bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spinal analgesia using bupivacaine 0·5% plain Variation in the extent of the block with patient age
Authors: Cameron A.E. , Arnold R.W. , Ghoris M.W. , Jamieson Virginia 
Published: February 2007

SummaryBupivacaine 0·5% plain solution was used to produce spinal analgesia on 63 occasions. In 33 patients a fixed dose of 4 ml injected at the L2/3 interspace at 0·5 ml/second produced an extent of analgesia which was directly related to patient age (P < 0·005). The latency was 17·3 minutes (SD 8·4) and duration of action was 286 minutes (SD 62). A second group receiving only 1 ml of solution had a much shorter duration of action (mean 154 minutes, SD 30). In 90% of patients the analgesia obtained was fully sufficient for surgery to be performed and no form of analgesic supplementation was given. On two occasions no analgesia occurred at all. Bupivacaine 0·5% plain proved to be an effective agent for subarachnoid block. The extent of analgesia was, however, poorly predictable, and even with low doses unacceptably high levels of block were sometimes achieved.
The effect of suxamethonium on intraocular pressure
Authors: COOK J.H. 
Published: February 2007

SummaryA method is described of measuring the elevation of the intraocular pressure (IOP) caused by suxamethonium in patients in whom other factors which may cause a change in IOP are kept constant. Use of this method confirms that suxamethonium 1 mg/kg causes a statistically significant rise in IOP which lasts for 10 minutes. A rise in IOP which is not significantly different from this is caused by suxamethonium 2–5 mg/kg, suxamethonium 1 mg/kg immediately preceded by thiopentone 3 mg/kg and by suxamethonium 1 mg/kg, 3 minutes after tubocurarine 0–1 mg/kg.
Haemodilution in an eight‐month‐old infant
Authors: KRAFT M. , DEDRICK D. , GOUDSOUZIAN N. 
Published: February 2007

SummaryTransient haemodilution was carried out in an 8‐month‐old infant whose parents were Jehovah's Witnesses during an abdominoperineal pull‐through procedure. Adult ACD blood packs were altered to suit the needs of the child. With judicious fluid management, the child was extubated and did well postoperatively.
Anaphylactic‐like reaction to suxamethonium
Authors: ASSEM E.S.K. , FROST P.G. , LEVIS R.D. 
Published: February 2007

SummaryA young woman developed an anaphylactic‐type reaction during induction of anaesthesia, which was later shown to be due to suxamethonium, to which the patient had not been previously exposed. In vitro testing identified not only suxamethonium as the causative agent, but also other potentially hazardous agents, pharmacologically and chemically related to suxamethonium. Furthermore, ‘unrelated’ neuromuscular blocking drugs elicited no reaction from the patient's leucocytes, suggesting that in future anaesthesia these agents may be used with little risk. The leucocytes of the patient's parents and brother were also tested, the brother showing a minimal positive reaction. Skin testing confirmed the significance of the in vitro histamine release by the patient's leucocytes.
Experiences with fibre‐optic bronchoscopic positioning of single‐lumen endobronchial tubes
Authors: Aps C. , Towey R.M. 
Published: February 2007

SummaryThe use of flexible fibre‐optic devices for positioning single‐lumen endobronchial tubes in one‐lung anaesthesia has been assessed. The technique is safe, easily learnt and provides a useful alternative to existing methods of establishing one‐lung anaesthesia.
Minaxolone, clinical effects and pharmacokinetics
Authors: MATHER L.E. , SEOW L.T. , GOURLAY G.K. , ROBERTS J.G. , COUSINS M.J. 
Published: February 2007

SummaryMinaxolone, infused at a constant rate of 0·01 mg/kg/min produced drowsiness followed by a sleep‐like state from which subjects could be easily awakened. After the infusion was stopped, initial recovery was rapid, and completed within 45 minutes. The ability to produce this state rapidly and reversibly would have great value in outpatient surgery, short operative procedures and for basal sedation during procedures performed under regional anaesthesia. In common with many intravenous induction agents, involuntary skeletal muscle movement and twitching during the latter part of the infusion regimen was observed in some subjects. The rapid recovery was consistent with the pharmacokinetic characteristics of Minaxolone, i.e. high total body clearance (near or even exceeding that of indocyanine green) and rapid redistribution. However, renal clearance of unchanged Minaxolone was negligible.
Nitrous oxide analgesia and altitude
Authors: JAMES M. F. M. , MANSON E. D. M. , DENNETT J. E. 
Published: February 2007

