bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new keyed vaporizer filler
Authors: WITTMANN P. H. , WITTMANN F. W. , CONNOR J. , CONNOR T. 
Published: February 2007

SummaryA new design of keyed filler with a dead space of 1.1 ml was used with 50 bottles of isoflurane to fill vaporizers. The volume of isoflurane remaining in the‘empty’bottle, the residual volume, was measured. The trial was repeated using the old style filler which has a dead space of 3.3 ml. The new filler reduced the mean residual volume by 73% but still did not completely empty the bottle.
Haemodynamic effects of R 80122 immediately after cardiopulmonary bypass; preliminary results
Authors: Herregods L. , Roily G. , Van Belleghem Y. , Van Nooten G. 
Published: February 2007

SummaryR 80122 is a new short‐acting phosphodiesterase type III inhibitor. In a preliminary investigation, three patients, scheduled for coronary artery bypass surgery, were given R 80122 after weaning from cardiopulmonary bypass. Two patients received 10μig.kg‐1.min‐1 for 10 min as a loading infusion followed by a 5 μg.kg‐1.min‐l maintenance dose. One patient received a 20 μg.kg‐1.min‐1 for 10 min loading infusion followed by a 10 μg.kg‐1min‐1 maintenance infusion. After weaning from cardiopulmonary bypass and during the administration period, no arrhythmias or cardiac ischaemia were detected. The administration of R 80122 improved the haemodynamic profile with an increase in cardiac output, a decrease in systemic vascular resistance and a stable heart rate and mean arterial blood pressure. These preliminary results indicate that R 80122 possesses positive inotropic activity in combination with vasodilating properties.
Calculation of inspired oxygen fraction during anaesthesia based on awake oxygen saturation
Authors: Mandal P. , Chaudhary S. 
Published: February 2007

SummaryOne hundred ASA grade 1 or 2 patients were studied to assess the use of awake oxygen saturation to determine the necessary inspired oxygen fraction during anaesthesia. The inspired oxygen fraction was adjusted gradually to the lowest possible value to maintain the pre‐operative oxygen saturation at a constant level. Normocapneic ventilation was maintained and analgesia was provided with 0.5mg.kg‐1 of pethidine given intravenously. In addition to routine monitoring and measurement (electrocardiograph, oxygen saturation, expired carbon dioxide concentration and noninvasive blood pressure), arterial samples for blood gas analysis and venous samples for lactate and pyruvate levels were taken when awake and 30 min after achieving a steady state with a minimum inspired oxygen fraction. The mean inspired oxygen fraction required in these patients was 20.91 (SD 1.92%) ranging from 18–25%. The arterial pH were 7.34 (SD 4.04) (awake) and 7.35 (SD 3.15) (after 30 min), the partial pressure of oxygen 13.17 (SD 1.97) (awake) and 13.83 (SD 1.6 kPa) (after 30 min) and the partial pressure of carbon dioxide and base excess were normal. Serum lactate levels were 1.04 (SD 0.25) (awake) and 1.15 (SD 0.48) (after 30 min) mmol.l‐1, whilst pyruvate levels were 0.1 (SD 0.02) (awake) and 0.12 (SD 0.21) (after 30 min) mmol.l‐1. Patients’recovery and postoperative course were uneventful.
Chair dental anaesthesia: a survey of current and intended practice in Mersey Region
Authors: Barrett P. J. , Skinner A. C. , Whelan E. 
Published: February 2007

SummaryWe performed a questionnaire survey to establish the current and intended practice of chair dental anaesthesia amongst recently appointed consultants, and senior registrars within the Mersey Region. Only 26% of the consultants surveyed practised chair dental anaesthesia, however, more consultants would have had their anaesthetic sessions allowed. Consultants performed 4.62 ± 3.5 sessions per month and anaesthetised 8.0 ± 2.27 patients per session. Cases were mostly performed in community dental centres. The most common reason for discontinuing the practice of chair dental anaesthesia was the Poswillo report and its implications. Sixty‐eight per cent of senior registrars declared an interest in chair dental anaesthesia. This group had received significantly more training (p < 0.005) in dental anaesthesia than those with no interest. Most anaesthetists (52/71) felt that chair dental anaesthesia was acceptable in centres approved to Poswillo standards; 16 anaesthetists felt that it should be confined to a hospital environment and three felt that it should not be performed at all.
A comparison of different modes of noninvasive ventilatory support: effects on ventilation and inspiratory muscle effort
Authors: ELLIOTT M. W. , AQUILINA R. , GREEN M. , MOXHAM J. , SIMONDS A. K. 
Published: February 2007

