bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre‐operative chest X‐rays in elderly patients
Authors: TÖRNEBRANDT K. , FLETCHER R. 
Published: February 2007

SummaryOf 100 consecutive patients of 70 or more years of age who presented for elective surgery, only 27 were considered to lack a medical indication for chest X‐ray. Of these 27, 10 patients had abnormal findings on the X‐ray. These figures suggest that routine pre‐operative chest X‐rays in elderly patients are well worthwhile, and that the savings made by abandoning the practice would be more than outweighed by potential delays and disruptions to theatre lists and the loss of relevant information.
A comparison of the response to suxamethonium in post‐partum and gynaecological patients
Authors: GANGA C. C. , HEYDUK J. V. , MARX GERTIE F. , SKLAR G. S. 
Published: February 2007

SummaryThe response to suxamethonium was assessed in 20 women undergoing tubal ligation on the first or second post‐partum day and in 20 women undergoing interval tubal ligation. The dose of suxamethonium which produced 80% depression of control twitch height was significantly lower in the puerperal patients. Similarly, recovery times following injection of a 20‐mg bolus of the drug were significantly longer in the post‐partum than the non‐obstetric group. Cholinesterase activity, determined in six post‐partum women, was inversely related to the time to maximal recovery. Thus, smaller doses of suxamethonium are required in the early puerperium.
Comparison of midazolam and flunitrazepam for night sedation
Authors: SJÖVALL S. , KANTO J. , KANGAS L. , PAKKANEN A. 
Published: February 2007

SummaryIn a double‐blind randomised study midazolam 15 mg and flunitrazepam 2 mg caused a significantly better night's sleep than placebo. Midazolam had a moderate sedative effect the following morning but, in other respects studied, no residual effects were found. In contrast, flunitrazepam decreased both the degree of apprehension and excitement the following morning. Flunitrazepam also inhibited salivary secretion and caused less cardiovascular changes than placebo or midazolam. The dose of thiopentone needed for induction of anaesthesia was significantly lower in those given flunitrazepam. The results show that midazolam is a potent sedative agent with a short duration of action.
An aldosterone‐producing adrenal cortical adenoma
Authors: SHIPTON E. A. , HUGO J. M. 
Published: February 2007

SummaryPrimary aldosteronism, when caused by an aldosterone‐producing adenoma, is a surgically treatable condition. An operation was performed on a 44‐year‐old patient with this condition. The pre‐operative preparation and anaesthetic management are presented. The specific problems of hypertension, hypokalaemia, hypokalaemic alkalosis and renal lesions, and their importance to the anaesthetist are discussed.
Total intravenous anaesthesia with etomidate‐fentanyl
Authors: JONES D. , LAURENCE A. S. , THORNTON J. A. 
Published: February 2007

SummaryA total intravenous anaesthetic technique using etomidate, fentanyl and neuromuscular blocking drugs with artificial ventilation of the lungs has been used in 90 patients undergoing elective general and gynaecological surgery. A two‐step schedule was used, based on a pharmacokinetic model for rapidly eliminated, intravenously administered drugs. Etomidate 100 μg/kg/minute with fentanyl 1 μg/kg/minute were given for 10 minutes, followed by a maintenance dose at a rate of one‐tenth this amount. Concurrent evaluation of the technique led to variations in the adjuvant drugs used (atropine, droperidol and neuromuscular blocking agent). The basic dose schedule provided adequate surgical anaesthesia for 76% of patients (although dose adjustments were used in the remainder), with recovery limes of 10 minutes or less in 57% of patients. No further opiate analgesia was needed in 40%o of patients postoperatively. Those patients given atropine intravenously prior to induction had a significantly lower incidence of nausea and vomiting postoperatively.
The effect of 50% nitrous oxide in oxygen on lower oesophageal sphincter tone
Authors: Brock‐Utne John G. , Downing John W. 
Published: February 2007

SummaryThe effect of 50% nitrous oxide on the lower oesophageal sphincter was studied in eight healthy volunteers. No effect on the sphincter lone was noted in these subjects. The importance of this finding is discussed in relation to the depressant effects of nitrous oxide and other anaesthetic or sedative drugs on the reflex protective mechanisms safeguarding the respiratory tract and lungs from aspiration of acid gastric content and other foreign matter.
Vascular resistance during cardiopulmonary bypass Its effect on cardiac performance in the immediate post‐bypass period
Authors: PUTNAM E. A. , MANNERS J. M. 
Published: February 2007

