bluuebunny/crossref_metadata_2025_split huggingface dataset:
General anaesthesia and undrained pneumothorax
Authors: CROFTS S. L. , HUTCHISON G. L. 
Published: February 2007

SummaryA patient who required pleurectomy had a 30% pneumothorax when she was presented for anaesthesia. She had refused to have this drained, and it had not responded to conservative management. She was anaesthetised using a computer‐controlled propofol infusion system, without the use of nitrous oxide, and a chest drain was inserted before the institution of positive pressure ventilation. This technique reduces the hazards associated with general anaesthesia in the presence of an undrained pneumothorax. It may be a safe alternative method of induction of anaesthesia in other conditions in which positive pressure ventilation must be avoided, such as bronchopleural fistula.
The neuromuscular blocking effect of Org 9426
Authors: BOOIJ L. H. D. J. , KNAPE H. T. A. 
Published: February 2007

SummaryOrg 9426, a new steroidal non‐depolarising muscle relaxant, which is stable in solution, was studied in 30 anaesthetised (thiopentone, fentanyl, nitrous oxide) male patients, ASA 1 or 2. A dose‐response curve for Org 9426 was constructed and the ED90, mean (SD), was found to be 0.36 (0.031) mg/kg. The onset of action was 3.8 (1.8) minutes, the clinical duration 17.4 (3.2) minutes, the total duration of action 31.9 (6.2) minutes and the recovery time 9.96 (3.2) minutes. No signs of histamine release or cardiovascular effects were observed. Org 9426 thus has a faster onset of action than vecuronium bromide or atracurium dibesylate.
The effect of prophylactic fentanyl on shivering in elective Caesarean section under epidural analgesia
Authors: LIU W. H. D. , LUXTON M. C. 
Published: February 2007

SummaryThe aims of this randomised double‐blind study were to investigate whether 25 μg of fentanyl administered prophylactically by the epidural route would influence the incidence of shivering in parturients who underwent elective Caesarean section under epidural analgesia and whether it would affect the axillary and calf temperatures. There was a 50% reduction (p < 0.05) in the overall incidence of shivering in patients who received fentanyl and there was some evidence to suggest that low‐dose epidural fentanyl might reduce shivering by an influence on thermoregulation.
Monitoring of irrigating fluid absorption during transurethral prostatectomy
Authors: HULTÉN J. , SARMA V. J. , HJERTBERG H. , PALMQUIST B. 
Published: February 2007

SummaryA simple, reliable method to detect absorption of irrigating fluid during transurethral prostatectomy is to tag irrigating fluids with 1% ethanol and monitor expired breath ethanol concentrations. This method correlated well (n = 0.79) with other existing methods of absorption monitoring in 20 anaesthetised patients. Ethanol (1%) tagging does not alter the optical quality of the irrigating fluid and is harmless to the patient. The technique is non‐invasive, repeatable, cheap and gives instant results. It can be used in anaesthetised or awake patients and can detect absorption of as little as 100–150 ml in any 10‐minute period.
Airway protection by the laryngeal mask
Authors: JOHN R. E. , HILL S. , HUGHES T. J. 
Published: February 2007

SummaryMethylene blue was placed in the pharynx of 64 patients undergoing anaesthesia with the laryngeal mask. No leak of dye into the larynx was detected on fibreoptic inspection of the inside of the mask in any subject. The use of the laryngeal mask as a means of protecting the airway during procedures such as minor nasal operations is therefore supported.
Flumazenil in intensive care The duration of arousal after an assessment dose
Authors: Fisher G. C. , Clapham M. C. C. , Hutton P. 
Published: February 2007

SummaryThe effect of an assessment dose of the benzodiazepine antagonist flumazenil was studied in 20 patients in an intensive care unit. The patients had been sedated with alfentanil and midazolam, and were ready to be weaned from mechanical ventilation. In 10 patients flumazenil was titrated just to produce full arousal whilst the midazolam infusion was continued; flumazenil administration was repeated one hour later after the infusion of midazolam had been stopped. In another 10 patients, flumazenil was administered only once, coinciding with the cessation of sedation. The duration of full arousal in both groups was less than 15 minutes in 75% of patients given a single dose of flumazenil (median dose 0.4 mg) although some effect persisted for up to 60 minutes. The cardiovascular effects of arousal were transient and probably not clinically significant. A brief duration of action is advantageous if the patient is found still to require sedation.
Cross‐sectional study of complications of inhalational anaesthesia in 16995 patients
Authors: LEW J. K. L. , SPENCE A. A. , ELTON R. A. 
Published: February 2007

