bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health and activity after intensive care
Authors: MUNN J. , WILLATTS S. M. , TOOLEY M. A. 
Published: February 2007

SummaryAll patients discharged from a general intensive care unit over a 4.5 year period were sent a questionnaire 3 months after discharge which investigated aspects of their health and physical abilities. Replies were compared on the basis of age, diagnosis and sickness severity on admission. Five hundred and four questionnaires were analysed. Overall, 47% of patients described their health as good/very good, 42% as fair and 11% as poor/very poor. Activity level, compared to that before their admission, was unchanged in 59%, worse in 33% and improved in 8% of patients. There were no differences in health status or changes in activity with age, diagnosis or severity of sickness. Patients aged 76 years or older were more likely to perceive their health as‘better than average’ than younger patients (p < 0.01). Eight percent of patients would be unwilling to undergo intensive care again. An unacceptable health status after intensive care cannot be predicted in any group of patients.
External high frequency oscillation in normal subjects and in patients with acute respiratory failure
Authors: AL‐SAADY N. M. , FERNANDO S. S. D. , PETROS A. J. , CUMMIN A. R. C. , SIDHU V. S. , BENNETT E. D. 
Published: February 2007

SummaryExternal high frequency oscillation was performed on 20 healthy volunteers using a cuirass‐based system, the Hayek Oscillator. Five‐min periods of oscillation were carried out on each subject at frequencies of 1, 2, 3, 4 and 5 Hz. Effective ventilation was measured in terms of the fall in alveolar partial pressure of carbon dioxide immediately after oscillation. The optimum frequency for oscillation was 1–3 Hz but most of the subjects were adequately ventilated over a wide range of frequencies. Thus, the Hayek Oscillator is capable of adequately ventilating normal subjects by means of chest wall oscillation. We also compared external high frequency oscillation with intermittent positive pressure ventilation in five patients with respiratory failure. Using the same inspired oxygen fraction, the external high frequency oscillation replaced intermittent positive pressure ventilation for a 30‐min period. External high frequency oscillation improved oxygenation by 16% and reduced the arterial carbon dioxide by 6%. These preliminary findings suggest that normal subjects and intensive care unit patients can be adequately ventilated by means of external high frequency oscillation.
Evaluation of a new method for determining tracheal tube length in children
Authors: FREEMAN J. A. , FREDRICKS B. J. , BEST C. J. 
Published: February 2007

SummaryMost paediatric tracheal tubes are marked in centimetres from the tip. In 105 children, nasotracheal tube length was set at the level of the vocal cords such that all 3.0 and 3.5 mm internal diameter tubes were placed with the 3 cm mark at the cords, all 4.0 and 4.5 tubes were set at 4 cm at the cords and all 5.0 and 5.5 tubes were set at 5 cm at the cords. Subsequent chest X ray showed that 79% of the tracheal tubes were in the ideal midtracheal position, one tube was marginally short and 20% of the tubes were marginally long. Neither bronchial intubation nor accidental extubation occurred in any subject. This is an effective method to determine tracheal tube length which may be used for both oral and nasal intubation.
Comparison of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient‐controlled analgesia
Authors: Alexander R. , Lovell A. T. , Seingry D. , Jones R. M. 
Published: February 2007

SummaryIn a randomised, placebo‐controlled trial we have compared the efficacy of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient‐controlled analgesia after orthopaedic surgery. One hundred and forty five patients, ASA 1 and 2, undergoing major orthopaedic surgery were anaesthetised using a standardised technique. They were randomly allocated to receive patient‐controlled analgesia as morphine 1 mg.ml‐1 alone; morphine as before plus a single dose of 1.25 mg droperidol together with 0.083 mg.ml‐1 in the infusion syringe; or morphine as before plus 4 mg ondansetron and 0.13 mg.ml‐1 in the syringe. The patient‐controlled analgesia bolus dose was set at 1 ml with a 5 min lockout and a 4 h maximum dose of 30 mg morphine. There was no background infusion. The occurrence of nausea, vomiting and sedation was assessed every 4 h. The incidence of vomiting decreased from 59% in the morphine‐only group to 35% and 14% in the droperidol (p < 0.05) and ondansetron groups (p < 0.001) respectively. The number of patients suffering from nausea alone was not significantly different between the three groups, although those in the ondansetron group experienced less severe nausea (p < 0.05) when using a two point scale. The droperidol group had significantly higher sedation scores than the other two groups (p < 0.005). We conclude that ondansetron is superior to droperidol when used with patient‐controlled analgesia and causes less sedation.
A prospective study to assess the demand for a high dependency unit
Authors: And C. G. LEESON‐PAYNE , AITKENHEAD A. R. 
Published: February 2007