SummaryA clinical study was undertaken to measure changes in systemic vascular resistance during cardiopulmonary bypass in 56 adults. Forty‐five patients snowed a rise in systemic vascular resistance and 77% required no inotropic support in the immediate post‐bypass period. Eleven of the 33 patients undergoing valve replacement surgery showed only a small increase or an actual decrease in systemic vascular resistance and required inotropic support. These results were statistically significant. Factors affecting cardiac performance are discussed.
Phaeochromocytoma in pregnancy
Authors: STONHAM J. , WAKEFIELD C. 
Published: February 2007

SummaryTwo cases are reported in which Caesarean section was successfully performed under epidural analgesia in patients whose pregnancy was complicated by a phaeochromocytoma. Pre‐operative phenoxybenzamine therapy together with careful peri‐operative monitoring produced cardiovascular stability and led in both cases to the delivery of a healthy infant.
Epidural buprenorphine for pain relief after major abdominal surgery
Authors: CAHILL J. , MURPHY D. , O'BRIEN D. , MULHALL J. , FITZPATRICK G. 
Published: February 2007

Summary In a controlled trial epidural buprenorphine was compared with epidural morphine as the sole means of analgesia after major abdominal surgery. Bolus injections of buprenorphine 60 μg in 10 ml or morphine 2 mg in 10 ml of normal saline were given on demand for the first 48 hours postoperatively. Both drugs produced significant reduction in pain scores as assessed by the linear visual analogue scale and both produced prolonged analgesia at this dosage, which could be extended by further ‘top‐ups’. The authors conclude that, for postoperative epidural analgesia, buprenorphine may be the opiate of choice and the reasons for this are discussed.
Accidental cross‐connexion of oxygen and nitrous oxide in an anaesthetic machine
Authors: BONSU A. K. , STEAD A. L. 
Published: February 2007

Summary Oxygen and nitrous oxide pipes were cross‐connected during the servicing of an anaesthetic machine. This resulted in the delivery of 100% nitrous oxide instead of 100% oxygen at the end of the operation. The patient fully recovered and was discharged on the 13th day.
Evaluation of a new range of air drawover vaporizers
Authors: BORLAND C. W. , HERBERT P. , PEREIRA N. H. , THORNTON J. A. , WILLIAMS N. , THORNTON J. G. 
Published: February 2007

SummaryThe ‘Ether Pac’ and ‘Fluo Pac’ temperature compensated vaporizers have been evaluated in the laboratory and the ‘field’. Rigorous testing has demonstrated that these vaporizers are robust and reliable. Shaking, tilting and overturning do not significantly affect their performance. Both vaporizers deliver lower concentrations of the vapour than the setting on the vaporizers at low tidal volumes (100 ml). The ‘Ether Pac’ vaporizer output declines progressively with ambient temperatures below 23°C and a similar result occurs with the ‘Fluo Pac’ at temperatures below 20°C.Clinical trials in Nepal, Kenya, Burma and the UK have demonstrated that, when halothane is used, oxygen enrichment is necessary during spontaneous and controlled ventilation. When ether is used with controlled ventilation oxygen enrichment is probably not necessary even with ambient pressures as low as 619 mmHg.
The safety of atropine premedication in children with Down's syndrome
Authors: WARK H. J. , OVERTON J. H. , MARIAN P. 
Published: February 2007

SummaryForty‐five operative procedures were performed in 32 patients with Down's syndrome at the Royal Alexandra Hospital for Children, Sydney in a single year recently. Atropine premedication was administered to 25 patients with Down's syndrome on 38 occasions. Three dosage regimes of atropine were used: 20/μ/kg, 12 μg/kg, both intramuscularly, and 10 μg/kg intravenously. There was no statistically significant difference in the alteration of heart rate for the three dosage groups of atropine used when children with Down's syndrome were compared with weight‐matched control children having similar operative procedures performed.
Cardiomyopathy and phaeochromocytoma
Authors: GILSANZ F. J. , LUENGO C. , CONEJERO P. , PERAL P. , AVELLO F. 
Published: February 2007

SummaryA ease is presented of phaeochromocytoma with catecholamine‐induced cardiomyopathy. The difficulties in the management when left ventricular failure occurred are reported and the importance of monitoring pulmonary artery pressure during the anaesthetic procedure is stressed.
Anaesthesia for lower limb amputation
Authors: MANN R. A. M. , BISSET W. I. K. 
Published: February 2007

