kg of propofol. A significant increase in arterial pressure (p < 0.02) and in heart rate (p < 0.001) followed insertion of the laryngeal mask and the Guedel airway, with no difference between the two groups at any time. The changes in arterial pressure and heart rate returned to ‘at insertion’ levels within 60 seconds of the stimulus.
Postpartum thrombosis of the great vein of Galen
Authors: KRENZ I. , POWER K. J. 
Published: February 2007

SummarySevere fits occurred in a patient 52 hours after placental abruption. Early use of computerised tomography scanning enabled a definitive diagnosis of thrombosis of the great vein of Galen to be made. The case illustrates the point that not all fits in the early postpartum period should be attributed to eclamptic toxaemia.
Blood pressure measurement during transport A comparison of direct and oscillotonometric readings in critically ill patients
Authors: RUNCIE C. J. , REEVE W. G. , REIDY J. , DOUGALL J. R. 
Published: February 2007

SummaryThis study assessed the accuracy of oscillotonometric blood pressure measurement in critically ill patients during transfer. Direct intra‐arterial pressure measurements were taken in 44 transported patients as a ‘gold standard’ and compared with readings from four portable automatic oscillotonometers—the Dinamap 8100, Lifestat 100, Propaq 102 and Takeda UA711. All under‐read systolic pressure (by 13%, 21%, 19% and 13% respectively) and over‐read diastolic pressure (by 15%, 5%, 27% and 15% respectively) in comparison to direct pressure measurement. The limits of agreement for 95% of comparisons were broad. The systematic difference between direct and oscillotonometric measurements and the variability between and within patients show that direct oscillotonometric measurements are not interchangeable in these patients. Portable automatic oscillotonometers should not be substituted for direct monitoring in such circumstances.
Loss of consciousness after emergence from anaesthesia. A case of suspected micturition syncope
Authors: KAO Y. J. , RACZ G. B. 
Published: February 2007

SummaryA case of postanaesthesia micturition syncope with respiratory arrest is described. If syncope occurs, the temporary myocardial ischaemia and cerebral hypoperfusion may increase anaesthetic risk in the marginally compensated patient. The loss of airway protection during the syncopal period is also a cause of concern. We recommend the use of an indwelling bladder catheter during any prolonged surgical procedure.
The laryngeal mask airway in children
Authors: Mason D. G. , Bingham R. M. 
Published: February 2007

SummaryThe laryngeal mask airway was used in 200 children during a variety of surgical procedures. Some problem with the use of the device was encountered in 47 cases (23%), but in only five cases (2.5%) were the problems serious enough to warrant abandonment of its use. A clear airway was ultimately achieved in 191 children. Downfolding of the epiglottis over the laryngeal inlet was identified in eight out of 24 patients where flexible laryngoscopy was performed, clinically all these had unobstructed airways. The mask was used in 16 children with known airway problems. It is concluded that the size 2 laryngeal mask airway can be successfully used within the weight range 6–30 kg.
An evaluation of a 30‐gauge needle for spinal anaesthesia for Caesarean section
Authors: Lesser P. , Bembridge M. , Lyons G. , Macdonald R. 
Published: February 2007

SummaryA 30‐gauge spinal needle was evaluated for Caesarean section, using a combined epidural/spinal technique, in 50 mothers. Spinal anaesthesia failed in six mothers and was inadequate in another six. General anaesthesia was required on one occasion. A 25% overall failure rate suggests that a 30‐gauge needle is not a practical proposition for routine clinical practice.
Tussive effect of a fentanyl bolus administered through a central venous catheter
Authors: BÖHRER H. , FLEISCHER F. , WERNING P. 
Published: February 2007

SummaryOne hundred and ten male patients scheduled for coronary artery bypass grafting were allocated randomly into one of three groups. Patients in group A received fentanyl 7 μg/kg via a central venous catheter, those in group B were given fentanyl 7 μg/kg through a peripheral venous cannula, and patients in group C received sterile water via a central venous catheter. In group A, 45.9% of patients coughed after injection of fentanyl; the mean onset time from the end of fentanyl administration to the beginning of coughing was 10.6 seconds. Only one patient in group B and no patient in the control group exhibited a cough response (p < 0.0001). We hypothesise that fentanyl can evoke the pulmonary chemoreflex.
The Keeler Pulsair air impulse tonometer Comparison with the Perkins hand‐held applanation tonometer for peri‐operative measurement of intra‐ocular pressure
Authors: BRICKER S. R. W. , McGALLIARD J. N. , MOSTAFA S. M. 
Published: February 2007

