bluuebunny/crossref_metadata_2025_split huggingface dataset:
Possible decrease in mortality associated with anaesthesia A comparison of two time periods in Massachusetts, USA
Authors: Zeitlin G. L. 
Published: February 2007

SummaryThis paper compares mortality associated with anaesthesia in Massachusetts USA, during two periods of time separated by 13 years. The denominators in the calculation of the mortality rates are not precisely comparable but there appears to be approximately a thirteenfold decrease in the death rate after general anaesthesia and a tenfold decrease after spinal anaesthesia.
Alkalinisation of bupivacaine for sciatic nerve blockade
Authors: COVENTRY D. M. , TODD J. G. 
Published: February 2007

SummaryThis double‐blind study investigates the effect of pH adjustment of bupivacaine 0.5% with adrenaline 1:200 000, on block latency, duration of analgesia and systemic absorption of local anaesthetic after sciatic nerve blockade. Twenty‐four adult patients were randomly allocated into one of two groups: Group A (n = 12) received bupivacaine with adrenaline 1:200 000 (pH 3.9) 2 mg/kg, while Group B (n = 12) received alkalinised bupivacaine with adrenaline 1:200 000 (pH 6.4) 2 mg/kg. Increasing the pH of the local anaesthetic solution significantly reduced block latency from 25 minutes in Group A to 12.5 minutes in Group B (p < 0.001) and prolonged the duration of useful analgesia from 14.1 hours to 18.3 hours (p < 0.001). There was no significant difference in plasma bupivacaine levels between the two groups. The results indicate that alkalinisation of bupivacaine reduces time to onset and prolongs the duration of useful analgesia when used for sciatic nerve blockade, without significantly increasing systemic absorption.
Occupational exposure to nitrous oxide in four hospitals
Authors: Gray W. M. 
Published: February 2007

SummaryDiffusive samplers were used to measure the exposure of the anaesthetist, anaesthetic assistant and circulating nurse to nitrous oxide in every operating theatre of four Glasgow hospitals. Each theatre was surveyed over 1 or 2 weeks; samples were taken during every operating session. The exposures were in general surprisingly high. The anaesthetist's exposure was greater than 100 ppm on more than half the occasions, while in two of the hospitals the anaesthetic nurse's exposure was greater than 100 ppm on about half the occasions. The study underlines the need for theatre ventilation systems and scavenging equipment to be properly maintained and for scavenging facilities to be used effectively. It is concluded that regular monitoring of staff exposures is required to check the effectiveness of antipollution measures.
Effect of single‐dose omeprazole on intragastric acidity and volume during obstetric anaesthesia
Authors: MOORE J. , FLYNN R. J. , SAMPAIO M. , WILSON C. M. , GILLON K. R. W. 
Published: February 2007

SummaryVarious antacid or antisecretory agents are used to reduce the risk to patients of aspiration of gastric contents during general anaesthesia and a trial of the gastric proton pump inhibitor, omeprazole, is reported here. Twenty women admitted for elective Caesarean section under general anaesthesia received a single 80‐mg oral omeprazole dose at 2000 hours on the evening before surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. Eighty‐five percent of pH measurements at induction and extubation and 80% and 95% of volume measurements at induction and extubation respectively met the defined success criteria (pH ≥ 2.5, volume < 25 ml). Omeprazole treatment was well tolerated by the women and Apgar scores and subsequent progress of the babies were acceptable. These results indicate that gastric acidity and volume were acceptable in the majority of women after omeprazole treatment, but the interval from drug administration to induction of anaesthesia may have been too long in some cases and resulted in unacceptably low pHs.
Equipment deadspace and drug administration
Authors: MACFIE A. G. 
Published: February 2007

SummaryEquipment deadspace can be a hazard in drug administration. The aim of this study was to measure the size of this problem. The deadspaces of a selection of cannulae, syringes and epidural catheters were measured by displacing the deadspace volume with water and measuring the weight gain. Between 10 and 30% of a 1‐ml intravenous dose will remain in the deadspace depending on the type and gauge of the cannulae. The deadspace of an epidural catheter and filter is approximately 1 ml. All cannulae should be flushed after drug administration. Epidural catheters must be flushed with the same solution as the test dose before insertion.
Pain on injection of propofol Methods of alleviation
Authors: JOHNSON R. A. , HARPER N. J. N. , CHADWICK S. , VOHRA A. 
Published: February 2007

