bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of droperidol and cyclizine in the prevention of postoperative nausea and vomiting associated with patient‐controlled analgesia
Authors: Walder A. D. , Aitkenhead A. R. 
Published: September 2007

SummaryFifty ASA 1 or 2 patients scheduled to undergo major gynaecological surgery were allocated randomly to one of two groups. All patients received a standard anaesthetic regimen. Patients in group 1 received droperidol 1.25 mg given intravenously 20min prior to the end of surgery and a patient‐controlled analgesia infusion containing morphine 1 mg.ml‐1 and droperidol 0.05 mg.ml‐1. Patients in group 2 received cyclizine 50 mg by slow intravenous injection 20 min prior to the end of surgery and a patient‐controlled analgesia infusion containing morphine 1 mg.ml‐1 and cyclizine 2 mg. ml‐1. Fifteen of 25 patients (60%) in group 1 and 18 (72%) of 25 in group 2 suffered no nausea or vomiting postoperatively. Two patients (8%) in group 1 and three (12%) in group 2 suffered severe postoperative nausea or vomiting. We conclude that cyclizine is as effective as droperidol in the prevention of postoperative nausea and vomiting when included in a patient‐controlled analgesia infusion using morphine.
Hypertension, admission blood pressure and perioperative cardiovascular risk
Authors: HOWELL S. J. , SEAR Y. M. , YEATES D. , GOLDACRE M. , SEAR J. W. , FOËX P. 
Published: September 2007

SummaryWe performed a retrospective case‐control study to investigate hypertension and admission blood pressure as risk factors for postoperative cardiovascular death. We identified records of 76 patients who had died of a cardiovascular cause within 30 days of anaesthesia and elective surgery and 76 matched controls. From the records of each patient (case and control) we recorded the admission blood pressure and details of any history of hypertension. A pre‐operative history of hypertension was strongly associated with perioperative cardiovascular death (p < 0.001 with one degree of freedom: odds ratio 4.14, 95% confidence intervals 1.63–11.69). There was no association between systolic or diastolic pressure at admission for operation and perioperative cardiovascular death. The mean admission systolic pressure of the cases was 145.5 mmHg (range 90–250 mmHg) and that of the controls was 146.5 mmHg (range 100–200 mmHg). The mean admission diastolic pressure of the cases was 83.2 mmHg (range 60–130 mmHg), and that of the controls was 84.5 mmHg (range 60–110 mmHg).
Pre‐operative parental anxiety
Authors: THOMPSON N. , IRWIN M. G. , GUNAWARDENE W. M. S. , CHAN L. 
Published: September 2007

SummaryThis study attempts to identify the incidence and specific sources of anxiety in the parents of children admitted to hospital for elective surgery, to isolate factors associated with increased anxiety and to identify useful ameliorative measures. One hundred parents were interviewed and completed a questionnaire before their child's surgery. Parental anxiety levels were measured using the Leeds scale for self‐assessment of anxiety. Anxiety‐related illness was identified in 47% of parents, who were significantly more concerned than others about all aspects of their children's hospitalisation. No factors were identified which could predict which parents were at high risk of developing an anxiety state. When questioned about educational and interventional measures which they felt would be reassuring, the same factors were identified by ‘anxious’ and ‘non‐anxious’ parents. As all parents agree on useful ameliorative factors, a general advice and education programme would be appropriate.
Premature failure of battery‐powered syringe pumps
Authors: TATMAN A. , BRUNNER H. , STOKES M. 
Published: September 2007

SummaryFailure of battery‐powered equipment during the interhospital transfer of patients is potentially life threatening. The time to failure of 60 fully‐charged identical syringe pumps (20 from each batch purchased in 1992, 1994 and 1995) was measured. Older pumps were associated with less predictable charge capacity, with 40% of the 1992 pumps failing within 60 min. The premature failure of these pumps is most likely due to poor battery care. It is unsafe to assume that a fully‐charged, battery‐powered pump will continue to function throughout a long transfer. The routine carriage of spare pumps or a backup power supply is recommended.
Anaesthetic management of a quadriplegic patient with severe respiratory insufficiency undergoing Caesarean section
Authors: Ahmed A. B. , Bogod D. G. 
Published: September 2007