SummaryPatients undergoing anaesthesia in which halothane, enflurane or isoflurane were used, were surveyed with reference to 16 unwanted effects selected by the nominal group method. A simple record card was completed at the time of anaesthetic administration. The overall incidence of complications was 13.9%. One complication was reported in 10.8% of the cases, and more than one in 3.1%. Complications were more frequent in the obese, the elderly and those patients receiving isoflurane, but in view of the small overall use of this agent, the anaesthetists involved may still have been on a learning curve.
A comparison of azapropazone and aspirin for pain relief following dental extractions
Authors: GARRIOCH M. A. , WARDALL G. J. , FITCH W. 
Published: February 2007

SummaryEighty patients received one of three treatments after elective dental surgery involving multiple extractions. Group A received aspirin 600 mg, group B azapropazone 300 mg and group C azapropazone 600 mg. All drugs were administered in a double‐blind fashion. Quality of analgesia was unsatisfactory for all treatments; over 30% of patients required supplementary analgesia with an opioid. In addition there were a large number of withdrawals from the study. There were no significant differences in analgesic efficacy between groups.
Paraplegia following coeliac plexus block
Authors: VAN DONGEN R. T. M. , CRUL B. J. P. 
Published: February 2007

SummaryA case is described in which a coeliac plexus block with alcohol 48%, performed under X ray control, resulted in paraplegia. Ischaemia of the spinal cord, due to damage to the arterial blood supply, was thought to be the cause.
The oesophageal detector device
Authors: WEE M. Y. K. , WALKER A. K. Y. 
Published: February 2007

SummaryIn 100 children between the ages of 1–10 years, observers of differing experience reliably and rapidly detected 50 oesophageal and 50 tracheal intubations in a randomised single‐blind trial using the original oesophageal detector device. However, only two children under the age of 2 years were tested and no conclusions can be drawn for this age group from this study.
Topical glyceryl trinitrate and eutectic mixture of local anaesthetics in children A randomised controlled trial on choice of site and ease of venous cannulation
Authors: Teillol‐Foo W. L. M. , Kassab J. Y. 
Published: February 2007

SummaryOne hundred and four children aged between 1 and 11 years were studied in a double‐blind randomised controlled trial of glyceryl trinitrate ointment versus placebo, when used in addition to standard eutectic mixture of local anaesthetics cream. Each child received glyceryl trinitrate ointment on one hand and placebo on the other, and thus acted as his/her own control. A group of 30 children who received only the eutectic mixture on both hands (60 measurements) was also studied. The choice of site and ease of cannulation was scored. Skin colour and venous dilatation under the eutectic mixture were scored on a visual analogue scale. The addition of topical glyceryl trinitrate ointment to the standard eutectic mixture positively affected venous dilatation (p < G.01), choice of cannulation site (p < 0.001), and ease of cannulation (p < 0.001) of topical anaesthetic‐treated skin.
A double‐blind study of the speed of onset of analgesia following intramuscular administration of ketorolac tromethamine in comparison to intramuscular morphine and placebo
Authors: RICE A. S. C. , LLOYD J. , MILLER C. G. , BULLINGHAM R. E. , O'SULLIVAN G. M. 
Published: February 2007

SummaryA double‐blind, randomised, parallel group, placebo‐controlled study was performed in 85 patients to compare the speed of onset of analgesia following the intramuscular administration of a single dose of 30 mg of ketorolac tromethamine, 10 mg of morphine or placebo. A new, sensitive, method was used to measure the latency of analgesia. The onset of analgesia was defined by the time taken for the pain intensity score to reach a specified percentage of the baseline value. Twenty‐five percent of patients achieving a 50% reduction in baseline pain intensity score appears to be the most appropriate parameter to assess the speed of onset of analgesia of ketorolac and morphine in the postoperative setting. Paired comparison demonstrated that ketorolac had a significantly faster onset of analgesia (p = 0.03) when compared to placebo, whilst comparison of morphine to placebo analgesic latency (p = 0.06) just failed to reach significance. There was no significant difference between the analgesic onset time of ketorolac and morphine (p = 0.73). Intramuscular ketorolac and intramuscular morphine have comparable analgesic onset times in the postoperative pain context. However, the sensitive method of measuring onset of analgesia described, highlights the slow onset of analgesia when analgesics of known efficacy are given by the intramuscular route in the postoperative period. More attention should be given to the speed of onset of analgesia in future assessments of analgesics.
Percutaneous dilational tracheostomy
Authors: BODENHAM A. , DIAMENT R. , COHEN A. , WEBSTER N. 
Published: February 2007

