bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a low‐power nerve stimulator during sciatic nerve block
Authors: SMITH B. E. , ALLISON A. 
Published: February 2007

SummaryThe use of a low‐power nerve stimulator to aid nerve location during the performance of sciatic nerve block was compared with a conventional anatomically based technique. The success rate, both in terms of the production of an effective block and the duration of postoperative analgesia, was significantly higher in the stimulator groups than in the non‐stimulator groups. The implications of the study for both clinical and teaching practice are discussed.
Retention of auditory information presented during anaesthesia
Authors: STANDEN P. J. , HAIN W. R. , HOSKER K. J. 
Published: February 2007

SummarySurgical procedures that involve a local anaesthetic block are often accompanied by light general anaesthesia. It is possible that under these circumstances, the patients are more likely to register auditory events while apparently unconscious. Two groups of children were exposed to auditory stimuli during surgery; one group received a lighter level of anaesthesia than the other. Retention of the stimuli was tested using a cued recall technique, and the performance of the two experimental groups was compared with a control group which had not been exposed to the material but was tested in the same way. The light anaesthesia group retained more items than did the other two groups but this difference was significant (p < 0.05) only when compared with the other experimental group. This is not very strong evidence of auditory registration, but a greater effect might be found with exposure to emotionally significant material. It is suggested that patients should be protected from unfortunate theatre conversation.
Failure of critically ill patients to metabolise midazolam
Authors: SHELLY M. P. , MENDEL L. , PARK G. R. 
Published: February 2007

SummaryThe pharmacokinetics of midazolam and its metabolite, 1‐OH midazolam, were studied in six critically ill patients during and after a continuous intravenous infusion of midazolam. Four patients had an increased elimination half‐life of midazolam; two were associated with a reduction in plasma clearance with low plasma concentrations of the metabolite, and two with normal metabolite levels and increased volume of distribution. The two patients with reduced clearance suffered from septic shock and were studied over a longer period. Their altered clearance was due to a reduced capability to form the 1‐OH metabolite. As their condition improved, plasma concentrations of 1‐OH midazolam increased and midazolam clearance returned towards normal. The impaired ability of critically ill patients with septic shock to metabolise midazolam, may be due to reduced organ perfusion and may lead to cumulation of midazolam in these patients.
Somatostatin, anaesthesia, and the carcinoid syndrome
Authors: ROY R. C. , CARTER R. F. , WRIGHT P. D. 
Published: February 2007

SummaryA patient with carcinoid syndrome on long‐term antiserotonin therapy with parachlorophenylalanine, experienced a flushing attack with hypotension during the prophylactic administration of aprotonin prior to the induction of anaesthesia. When she was subsequently prepared with a long‐acting somatostatin analogue, octreotide (Sandostatin, Sandoz SMS 201–995), plasma levels of tumour‐released hormones were reduced and anaesthesia for resection of hepatic metastases was uneventful. The advantages of an anaesthetic approach based on inhibition of carcinoid tumour activity, rather than antagonism of released hormones, are discussed.
Day‐case herniotomy in children.
Authors: Reid M.F. , Harris R. , Phillips P.D. , Barker I. , Pereira N.H. , Bennett N.R. 
Published: February 2007

SummaryForty‐nine boys scheduled for day‐case inguinal herniotomy Here studied to compare ilio‐inguinal nerve block and wound infiltration for postoperative analgesia. Both techniques were simple to perform and produced no complications. In the ilio‐inguinal block group, 100% had either no pain or very mild discomfort when assessed 60 minutes after return to the day unit, compared to 95% in the infiltration group. Some children did appear to have pain following discharge but in all cases this responded well to simple analgesics. We conclude that both techniques provide satisfactory analgesia whilst the complications of narcotics are avoided, and suggest that simple infiltration of the wound with local anaesthetic solution should be encouraged in paediatric anaesthesia.
Epidural catheter migration during labour
Authors: Phillips D.C. , Macdonald R. , Wing Gledhow 
Published: February 2007

SummaryA study was undertaken to determine the incidence, magnitude and direction of catheter migration in 100 patients who had epidural analgesia for pain relief in labour. Over 50% of catheters migrated from the original position at siting. The relevance of this migration and the usefulness of its measurement are discussed.
Propofol combined with nitrous oxide‐oxygen for induction and maintenance of anaesthesia
Authors: HERREGODS L. , ROLLY G. , VERSICHELEN L. , ROSSEEL M. T. 
Published: February 2007