SummaryA controlled randomised double‐blind design was used to study the effect of lignocaine on the pain produced by intravenous injection of propofol. Patients received a 2‐ml pretreatment solution with temporary venous occlusion, followed by an induction solution. One hundred and three patients were assigned to one of five groups: saline pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 20 mg pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 40 mg pretreatment, followed by induction with propofol plus saline 2 ml; saline pretreatment, followed by induction with propofol plus lignocaine 20 mg; or saline pretreatment, followed by induction with propofol plus lignocaine 40 mg. Pain was reduced significantly in all groups in which lignocaine was used and a dose of 40 mg was more effective than 20 mg. There were no significant differences in the incidence of pain among the groups which received lignocaine as pretreatment and the groups which received lignocaine mixed with propofol. Sixty‐eight percent of patients who experienced pain or discomfort recalled it in the postoperative period.
Epidural anaesthesia and Von Willebrand's disease
Authors: MILASKIEWICZ R. M. , HOLDCROFT A. , LETSKY E. 
Published: February 2007

SummaryA case is described of a primiparous patient with Von Willebrand's type 1 disease and diabetes who presented at 36 weeks’gestation for Caesarean section. This was performed under epidural anaesthesia in the absence of any coagulation disorder. The effects of pregnancy on coagulation factors in this disorder are discussed.
Intra‐operative pulmonary embolism after intravesical instillation of formalin
Authors: OSHIMA S. , MAEDA A. , MATSUKI A. 
Published: February 2007

SummaryIntra‐operative pulmonary embolism is a rare and severe complication which is difficult to diagnose. A case is reported in which this condition occurred after intravesical instillation of formalin during radical cystectomy under general anaesthesia. Formalin may be related to formation of intravascular thrombi and result in pulmonary embolism.
Intrathecal diamorphine during laparotomy in a patient with advanced multiple sclerosis
Authors: LEIGH J. , FEARNLEY S.‐J. , LUPPRIAN K. G. 
Published: February 2007

SummaryA patient with advanced multiple sclerosis was successfully managed for a sigmoid colectomy using spinal anaesthesia. Effective postoperative analgesia was achieved with intrathecal diamorphine administered through an indwelling intrathecal catheter, and wound infiltration with 0.25% bupivacaine.
Anaesthetic problems in ex situ resection of the liver
Authors: GROSSE H. , PICHLMAYR R. , HAUSEN B. , LÜBBE N. , KIRCHNER E. 
Published: February 2007

SummaryEx‐situ resection of the liver is a new surgical technique for treatment of liver tumours not amenable to conventional surgery. This paper describes the cardiovascular and metabolic changes that occurred in nine consecutive such patients. No severe haemodynamic or pulmonary complications occurred. Specific problems were encountered during the prolonged anhepatic period, which lasted an average of 5.96 (SD 1.46) hours. Significant metabolic and coagulation disorders occurred 2 to 3 hours after hepatectomy because of complete loss of hepatic function. The predominant findings during the anhepatic period were hypoglycaemia and severe metabolic acidosis, mainly from increased levels of lactic acid. Exogenous administration of dextrose 5% at an average rate of 188 ml/hour was necessary to maintain normoglycaemia, while correction of metabolic acidosis required 403 (SD 159.79) mmol of sodium bicarbonate, supplemented by hyperventilation. Tris‐hydroxymethylaminomethane was used when sodium overload was thought to be a problem. There was a marked decrease of Factor V and fibrinogen, a moderate thrombocytopenia and fibrinolysis. The severity of these alterations was dependent on the duration of the anhepatic period and the primary function of the re‐implanted liver.
Resistance to fluid flow through two spinal needles
Authors: TOOMEY P. J. 
Published: February 2007

SummaryA new needle, 120 mm long and 26 gauge in diameter, has been introduced for subarachnoid anaesthesia. The resistance to flow through the needle was measured using a pressure monitor infusion pump and compared with the resistance to flow through a 90‐mm 26‐gauge needle; there was a threefold increase in resistance in the 120‐mm needle compared to the 90‐mm needle, which could not be explained by the difference in length alone and must reflect a decrease in the internal diameter of the long needle. This results in difficulty in identifying the subarachnoid space by backflow of cerebrospinal fluid.
Attenuation of suxamethonium myalgias. Effect of midazolam and vecuronium
Authors: MINGUS M. L. , HERLICH A. , EISENKRAFT J. B. 
Published: February 2007