SummaryTracheostomy is performed commonly to aid weaning from assisted ventilation in patients who require intensive care. The procedure carries a significant mortality and morbidity, in part due to problems in moving unstable patients. We report the use of a bedside percutaneous tracheostomy technique for use in adult patients who require intensive care. The procedure was successful in 19 of 20 cases. The one failure, in the first case, resulted from transection of a superficial midline vein. The lack of significant haemorrhage was notable in all other cases. The procedure has proved to be efficient and cost‐effective in this unit and has now replaced conventional surgical tracheostomy in this group of patients.
Induction and recovery characteristics of desflurane in day case patients: A comparison with propofol
Authors: WRIGLEY S. R. , FAIRFIELD J. E. , JONES R. M. , BLACK A. E. 
Published: February 2007

SummaryDesflurane is an ether halogenated exclusively with fluorine. It has a blood/gas partition coefficient of 0.42 (of. isoflurane 1.40 and nitrous oxide 0.46). This characteristic suggests that it should provide both a fast induction of anaesthesia and a rapid recovery from anaesthesia. To assess this, 60 patients were entered into a study and allocated at random to one of four groups receiving either desflurane or propofol for induction and maintenance of anaesthesia. Desflurane caused loss of consciousness in approximately 2 minutes during gaseous inductions. The psychomotor scores in the patients who received propofol for induction and maintenance of anaesthesia were significantly worse compared with those who were given desflurane for either induction and maintenance or for maintenance only. There was also a tendency for other recovery parameters to be faster in the patients receiving desflurane although this did not reach statistical significance. This suggests that desflurane would be a suitable agent for day case anaesthesia providing for a rapid recovery.
Spondyloepiphyseal dysplasia congenital
Authors: RODNEY G. E. , CALLANDER C. C. , HARMER M. 
Published: February 2007

SummarySpondyloepiphyseal dysplasia congenita is a rare condition with several features of concern to the anaesthetist. The patients are of extremely short stature and the presence of kyphoscoliosis may lead to significant respiratory impairment. Cervical vertebral body changes can result in spinal cord compression and laryngotracheal stenosis may be present. The management of such a patient presenting for elective Caesarean section under epidural anaesthesia is described.
A prospective study of liver function in infants and children exposed to daily isoflurane for several weeks
Authors: Jones R. M. , Diamond J. G. , Power S. J. , Bajorek P. K. , Munday I. 
Published: February 2007

SummaryEleven infants and children presenting for daily radiotherapy for a period of at least 2 weeks were anaesthetised with isoflurane in 33% oxygen and nitrous oxide. They were unpremedicated and given no other agents to supplement anaesthesia. The average number of exposures was 24 (SD 11; range 10–39) and the total anaesthetic time per exposure varied between 15 and 30 minutes. Liver function was assessed by determining serum total bilirubin, aspartate amino transferase, gamma glutamyl transferase and alkaline phosphatase before the start of treatment and at 5‐daily intervals thereafter. There was no measurable change in any of these determinants of liver function. All children accepted daily induction of anaesthesia with isoflurane. Induction, maintenance and recovery from anaesthesia were uncomplicated.
Removal of a laryngeal foreign body using high frequency jet ventilation
Authors: TAN S. S. , DHARA S. S. , SIM C. K. 
Published: February 2007