SummaryThe analgesic effectiveness of 50% nitrous oxide and oxygen or oxygen‐enriched air, measured by variations in pain threshold, was studied at an altitude of 1460 m and simulated altitudes of sea level and 3300 m.At sea level pressures, 50% nitrous oxide exerted a similar analgesic effect to that found for morphine, raising the pain thresholds by a mean of 71.5%. At 1460 m, the increase in pain threshold produced was 40% and at 3300 m the increase in pain threshold was only 19%.The difference between the analgesic effects of nitrous oxide at each altitude was statistically significant. It is concluded that moderate altitudes significantly reduce the effectiveness of nitrous oxide in a manner directly related to the partial pressure of nitrous oxide at each altitude.
Continuous thoracic epidural fentanyl
Authors: WELCHEW E. A. , THORNTON J. A. 
Published: February 2007

SummaryA prospective open trial was conducted to compare the analgesic and side‐effects of continuously infused fentanyl into the thoracic epidural space with those of intramuscular papaveretum given 4 hourly as required. It was demonstrated that during the first 24 hours after upper abdominal surgery thoracic epidural fentanyl produced better analgesia with less sedation than intramuscular papaveretum. However, the epidural group suffered more nausea. Likewise, postoperative respiratory function tests were statistically significantly better in those patients who received epidural fentanyl. Despite a significantly greater volume of nasogastric aspirate during the period of study, the epidural fentanyl group also had a significantly greater urine output than did the patients receiving papaveretum. Hypotension and respiratory depression were not problems, but pruritus occurred in two patients given fentanyl. It is concluded that epidural fentanyl delivered by continuous infusion offers significant advantages over a conventional intramuscular narcotic regime.
Blood disoprofol levels in anaesthetised patients
Authors: ADAM H. K. , KAY B. , DOUGLAS E. J. 
Published: February 2007

SummaryThe blood concentrations of disoprofol (Diprivan) after single intravenous doses of 1, 2 or 3 mg/kg have been examined in a subpopulation from previously reported clinical studies. The linear relationship between sleep time and dose could be explained by the linearity of the pharmacokinetics at these doses. After a single injection the awakening concentration was independent of dose, with a mean value of 1.04 μg/ml. No acute tolerance occurred with disoprofol. On repeated 1 mg/kg bolus injections the sleeping time rose initially but stabilised after four doses. The waking concentration was independent of the number of doses administered. The clinical findings fitted an agent with a very rapid distribution phase and a short elimination half‐life.
Cardiopulmonary bypass and complement activation
Authors: JONES H. M. , MATTHEWS N. , VAUGHAN R. S. , STARK J. M. 
Published: February 2007

SummaryComplement is activated during cardiopulmonary bypass with consumption of the complement components C3, C4 and factor B. This takes place when either a bubble or membrane oxygenator is used and is not affected by steroid therapy. Complement activation is predominantly by the classical pathway and may be related to the aggregation of IgM found in bypass sera.
Anaesthesia for Caesarean section. The potential for regional block
Authors: Davis A.G. 
Published: February 2007

SummaryThis study of the obstetric and anaesthetic circumstances relating to 100 consecutive Caesarean sections under general anaesthesia suggests that the general anaesthesia rate for Caesarean section could he reduced from the present 37 to 22% by making maximum use of epidural block and to 16% by using subarachnoid block in addition. The need for general anaesthesia on account of urgency to deliver can be greatly reduced by the administration of epidural analgesia during labour in patients identified as being more likely than average to require Caesarean section, and by the use of subarachnoid block when the need for section arises unexpectedly. Patients' objections to undergoing Caesarean section while conscious were analysed, and suggestions are made for minimising the number of patients who decline. Technical problems with blocks may sometimes be overcome without resort to general anaesthesia, while patients at risk from haemorrhage or coagulopathy will continue to require general anaesthesia.
Hypotensive anaesthesia for microsurgery of the middle ear. A comparison between enflurane and halothane
Authors: Eltringham R.J. , Young P.N. , Fairbairn M.L. , Robinson J.M. 
Published: February 2007