SummaryAmputation of the lower limb for vascular disease has a high morbidity and mortality. A comparative study in 60 patients was carried out between spinal analgesia with sedation and general anaesthesia with controlled ventilation which maintained end expiratory carbon dioxide between 4–4.5 kPa. The spinal technique had advantages over general anaesthesia during surgery and in the first 24 hours, but no long term benefits.Meticulous pre‐operative preparation, intra‐operative care and careful postoperative management, including monitoring of end expiratory carbon dioxide tension, appeared to be major factors contributing towards the low morbidity and mortality.
Interscalene block for Colles' fractures
Authors: Hughes T.J. , Desgrand D.A. 
Published: February 2007

SummaryInterscalene brachial plexus block was considered for analgesia in 100 outpatients requiring manipulation of a displaced Colles' fracture. Of the 96 blocks performed, 88 (92%) provided satisfactory analgesia, and there were no serious problems. The place of this technique in the accident and emergency department is discussed with particular relation to alternative anaesthetic techniques.
Intensive management of severe head injuries
Authors: MOSS E. , GIBSON J. S. , McDOWALL D. G. , GIBSON R. M. 
Published: February 2007

SummarySeventy‐six severely head‐injured patients, 67% of whom had Glasgow Coma scores of five or less on admission, were managed according to an intensive treatment regime which included controlled hyperventilation (under full muscular paralysis), high‐dose steroids, dehydrating agents, diuretics and hypnotics (Althesin and thiopentone). Intracranial pressure (ICP) was measured throughout the period of controlled ventilation. Treatment was directed to keeping the mean ICP below 25–30 mmHg and to the prevention of increases in ICP during chest physiotherapy and other noxious stimulation.Six months after injury 46% of patients had died and 4% were vegetative survivors, whilst 43% had made a good recovery or were only moderately disabled. Features associated with worse than average prognosis were: low coma score, pupillary abnormalities, respiratory dysrhythmia and ICP > 30 mmHg. Spontaneous hyperventilation was a relatively good initial feature.These results support the employment of intensive care in severely head‐injured patients, particularly those with diffuse brain injury.
Hypotension following cimetidine administration during cardiopulmonary bypass
Authors: HEINING M. , GROOM J. , LUTHMAN J. , APS C. 
Published: February 2007

SummaryIntravenous administration of cimetidine may occasionally cause profound hypotension. Cimetidine 200 mg was administered as a bolus injection to patients whilst on cardiopulmonary bypass and subsequent changes in systemic arterial pressure were recorded. A statistically significant fall in arterial pressure was observed (P < 0.001), which was attributable to a fall in systemic vascular resistance.
The urinary catheter as a bronchial blocker
Authors: CONACHER I. D. 
Published: February 2007

SummaryTwo cases are described in which problems with double lumen bronchial tubes occurred during thoracic surgery. A urinary catheter inserted down one lumen of each of the tubes enabled one lung anaesthesia to be continued without disturbing the surgery. This technique should be considered before abandoning one lung anaesthesia in those few cases where double lumen tubes fail to function as desired.
An assessment of the Dinamap 845
Authors: HUTTON P. , DYE J. , PRYS‐ROBERTS C. 
Published: February 2007

SummaryThe accuracy of the Dinamap 845 automatic blood pressure recorder was assessed by comparing its own indirect determinations of blood pressure with direct intra‐arterial recordings. It was found that in the majority of cases it was capable of producing reliable trend information during anaesthesia. The instrument may not be able to interpret pressure signals from a patient with a severe dysrhythmia. It is probably an unsuitable monitor for use with very rapidly acting drugs such as sodium nitroprusside.
Beta‐adrenoceptor blockade and anaesthesia for thyroidectomy
Authors: HAMILTON W. F. D. , FORREST A. L. , GUNN A. , PEDEN N. R. , FEELY J. 
Published: February 2007

SummaryThe administration of beta‐adrenoceptor blocking drugs in the pre‐operative preparation and operative management of thyrotoxic patients undergoing subtotal thyroidectomy is reviewed. Particular reference is made to some of the recent advances and it is emphasised that there has been a considerable reduction in the incidence of problems following judicious use of these drugs. The choice of anaesthetic technique employed for thyroidectomy is less important than the degree of control of thyrotoxicosis by the beta‐adrenoceptor blocking drug. Propranolol has proved safe and effective for the majority of patients. The longer acting agent nadolol is easier to administer, particularly in the peri‐operative period. Patients are rendered less thyrotoxic and safety thereby enhanced by adding potassium iodide for 10 days pre‐operatively. The combination of nadolol and potassium iodide offers real advantages in the preparation of the thyrotoxic patient for surgery.
Immune reaction to propanidid*
Authors: CHRISTMAS D. 
Published: February 2007