SummaryThe Keeler Pulsair is a noncontact tonometer which can be used by those without specialist ophthalmic training. The instrument was compared, in a series of 30 patients in whom a total of 150 readings were taken, in respect of accuracy, ease and speed of use, and acceptability to patients, with the Perkins hand‐held applanation tonometer. There was good correlation between measurements obtained with the two instruments: r = 0.92, (p < 0.001); the Pulsair was described as easy to use in 87% of subjects, and no patient found the procedure unpleasant. The median times taken for Pulsair measurements were 7 (range 4–14) seconds for a single reading in conscious patients, and 11 (range 4–29) seconds for four readings in anaesthetised patients. These times were significantly quicker than those recorded with the Perkins tonometer which were 83 (range 66–138) seconds and 20 (range 8–45) seconds respectively (p < 0.001). We conclude that the Pulsair is suitable for use by those who are not ophthalmologists for the rapid measurement of intra‐ocular pressure changes during anaesthesia.
Clinical presentation of suspected malignant hyperthermia during anaesthesia in 402 probands
Authors: ELLIS F. R. , HALSALL P. J. , CHRISTIAN A. S. 
Published: February 2007

SummaryAs anaesthetists have become more aware of malignant hyperthermia the mortality rate has fallen, but concommitantly the number of dubious and aborted cases has increased. All probands who developed a suspected malignant hyperthermia reaction during anaesthesia and subsequently underwent muscle biopsy were classified according to the clinical presentation. A probability for malignant hyperthermia can be calculated, using the classification, for each type of clinical presentation; this varied from 0.96 to 0.07. Certain clinical features were found to be of more value as predictors than others; these included a high creatine kinase and myoglobinuria. The accuracy of prediction depends on a clear contemporaneous description of the clinical events.
Total intravenous anaesthesia with propofol and buprenorphine
Authors: Kamal R. S. , Khan F. A. , Khan F. H. 
Published: February 2007

SummaryA combination of propofol infusion and two bolus doses of buprenorphine, 2.5 or 5.0 μg/kg were evaluated in a total intravenous anaesthesia technique in 36 patients of ASA grade 1 or 2 undergoing cholecystectomy. Additional boluses of propofol were given intravenously if needed. Systolic blood pressure after tracheal intubation increased significantly only in those who received the smaller dose of buprenorphine. Patients in both groups remained haemodynamically stable throughout surgery with minimal side effects. Recovery was fast even with prolonged infusions and without major side effects. No patient reported awareness on postoperative questioning.
The laryngeal mask airway in paediatric anaesthesia
Authors: JOHNSTON D. F. , WRIGLEY S. R. , ROBB P. J. , JONES H. E. 
Published: February 2007

SummaryForty‐eight children, aged between 2 and 10 years, admitted as day cases for otological surgery were allocated at random into two groups. The first group was anaesthetised using a standard facemask, and the second with a laryngeal mask airway. The laryngeal airway produced a satisfactory airway in all children, and was inserted on the first attempt in 67% of patients. Hypoxia was significantly less frequent in the laryngeal airway group (p < 0.05), and there were significantly fewer interruptions to surgery than in the facemask group (p< 0.001). Patient safety, operating and anaesthetic conditions were all considered superior in the laryngeal airway group.
Flumazenil in ketamine and midazolam anaesthesia
Authors: RESTALL J. , JOHNSTON I. G. , ROBINSON D. N. 
Published: February 2007