SummaryOne hundred patients undergoing microsurgery of the ear were anaesthetised using thiopentone, nitrous oxide, oxygen and either halothane or enflurane with spontaneous respiration. Blood pressure was reduced to approximately 70 mmHg by the use of hypotensive agents.The efficacy of halothane and enflurane in producing good operating conditions was compared during this technique. Haemostasis was assessed by the surgeon who was unaware which volatile agent was being used. Both agents were found to be satisfactory and enflurane was shown to be a safe and reliable agent with this technique should an alternative to halothane be required. No impairment of renal function was seen with either agent in combination with hypotension.
Haloperidol as an adjunct analgesic in the management of postoperative pain
Authors: Judkins K.C. , Harmer M. 
Published: February 2007

SummaryThirty‐four patients have been studied to evaluate the effect on postoperative analgesia of haloperidol in two doses as a premedicant compared with a placebo. Analgesia was provided by tin on‐demand system and assessed by visual analogue score. No significant difference was noted between the groups in regard to analgesic requirements or degree of pain relief. However, potent anti‐emesis was clearly demonstrated.
The ‘induction’ dose of thiopentone
Authors: DUNDEE J. W. , HASSARD T. H. , McGOWAN W. A. W. , HENSHAW J. 
Published: February 2007

SummaryStudy of the minimal dose requirements for induction of anaesthesia poses great problems which are solved by the use of a standard administration technique and the abolition of the eyelash reflex as an endpoint. This has been used in 2206 consecutive unselected inductions, in which variables considered to be likely to influence the dosage were recorded. Milligram per kilogram is the most acceptable method of expressing the average dosage of thiopentone. Doses follow a right skew distribution. Women required a significantly lower average dose of thiopentone than men, while obese patients required less than others. Moderate or heavy drinking increased the induction dose but the use of tobacco did not have any influence. The most important factors governing dosage are the physical fitness of the patient and the premedication used. Patients in ASA grades 1 and 2 required significantly more thiopentone than those in grades 3 and 4. This effect is as great as that of premedication in which an opiate with a phenothiazine or hyoscine markedly reduced the induction dose. It was more important than the patient's pre‐operative condition with respect to sedation or apprehension. Small doses of opiates or benzodiazepines do not have as much effect on dosage.
Peri‐operative management of insulin‐dependent diabetic patients. Use of continuous intravenous infusion of insulin‐gluocose‐postassium solution
Authors: Bowen D.J. , Nancekievill M.L. , Proctor E.A. , Norman J. 
Published: February 2007

SummaryThe effect of a constant intravenous infusion of an insulin‐glucose‐potassium mixture was studied on 20 insulin‐dependent patients undergoing elective surgery. The infusion provided insulin 2 units, glucose 10 g and potassium 4 mmol every hour.It was concluded that the infusion was simple to use and could be administered safely for periods up to 4 hours. After that time the insulin dosage should be reassessed to maintain good control of the blood glucose levels.
The influence of haemoglobin and plasma urea levels on the induction dose of thiopentone
Authors: DUNDEE J. W. , HASSARD T. H. 
Published: February 2007

SummaryA standard method was used for estimating the induction dose of thiopentone. In 1812 patients there was a positive relationship between the induction dose and the haemoglobin levels of patients. In 1711 patients an inverse relationship was found between the induction dose and plasma urea. Both of these findings can be explained by alterations in plasma binding of thiopentone.
Respiratory injury in the burned patient
Authors: CLARK C. J. , REID W. H. , TELFER A. B. M. , CAMPBELL D. 
Published: February 2007

SummaryThe purpose of the study was to investigate the role of flexible bronchoscopy in the management of patients admitted to a busy Regional burns unit, with particular reference to possible smoke inhalation injury. The basic procedure employed was that used in routine bronchoscopy for the diagnosis of bronchial carcinoma, with modification of the premedication required in view of the shorter duration of the technique and the lack of a requirement for bronchial biopsy. We have found the procedure easy to perform, well tolerated by the patients and not associated with any complications. It provides additional information not otherwise available, which can influence the subsequent management of the patient. An experienced bronchoscopist and additional personnel skilled in resuscitation techniques are required. It should be performed in patients with clear evidence of smoke inhalation injury and in particular with facial burns in order to visualise the extent of airway injury, remove debris and give some indication of the likelihood of subsequent complications such as acute upper airways obstruction.
Effects of nitrous oxide on pressure changes of tracheal tube cuffs following inflation with air and saline
Authors: PATEL R. I. , OH T. H. , EPSTEIN B. S. 
Published: February 2007