SummaryWe performed a prospective study in our teaching hospital to determine the demand for a High Dependency Unit where none had existed before. An admission criteria protocol was designed for medical and surgical patients and this was used in an intense surveillance of 22 acute wards over 2 weeks. It was predicted that a high dependency unit of eight beds would operate to capacity 50% of the time. An analysis of this type over a short period of time using similar admission criteria could be used to assist in the prediction of the necessary size of a High Dependency Unit facility in any hospital.
Prevention of nausea and vomiting after day case gynaecological laparoscopy
Authors: PAXTON L. D. , McKAY A. C. , MIRAKHUR R. K. 
Published: February 2007

SummaryWe have compared the efficacy of ondansetron, metoclopramide, droperidol and placebo in the prevention of postoperative nausea and vomiting in 118 day stay patients undergoing laparoscopic gynaecological procedures. All received a standardised general anaesthetic offentanyl, propofol, nitrous oxide in oxygen and isoflurane. Three to five min before induction of anaesthesia, patients were allocated to receive ondansetron 4mg, metoclopramide 10 mg, droperidol 1 mg or placebo in a randomised, double‐blind manner. Visual analogue scores for nausea, the incidence of emetic episodes, and analgesic and antiemetic consumption were recorded for 48 h postoperatively. The scores for nausea were significantly lower in the ondansetron group (p < 0.01) compared with the other three groups at 1, 2 and 4h after operation; thereafter there was no difference. The incidence of erne sis was lower (p = 0.063) and time to first oral fluids was shorter (p < 0.05) in the ondansetron group. Oral analgesic requirements were significantly greater in the ondansetron group over the 48 h study period. Two patients, one each in the placebo and metoclopramide groups, had to remain in hospital overnight because of persistent emetic symptoms.
Somatosensory evoked potential changes following electro‐acupuncture therapy in chronic pain patients
Authors: KUMAR A. , TANDON O. P. , BHATTACHARYA A. , GUPTA R. K. , DHAR D. 
Published: February 2007

SummarySomatosensory evoked potentials were recorded in 20 healthy volunteers and 20 patients with chronic pain undergoing electro‐acupuncture therapy. The values of absolute peak latency and amplitudes of N19 and P22 in the control group were compared with the corresponding baseline values in the study group and after electro‐acupuncture therapy at three stages during a 10‐treatment cycle. On these occasions the intensity of pain was recorded using a 100 mm visual analogue scale score. Each patient in the study group had 10 treatments given on alternate days. The absolute peak latency of N19 was significantly delayed (p < 0.05) in chronic pain patients when compared to the control group. This increase in latency of N19 persisted after the first electro‐acupuncture treatment (p < 0.05), tended to revert to normal after the fifth treatment (p > 0.05) and reverted completely to control values after the 10th treatment (p > 0.05). Visual analogue scores also decreased significantly (p < 0.05) after the fifth and 10th electro‐acupuncture sessions. These observations suggest that there is an interaction of the neural mechanisms of electro‐acupuncture with the thalamic generator of somatosensory evoked potentials i.e. N19.
Prolonged starvation in paediatric surgery
Authors: Veall G. R. Q. 
Published: February 2007

SummaryAn evaluation of the pre‐operative preparation of 285 children attending Sheffield Children's Hospital for elective surgery showed that prolonged and unnecessary starvation takes place, particularly in children over 1 year of age who have their operation in the morning. Excessive starvation of children is unkind and unnecessary. In order to prevent it a revision of current starvation guidelines is required.
Discrepancy of recovery times related to potency between atracurium and mivacurium simultaneously administered in isolated forearms
Authors: KIM S. Y. , HWANG K. H. , OK S. Y. , KIM S. I. , KIM S. C. , PARK W. 
Published: February 2007