SummaryThe aims of noninvasive ventilation include the correction of hypoventilation and unloading of inspiratory muscles. Volume cycled flow generators, bi‐level positive airway pressure and continuous positive airway pressure techniques have all been used with face and nasal masks. We have compared these modes of ventilatory support, administered by a nasal mask in stable, awake outpatients with chronic obstructive pulmonary disease or neuromusculo‐skeletal disease in respect of their effects on ventilation, inspiratory muscle effort and oxygen saturation. There were no clinically significant differences between the volume cycledflow generator and bi‐level positive airway pressure methods; compared to spontaneous ventilation, oxygen saturation increased and inspiratory muscle effort decreased. Tidal volume increased and respiratory rate reduced, the largest changes occurring with bi‐level positive airway pressure. Only the volume cycledflow generator increased minute ventilation significantly. Ventilation and inspiratory muscle effort were unaffected by continuous positive airway pressure but oxygen saturation was lower than during spontaneous ventilation. In awake, stable outpatients acclimatised to nasal ventilation there were no clinically significant differences between volume cycledflow generator and bi‐level positive airway pressure techniques, but continuous positive airway pressure was less effective.
A simple method for monitoring the concentration of inhaled nitric oxide
Authors: PETROS A. J. , COX P. , BOHN D. 
Published: February 2007

SummaryNitric oxide is a potent endogenous vasodilator involved in the homeostatic control of systemic blood pressure. It has also recently been demonstrated that when inhaled in low concentrations it acts as a specific pulmonary vasodilator. The concept of inhaled nitric oxide as a form of therapy is almost an anathema to anaesthetists. However, nitric oxide is being used increasingly for the treatment of persistent pulmonary hypertension of the neonate and in the adult respiratory distress syndrome. One major limitation to its frequent and widespread use is the problem of measuring the concentration of nitric oxide delivered. Currently, the gold standard technique used is chemiluminesence. However, the equipment required is costly and can be difficult to use. If the use of inhaled nitric oxide increases and it develops a therapeutic role then its applications may be limited only to centres which can afford such equipment. Others may be prevented from using a potentially valuable therapy due to lack of a controlled delivery system for nitric oxide. An inexpensive, simple alternative technique to chemiluminesence is described, which will allow most intensive care units the freedom to use inhaled nitric oxide if necessary.
Severe tracheal stenosis and operative delivery
Authors: SUTCLIFFE N. , REMINGTON S. A. M. , RAMSAY T. M. , MASON C. 
Published: February 2007

SummaryWe report the management of anaesthesia for Caesarean section in a woman with severe extensive tracheal stenosis. Management was initially with spinal anaesthesia, but general anaesthesia became necessary as a result of profuse intra‐operating bleeding. We describe the use of the Hayek oscillator cuirass ventilator to allow instrumentation of the larynx whilst maintaining respiratory support, and for weaning from mechanical ventilation.
Determination of the reliability of three scoring systems to evaluate children after general anaesthesia
Authors: KEEGAN N. J. , YUDKOWITZ F. S. , BODIAN C. A. 
Published: February 2007

SummaryThe inter‐observer reliabilities of three scoring systems (Excitement Score, Face Mask Acceptance Score, Steward Score) were assessed by pairs of independent evaluators who observed 21 children during emergence from general anaesthesia. Each scoring system was analysed using the intraclass correlation coefficient giving values of 0.997 and 0.988 for the Excitement and Face Mask Acceptance Scores, respectively. Those for the Steward Score were 0.956, 0.924 and 0.295for the‘consciousness’,‘airway’, and‘movement’subdivisions, respectively. Ambiguous wording and inexplicit instructions may explain the lower correlations for the Steward Score. Reliability of scoring systems cannot be assumed and systems of undocumented reliability bring into question the results of the studies in which they are employed.
Lignocaine test dose to detect intravenous injection
Authors: MICHELS A. M. J. , LYONS G. , HOPKINS P. M. 
Published: February 2007