SummaryThe effects of nitrous oxide diffusion on tracheal tube cuff pressure following inflation with air and saline were studied at a temperature of 37°C. The pressure in the cuff inflated with air increased more rapidly and to a higher level (about 200 mmHg) than pressure in the cuffs inflated with saline (about 12 mmHg).
Closed system enflurane in oxygen
Authors: Robins D. W. 
Published: February 2007

SummaryA safe method of administering enflurane from a Goldman vaporizer in a closed system is described, using a fresh gas, flow of 0.5 litres/minute of oxygen. There was a drawback, in that, until the system was closed, insufficient concentration of enflurane was achieved in seven out of 20 patients, who then moved on surgical incision, When the system was closed, the concentration of enflurane increased so that satisfactory anaesthesia occurred. The maximum inspired concentration of enflurane in the system was 4.5% which occurred in one patient on the 3rd notch of the Goldman. A portable interference refractometer was used to measure the percentage of enflurane.
Cardiac output and the recumbent position in late pregnancy
Authors: NEWMAN B. , DERRINGTON C. , DORE C. 
Published: February 2007

SummaryChanges in cardiac output were measured by transcutaneous aortovelography in 30 pregnant patients and in 30 control subjects with change of position from the supine. When compared to the supine position, the left and right lateral and left 15 till positions caused statistically significant increases in cardiac output, whereas the right 15 tilt position did not. Neither fetal head engagement nor the lime spent in each position had significant effects on the changes in cardiac output. It was not possible to identify a subgroup of pregnant patients who were particularly sensitive to changes in posture.
Adrenal suppression following extradural steroids
Authors: JACOBS S. , PULLAN P. T. , POTTER JULIA M. , SHENFIELD G. M. 
Published: February 2007

SummaryAdrenocortical function was tested in 12 patients following a single lumbar extradural injection ofmethyl‐prednisolone acetate (‘Depo‐Medrol’) 80 mg as treatment for chronic sciatica. There was no absorption of the corticosteroid into the systemic circulation, but marked suppression of plasma Cortisol levels was documented for up to 3 weeks following the injection and the capacity of the adrenal cortex to secrete Cortisol in response to synthetic adrenocorticotrophin (ACTH) was diminished. These results suggest that the dose and frequency of extradural steroid administration should be kept to a minimum to prevent suppression of the hypothalamicjpituitaryladrenocortical axis and that patients thus treated should he considered candidates for steroid cover during surgery and other stressful procedures.
A comparison of intramuscular and sublingual buprenorphine, intramuscular morphine and placebo as premedication
Authors: O'SULLIVAN G. , BULLINGHAM R. E. S. , MCQUAY H. J. , POPPLETON P. , ROLFE M. , WEIR L. , MOORE R. A. 
Published: February 2007

SummaryBuprenorphine premedication by two routes, 0.4 mg sublingual and 0.3 mg intramuscular was compared double‐blind, double‐dummy with intramuscular morphine 10 mg and placebo in 74 patients undergoing elective total hip replacement.Anxiety, depressive mood, sedation, vital signs and side‐effects were measured before surgery. All patients then received a standardised general anaesthetic using a muscle relaxant and ventilation. The effects of the premedication on the anaesthetic were assessed by a scoring system. Intra‐ and postoperative blood gases, plasma Cortisol and glucose were measured and the 1 hour postoperative pain intensity, side‐effects and sedation were assessed.No differences between the premedications were seen on any of the pre‐, intra‐ or postoperative measurements, suggesting that even with adequate measurement sensitivity it is difficult to distinguish opiate from placebo premedication.
Acute renal failure in an intensive care unit: incidence, prediction and outcome
Authors: WILKINS R. G. , FARAGHER E. B. 
Published: February 2007

SummaryA review of the case notes of 475 patients with no history of renal disorder admitted to an intensive care unit, showed that 23% (109) developed acute renal failure. This complication occurred more commonly in patients with major burns (75%), and following surgery to the abdominal aorta (38%), but less commonly after self‐poisoning episodes (5%).Scores were provided from stepwise multiple regression analysis which were derived from the diagnostic group, the presence of sepsis, the presence of systolic hypotension and age, and correctly predicted development of acute renal failure in 79% of the cases studied. Attempted prophylaxis appears to have little effect on the incidence of acute renal failure whilst dialysis reduced the mortality from 95% to 72%. Use of the scoring system to allow earlier diagnosis and treatment of acute renal failure could reduce the present mortality by 43%.
Narcotics and spasm of the sphincter of Oddi. A retrospective study of operative cholangiograms
Authors: Chisholm R.J. , Davis F.M. , Billings J.D. , Gibbs J.M. 
Published: February 2007