SummaryThe anaesthetic management of a 30‐year‐old pregnant quadriplegic patient with severe respiratory insufficiency undergoing Caesarean section is described. Quadriplegia and respiratory insufficiency pose potential problems for anaesthetists and these are discussed. In particular autonomic hyperreflexia may occur and this may be mistaken for pre‐eclampsia.
Acute stridor as a presentation of bilateral abductor vocal cord paralysis
Authors: Strauss A. , Finder M. , Lipman J. , Conidaris M. 
Published: September 2007

SummaryWe report the case of a 48‐year‐old woman, referred to the Intensive Care Unit with community‐acquired pneumonia, who was noted to have stridor of acute onset. Subsequent indirect laryngoscopy revealed bilateral abductor vocal cord paralysis, secondary to unsuspected carcinoma of the oesophagus, requiring immediate tracheostomy. We highlight the importance of visualisation of the vocal cords in cases of stridor of uncertain aetiology.
Compartment syndrome as a complication of the prolonged use of the Lloyd‐Davies position
Authors: Goldsmith A. L. , McCallum M. I. D. 
Published: September 2007

SummaryCompartment syndrome in the legs is a rare complication of the prolonged use of the lithotomy position. We report two cases of compartment syndrome developing as a complication of the prolonged use of the Lloyd‐Davies position. Both patients received combined general and epidural anaesthesia and postoperative epidural analgesia. The diagnosis was delayed in the first case, resulting in the avoidable complications of renal failure and permanent neuromuscular dysfunction.
Comparison of sufentanil/propofol versus isoflurane/nitrous oxide anaesthesia on mesenteric artery blood flow
Authors: Zwijsen J. H. M. J. , Bovill J. G. , Geelkerken R. H. , Delahunt T. A. , Van Bockel J. H. , Hermans J. 
Published: September 2007

SummaryDuplex sonography was used to determine the changes in mesenteric arterial blood flow occurring in patients undergoing aortic surgery, anaesthetised either by total intravenous anaesthesia with propofol and sufentanil (group A) or inhalational anaesthesia with isoflurane and nitrous oxide (group B). Sixteen patients were studied. Measurements were performed immediately before and 15 min after induction of anaesthesia, before surgery. There was a 38% decrease (p = 0.015) in the superior mesenteric artery end diastolic velocity in group A and a 23% decrease (p = 0.033) in the superior mesenteric artery peak systolic velocity in group B. There were no changes in any of the other sonography parameters in either group. We conclude that neither total intravenous anaesthesia with propofol and sufentanil nor inhalational anaesthesia with isoflurane and nitrous oxide have any clinically significant influence on mesenteric blood flow in the absence of surgical stimulation.
The analgesic efficacy of tenoxicam versus placebo in day case laparoscopy: a randomised parallel double‐blind trial
Authors: Windsor A. , McDonald P. , Mumtaz T. , Millar J. M. 
Published: September 2007

SummaryThe analgesic efficacy and duration of action of tenoxicam, an injectable non‐steroidal analgesic with a long elimination half‐life, were studied in day case laparoscopy in a double‐blind randomised prospective parallel placebo‐controlled trial. Tenoxicam 20 mg or saline was given intravenously at induction of anaesthesia in 67 women undergoing day case investigative laparoscopy for infertility or abdominal pain. Outcome measures were time to first analgesia, pain levels at 2, 4 and 24 h plus postoperative analgesic consumption in hospital and at home. The study showed no statistically significant difference in any of these measures between the two groups. Tenoxicam 20mg intravenously immediately pre‐operatively cannot be recommended for day case surgery on the basis of this study.
Intra‐ocular pressure changes during gynaecological laparoscopy
Authors: LENTSCHENER C. , BENHAMOU D. , NIESSEN F. , MERCIER F. J. , FERNANDEZ H. 
Published: September 2007