SummaryA double‐blind, parallel group study using flumazenil and placebo was carried out to determine whether patients who received flumazenil would awake more quickly and whether this drug would reverse the protection conferred by midazolam on the psychic sequelae of ketamine. Fifty female patients were studied. The results showed that there was a significant reduction in awakening time (p = 0.02) and a very significant increase (p = 0.001) in the incidence of dreams in the flumazenil group.
Spinal anaesthesia in a child with Job's syndrome, pneumatoceles and empyema
Authors: TAPPER J. B. , GIESECKE A. H. 
Published: February 2007

SummaryWe present a case of acute bowel obstruction in an immunocompromised child, who also had lobar pneumonia and a giant unilateral pneumatocele. She was successfully managed with subarachnoid anaesthesia for exploratory laparotomy to relieve a colonic obstruction. This proved to be a safe alternative to general anaesthesia with tracheal intubation in this patient and should be considered in infants and children in selected cases whenever a contraindication to general anaesthesia exists.
Evaluation of two formulations of dihydrocodeine using patient‐controlled analgesia
Authors: AITKEN H. A. , CLARK E. C. , McARDLE C. S. , DIMITRI W. , KENNY G. N. C. 
Published: February 2007

SummaryA randomised, double‐blind study of 90 patients after cardiac bypass surgery was undertaken to assess the relative analgesic efficacies of normal‐ and controlled‐release oral dihydrocodeine. Patients received either placebo, normal‐release dihydrocodeine, or controlled‐release dihydrocodeine at regular intervals on the first to third days after operation. This was supplemented in all groups by intravenous morphine administered on demand by a patient‐controlled analgesia system. Morphine requirements in the control group were significantly greater during this 48‐hour period than in either of the active groups (p < 0.01), but there was no statistically significant difference between the two active preparations.
Comparison of intramuscular ketorolac and morphine in pain control after laparotomy
Authors: POWELL H. , SMALLMAN J. M. B. , MORGAN M. 
Published: February 2007

SummaryKetorolac, a prostaglandin synthetase‐inhibiting analgesic, was compared with morphine for relief of pain after laparotomy for gynaecological surgery. Eighty patients were studied; they were given either ketorolac 30 mg intramuscularly followed by 10 mg 4‐hourly as required, or morphine 10 mg intramuscularly 4‐hourly as required, administered in a double‐blind, randomised fashion. Pain scores (verbal and visual analogue) were recorded at baseline and assessed at 30 and 60 minutes and then hourly for 6 hours. Pain relief was measured at the same times. Pain and pain‐relief scores were further assessed on the evening of day 1 and at 24 hours. Pain scores were similar in the two groups but pain‐relief scores were better in the morphine group. A considerable number of patients suffered postoperative nausea and vomiting but there was no difference between the groups. One patient in the ketorolac group had unexplained hypotension. It is concluded that ketorolac can provide effective postoperative analgesia.
Pre‐operative anxiety and serum potassium
Authors: McCleane G. J. , Watters C. H. 
Published: February 2007

SummarySmall decreases in serum potassium in a study of 200 pre‐operative patients were demonstrated in those who had an increase in anxiety, as measured on a linear analogue anxiety scale, in the 24 hours before anaesthesia. The possible aetiology and implications of this change are discussed. The combination of temazepam and a pre‐operative visit by the anaesthetist effectively reduced pre‐anaesthetic anxiety in 60% of patients.
Emergency adenotonsillectomy for acute postoperative upper airway obstruction
Authors: LIVESEY J. R. , SOLOMONS N. B. , GILLIES E. A. D. 
Published: February 2007

SummaryPeri‐operative acute upper airway obstruction may be life‐threatening. A case is reported of a child with severe adenotonsillar hypertrophy who developed acute upper airway obstruction after a routine surgical procedure and required emergency adenotonsillectomy. The importance of pre‐operative assessment is stressed.
The role of a critical care unit in an epidemic
Authors: Kumar A , Gupta S. , Ahuja S. , Sethi A. , Bhattacharya A. 
Published: February 2007

SummaryThe role of a critical care unit in life‐threatening situations is well established. The management of 52 children with acute gastroenteritis and 22 children with acute paralytic poliomyelitis as part of recent epidemics is described. The solutions to the problems in the critical care management of these 74 victims (out of a total of 6197 patients admitted during the epidemics) are discussed.
Plasma concentrations of bupivacaine after supraclavicular brachial plexus blockade in patients with chronic renal failure
Authors: RICE A. S. C. , PITHER C. E. , TUCKER G. T. 
Published: February 2007