SummaryThe operative cholangiograms of 112 patients undergoing elective cholecystectomy were reviewed independently and retrospectively by two radiologists who were not aware of the anaesthetic technique used. Fifty four patients who received opioid drugs either pre‐ and/or intra‐operatively comprised one study group whilst 58 patients who received no opioids comprised the other. Spasm of the sphincter of Oddi was observed in two patients in the opioid group and in one patient in the non‐opioid group. The use of opioid drugs as part of the anaesthetic management for cholecystectomy did not appear to interfere with the radiological interpretation of operative cholangiography nor to increase the low incidence of spasm of the sphincter of Oddi.
Acute epiglottitis and severe croup
Authors: WELCH D.B. , PRICE D.G. 
Published: February 2007

SUMMARY The case histories of 50 children who required tracheal intubation for epiglottitis or croup in two English regions have been reviewed. The incidence of severe croup was different in the two regions. The presentation of epiglottitis was variable, and the correct diagnosis was frequently made only at laryngoscopy. Unexpected and rapid deterioration occurred in both diseases, and cyanosis was commonly present on hospital admission and at laryngoscopy. Two children required planned tracheostomy and there were two deaths. The principles of safe management are discussed.
Grading of pain and anxiety
Authors: BHACHU H. S. , KAY B. , HEALY T. E. J. , BEATTY P. 
Published: February 2007

SummaryComparison of a linear analogue scale on paper and a computerised audiovisual analogue scale presented on a visual display unit is described. Pain was assessed postoperatively in 109 patients and anxiety pre‐operatively in 146 patients. Results show a strong correlation between gradings obtained using the two methods, indicating the computerised method is as reliable as the conventional one.
The management of insulin dependent diabetes during cardiopulmonary bypass and general surgery
Authors: THOMAS D. J. B. , HINDS C. J. , REES G. M. 
Published: February 2007

SummaryTwo groups of insulin dependent diabetic subjects have been studied: six undergoing general surgical procedures und six undergoing hypothermic cardiopulmonary bypass surgery for coronary artery vein grafting. Intravenous glucose insulin mixtures were infused from the onset of surgery in both groups of patients, supplying 0.4 units of insulin per gram of glucose per hour, and 0.6 units of insulin per gram of glucose per hour in general and cardiac surgical patients respectively. Postoperatively diabetes was controlled carefully with an insulin syringe pump regulated by venous blood glucose monitoring. In cardiac surgical patients far more insulin was required to control diabetes postoperatively than in the generul surgery patients (at 1 hour 1.6 units, SEM 0.4 compared to 0.7 SEM 0.1, p < 0.05; and at 4 hours 2.0 units SEM 0.3 compared to 0.8 units SEM 0.1, p < 0.02). Five non‐diabetic subjects who underwent surgery for coronary artery venous bypass grafting were also studied. They developed significant postoperative hyperglycaemia (5.0. SEM 0.2, mmol/litre pre‐operutively, compured with 8.8. SEM 0.7, mmol/litre p < 0.03 ul I hour and 10.2, SEM 1.7, mmolilitre, p < 0.02 at 4 hours after bypass terminated).
Zebulon Mennell
Authors: HUNTER A. R. 
Published: February 2007

SummaryDr Zebulon Mennell, the first anaesthetist to devote himself largely to anaesthesia for neurosurgery, was horn on 15 June 1876. He graduated at St Thomas's Hospital in London, where he was an anaesthetist. He was also an anaesthetist at the Royal National Hospital for Nervous Diseases, Queen Square, London, a post which he held until 1945. His writings indicate that he appreciated the problems of neurosurgical anaesthesia and he was the first individual to work in this field as a specialist.
Unrecognised presentation of a meningioma
Authors: FRASER A. C. L. , GOAT VALERIE A. 
Published: February 2007

SummaryA general anaesthetic was followed by a rapid progression of signs and symptoms subsequently attributable to a meningioma. The general anaesthetic had been uneventful except for a significant delay in recovery. The interaction between general anaesthesia and intracranial masses is discussed and the conclusion reached that in cases of prolonged recovery from anaesthesia underlying intracranial pathology should always be suspected.