SummaryLaparoscopic surgery carried out under general anaesthesia is associated with physiological changes, which also determine changes in intra‐ocular pressure. We measured intra‐ocular pressure at each phase of gynaecological laparoscopy, carried out under propofol‐alfentanil‐isoflurane general anaesthesia, in young women of ASA 1 status, with no pre‐existing eye disease. Measurements were made with a Perkins applanation tonometer. Mean arterial pressure and end‐tidal CO, tension were kept constant throughout the study. Intra‐ocular pressure decreased significantly after induction of anaesthesia, remained unchanged after a pneumoperitoneum of up to an intraperitoneal pressure of 15 mmHg had been created, increased significantly with head down tilt, but did not increase significantly above pre‐induction values. Adequate depth of anaesthesia compensated for the intra‐ocular pressure increase caused by head down position. Plateau airway pressure, considered as reflecting intrathoracic pressure, increased with intraperitoneal pressure elevation. However, such changes did not correlate with intra‐ocular pressure changes.
Blood flow in the lower limbs in the knee‐chest position: Ultrasonographic study in unanaesthetised volunteers
Authors: LAAKSO E. , AHOVUO J. , ROSENBERG P. H. 
Published: September 2007

SummaryThe knee‐chest position for lumbar spine surgery is favoured because decreased filling of the epidural veins is associated with reduced peroperative bleeding. However, the position may be unfavourable from a circulatory point of view. In the present study, non‐invasive assessment of circulation in the lower limbs was performed in 21 unanaesthetised, healthy volunteers who were placed in the surgical knee‐chest position. Measurements included blood flow velocity (colour Doppler ultrasonography), oscillotonometric arterial blood pressure from upper and lower limbs and pulse oximetry from a toe. There was a statistically significant reduction in the posterior tibial artery flow velocity, maximally 31.6%, when the subject was moved from the prone to the knee‐chest position. An enlargement of the trunk‐femoral angle at the hip did not improve arterial flow. In 10 of the 21 volunteers, no flow in the posterior tibial vein was detected in the knee‐chest position. In spite of the deteriorated blood flow, pulse oximetry indicated sufficient capillary flow in the very periphery of the lower limb. The change from prone to knee‐chest position resulted in an increase in arterial blood pressure of the upper limb; the increase in diastolic arterial pressure was statistically significant (p < 0.001). It is concluded that the surgical knee‐chest position involves deterioration of both the arterial and venous flow of the lower limbs. This should be considered in patients undergoing surgery in this position and, in particular, in those at risk of developing cardiovascular complications.
Respiratory effects of spinal anaesthesia for Caesarean section
Authors: Kelly M. C. , Fitzpatrick K. T. J. , HILL D. A. 
Published: September 2007

SummaryWe report the changes observed in a number of pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow, forced expiratory volume in one second, forced vital capacity, forced expiratory volume in one second to forced vital capacity ratio and the maximal mid‐expiratory flow. Significant changes occurred that are consistent with a restrictive ventilatory defect. These changes persisted for four hours after the induction of spinal anaesthesia. Administration of 35% oxygen by facemask failed to change significantly fetal umbilical vein pH or partial pressure of oxygen.
A ventilation‐exchange bougie for fibreoptic intubations with the laryngeal mask airway
Authors: ATHERTON D. P. L. , O'SULLIVAN E. , LOWE D. , CHARTERS P. 
Published: September 2007

SummaryThe ventilation‐exchange bougie is a new airway device which can be mounted on a fibreoptic laryngoscope for passage through the larynx into the trachea via a laryngeal mask airway. Subsequent removal of the fibreoptic laryngoscope and laryngeal mask airway allows a tracheal tube to be railroaded into position over the ventilation‐exchange bougie. This study described the use of this technique for elective tracheal intubation in two groups of 12 subjects in whom difficulty with intubation was not expected. All the subjects were successfully intubated by one of two anaesthetists, one experienced and the other inexperienced with fibreoptic intubation techniques. Neither had had prior experience with the ventilation‐exchange bougie. Because ventilation was maintained throughout the procedure, intubation did not need to be hurried. Cusum analysis confirmed the impression of a learning curve and the technique could be considered learnt after four and six intubations for the experienced and inexperienced fibreoptic larvngoscopists respectively. No difficulty was found either in intubating the larynx with the fibreoptic laryngoscope and ventilation‐exchange bougie or when railroading the tracheal tube over the ventilation‐exchange bougie. It is suggested that this new device could have an important role in teaching fibreoptic techniques, management of the difficult airway and failed intubations.
Pruritus—itching for a cause and relief?
Authors: KAM P. C. A. , TAN K. H. 
Published: September 2007