SummaryThe accidental intravascular injection of bupivacaine or etidocaine epidurally has resulted in several maternal deaths. To be effective, a test dose must allow detection of intravenous catheter placement and prevent accidental intravenous injection. This study was designed to determine the dose of lignocaine required for this purpose. Sixty healthy gynaecological patients were allocated randomly to receive an intravenous dose of normal saline (group 1), lignocaine 0.5 mg.kg‐1 (group 2) or 1 mg.kg‐1 (group 3) 3 min prior to induction of anaesthesia. At 1 min intervals the patients were asked about subjective symptoms produced by this‘test dose’In group 2 only 50% of patients reported a positive test dose, whereas in the patients of group 3, a significantly greater percentage (95%) had a positive test dose (p < 0.01). This suggests that the use of 1 mg.kg‐1 lignocaine as a test dose would result in a significantly higher sensitivity for detecting intravascular injection than the use of 0.5 mg.kg‐1
The effects of pethidine, fentanyl and lignocaine on postanaesthetic shivering
Authors: ALFONSI P. , HONGNAT J.‐M. , LEBRAULT C. , CHAUVIN M. 
Published: February 2007

SummaryPethidine is reported to be more effective than equi‐analgesic doses of other opioids as an inhibitor of postanaesthetic shivering. The aim of this study was to verify whether this action resulted from a local anaesthetic effect of pethidine or from inadequate fentanyl dosage in previous studies. We studied 52 ASA 1 or 2 patients. They were randomly allocated, in a double ‐blind fashion, to one of four groups to receive either pethidine (0.85 mg.kg‐1) or fentanyl (1.7 μg.kg‐1) or lignocaine (1 mg.kg‐1) or 0.9% saline. All the patients were shivering and had a core temperature below 36°C during recovery from non‐septic abdominal or orthopaedic surgery. After 15 min, all the patients given saline were still shivering, as were 92% in the lignocaine group. In contrast, only 23% of the patients who were given fentanyl still shivered (p < 0.01 versus saline) and 8% in the pethidine group (p < 0.001 versus saline). The mean (SD) core temperature in the pethidine group was slightly lower than that in the fentanyl group (35.1 (0.6) and 35.9 (0.5)) when the patients stopped shivering. Furthermore, shivering restarted in 6/10 patients in the fentanyl group after 15 min compared with 1/12 in the pethidine group. Our results show that fentanyl (1.7μg.kg‐1) can inhibit postanaesthetic shivering but this effect is less pronounced and of shorter duration than with pethidine (0.85 mg.kg‐1).
The influence of ketanserin or urapidil on haemodynamics, stress response and kidney function during operations for myocardial revascularisation
Authors: PETRY A. , WULF H. , BAUMGÄRTEL M. 
Published: February 2007

SummaryThe study was performed to investigate the different effects of ketanserin and urapidil on haemodynamics, kidney function and plasma catecholamine and aldosterone levels. Forty male patients scheduled for myocardial revascularisation were assigned at random to two groups: group K received ketanserin, group U received urapidil. Anaesthesia consisted of fentanyl, flunitrazepam and pancuronium. Haemodynamic variables were evaluated at eight predefined time points of the operation. Creatinine and free‐water clearance as well as plasma levels of adrenaline, noradrenaline and aldosterone were measured in three different periods of the operation. While the groups showed no clinically relevant differences in the haemodynamic variables and the hormone plasma concentrations, the creatinine clearance in group K was slightly increased in the period after cardiopulmonary bypass. Both ketanserin and urapidil prevented hypertension even in the presence of elevated catecholamine plasma levels during and after cardiopulmonary bypass.
Effects of propofol and Intralipid on immune response and prostaglandin E2 production
Authors: PIRTTIKANGAS C.‐O. , SALO M. , RIUTTA A. , PERTTILÄ J. , PELTOLA O. , KIRVELÄ O. 
Published: February 2007