SummaryAspiration of a foreign body into the respiratory tract is a common and serious accident in childhood. Laryngotracheal foreign bodies, although less common than bronchial foreign bodies, are potentially more dangerous. Removal is commonly achieved using a rigid ventilating bronchoscope. We report a 16‐month‐old boy who had an open safety pin impacted in his larynx. This was removed through a tracheostomy, using high frequency jet ventilation to maintain gaseous exchange. We believe that this is the first case in which this method of removal has been reported.
Propofol: bolus or continuous infusion
Authors: Brownlie G. S. , Baker J. A. , Ogg T. W. 
Published: February 2007

SummaryForty patients undergoing vaginal termination of pregnancy were randomly allocated to receive a propofol anaesthetic using either a repeat bolus or infusion technique. The Ohmeda 9000 Infusion Pump was used in the study. Patients in the infusion group recorded significantly longer induction times, greater maintenance doses and prolonged immediate recovery characteristics. Both techniques offered cardiovascular stability but no advantages were demonstrated for the infusion technique over a conventional repeat bolus method.
Effects of epidural diamorphine on the somatosensory evoked potential to posterior tibial nerve stimulation
Authors: LOUGHNAN B. A. , YAU K. W. , RANSFORD A. O. , HALL G. M. 
Published: February 2007

SummaryWe have studied the effects of the epidural administration of diamorphine 0.1 mg/kg at the L3–4 interspace on somatosensory evoked potentials in the cervical epidural space before corrective surgery for idiopathic adolescent scoliosis. A further eight patients in whom anaesthesia was maintained with a propofol infusion acted as a control group. Epidural diamorphine had no effect on the latency or amplitude of the evoked potentials. We conclude that epidural diamorphine is a suitable technique to use in scoliosis surgery because of its lack of effect on neurophysiological variables, although the potential respiratory problems need investigation.
Double‐blind testing fails to confirm analgesic response to extradural morphine
Authors: JADAD A. R. , POPAT M. T. , GLYNN C. J. , McQUAY H. J. 
Published: February 2007

SummaryWe report two patients with chronic non‐malignant pain in whom morphine given intravenously via a patient‐controlled analgesia system produced partial pain relief but was accompanied by severe side effects. Open administration of epidural morphine resulted in complete pain relief with minimal side effects and the patients were considered as candidates for implanted opioid delivery systems. However, when the epidural morphine was given in a double‐blind and placebo‐controlled manner, morphine did not produce greater analgesia than placebo and no dose‐response relationship was seen. These cases show that careful investigation is necessary before proceeding to implanted systems and that changing the route did not improve the analgesia: side effect balance for morphine in these patients.
Acid aspiration prophylaxis in morbidly obese patients: famotidine vs. ranitidine
Authors: Vila P. , Vallès J. , Canet J. , Melero A. , Vidal F. 
Published: February 2007

SummaryFamotidine and ranitidine were compared as agents for the prevention of acid aspiration syndrome in 32 morbidly obese patients undergoing vertical banded gastroplasty. Single‐dose oral famotidine or double‐dose oral ranitidine were administered on a random basis before surgery. Gastric contents were aspirated through a gastric tube, manually aided by the surgeon with the abdomen open. Mean (SD) gastric volumes were 13.8 ml (6.7) and 12.1 ml (13.0) for the famotidine and ranitidine groups, respectively. Mean (SD) gastric pH values were 6.2 (1.5) and 6.8 (1.5), respectively. There were no significant differences between the groups and no patient was considered‘at risk’ (pH < 2.5 and gastric volume > 25 ml). We conclude that single‐dose oral famotidine and double‐dose oral ranitidine are equally effective for preventing acid aspiration syndrome in morbidly obese patients.
Diamorphine analgesia after Caesarean section
Authors: Smith I. D. , Klubien K. E. , Wood M. L. B. , Macrae D. J. , Carli F. 
Published: February 2007

SummaryIn a randomised double‐blind study, the efficacy, duration of action and side effects of five diamorphine analgesia regimens following Caesarean section are described. The time to next analgesia was shorter in the 5 mg intramuscular group (3.53 hours) than in any of the four epidural groups: 5 mg (5.7 hours, p = 0.007), 2.5 mg (4.76 hours, p = 0.103), 5 mg with adrenaline 1/200 000 (7.2 hours, p = 0.001) and 2.5 mg with adrenaline 1/200 000 (6.05 hours, p = 0.007). Multiple regression analysis showed that the addition of adrenaline significantly increased the duration of action of epidural diamorphine (p < 0.05). The 5 mg dose with adrenaline showed no advantage when compared with 2.5 mg with adrenaline (p = 0.16). No serious side effects were reported in any group.
Septic a trial thrombus
Authors: JOSHI P. , BULLINGHAM A. , SONI N. 
Published: February 2007