SummaryRecovery from potent non‐depolarising muscle relaxants is slower than from the less potent agents. However, recovery from mivacurium, which is more potent than atracurium, is faster than from atracurium following systemic administration. In an attempt to confirm this discrepancy we compared recovery times following simultaneous administration of equipotent doses of atracurium and mivacurium into the isolated forearms of human volunteers (n = 10). This method enabled us to study the interaction of muscle relaxants with receptors at the neuromuscular junction separated from the effects of plasma drug concentration. In these experiments, the recovery times from maximum block to 50% recovery of control twitch height were significantly longer with mivacurium than with atracurium (mean 25.2(SD 4.7) versus 22.6(3.1) min, p < 0.01). We found that the evidence that mivacurium has a slower recovery than the less potent atracurium may be true using the bilateral isolated forearm technique and that the discrepancy might be due to a difference in the pharmacokinetic variables of the two drugs.
Improved P CO2 measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry
Authors: KNICHWITZ G. , MERTES N. , KUHMANN M. 
Published: February 2007

SummaryThe measurement of gastric intramucosal pH serves as a non‐invasive technique for early detection of gastrointestinal ischaemia in critically ill patients. The method is based on the determination of the partial pressure of carbon dioxide in a 0.9% saline solution using a standard blood gas analyser. However, the use of standard blood gas analysers leads to an underestimation of carbon dioxide partial pressure in saline. Instrumental biases of six blood gas analysers were investigated using either a saline or a phosphate‐buffered solution. Both test solutions were equilibrated with five defined carbon dioxide concentrations. Each blood gas analyser underestimated this defined partial pressure of carbon dioxide with a bias between ‐3.7% and ‐57.5% if saline was used. The phosphate‐buffered solution considerably improved instrumental precision, resulting in biases between +2.7% and ‐17.6%. Thus, a phosphate‐buffered solution increases the accuracy of gastric intramucosal pH measurement.
Hereditary angioneurotic oedema: current management in pregnancy
Authors: Cox M. , Holdcroft A. 
Published: February 2007

SummaryA 20‐year‐old primiparous woman, with a history of type 1 hereditary angioneurotic oedema, presented for induction of labour. She was hirsute, obese and presented technical difficulties for both general and epidural/spinal anaesthesia. Her management included prophylactic C1 esterase inhibitors and epidural analgesia for pain relief. A spontaneous vaginal delivery was achieved and no adverse complications occurred. Five days after delivery she had abdominal pain which was investigated and resolved spontaneously. The management of this condition is discussed.
The role of continuous positive airway pressure during weaning from mechanical ventilation in cardiac surgical patients
Authors: BAILEY C. R. , JONES R. M. , KELLEHER A. A. 
Published: February 2007

SummaryWe investigated the effects of providing patients with continuous positive airway pressure during a short weaning period from mechanical ventilation to extubation. Following elective primary aortocoronary bypass surgery employing cardiopulmonary bypass, 80 patients received intermittent positive pressure ventilation for 5 h. At the end of this time patients were randomly allocated to one of the following three groups for a 2 h period of spontaneous respiration prior to extubation: group CPAP0 = T‐piece circuit (n = 27); group CPAP5 = 5cmH2O of continuous positive airway pressure (n = 27); group CPAP10 = 10cmH2O of continuous positive airway pressure (n = 26). Following extubation, pulmonary gas exchange was assessed after 1,2,4, and 24 h. All patients had good pre‐operative lung function. There was a significant increase in the median alveolar‐arterial oxygen partial pressure difference and a decrease in the oxygenation index in all three groups during the period of added inspired oxygen which persisted until 24 h post‐extubation, but there were no differences between the groups. In patients with good pre‐operative lung function requiring primary aortocoronary bypass surgery, the use of continuous positive airway pressure confers no advantage over a simple T‐piece attachment during the short period of weaning from mechanical ventilation to extubation.
Movement of oral and nasal tracheal tubes as a result of changes in head and neck position
Authors: HARTREY R. , KESTIN I. G. 
Published: February 2007