SummaryThe mechanisms of pruritus, an unpleasant irritation on the skin that provokes an urge to scratch, are reviewed. Whilst symptomatic treatment is only partially effective, antihistamines remain the first choice of treatment. However, recent novel treatment using opiate antagonists, propofol (subhypnotic doses) and serotonin antagonists offer attractive alternatives.
Sciatic nerve palsy following childbirth
Authors: Silva M. , Mallinson C. , Reynolds F. 
Published: September 2007

SummaryTwo cases are reported of sciatic nerve palsy after delivery by Caesarean section in primigravidae. One mother was slender and had an emergency Caesarean section for failure to progress with a breech presentation. Epidural analgesia during labour was extended for operative delivery. The other mother was obese, mildly hypertensive, had a large baby with a high head and was delivered by elective Caesarean section under epidural anaesthesia. She experienced severe intrapartum hypotension. Both patients suffered right sided sciatic nerve palsy. The aetiologies of obstetric palsies and those following regional block are reviewed and the importance of careful diagnosis and of avoiding peripheral nerve compression during regional block are emphasised.
Epidural anaesthesia, ephedrine and phenylephrine in a patient taking moclobemide, a new monoamine oxidase inhibitor
Authors: Martyr J. W. , Orlikowski C. E. P. 
Published: September 2007

SummaryWe report a case of low thoracic epidural and general anaesthesia in a patient receiving moclobemide, a new selective inhibitor of monoamine oxidase A. Intra‐operative hypotension was initially treated with phenylephrine and then with ephedrine. The short half‐life of moclobemide and its modest interaction with direct and indirect acting sympathomimetic drugs permit the use of epidural anaesthesia, since any associated hypotension can be safely treated.
Acquired laryngomalacia as a cause of airway obstruction immediately after unilateral mouth floor surgery
Authors: Mima H. , Ishida H. , Yamazaki K. 
Published: September 2007

SummaryWe report a case of acquired laryngomalacia in which airway obstruction due to prolapse of the epiglottis during inspiration was observed immediately after a unilateral mouth floor resection. Suggested causes are resection of unilateral elevator muscles of the hyoid bone, epiglottic oedema and transient loss of pharyngeal motor control due to surgical intervention and high‐dose radiation.
Lithium toxicity
Authors: Vipond A. J. , Bakewell S. , Telford R. , Nicholls A. J. 
Published: September 2007

SummaryWe report a case of severe lithium toxicity precipitated by a thiazide diuretic and compounded by an angiotensin converting enzyme inhibitor. There was severe vasodilatation refractory to noradrenaline.
Spinal anaesthesia and spina‐bifida occulta
Authors: Davies P. R. F. , Loach A. B. 
Published: September 2007

SummaryWe describe a patient with unexpected spina bifida who underwent spinal anaesthesia for trans‐urethral resection of prostate and developed serious neurological signs. An unexpected spinal tumour was removed two weeks later. This report demonstrates that not all neurological problems associated with spinal anaesthesia should be blamed on the technique.
Tissue expander causing iatrogenic difficult intubation
Authors: Chadha I. A. , Multani S. T. , Chadha A. 
Published: September 2007

SummaryDifficulty during tracheal intubation may occur due to a number of anatomical factors and pathological conditions. These factors may be influenced by earlier surgical manoeuvres, so that dificulty may occasionally be encountered at subsequent operation. One such case of‘iatrogenic’dificulty, where a tissue expander beneath the anterolateral skin of the neck caused transient intubation problems, is reported.
A comparison of prophylactic ondansetron and metoclopramide administration in patients undergoing major neurosurgical procedures
Authors: Pugh S. C. , Jones N. C. , Barsoum L. Z. 
Published: September 2007