SummaryWe studied the incidence of fasciculations and postoperative myalgias in 100 female outpatients who had laparoscopy under thiopentone, N2O, isoflurane anaesthesia. Four groups of 20 patients each were pretreated with saline (group 1), tubocurarine 0.05 mg/kg (group 2), vecuronium 0.006 mg/kg (group 3), or midazolam 0.025 mg/kg (group 4), followed by suxamethonium 1.5 mg/kg. Group 5 received only vecuronium 0.1 mg/kg as relaxant (no suxamethonium). Fasciculations were graded, and postoperative myalgias rated on the first and third postoperative days. In groups 1–5 the incidence of fasciculations was 95, 15, 25, 95 and 0%; the incidence of myalgias on the first day after operation was 70, 45, 65, 75 and 60%, and on the third day after operation 20, 5, 20, 20, and 5%, respectively. We conclude that pretreatment with vecuronium, but not midazolam, decreases the incidence of fasciculations after suxamethonium (p < 0.05) and that in this patient population, postoperative myalgias appear to be unrelated to the use of suxamethonium.
Adverse haemodynamic effects of high‐dose aprotinin in a paediatric cardiac surgical patient
Authors: BÖHRER H. , BACH A. , FLEISCHER F. , LANG J. 
Published: February 2007

SummaryHigh‐dose aprotinin for reduction of intra‐ and postoperative blood loss was associated with profound hypotension and flushing in a 3.5‐year‐old child who underwent cardiac surgery. Treatment with noradrenaline and intravenous fluid was required. Cardiovascular stability was restored after 10 minutes.
Embolism during Caesarean section
Authors: Matthews N. C. , Greer G. 
Published: February 2007

SummaryWe investigated the occurrence of gas embolism during Caesarean section using a Doppler ultrasound probe and found that it occurs between uterine incision and delivery. Embolism is less common during general anaesthesia than has been reported during regional anaesthesia. Both ruptured membranes and a protracted uterine incision to delivery interval predispose to embolism.
Isolated lung transplantation for pulmonary fibrosis
Authors: Conacher I. D. , Dark J. , Hilton C. J. , Corris P. 
Published: February 2007

SummaryThe peri‐operative anaesthetic management of 11 patients with pulmonary fibrosis undergoing single‐lung transplantation is presented. Intra‐operative problems, the early postoperative phase of recovery and intensive care, and other incidents in which general anaesthesia was required for the management of complications, are featured. Results, both short‐ and long‐term, are mentioned. Major intra‐operative events that cause concern appear to be related to the severity of the presenting illness and the development of respiratory failure. Others have reported the development of intra‐operative cardiac failure. All cases were successfully managed operatively using conventional one‐lung anaesthesia, although resort to partial cardiopulmonary bypass may have been indicated in some. The indications and attitudes to utilising cardiopulmonary bypass in the evolution of techniques for facilitating single‐lung transplantation are reviewed.
Pregnanolone emulsion A preliminary pharmacokinetic and pharmacodynamic study of a new intravenous anaesthetic agent
Authors: CARL P. , HØGSKILDE S. , NIELSEN J. W. , SØRENSEN M. B. , LINDHOLM M. , KARLEN B. , BÄCKSTRØ T. 
Published: February 2007

SummaryPregnanolone emulsion, a new steroid anaesthetic agent, was administered intravenously as bolus doses to six young healthy male volunteers in a preliminary pharmacokinetic and pharmacodynamic study. The plasma concentration‐time curves fitted a two‐compartment model. The elimination half‐life was between 0.9 and 1.4 hours, volume of central compartment between 0.95 and 2.10 litres/kg, volume of distribution between 3.75 and 5.58 litres/kg and total body clearance between 1.80 and 3.07 (litres/hour)/kg. The excretion in urine of unchanged pregnanolone was less than 0.1%. The pharmacodynamic properties were found to be similar to those of Althesin, with immediate induction of anaesthesia of short duration. The anaesthetic affected haemodynamics only slightly; minor depression of ventilation, with an increase in Paco2, occurred in several of the subjects. Excitation of short duration occurred in one subject during induction of sleep and slight involuntary muscle movements in another subject during sleep. It is impossible to draw any clear conclusions of the clinical efficacy and tolerance from this limited normal subject trial, but pregnanolone emulsion seems worthy of further clinical trial.
Contralateral tension pneumothorax during thoracotomy for lung resection
Authors: GABBOTT D. A. , CARTER J. A. 
Published: February 2007