SummaryThe plasma concentrations of bupivacaine and the latency and duration of anaesthesia after supraclavicular block with 30 ml of 0.5% bupivacaine were measured in 10 patients with chronic renal failure and in 10 patients with normal renal function. No significant difference was found between the two groups in respect of pharmacokinetic parameters, or in block latency or duration.
Hypermetabolism in arthrogryposis multiplex congenita
Authors: HOPKINS P. M. , ELLIS F. R. , HALSALL P. J. 
Published: February 2007

SummaryTwo patients who developed hypermetabolic reactions during anaesthesia and surgery and who were suffering from arthrogryposis multiplex congenita are reported and it is proposed that the reaction is distinct from malignant hyperthermia and independent of the anaesthetic agents used. The implications for anaesthetists involved in the management of patients with arthrogryposis multiplex congenita are discussed.
Cyclopropane and the Datex Capnomac
Authors: MASON D. G. , LLOYD‐THOMAS A. R. 
Published: February 2007

SummaryWe report the effect of cyclopropane used for induction of anaesthesia in children on the subsequent measurement of maintenance volatile anaesthetic agents with the single wavelength infrared absorption technique. After using cyclopropane to induce anaesthesia we have observed that falsely high readings of the expired maintenance agent occur for up to 60 minutes when using the Datex Capnomac. This is because of the effect of low concentrations of cyclopropane expired from the patient.
Posterior tibial nerve block
Authors: WASSEF M. R. 
Published: February 2007

SummaryA local analgesic block of the posterior tibial nerve, using a new subcalcaneal approach, is described. The point of insertion of the needle is defined in relation to a bony prominence below the medial malleolus, the sustentaculum tali, to which the posterior tibial nerve bears a constant relationship. Twenty patients given a posterior tibial block using the subcalcaneal approach were compared with 20 patients in whom a traditional retrotibial approach was used. In this technique the major landmark for needle insertion is the posterior tibial artery. In all patients the techniques formed part of an ankle block for foot surgery. Eighty‐five to 90% of patients had peripheral vascular disease and in 60–65% the posterior tibial artery was not palpable. In the group of patients without palpable pulses, the subcalcaneal approach had a success rate of 100%, whereas all those having the retrotibial approach required additional local analgesic supplements (p < 0.001). The subcalcaneal approach is simple and is particularly recommended for patients with peripheral vascular disease.
Are you getting the message?
Authors: WEIR P. M. , WILSON M. E. 
Published: February 2007

SummaryA questionnaire sent to 109 anaesthetists in the South West Region has revealed that there is a problem with dissemination of information relating to hazards with equipment. Thirty‐four per cent of consultants, and 67% of junior anaesthetists were only slightly or not at all confident that they see the Hazard Notices and Safety Action Bulletins relating to the equipment they use. The study has also demonstrated the large amount of new equipment coming into circulation and has highlighted deficiencies in the reading of equipment manuals. Some suggestions are made as to how the current system may be improved.
Marked decrease in arterial oxygen tension associated with continuous intravenous nifedipine administration
Authors: BÖHRER H. , SCHICK M. , SCHÖNSTEDT R. , BACH A. 
Published: February 2007

SummaryIntravenous nifedipine was administered to treat arterial hypertension in a 54‐year‐old woman presenting for removal of a meningioma. A marked decrease in arterial oxygen tension occurred during the nifedipine infusion. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine is discussed.
Prolonged action of enoximone in renal failure
Authors: BURNS A. M. , PARK G. R. 
Published: February 2007

SummaryEnoximone was administered on two separate occasions to a 37‐year‐old woman with renal failure secondary to thrombotic thrombocytopenic purpura. Plasma concentrations of enoximone and its principal metabolite, enoximone sulphoxide, were measured over a 9‐day period. As renal function improved the rate of elimination of enoximone sulphoxide increased. The duration of effect of enoximone may be prolonged in patients with renal failure.