SummaryA 77‐year‐old man underwent repair of a vesicocolic fistula following which he had a protracted stay in the intensive care unit due to recurrent septicaemia, which was initially caused by bowel anastomosis breakdown. Management included central venous cannulation and pulmonary artery catheter monitoring. A septic, mobile right atrial thrombus developed, which was successfully treated. The literature on this condition is reviewed.
Reversal of prolonged suxamethonium apnoea with fresh frozen plasma in a 6‐week‐old infant
Authors: GILL R. S. , O'CONNELL N. , SCOTT R. P. F. 
Published: February 2007

SummaryA period of apnoea lasting 480 minutes following suxamethonium in a 6‐week‐old male infant is described. Neuromuscular function recovered following the administration of fresh frozen plasma. The infant was found to be homozygous for atypical cholinesterase (E1a E1a). This is believed to be the youngest reported case of suxamethonium apnoea.
Respiratory failure as presentation of achalasia of the oesophagus
Authors: KENDALL A. P. , LIN E. 
Published: February 2007

SummaryA 68‐year‐old woman with a history of hiatus hernia developed aspiration pneumonia after operation for fractured neck of femur. After 8 days, acute respiratory failure was caused by massive retention of air and food in the oesophagus. This was relieved by aspiration, and treated by balloon dilation of the gastic cardia.
Continuous direct and indirect blood pressure measurement (Finapres) in the critically ill
Authors: FARQUHAR I. K. 
Published: February 2007

SummaryContinuous noninvasive blood pressure measurement is of great potential use in the critically ill. This study was designed to find out whether measurements of blood pressure by a Finapres accurately represented intra‐arterial pressure. Comparisons were made between readings from a radial artery line and from a Finapres finger cuff in 10 critically ill patients. There was an unpredictable but usually stable difference between measurements from the two sources; this difference varied in magnitude and direction in individual patients. A t present the Finapres cannot be recommended as a substitute for intra‐arterial blood pressure measurement in the critically ill.
Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac
Authors: Edwards N. D. , Barclay K. , Catling S. J. , Martin D. G. , Morgan R. H. 
Published: February 2007

SummaryA randomised, controlled study was undertaken to assess the postoperative pain and side effects experienced by patients undergoing day case diagnostic laparoscopy and laparoscopic sterilisation, and to evaluate the effectiveness in these patients of peroperative diclofenac. Patients undergoing laparoscopic sterilisation had significantly higher pain scores at one hour postoperatively, and at discharge, than patients undergoing diagnostic laparoscopy (p < 0.01) but there were no significant differences in pain scores 24 hours after discharge. The incidence of postoperative side effects following discharge from hospital was high, but there were no significant differences between the groups. Diclofenac had no significant effect in either group on the severity of postoperative pain, or the incidence of postoperative side effects.
Pulse oximeter probes A comparison between finger, nose, ear and forehead probes under conditions of poor perfusion*
Authors: CLAYTON D. G. , WEBB R. K. , RALSTON A. C. , DUTHIE D. , RUNCIMAN W. B. 
Published: February 2007

SummaryThe performances of 10 pulse oximeters using finger probes were compared with the same pulse oximeters using alternative probes (eight finger probes, two nose probes and a forehead probe) in poorly perfused patients. All readings were then compared with directly measured arterial blood oxygen saturations. The mean difference (bias, ‘accuracy’), standard deviation (precision) and ‘drop out’ rate for each pulse oximeter combination was determined. An overall ranking of performance of each pulse oximeter was calculated using five criteria (accuracy, precision, number of readings within 3% of standard, percentage of readings given within 3% of standard, expected overread limit in 95% of cases). Nose and forehead probes performed poorly. Some ear probes performed well compared to some finger probes, but the overall performance of probes in other sites compared to finger probes was worse, (p = 0.05). Two of eight ear probes and no nose or forehead probes would be expected to be within 4% of the reference value in 95% of readings. The use of finger probes rather than probes in other sites is recommended in the patient with poor peripheral perfusion.