SummaryA patient underwent right thoracotomy and upper lobectomy for a mass found on routine chest radiography. He became profoundly cyanosed with a bradycardia and severe reduction in oxygen saturation at completion of surgery. The diagnosis of tension pneumothorax on the contralateral side to surgery was made and treatment instituted. The causes, treatment and implications of such an event during general anaesthesia for lung resection are discussed.
Minimum airway pressure weaning Weaning from mechanical ventilation at 50 breaths/minute by reduction of inflation pressure using a pressure generator
Authors: TAN P. S. K. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryTen patients, whose lungs were ventilated initially with intermittent positive pressure ventilation at conventional rates after myocardial revascularisation or cardiac valvular surgery, were weaned using a valveless high frequency jet ventilator at a constant rate of 50 breaths/minute. The withdrawal of ventilation was achieved, when clinical criteria permitted, by reduction of the tidal volume preset on the jet ventilator in successive stages; this was effected by stepwise decreases in the jet driving pressure. This new mode of weaning at a constant rate of 50 breaths/minute is associated with minimum peak airway pressures. Synchronisation of the patient's breathing with the valveless ventilator is not required and weaning is tolerated well by the patient. Arterial oxygen tension and saturation were maintained throughout weaning and did not decline after extubation of the trachea.
Postoperative sore throat A comparison after premedication with papaveretum/hyoscine or temazepam
Authors: VALENTINE S. , McVEY F. K. , COE A. 
Published: February 2007

Summary A randomised double‐blind trial was conducted to study the use of two commonly used premedication regimens and the subsequent incidence of sore throat. Fifty adult patients who underwent routine surgery were anaesthetised in a standard fashion after premedication with papaveretum and scopolamine or temazepam, and interviewed after operation to assess the presence of sore throat. A significantly higher incidence of sore throat was associated with the use of papaveretum and scopolamine.
Meningitis after obstetric spinal anaesthesia
Authors: ROBERTS S. P. , PETTS H. V. 
Published: February 2007

SummaryA case of meningitis after obstetric spinal anaesthesia is reported. The possible aetiological causes of postspinal meningitis are discussed and the difficulty in differentiation between aseptic and bacterial meningitis noted. Ways to reduce the risk of bacterial contamination of cerebrospinal fluid are mentioned. The patient in this case made a full recovery, but the use of spinal anaesthesia in these patients is open to question.
Opisthotonus and other unusual neurological sequelae after outpatient anaesthesia
Authors: SAUNDERS P. R. I. , HARRIS M. N. E. 
Published: February 2007

SummaryFour patients who developed unusual neurological sequelae after outpatient anaesthesia are described. Propofol is strongly implicated as the cause. All four patients were female with no previous history of psychiatric disorder or neurological disease, unpremedicated, and had procedures of duration less than 20 minutes. Hyperreflexia and hypertonicity were present postoperatively and the reactions appeared to be triggered by an external stimulus. Three patients were examined by a neurologist and had a normal electroencephalograph. Two patients were on the same operating list; quality control was carried out on the anaesthetic agents used, and blood samples sent for toxicology showed no abnormalities. Mechanisms underlying these reactions are discussed.
Maintenance of body temperature in elderly patients who have joint replacement surgery A comparison between the heat and moisture exchanger and heated humidifier
Authors: Yam P. C. Ip , Carli F. 
Published: February 2007

SummaryThe effect of a heat and moisture exchanger on intra‐operative aural canal (core) and mean skin temperatures was investigated in elderly patients who had elective total hip arthroplasty under general anaesthesia with artificial ventilation of the lungs. Group 1 (n = 20) did not receive any form of artificial humidification while in group 2 (n = 20) a heat and moisture exchanger was inserted in the breathing system and in group 3 (n = 20) the inspired gases were humidified and warmed at 40°C by means of a heated humidifier. Time of surgery, intravenous fluid administration and operating theatre temperature were standardised. Mean (SD) aural canal (core) temperature decreased significantly in groups 1 and 2 (p < 0.001), while there was a fall of 0.3°C(0.6) in group 3, which was not significant. Mean skin temperature decreased during anaesthesia and surgery in both groups 1 and 2 (p < 0.05), while it increased in group 3. There was a significantly greater loss of body heat in groups 1 and 2 compared with group 3 intra‐operatively (p < 0.001). We conclude that a heat and moisture exchanger did not prevent the decrease in intra‐operative body temperature in elderly patients.
Prevention of TUR syndrome by detection of trace ethanol in the expired breath
Authors: Hahn R. G. 
Published: February 2007