SummaryThe present study evaluated the effects of propofol and its solvent Intralipid on the immune response and in vivo prostaglandin E2 production in patients during induction of anaesthesia and in healthy volunteers after Intralipid injection. Fifteen female patients (median age 48 years, ASA 1‐2) scheduled for uterine dilatation and curettage were randomly assigned to two groups. In group 1 propofol (median dose 3.1 mg.kg‐1) and in group 2 thiopentone (median dose 6.0 mg.kg‐1) were injected intravenously over 60s. Surgery was started after collection of the last blood sample. In the second part of this study, Intralipid 10% 0.3 ml. kg‐1 was injected intravenously in eight healthy volunteers (four women and four men, median age 32 years) over 60s. Plasma bicyclo‐PGE2 concentrations increased during anaesthesia induction in both anaesthetic groups (p<0.01). By contrast, no changes were seen in plasma bicyclo‐PGE2 concentrations after Intralipid injection in volunteers. Lymphocyte proliferative responses to mitogens did not change during anaesthesia induction in patients. In volunteers, Intralipid injection caused a slight increase in T‐cell percentages (p<0.01) and unstimulated lymphocyte proliferative responses (p<0.05), but it did not affect other lymphocyte subsets and immunoglobulin production. Intralipid and propofol were not found to be immunosuppressive at clinical doses used during anaesthesia induction.
Air embolism during awake craniotomy
Authors: Scuplak S.M. , Smith M. , Harkness W.F.J. 
Published: February 2007

SummaryA case of venous air embolism during awake craniotomy is described. Chest pain and electrocardiographic changes were the major presenting features. Capnography detected a decrease in end‐tidal carbon dioxide and demonstrates its use as an aid in the diagnosis of air embolism in the awake patient. Following this episode persistent hypoxaemia developed secondary to acute pulmonary oedema and a pleural effusion.
An adaptation of the objective structured clinical examination to a final year medical student course in anaesthesia and intensive care
Authors: Critchley L. A. H. , Short T. G. , Buckley T. , Gin T. , O'Meara M. E. , Oh T. E. 
Published: February 2007

SummaryThe Department of Anaesthesia and Intensive Care at the Chinese University of Hong Kong provides a 4 week course in our specialty for final year medical students. Our curriculum covers basic concepts in anaesthesia and intensive care, management of common medical emergencies and the safe performance of basic practical skills. For the last 4 years we have used an adaptation of the Objective Structured Clinical Examination to assess learning. Question stations included the use of manikins to assess practical skills, such as cardiopulmonary resuscitation and airway management, identification and description of the use of equipment and interpretation of clinical scenarios and investigations. We believe that our adaptation of the Objective Structural Clinical Examination is better than traditional methods of examination and it has allowed us to identify deficiencies in our teaching methods. The Objective Structured Clinical Examination has been well received by our students and is perceived by them to be a fair reflection of their level of knowledge and skill attainment during the course.
A cadaver study appraising accuracy of blind placement of percutaneous tracheostomy
Authors: DEXTER T. J. 
Published: February 2007

SummaryAn attempt was made to place a percutaneous catheter between the first and second cartilaginous rings of the trachea in 20 cadavers presenting for postmortem examination. Only nine of the catheters entered the trachea in the intended space. All catheters which were noted to be difficult to place entered the trachea higher than intended. One third of all catheters punctured the thyroid isthmus.
The Ohmeda Universal PAC drawover apparatus
Authors: LUNN D. V. , YOUNG P. C. 
Published: February 2007

SummaryThe Ohmeda Universal PAC drawover apparatus, a modification of an earlier series of vapour‐specific vaporizers, was assessed with regard to its output under varying gas flows and temperatures and its clinical usage with isoflurane and enflurane. The device tended to over‐deliver vapour, particularly at low flows and at high temperatures. Its clinical performance during spontaneous and positive pressure ventilation was satisfactory, although adequate concentrations were not achieved using enflurane in the spontaneous ventilation mode. The device was not assessed with ether or halothane. The robust construction, relatively large capacity and thermocompensation make it suitable for field or military anaesthesia.
Case reports Cardiopulmonary complications during anaesthesia and surgery for severe thoracic lordoscoliosis
Authors: Bagshaw O. N. T. , Jardine A. 
Published: February 2007

SummaryA 15‐year‐old girl underwent a posterior spinal fusion procedure for severe lordoscoliosis. On turning to the prone position acute posture‐related upper airway obstruction occurred. During surgery, manipulation of the spine caused several episodes of loss of cardiac output. Retrospective assessment of the pre‐operative chest X rays demonstrated approximation of the sternum and thoracic vertebrae, with evidence of tracheal narrowing at the level of the thoracic inlet. We feel that both complications were directly related to the severity of the lordoscoliosis and that careful pre‐operative clinical, spirometric and X ray assessment should be undertaken in such patients.
Post cholecystectomy admission to the intensive care unit
Authors: Messahel F. M. 
Published: February 2007