SummaryAn adverse reaction to the intravenous anaesthetic agent propanidid is described in which the main features were hypotension, facial erythema, and abdominal pain. Changes in serum complement levels and differential white cell counts indicate that this was an immune reaction mediated by the classical complement pathway. The immune reaction apparently involved antibodies other than those of the IgE (reagin) class, and circumstantial evidence suggests that it was specific to propanidid rather than to the entire formulation or to Cremophor EL.
Dantrolene sodium and dystrophia myotonica
Authors: PHILLIPS D. C. , ELLIS F. R. , EXLEY K. A. , NESS M. A. 
Published: February 2007

SummaryA patient with dystrophia myotonica was given dantrolene sodium to try to provide muscle relaxation during a cholecystectomy. Dantrolene was used as it is accepted that the drug has a place in the control of spasticity and also causes muscle relaxation, whereas conventional muscle relaxants are unable to control myotonia of muscle origin. Dantrolene alone did not provide good enough intubating and operating conditions in this subject. Later studies showed that, after dantrolene, EMG recordings from the patient were not significantly altered, although an impression of a slight increase in the myotonic potentials was gained.
Etomidate by infusion for neuroanaesthesia
Authors: SEAR J. W. , WALTERS F. J. M. , WILKINS D. G. , WILLATTS S. M. 
Published: February 2007

SummaryAn etomidate infusion was used to anaesthetise twelve patients for spinal surgery; six (group I) with 67% nitrous oxide and six (group II) with oxygen enriched air. Anaesthesia was induced with infused etomidate at a rate of 100 μg/kg/minute for 10 minutes and maintained at a rate of 10 μg/kg/minute.Recovery was assessed as the time to opening eyes on command (t1) and the time to giving correct date of birth (t2). In group I, mean value for t1 was 37.9 minutes and t2 59.1 minutes which is significantly longer than in group II where mean value for t1 was 9.0 minutes and t2 15.1 minutes. Blood was taken for estimation of etomidate levels. In group I the maintenance level was 501 ng/ml and the plasma clearance 20.9 ml/kg/minute. In group II the maintenance level was 367 ng/ml and plasma clearance 27.3 ml/kg/minute. Etomidate infusion appears to be a suitable alternative for neuroanaesthesia when nitrous oxide is contra‐indicated.
Postoperative spasticity and shivering
Authors: GOOLD J. E. 
Published: February 2007

SummaryThe cause of postoperative shivering is not known. The theories and possible remedies are reviewed. Five hundred patients were observed for the possible effect of lissive doses of gallamine, and of analgesic or benzodiazepine premedication. Diazepam premedication appeared to reduce the incidence of post‐halothane shivering.
Liquid crystal thermometry during anaesthesia
Authors: LACOUMENTA S. , HALL G. M. 
Published: February 2007

SummaryThe use of cutaneous liquid crystal thermometry (EZ Temp) as an estimate of core temperature during routine surgery was investigated in 20 patients. Seventeen per cent of the recordings made with the EZ Temp were more than 1°C different from oesophageal temperature. There was a poor correlation between EZ Temp values and both oesophageal and aural temperatures (r = 0.54 for both sites). We conclude that liquid crystal thermometry of the forehead is not sufficiently accurate to be used as an indicator of core temperature during routine surgery.
Intradural morphine and diamorphine
Authors: PATERSON G. M. C. , McQUAY H. J. , BULLINGHAM R. E. S. , MOORE R. A. 
Published: February 2007

SummaryThis open study of 81 patients having major orthopaedic surgery reviews the duration of analgesia and side‐effects of 0.625, 1.25 or 2.5 mg of morphine or 1.25 or 2.5 mg of diamorphine given intradurally in combination with 7.5 mg of cinchocaine at induction of anaesthesia.A significant dose‐response relationship for duration of analgesia measured by time to first requirement of postoperative analgesic was found with morphine; 1.25 and 2.5 mg of morphine produced analgesia of longer duration than 0.625 mg. No such dose‐response was found for side‐effects. There was no significant difference in duration of analgesia between diamorphine 1.25 and 2.5 mg. and the duration was similar to that seen with the higher doses of morphine. An intradural dose of between 0.625 mg and 1.25 mg of either morphine or diamorphine used with cinchocaine and without additional parenteral opiate, may he appropriate.
Inhalation sedation with 25% nitrous oxide
Authors: EDMUNDSand D. H. , ROSEN M. 
Published: February 2007