SummaryPrevious studies suggest that severe symptoms of the ‘TUR syndrome’ occur from transurethral prostatic resection only when the volume of irrigant absorbed exceeds 2000 ml. An ethanol‐containing irrigating fluid was used in this study of 100 transurethral resections so that the irrigant absorption could be monitored by measuring ethanol in expired air. Fluid absorption was found in 41 patients, and in nine of them the volume of irrigant absorbed exceeded 1000 ml. Four of these operations were terminated promptly when the ethanol monitoring indicated rapid massive absorption that threatened to exceed 2000 ml. There were few and only mild adverse effects of the irrigant by following this regimen. It is concluded that ethanol monitoring makes it possible to prevent the TUR syndrome by selective termination of those operations in which large amounts of irrigant is absorbed.
Effect of glyceryl trinitrate and ice on dilation of hand veins
Authors: WILLIAMS S. , HECKER J. F. 
Published: February 2007

SummaryApplication of glyceryl trinitrate to a finger produced significant dilation of superficial hand veins. Gently rubbing ice over these veins for one minute slightly reduced this dilation, whereas rubbing ice over veins without glyceryl trinitrate caused significant venoconstriction. These results indicate that application of glyceryl trinitrate followed by local cooling may provide a simple and painless means of assisting venepuncture.
Rupture of the oesophagus during cricoid pressure
Authors: RALPH S. J. , WAREHAM C. A. 
Published: February 2007

SummaryRupture of the oesophagus occurred during the application of cricoid pressure at induction of anaesthesia when the patient vomited. The patient, who was bleeding from a gastric ulcer, was found to have a lower oesophageal tear which, although repaired at operation, resulted in a fatal mediastinitis.
Modification of pain on injection of propofol—a comparison between lignocaine and procaine
Authors: Nicol M. E. , Moriarty J. , Edwards J. , Robbie D. S. , A'Hern R. P. 
Published: February 2007

SummaryPain on injection of propofol was assessed in a controlled, randomised study of 273 patients. They received either lignocaine 10 mg, procaine 10 mg or isotonic saline 0.5 ml, 15 seconds before the injection of propofol into a vein on the back of the hand. The incidence of pain on injection in the'control group (51%) was comparable with other studies. Lignocaine and procaine both significantly reduced the pain (35% and 34% respectively, p < 0.05) but there was no statistical difference between these two groups.
Pulmonary air embolism during laparoscopic laser cholecystectomy
Authors: GREVILLE A. C. , CLEMENTS E. A. F. , ERWIN D. C. , McMILLAN D. L. , WELLWOOD J. McK. 
Published: February 2007

SummaryWe describe a case of pulmonary air embolism that occurred during laparoscopic cholecystectomy using the neodymium: yttrium‐aluminium‐garnet laser.
Anaesthesia for Proteus syndrome
Authors: PENNANT J. H. , HARRIS M. F. 
Published: February 2007

SummaryA 14‐year‐old boy with Proteus syndrome presented for orthopaedic surgery to his legs. No report in the literature exists on anaesthesia for this condition. Our patient posed airway problems that were managed by tracheal intubation under sedation using a fibreoptic bronchoscope. Anaesthesia was induced with thiopentone and maintained with nitrous oxide and isoflurane in oxygen. His lungs were ventilated mechanically throughout surgery, which was uneventful.
The alkalinisation of bupivacaine for intercostal nerve blockade
Authors: SWANN D. G. , ARMSTRONG P. J. , DOUGLAS E. , BROCKWAY M. , BOWLER G. M. R. 
Published: February 2007

SummaryA double‐blind randomised study was performed to investigate the effect of pH adjustment of bupivacaine, with adrenaline 1: 200 000, on the duration of block and pain relief after intercostal nerve blockade following thoracotomy. One group (n = 10) received bupivacaine with adrenaline 1: 200 000 (pH = 4.1) and the other (n = 10) received alkalinised bupivacaine with adrenaline 1: 200 000 (pH = 6.9). There was no significant difference in block duration (mean 23.9 and 26.4 hours respectively) visual analogue pain scores or morphine usage. Patients were more likely to have a block during the first 12 hours if they received alkalinised bupivacaine (p < 0.01, Chi‐squared test). A progressive regression of block, not previously described, was observed, explicable by means of spread of local anaesthesia to adjacent intercostal nerves. Alkalinisation of bupivacaine with adrenaline for intercostal nerve blockade has little clinical benefit.