SummaryAdmissions to the intensive care unit following three different techniques for cholecystectomy, the open, mini‐lap and laparoscopic methods, were studied over an 18‐month period. Of 1078 cases of operative cholecystectomy performed during that period, 28 cases (2.6%) from all groups were admitted to the intensive care unit. Cases in the open and mini‐lap cholecystectomy groups were admitted for postoperative monitoring because of pre‐existing medical diseases and were discharged after an average period of stay of 2.4 and 4.7 days respectively. In contrast, the average stay of patients in the laparoscopic group was 14.8 days and the majority were admitted as a result of complications related to the procedure. In this group, one patient died on the first day of admission to the unit (mortality of 8.3%). This study has shown that laparoscopic surgery, from the intensive care point of view, is a very costly surgical procedure.
The effect of cerebrospinal fluid dilution of isobaric 0.5% bupivacaine used for spinal anaesthesia
Authors: Cherng Y‐G. , Huang H‐H. , Chen T‐G. , Huang C‐L. 
Published: February 2007

SummaryA prospective study was conducted to see the effect on spinal anaesthesia of the dilution of isobaric 0.5% bupivacaine with cerebrospinal fluid. Sixty patients were randomly allocated to three groups. In group 1, patients received 3 ml isobaric 0.5% bupivacaine intrathecally without aspirating cerebrospinal fluid. In groups 2 and 3, cerebrospinal fluid 1 ml and 2 ml was aspirated respectively and mixed with 3 ml isobaric 0.5% bupivacaine. A total volume of 4 ml in group 2 and 5 ml in group 3 was administered. Thus, the volume of cerebrospinal fluid remained unchanged. Pinprick analgesia and motor block was evaluated from induction until recovery. No differences in onset time, duration and‘two segments regression’ were noticed. The only statistical difference was the time to reach complete motor block, which was shorter in group I as compared to groups 2 and 3 (6.9 SD 1.4 min versus 11.3 SD 3.0 and 13.5 SD 3.9 min respectively). The mean value of maximum decrease in systolic blood pressure was small, being less than 15% of the pre‐operative value for each group. In conclusion, the effect of diluting isobaric 0.5% bupivacaine with cerebrospinal fluid, 1 ml and 2 ml, is minimal and it is an unnecessary procedure with limited clinical effect.
Interobserver variation in the chest radiograph component of the lung injury score
Authors: BEARDS S. C. , JACKSON A. , HUNT L. , WOOD A. , FRERK C. M. , BREAR G. , EDWARDS J. D. , NIGHTINGALE P. 
Published: February 2007

SummaryThe lung injury score is a semi‐quantitative system used in the definition and grading of the acute respiratory distress syndrome. It is composed of two, three or four equally weighted components. One component is derived from the chest radiograph, which may contribute up to 50% of the total score. A score of 1 is awarded for each quadrant on the chest radiograph which contains alveolar consolidation. We examined the interobserver variation between two anaesthetists, two radiologists and two critical care physicians who scored blindly 100 chest radiographs from patients with adult respiratory distress syndrome. There was very good agreement between the two radiologists in the total scores (kappa 0.97) and in individual scores in each of the 4 quadrants (kappa 0.97–1.0). The agreement between anaesthetists and radiologists was only fair for the total score (kappa 0.37–0.42), but moderate to good for individual quadrant scores (kappa 0.43–0.73). The agreement between the two anaesthetists was moderate for individual quadrant scores (kappa 0.44–0.60), but only fair for total score (kappa 0.34). There was poor agreement between the two critical care physicians for total score (kappa 0.05) and for individual quadrant scores (kappa 0.04–0.20). Agreement between the physicians and other observers was poor to fair for the total score (kappa 0.12–0.32) and poor to moderate for the individual quadrant scores (kappa 0.15–0.63). Both anaesthetists and physician 2 underestimated the overall chest scores (median scores 2, 3 and 1 respectively) in comparison to the radiologists (median scores 3.5). Physician 1 significantly overscored (median score 4). The chest radiograph component of the lung injury score can be consistently assessed by radiologists, but significant variations may be introduced when assessed by other clinicians. This has significant implications for the use of the lung injury score in studies of adult respiratory distress syndrome and other studies which incorporate radiographic appearances in the definition.