bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure support ventilation during isoflurane anaesthesia
Authors: BHATT S. B. , CHUI P. T. , GIN T. , TAM Y. H. , OH T. E. 
Published: February 2007

SummaryWe have studied the respiratory effects of 5and 10cmH2O pressure support ventilation during anaesthesia with 1.5% end‐tidal concentration of isoflurane in nine healthy, spontaneously breathing, adult patients. Some of the patients demonstrated an irregular respiratory pattern with periods of apnoea and we therefore went on to study a further seven patients with a continuous 500 s recording of airflow. Pressure support ventilation augmented mean (SD) tidal volume from 212 (56) ml to 360 (88) ml at 5 cmH2O and to 509 (108)ml at 10cmH2O (n = 16, p < 0.05). Mean (SD) respiratory rate decreased from 26 (6)min‐1 to 22 (6)min‐1 at 5cmH2O and 17(5)min‐1 at 10 cmH2O pressure support (n = 16, p < 0.05). Mean (SD) inspiratory work of breathing decreased from 1.77 (0.70) J.min‐1 to 0.31 (0.36) J.min‐1 at 5 cmH2O and 0.16 (0.26) J.min‐1 at 10cmH2O pressure support ventilation (n = 9, p < 0.05). Analysis of the respiratory rhythm in the second group of seven patients revealed an oscillating respiratory pattern in four patients at 5cmH2O and six of the seven patients at 10 cmH2O pressure support ventilation. The metabolic advantage of the decreased work of breathing during pressure support ventilation during anaesthesia is unlikely to balance the disadvantage of an oscillating respiratory rhythm.
Gastric regurgitation during general anaesthesia in different positions with the laryngeal mask airway
Authors: EL MIKATTI N. , LUTHRA A. D. , HEALY T. E. J. , MORTIMER A. J. 
Published: February 2007

SummaryNinety patients, divided into three groups of 30, were investigated to determine the incidence of gastric regurgitation during general anaesthesia administered via the laryngeal mask airway in the supine, Trendelenburg and lithotomy positions. Fifteen minutes before induction of anaesthesia each patient swallowed a 75mg methylene blue capsule. At the end of surgery, the LMA and the oropharynx were inspected for bluish discoloration which was considered to be a sign of gastric regurgitation. No blue dye was detected in the supine group but it was observed in one patient in each of the other two groups.
The influence of anaesthetic technique upon the immune response to hysterectomy
Authors: PIRTTIKANGAS C‐O. , SALO M. , MANSIKKA M. , GRÖNROOS J. , PULKKI K. , PELTOLA O. 
Published: February 2007

SummaryEarlier studies on propofol have shown increased percentages of T helper cells after minor surgery. In this study, the effects of propofol infusion anaesthesia on the immune response were compared with those of combined isoflurane anaesthesia in 30patients (median age 47 years, ASA 1–2) undergoing major surgery. The total dose of propofol in the propofol infusion group of 15 women was 860 mg (range 540–1520 mg) and the median end‐expiratory isoflurane concentration in the combined isoflurane group of 15 women was 0.6% (range 0.5–0.8). The following were measured; leucocyte and differential counts; percentages of lymphocyte subpopulations (CDS, CD4, CD8, CD 19, CD 16 and HLA‐DR + CD3); phytohaemagglutinin‐, concanavalin A‐, and pokeweed mitogen‐induced and unstimulated lymphocyte proliferation; plasma interleukin‐6; serum group II phospholipase A2, C‐reactive protein and cortisol concentrations. Measurements were made pre‐operatively, at the end of the operation and on the first and fifth postoperative days. No statistically significant overall differences were observed in the immune response between the groups. The serum cortisol response was weaker in the propofol group than in the isoflurane group (p < 0.05). Time‐related changes were seen within the groups.
Postoperative emesis following otoplasty in children
Authors: Paxton D. , Taylor R. H. , Gallagher T. M. , Crean P. M. 
Published: February 2007

SummarySixty unpremedicated children aged between 3 and 14 years, scheduled for otoplasty, were randomly divided into one of three groups to receive either ondansetron 0.1 mg.kg‐1, droperidol 75 μg.kg‐1, or placebo at induction of anaesthesia. All patients received a standard general anaesthetic using thiopentone, atracurium and halothane. Opioid analgesia was avoided intra‐operatively and infiltration with local anaesthetic was used prior to the start of surgery. Children who received ondansetron were less likely to vomit (15%) than those who received either droperidol (40%) or placebo (60%) (p < 0.01). This group also tolerated oral ingestion of fluids and solids earlier than those who received either droperidol or placebo (p < 0.001). There was no difference between the placebo or droperidol group in the incidence of vomiting or time to ingestion of oral fluids and meals. Three patients in the ondansetron group had a self‐terminating nodal rhythm which was not associated with any haemodynamic disturbances. Postoperatively there were no untoward incidents in any of the groups and all patients were discharged home the day after surgery.
The influence of nitrous oxide on propofol dosage and recovery after total intravenous anaesthesia for day‐case surgery
Authors: LINDEKÆR A. L. , SKIELBOE M. , GULDAGER H. , JENSEN E. W. 
Published: February 2007