SummaryAfter a bolus of 2 mg/kg, propofol was given by continuous infusion (150 μg/kg/minute for 30 minutes and then 100 μg/kg/minute) supplemented with nitrous oxide for anaesthesia during ear surgery in 12 patients. Cardiovascular changes were not significant except for a decrease in heart rate after 60 minutes. Acid‐base balance was unaffected by the amount of fatty emulsion. Cortisol levels showed a nonsignificant decrease during the prolonged administration of propofol but had recovered completely by one hour following anaesthesia. Mean blood concentrations of propofol were 10.5 μg/ml (SEM 1.2) at the onset of unconsciousness, between 3.4 and 4.5 μg/ml during continuous infusion and 2.9 μg/ml (SEM 0.3) on awakening. Patients opened their eyes 6 minutes (SEM 1) after discontinuation of the infusion, and were responsive at 7.5 minutes (SEM 0.5), which suggests that propofol infusion can be used safely for surgery of 2 hours' duration.
Vecuronium infusions in patients with renal failure in an ITU
Authors: SMITH C. L. , HUNTER J. M. , JONES R. S. 
Published: February 2007

SummaryThe use of an infusion of vecuronium is described in seven patients with renal and respiratory failure in an intensive therapy unit. Neuromuscular function was monitored throughout using the train‐of‐four twitch technique. A bolus dose of vecuronium (0.1 mg/kg) was given, followed immediately by a continuous infusion (0.05 mg/kg/hour). The infusion rate was adjusted until the first twitch of the train was helow 20% of control and then run at a constant rate.There was a marked variation in the dose of vecuronium administered (0.01—0.65 mg/kg/hour). Two patients, who appeared to be most sensitive to the drug, were both receiving metronidazole. Recovery of neuromuscular function was extremely prolongea and widely variable (6–37 hours) on stopping the infusion. No adverse cardiovascular effects or evidence of histamine release were seen as a result of administration of the drug. Vecuronium is probably more suitable for administration in bolus doses rather than by infusion in patients with renal and respiratory failure.
High frequency jet ventilation for bilateral bullectomy
Authors: McCarthy G. , COPPEL D. L. , GIBBONS J. R. , COSGROVE J. 
Published: February 2007

SummaryThis case report describes the use of high frequency jet ventilation for resection of bilateral lung bullae. Low airway pressures reduced the risk of pulmonary barotrauma. A continuous infusion of ketamine provided acceptable anaesthesia.
Arterial to end‐tidal carbon dioxide tension difference during anaesthesia for tubal ligation
Authors: SHANKAR K. BHAVANI , MOSELEY H. , KUMAR Y. , VEMULA V. , KRISHNAN A. 
Published: February 2007

SummaryTwenty‐nine patients scheduled for postnatal tubal ligation by minilaparotomy under general anaesthesia were studied. Arterial and end‐tidal carbon dioxide tensions were determined during anaesthesia. The mean arterial to end‐tidal carbon dioxide tension difference was 0.08 kPa (SEM 0.05). Thirty‐one percent of the patients had negative values. These results were similar to those observed during Caesarean section. The physiological changes responsible for reduced arterial to end‐tidal carbon dioxide values, persist into the postnatal period. It is predicted from the regression analysis of the time between delivery and anaesthesia for tubal ligation and arterial to end‐tidal CO2 difference, that the values might return to normal nonpregnant levels by 8 days following delivery.
Myalgia and biochemical changes following intermittent suxamethonium administration
Authors: LAURENCE A. S. 
Published: February 2007

SummaryOne hundred gynaecological patients for laparoscopy divided into five groups were studied to determine the effects of a number of pretreatments on serum myoglobin, creatinine kinase and myalgia following intermittent suxamethonium administration. One group acted as controls, while the other groups were given intravenous pretreatments of alcuronium 2 mg, midazolam 0.15 mg/kg, lignocaine 1.5 mg/kg and suxamethonium 7 mg. Serum myoglobin was determined by radio‐immunoassay. The mean increases in the control group were 167 μg/litre myoglobin at 20 minutes and 196 IU creatinine kinase at 24 hours; 13 out of 20 patients responded with a marked increase of serum myoglobin at 20 minutes and of creatinine kinase at 24 hours. Only alcuronium pretreatment prevented myoglobin increase at 20 minutes, abolished creatinine kinase increase at 24 hours and reduced 24‐hour myalgia. The other pretreatments slightly reduced myoglobin increase at 20 minutes and 24‐hour creatinine kinase but did not reduce myalgia. Only one patient in the whole study had markedly elevated serum myoglobin at 24 hours. We conclude that only non‐depolarising relaxant pretreatment is effective in the reduction of some of the adverse effects of suxamethonium administration.
Prolonged paralysis following an infusion of alcuronium in a patient with renal dysfunction
Authors: SMITH C. L. , HUNTER J. M. , JONES R. S. 
Published: February 2007