SummaryA field trial is reported of the use of a fixed concentration of 25% nitrous oxide to produce sedation in anxious dental patients. Three hundred and ninety‐four patients were treated on 1005 occasions. Ninety‐nine per cent of patients were treated successfully without any incidence of loss of consciousness, including 47 children who were treated on 88 occasions.
High frequency jet ventilation
Authors: JOHNSTON J. R. , COPPEL D. L. , WILSON J. J. , McLAUGHLIN B. F. , HILDEBRAND P. J. 
Published: February 2007

SummaryA case is described where high frequency jet ventilation was used to avoid the cardiovascular depressant effects associated with conventional ventilation. Early weaning from inotropic and ventilatory support proved possible.
Anaesthetic vapour concentrations in the EMO system
Authors: SCHAEFER H.‐G. , FARMAN J. V. 
Published: February 2007

SummaryMeasurements of the vapour concentrations delivered by the EMO and Oxford Miniature Vaporizers (OMV) were made with both continuous (plenum mode) and intermittent (drawover mode) air flows. Leakage of ether, halothane and trichloroethylene vapours through the corrugated elephant tubing was also measured.Both vaporizers performed most consistently with the intermittent flows, for which they were designed. Outputs were minimal at very low carrier gas flows, reached their greatest at the higher settings in the middle flow range and tended to be low at the highest flows. These effects were far more notable with continuous than with intermittent flows. Minimal amounts of ether were lost through the tubing but halothane losses were appreciable, while losses of trichloroethylene were enough to reduce the concentrations available to the patient.The EMO is not suitable for plenum use with carrier gas flows below about 10 litres/min. The OMV is a useful plenum vaporizer although the outputs are generally lower than indicated at higher flows.
Postoperative analgesia in hip surgery A controlled comparison of epidural buprenorphine with intramuscular morphine
Authors: Murphy D.F. , MacGrath P. , Stritch M. 
Published: February 2007

SummaryIn a randomised controlled trial, epidural buprenorphine was compared with intramuscular morphine for postoperative analgesia in patients after hip surgery. Analgesia was given on demand and consisted of epidural boluses of 60 μg of buprenorphine in 10 ml of normal saline or intramuscular morphine 0.15 mg/kg. Both forms of analgesia produced excellent pain relief as assessed by the linear analogue scoring system. In both quality and duration of pain relief, no significant difference was found between the two forms of analgesia, but the total dose of epidural buprenorphine required was Jive times less than the equivalent dose of intramuscular morphine. No side effects attributable to epidural buprenorphine administration were found. The authors conclude that low dose epidural buprenorphine provides an excellent alternative to intramuscular opiates for pain relief after hip surgery.
Ventilatory response during halothane and enflurane anaesthesia
Authors: CHARLTON A. J. , LINDAHL S. G. E. 
Published: February 2007

SummaryIn six children with body weights between 11.4–18.7 kg, minute ventilation, tidal volume, respiratory rate, end‐tidal CO2 concentration and CO2 elimination were measured during both CO2 free breathing and CO2 breathing due to low fresh gas flows (maximal inspired CO2 about 2%) or the addition of CO2 from Rotameters (mean inspired CO2 about 1.5%) during both halothane and enflurane anaesthesia. All patients were undergoing hypospadias repair, received caudal analgesia prior to surgery and were intubated and allowed to breathe halothane/enflurane in O2/N2O (Fio2 0.5) spontaneously through a modified T‐piece system (Mapleson F). End‐tidal CO2 concentrations were similar with both agents during CO2‐free breathing and did not increase during CO2 breathing because of increased minute ventilation, of the same magnitude with both agents, which was achieved by larger tidal volumes. Respiratory rates were unchanged. No differences were found between halothane and enflurane at the light levels of general anaesthesia made possible by combination with caudal block.
Fibre‐optic assessment of tracheal tube position. A comparison of tracheal tube position as estimated by fibre‐optic bronchoscopy and by chest X‐ray
Authors: O'Brien D. , Curran J. , Conroy J. , Bouchier‐Hayes D. 
Published: February 2007

SummaryThe distance between the tip of a tracheal tube and the carina was measured in twenty five patients who required tracheal intubation and artificial ventilation of the lungs. Two methods of evaluation of this distance—limited fibre‐optic bronchoscopy and chest X‐ray—were compared. There was no significant difference between the distance measured by either method. The advantages of checking tracheal tube placement by fibre‐optic bronchoscopy are discussed.