SummaryThe tracheas of 20 ASA grade 1 and 2 patients were each consecutively intubated with an oral and nasal cuffed tracheal tube. Measurements of tube movement, as the position of the head and neck altered, were made with a fibreoptic bronchoscope. Both oral and nasal tubes moved an average distance of 15 mm towards the carina with head and neck flexion and 8.5 mm away with head and neck extension. Movement in both directions occurred with lateral rotation of the head. Optimal placement of tracheal tubes can be aided with a single guide mark placed 3 cm proximal to the cuff and 8 cm proximal to the distal end, which may reduce complications arising from this movement. This is a better method in women than inserting a pre‐determined length of tracheal tube measured from the lips or nares. However, current guide marks vary in their position relative to the cuff and tip of the tube.
The effect of nasal oxygen flow and catheter position on the accuracy of end‐tidal carbon dioxide measurements by a pharyngeal catheter in unintubated, spontaneously breathing subjects
Authors: ØBERG B. , T. WALDAU  , LARSEN V. H. 
Published: February 2007

SummaryReliable recordings of carbon dioxide concentrations during spontaneous respiration can be obtained from a catheter positioned in the hypopharynx. The present study investigated the possible influence on end‐tidal carbon dioxide measurement of nasal oxygen administration, position of the sampling catheter and mouth breathing. The study demonstrated that not only can reliable capnographic tracings be obtained from a thin catheter placed in the unintubated airway, but the subject may also receive up to 6 l.min‐1 of oxygen via the nasal route without interference with the accuracy of the measurements. Furthermore, the exact position of the sampling catheter tip in the airway is not critical, which means that it may be placed where it causes the patient least discomfort. Finally, mouth breathing caused a mean decrease in end‐tidal carbon dioxide of 0.25kPa compared to nose breathing.
The TOF‐Guard neuromuscular transmission monitor
Authors: LOAN P. B. , PAXTON L. D. , MIRAKHUR R. K. , CONNOLLY F. M. , McCOY E. P. 
Published: February 2007

SummaryThe TOF‐Guard neuromuscular monitor uses an accelerometer to measure the response to nerve stimulation. In this study, we have compared it to a standard mechanomyographic monitor, the Myograph 2000, for neuromuscular monitoring in 28 subjects. A train‐of‐four mode of stimulation was used in both cases. The times taken for onset of block, and for the recovery of T1 (the first response in the train of four) to 25% of control, the time from recovery of T1 from 25–75% and for the recovery of the train of four ratio to 0.7 were compared with the two monitors. There was a good correlation between the two devices for both onset and recovery times. However, differences were highlighted when the data were analysed by the method of Bland and Altman. The 95% limits of agreement for the T1 recovery to 25%, as measured by the TOF‐Guard, ranged from 5 min less to 8 min more than when measured by the Myograph 2000. For recovery of the train of four ratio to 0.7, the limits of agreement were approximately 6 min in either direction. The 95% limits for the TOF‐Guard measured train of four ratio were from 0.47 to 0.99, at the Myograph reading of 0.7. We recommend that information from the TOF‐Guard and the Myograph 2000 should not be used interchangeably. However, the TOF‐Guard is likely to improve considerably on tactile evaluation of the responses to stimulation.
An assessment of portable carbon dioxide monitors during interhospital transfer
Authors: DONNELLY J. A. , SMITH E. A. , HOPE A. T. , ALEXANDER R. J. T. 
Published: February 2007

SummaryFour portable carbon dioxide monitors were assessed by a mobile intensive therapy team during interhospital transfer of critically ill patients. Particular attention was paid to practical considerations such as size, battery life and ease of use. All the monitors performed well in terms of accuracy but problems with size and battery life made some less suitable for use outside hospital.
Lifting and handling of patients by anaesthetists
Authors: Luntley J. B. , Ross J. 
Published: February 2007