SummaryThe case is described of a patient who underwent artificial ventilation in an intensive therapy unit and received an infusion of alcuronium 10 mg/hour for more than 4 days, in the presence of significant renal (and later, some degree of hepatic) impairment. Prolonged and profound neuromuscular block persisted despite haemodialysis (5 hours on each of 3 days) followed by 72 hours of continuous haemofiltration; it appeared to resolve only after plasma exchange (4 litres). The total period of persistent block, for 9 days after the infusion had been stopped, is thought to be the longest period ever reported after administration of alcuronium. Neuromuscular block was monitored throughout this period using the train‐of‐four twitch technique. The potentiating effects of concurrent aminoglycoside therapy and hepatic dysfunction on the degree of paralysis are discussed.
Postoperative complications of dystrophia myotonica
Authors: MOORE J. K. , MOORE A. P. 
Published: February 2007

SummaryA 44‐year‐old man with known mitral stenosis presented for minor surgery. Anaesthesia was induced with fentanyl, droperidol and etomidate and maintained with nitrous oxide, oxygen and vecuronium. Surgery and anaesthesia were uneventful but the postoperative course was stormy, with respiratory arrest, Haemophilus pneumonia, refractory cardiac dysrhythmias and gastrointestinal atony. A diagnosis of dystrophia myotonica was made after 3 weeks in the intensive care unit, and he spent 6 weeks in hospital. A high index of suspicion for this disease must be maintained and intensive care facilities and monitoring should be available for all procedures.
Tactile orotracheal tube placement test
Authors: CHARTERS P. , WILKINSON K. 
Published: February 2007

SummaryThe development of a tactile clinical test of the positioned orotracheal tube is described which allows confirmation of its location within the larynx. It was possible, after preliminary experience with the test, to confirm laryngeal placement confidently in an average of 97% of cases in two concurrent series each of which consisted of 100 patients. Inevitably, there are limitations to its usefulness but it has the advantage that no special apparatus is required for its performance. The implications of this test are discussed in relation to difficult intubation, obstetric anaesthesia, the teaching of applied anatomy and checking by their trainers of intubations performed by very junior anaesthetists. Familiarity with this test should be considered essential for its reliable implementation.
Anaesthesia for laparoscopy
Authors: de GROOD P. M. R. M. , HARBERS J. B. M. , van EGMOND J. , CRUL J. F. 
Published: February 2007

SummaryThis is a report about five anaesthetic techniques for laparoscopy. Propofol and etomidate were used for total intravenous anaesthesia. Propofol, etomidate and thiopentone were used as induction agents prior to inhalational anaesthesia with isoflurane and nitrous oxide. Fentanyl was used for analgesia. Induction with propofol and thiopentone was rapid. Etomidate induction was characterised by myoclonus. Maintenance was smooth with inhalational anaesthesia. Of the groups that received total intravenous anaesthesia, propofol provided stable anaesthesia but required extra bolus doses. Recovery was the most rapid following total intravenous anaesthesia with propofol. Postoperative side effects were much lower after propofol. No difference was observed between the groups with regard to changes in arterial blood pressure and heart rate.
Controlled release morphine tablets: a double‐blind trial in patients with advanced cancer
Authors: HANKS G. W. , TWYCROSS R. G. , BLISS J. M. 
Published: February 2007

SummaryEighteen of 27 patients with pain due to advanced cancer, completed a randomised crossover comparison of4‐hourly aqueous morphine sulphate and twice daily controlled release morphine tablets. There was no difference between the two regimens in analgesic efficacy or adverse effects, but there was an apparent improvement in quality of sleep on the controlled release tablets. After completion of the study, 17 patients continued with the latter medication for periods that ranged from 2 days to 94 weeks (median 6.5 weeks). Controlled release morphine tablets given twice daily provide a simpler and more convenient treatment regimen than a 4‐hourly opioid for patients with cancer pain, once they have been stabilised.
Anaesthetic properties of pregnanolone emulsion
Authors: HØGSKILDE S. , WAGNER J. , CARL P. , SØRENSEN M. BREDGAARD 
Published: February 2007