SummaryIn a prospective, randomised, double‐blind trial, we assessed the relative efficacy of prophylactic ondansetron and metoclopramide administration in the reduction of postoperative nausea and vomiting in 60 patients undergoing routine major neurosurgical procedures. The patients were randomly allocated into one of two groups. Both groups received a standardised anaesthetic. When the dura mater was closed, patients in group A received an intravenous injection of metoclopramide 10 mg whilst group B received ondansetron 8 mg intravenously. Patients who received metoclopramide experienced less postoperative nausea and vomiting than those who received ondansetron in the 48 h following surgery (17 (56%) versus 9 (30%) p = 0.038). In the light of these findings, we believe that ondansetron is an inappropriate agent for the prevention of postoperative nausea and vomiting in the neurosurgical population.
The incidence of post dural puncture headache in children
Authors: Wee L. H. , Lam F. , Cranston A. J. 
Published: September 2007

SummaryOne hundred and five children with malignant disease attended for lumbar puncture which was performed under general anaesthesia. A questionnaire was answered over the next three days to determine the incidence of post dural puncture headache. Ninety‐seven questionnaires were returned and the results show that no child aged under ten years developed a headache. Of the children aged 10–12 years, two out of seventeen developed a headache (11.8%). In children aged 13–18 years, five out of ten developed a headache (50%).
Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask
Authors: Drage M. P. , Nunez J. , Vaughan R. S. , Asai T. 
Published: September 2007

SummaryWe have studied the efficacy of the loss of response to jaw thrust as a clinical test to assess adequate depth of anaesthesia for insertion of the laryngeal mask in 60 patients. After induction of anaesthesia with propofol (infused using a syringe driver), the patients were randomly allocated to one of two groups. In one group, insertion of the laryngeal mask was attempted immediately after the loss of verbal contact and in the other group, after the loss of motor response to a jaw thrust. Conditions for insertion of the laryngeal mask were assessed. The mean dose of propofol required to obtain loss of verbal contact was 1.94 mg. kg−1(SD 0.39, 95% confidence intervals (CI) 1.79–2.08 mg. kg−1) and that for the loss of response to jaw thrust was 2.55mg. kg−1(SD 0.46, 95% CI 2.38–2.72 mg. kg−1). When depth of anaesthesia was assessed using jaw thrusting, it was always possible to insert the mask and the conditions were optimal in 87% (95% CI 72–95%) of patients. Neither coughing nor gagging occurred. In contrast, conditions were almost always less than optimal when insertion was attempted after the loss of verbal contact. Conditions were significantly better when jaw thrust was used as a clinical test compared with loss of verbal contact (p = 0.001). No marked haemodynamic depression occurred in any patient. Thus, jaw thrust is a reliable clinical test to assess the adequate depth of anaesthesia for uncomplicated insertion of the laryngeal mask after induction of anaesthesia with propofol.
The optimal dose of ketamine for caudal epidural blockade in children
Authors: Semple D. , Findlow D. , Aldridge L. M. , Doyle E. 
Published: September 2007

SummarySixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml. kg−1 of 0.25% bupivacaine with 0.25 mg. kg−1of preservative‐free ketamine, group B received 1 ml. kg−1 of 0.25% bupivacaine with ketamine 0.5mg. kg−1 and group C received 1 ml. kg−1 of 0.25% bupivacaine with 1 mg. kg−1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. The median duration of caudal analgesia was 7.9h in group A, 11 h in group B and 16.5 h in group C. There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.
Pre‐operative oral administration of morphine in day‐case gynaecological laparoscopy
Authors: Rasanayagam R. , Harrison G. 
Published: September 2007

SummaryThe analgesic effect of morphine sulphate 10 mg by mouth given pre‐operatively on pain after gynaecological laparoscopy was studied in a randomised, prospective, double‐blind, placebo‐controlled comparison. Two groups of 56 patients were studied, one group undergoing diagnostic laparoscopy and the other laparoscopic sterilisation. All patients received a standard anaesthetic after premedication with morphine or placebo 1 h before the operation. Morphine premedication did not significantly influence postoperative pain as assessed on a visual analogue scale in either group and postoperative opioid consumption was unaffected. Premedication with morphine Wmg orally does not significantly decrease pain after day‐case gynaecological laparoscopy.