SummaryThe process of transferring patients from the operating table was assessed in a district general hospital. The survey was conducted in two parts; a confidential questionnaire was sent to all members of the department and a month long assessment of three anaesthetists’ caseload was undertaken. All the anaesthetists questioned had scanty knowledge of the relevant manual handling regulations. Although 70% of anaesthetists questioned lift and transfer patients on a regular basis, none had received any relevant training. Ninety‐six percent of patient transfers were performed by two staff alone, even though there were five or more staff available to assist at 95% of transfers. Difficulty in transferring patients occurred in 32% of cases. Improvement of training anaesthetists in safe manual handling procedures is recommended.
Awareness during anaesthesia for implantable cardioverter defibrillator implantation
Authors: Moerman A. , Herregods L. , Foubert L. , Poelaert J. , Jordaens L. , D'Hont L. , Roily G. 
Published: February 2007

SummaryImplantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. After induction, anaesthesia was maintained using continuous infusions of propofol and atracurium and intermittent boluses of alfentanil. Propofol was given in the same arm as the implantation side. In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.
Difficult direct laryngoscopy in patients with cervical spine disease
Authors: CALDER I. , CALDER J. , CROCKARD H. A. 
Published: February 2007

SummaryTwo hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classification proposed by Cormack and Lehane. The overall prevalence of difficulty (grades 3 and 4) was 20%. Patients with disease that includes the occipito‐atlanto‐axial complex have a higher prevalence of difficulty than those with disease below the axis vertebra. Occipito‐atlanto‐axial disease is associated with poor mandibular protrusion. The best single predictor of difficulty was reduced separation of the posterior elements of the first and second cervical vertebrae on lateral radiographs. The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator of poor cranio‐cervical extension. Difficulty was rare in patients with class A mandibular protrusion, and invariable in patients with class C protrusion.
The effect of nitrous oxide on the performance of psychomotor tests
Authors: CHEAM E. W. S. , DOB D. P. , SKELLY A. M. , LOCKWOOD G. G. 
Published: February 2007

SummaryThe effect of different nitrous oxide concentrations on the performance of psychomotor tests (inspection time, tapping frequency, critical flicker fusion, picture memory and time sense) was investigated in seven healthy volunteers. The results show a dose‐related impairment of memory, a reduction in tapping frequency and an increase in inspection time. A paradoxical increase in critical flicker‐fusion threshold was observed. There was no effect on critical fusion‐flicker threshold or time sense. Recovery was incomplete for memory tests performed 20 min after withdrawal of nitrous oxide. Subjective effects persisted for several hours.
The clinical pharmacology of doxacurium in young adults and in elderly patients
Authors: MARTLEW R. A. , HARPER N. J. N. 
Published: February 2007

SummaryNeuromuscular blockade induced by doxacurium 30 μg.kg‐1 was compared in 21 young (18–55years) and 17elderly (65–85years) patients. Anaesthesia was induced with thiopentone and maintained with fentanyl, nitrous oxide in oxygen and isoflurane. Neuromuscular blockade was measured electromyographically (Datex Relaxograph) at the adductor pollicis using train‐of‐four stimuli at 20 s intervals. The depth of maximum neuromuscular blockade was similar in young and elderly patients (median 100% compared to 96%). However, the onset was significantly slower in the elderly: their mean (SD) time to 90% suppression of the first response of the train‐of‐four was 7.7 (1.8)min compared to 5.7 (1.7)min in the young (p = 0.002). Four min after doxacurium, the conditions for tracheal intubation were significantly poorer in the elderly (p < 0.001). Mean (SD) recovery of first response of the train‐of‐four to 25% of control was unaffected by age: young 79.0 (41.6)min; elderly 66.2 (32.1)min (p > 0.05). When the first response had reached 25% of control, neuromuscular blockade was antagonised with neostigmine 60 μg.kg‐1. The mean time to first response to 90% of control was similar in the young and the elderly patients (9.1 min compared to 10.4 min). Recovery of the train‐of‐four ratio to 0.7 was significantly slower in the elderly: mean (SD) 17.1 (10.6) min compared to 10.1 (7.0) min (p = 0.03). Doxacurium was associated with clinically insignificant haemodynamic changes in both groups.