SummaryThe anaesthetic properties of pregnanolone emulsion, a new steroid preparation for intravenous administration, were evaluated in rats and compared to those of Althesin, propofol, thiopentone and midazolam. The therapeutic index was found to be 50% higher than that of Althesin and 6–8 times higher than those of propofol, thiopentone and midazolam. Induction with pregnanolone emulsion was reliable and fast, with only minor excitatory side effects, although induction time was longer compared to Althesin, propofol and thiopentone. Movement of unstimulated rats during sleep was similar to that seen with Althesin but movement on painful stimulation was less than with propofol and thiopentone. Recovery was rapid and smooth, and the proportion of sleeping time to recovery time was higher than found for the other four anaesthetics. No cumulative effects were seen on repeated administration and there were no venous sequelae. The results indicate that pregnanolone emulsion may provide a shortacting, less cumulative and less toxic alternative to existing intravenous anaesthetic agents.
A comparison of the early pharmacokinetics of midazolam in pregnant and nonpregnant women
Authors: WILSON C. M. , DUNDEE J. W. , MOORE J. , HOWARD P. J. , COLLIER P. S. 
Published: February 2007

SummaryThe early pharmacokinetics of midazolam were compared in pregnant (active labour, awaiting and during elective Caesarean section) and matched gynaecological patients scheduled to undergo elective hysterectomy, half of whom were given an oxytocin infusion. A standard dose of 5 mg was given intravenously. For the first 15 minutes patients in labour had significantly higher plasma midazolam levels compared to all other groups. This was associated with the largest area under the curve (2 hours), the smallest volume of distribution and lowest clearance. Midazolam when given immediately before Caesarean section, can result in depression of the infant.
Interview method affects incidence of postoperative sore throat
Authors: Harding C.J. , McVey F.K. 
Published: February 2007

SummaryTwo hundred and forty‐two routine surgical patients who had undergone general anaesthesia, were questioned about postoperative sore throat by one of two methods, either direct or indirect questioning. A significantly higher incidence of sore throat was obtained by direct questioning (P < 0.001).
Comparison of epidural fentanyl with sufentanil
Authors: MADEJ T. H. , STRUNIN L. 
Published: February 2007

SummaryDuration of analgesia and side effects following single bolus doses of epidural fentanyl (100 μg) or sufentanil (10, 20, 30 or 50 μg) were studied in 50 patients who underwent Caesarean section under epidural anaesthesia. Fewer patients experienced pain peroperatively in the fentanyl group than in a joint group of those given sufentanil 20 or 30 μg (p < 0.05). The combined fentanyl and sufentanil 50 μg groups had fewer patients in pain than the sufentanil 10 μg group at 3 hours after injection (p < 0.05). Patients given fentanyl also had a longer pain‐free interval than those who received sufentanil 10 μg (p < 0.02). The sufentanil 50 μg group had more patients asleep than the 10 μg group and also had more patients with pruritus than the 10 μg or 30 μg groups (p < 0.02). The patients given sufentanil 30 and 50 μg had more emetic sequelae than those who received sufentanil 10 and 20 μg or fentanyl 100 μg (p < 0.05). There was no detectable excretion of drug into breast milk and no significant respiratory depression at the time of first postoperative analgesia in the patients who received fentanyl or 30 μg or less of sufentanil.
Low dose sufentanil pretreatment
Authors: FURNESS G. , DUNDEE J. W. , MILLIGAN K. R. 
Published: February 2007

SummaryThe effects of pretreatment with varying doses of sufentanil on the subsequent induction of anaesthesia with thiopentone, methohexitone or midazolam were studied in 240 healthy patients. The induction dose requirements for the barbiturates were significantly reduced by sufentanil 5.0 μg (methohexitone p < 0.05. thiopentone p < 0.01). Excitatory effects following methohexitone were decreased (p < 0.01) but brief respiratory depression was increased in both cases. Midazolam onset time was reduced, as was the frequency of failed induction, after sufentanil 5.0 μg (p < 0.01).
Liver tumours and muscle relaxants
Authors: BROWN T. C. K. , GREGORY M. , BELL B. , CAMPBELI P. C. 
Published: February 2007

SummaryElectromyographic studies of the onset of action of tubocurarine or alcuronium were performed on eight occasions in five patients who had liver masses. There was a slow onset of action and an increased dose requirement in those with malignant disease. Normal responses were found in a patient with benign nodular hyperplasia and in another where the malignant tumour was successfully treated with chemotherapy.
The use of opioids in neonates. A retrospective study of 933 cases
Authors: Purcell‐Jones G. , Dormon F. , Sumner E. 
Published: February 2007

SummaryThis is a retrospective study on the use of postoperative opioids in neonates admitted to the surgical intensive care unit at Great Ormond Street over a 5‐year period (1980 84). A total of 131 (14%) babies received opioids out of 933 neonates admitted to the unit. The use of opioids increased from 9.7% to 27.2% of admitted cases during the survey period. Postoperative ventilation of the lungs was necessary in 240 (25.7%) cases and 88 (36.6%) of these were given opioids. Four babies initially failed to wean from controlled ventilation as a result of opioid induced respiratory depression. A total of 51 (7.35%) spontaneously breathing neonates received opioids and seven (13.7%) of these developed apnoea or respiratory failure thought to be induced by opioids. The administration of opioids by nurses occurred most frequently in the late evening and early hours of the morning, when medical cover is at its lowest level.
Gastric emptying and small bowel transit times in volunteers after intravenous morphine and nalbuphine
Authors: YUKIOKA H. , ROSEN M. , EVANS K. T. , LEACH K. G. , HAYWARD M. W. J. , SAGGU G. S. 
Published: February 2007

SummaryGastric emptying half‐times and small intestinal transit times were measured in a double‐blind crossover study of 17 volunteers who received an intravenous injection of nalbuphine (5 or 10 mg), morphine (5 mg) or placebo. Both times were monitored using a gamma camera after a radioactive test meal and gastric emptying half‐time was calculated. Small intestinal transit time was measured by the appearance of radioactivity in the caecum and also of hydrogen in end tidal air. Gastric emptying was prolonged over placebo by nalbuphine 10 mg, which had more effect than nalbuphine 5 mg or morphine 5 mg: morphine 5 mg had less effect than nalbuphine 5 mg. Small intestinal transit time was prolonged over placebo by nalbuphine 10 mg more than by nalbuphine 5 mg or morphine 5 mg, which had approximately equal effects. In these respects, the potency ratio of nalbuphine appears roughly equivalent to morphine. Small intestinal transit times measured by end tidal hydrogen concentration and gamma camera showed close agreement.
The morphine sparing effect of ketorolac tromethamine
Authors: GILLIES G. W. A. , KENNY G. N. C. , BULLINGHAM R. E. S. , McARDLE C. S. 
Published: February 2007

SummaryA randomised, double‐blind study of patients after upper abdominal surgery was undertaken to assess the analgesic efficacy of ketorolac tromethamine, a new, parenteral non‐steroidal anti‐inflammatory agent. Postoperatively, patients received a 24‐hour intramuscular infusion of either saline (n = 20), ketorolac 1.5 mg/hour (n = 21) or ketorolac 3.0 mg/hour (n = 20). Cumulative morphine requirements were measured using a patient‐controlled analgesia system which delivered intravenous increments of morphine on demand. Pain was assessed by visual analogue scores. Arterial blood gas analyses were performed pre‐operatively and on the first postoperative day.Patients who received low and high dose ketorolac infusions required less morphine than the control group (p < 0.05 and p = 0.06, respectively). This was associated with significantly lower pain scores. Patients who received the higher ketorolac dose had significantly less postoperative increase in arterial carbon dioxide tensions than controls. This study suggests that ketorolac tromethamine is a useful analgesic drug with significant morphine sparing properties.
Intercostal catheterization
Authors: MOWBRAY A. , WONG K. K. S. , MURRAY J.M. 
Published: February 2007

SummaryTwenty‐one patients scheduled to undergo thoracotomy or median sternotomy had intercostal catheters inserted pre‐operatively. During thoracotomy, under direct vision, the spread of 20 ml of a solution containing bupivacaine and methylene blue was followed. In most cases the spread involved one or two intercostal spaces. However, in all but one patient, dye spread medially to the paravertebral space where it then spread in both caudad and cephalad directions to reach between two and five vertebrae. In three cases, dye was seen crossing the anterior surface of the vertebrae to reach the contralateral aspect. It is concluded that a major component of dermatomal block during intercostal catheterisations may be secondary to paravertebral spread.