SummaryWe studied the influence of nitrous oxide on the maintenence dose of propofol and recovery characteristics in 42 patients, aged 18–62 years, ASA 1 or 2, scheduled for day case inguinal herniotomy. Using a double‐blind, randomised design, patients received anaesthesia with propofol‐alfentanil‐vecuronium‐oxygen and either nitrous oxide or room air (Fio2= 0.30). The rate of propofol infusion was adjusted depending on anaesthetic depth as judged using standard clinical criteria; alfentanil was administered on a weight basis. Patients’ lungs were manually ventilated after tracheal intubation and muscle relaxation was reversed at the end of surgery with neostigmine and atropine. A series of psychomotor tests was performed pre‐operatively and 30 and 120min postoperatively. The mean maintenance doses of propofol were 0.084 mg .kg‐1 .min‐1 in the N2O group and 0.088 mg.kg‐1.min‐1 in the air group (p = 0.97). In the nitrous oxide group the mean (SD) interval to spontaneous eye opening was 13.1 (7.3) min compared to 8.1 (4.9)min in the air group (p = 0.01). Similarly, the interval until obtaining a standardised response was 13.5 (5.3) min and 9.8min (5.4) in the nitrous oxide and air groups, respectively (p = 0.04). The addition of nitrous oxide to propofol‐alfentanil‐vecuronium anaesthesia does not reduce propofol requirements and prolongs early recovery compared to air.
Epidural infusions of bupivacaine and diamorphine in labour
Authors: LOWSON S. M. , EGGERS K. A. , WARWICK J. P. , MOORE W. J. , THOMAS T. A. 
Published: February 2007

SummaryThree different concentrations of bupivacaine, 0.125%, 0.062% and 0.031%, all with diamorphine 0.0025%, were given as an epidural infusion at 10 ml.h‐1 to 63 mothers in labour. When the three infusions were compared, significant differences were found in maternal requirements for top‐ups and the degree of motor block, but there were no differences in the pain scores. The reduced motor block was not associated with a reduction in the instrumental delivery rate.
Measurement of tidal flow using a transit‐time ultrasonic breath analyser
Authors: WILLIAMS E. M. , BURROUGH S. L. M. , McPEAK H. 
Published: February 2007

SummaryThe ability of the Transit‐time Ultrasonic Breath Analyser (TUBA, GHG Medical Electronics GMBH, Zürich, Switzerland) to measure peak flow and tidal volume in the laboratory was tested using a variety of flow and pressure conditions, chosen to simulate the respiratory patterns of patients receiving mechanical ventilatory support. A stable zero baseline was achieved by acoustic damping of the TUBA flow sensor head. A piston pump was used to generate sinusoidal flow pattern, with a peak flow range from 0.1 to 1.5 l.s‐1. The calculated peak flow matched the peak flow measured by the TUBA. The TUBA accurately measured tidal volumes (± 10%) delivered using three different flow patterns over a range of volumes from 0.25 to 11. We conclude, that once modified, the TUBA can provide an accurate measurement of peak flow and tidal volume over a range of values likely to be encountered during mechanical ventilation of the lungs.
Implications of chemical and physical properties of desflurane for longer surgery
Authors: WEISKOPF R. B. 
Published: February 2007

SummaryIncreased duration of anaesthetic administration has implications for recovery from anaesthesia, has cardiovascular effects, and potential for toxicity through metabolism and breakdown of the anaesthetics. Recovery of function after desflurane or sevoflurane anaesthesia, because of the low blood gas and tissue solubilities of these agents, is more rapid than after halothane, isoflurane or enflurane, with recovery being most rapid after desflurane. Increased duration of anaesthesia amplifies the differences in rate of recovery because of the additional anaesthetic (greater with more soluble agents) dissolved in tissues. Increased duration of anaesthesia lessens the cardiovascular depression associated with most halogenated inhaled anaesthetics including desflurane, but not isoflurane. Increased duration of anaesthesia allows for greater metabolism of anaesthetics and greater exposure to metabolites and potentially toxic breakdown products. Desflurane is the least metabolised of the available anaesthetics and is stable in soda lime and Baralyme. Thus, it has exceedingly low potential for toxicity. Sevoflurane undergoes considerable metabolism, producing free fluoride ion, with plasma concentrations proportional to dose and duration of anaesthesia exceeding 50 μM in approximately 7% of patients. In rats, the effects of a toxic breakdown product of sevoflurane, CF2=C(CF3)OCH2F (compound A), are also dose‐and duration‐dependent, with lower concentrations producing toxic effects as duration of exposure increases. The clinical importance of the metabolism and in vitro breakdown of sevoflurane has still to be adequately tested.
Malignant hyperthermia—a large kindred linked to the RYR1 gene
Authors: WALLACE A. J. , WOOLDRIDGE W. , KINGSTON H. M. , HARRISON M. J. , ELLIS F. R. , FORD P. M. 
Published: February 2007

SummaryMalignant hyperthermia susceptibility is genetically heterogeneous. The ryanodine receptor gene on the long arm of chromosome 19 represents an important candidate gene but not all families with malignant hyperthermia demonstrate ryanodine receptor mutations or linkage to this region of 19q. Linkage to chromosome 17 in the region of the adult muscle sodium channel α subunit gene has been suggested in some families; others are not linked to either of these loci. For most families the in vitro muscle contracture test remains the only reliable method of predicting susceptibility to malignant hyperthermia. We have performed linkage analysis in a large family group with malignant hyperthermia in which the in vitro muscle contracture test had been carried out using the procedure standardised by the European Malignant Hyperthermia Group. None of the published ryanodine receptor gene mutations associated with malignant hyperthermia susceptibility were detected in affected individuals but linkage to intragenic ryanodine receptor markers strongly suggest that this gene is involved in malignant hyperthermia susceptibility in this family. This enabled accurate predictive testing by DNA analysis in 11 untested subjects at 50% risk.
Peri‐operative management of diabetic patients
Authors: ELDRIDGE A. J. , SEAR J. W. 
Published: February 2007

SummaryTwo hundred and seven anaesthetists in the Oxford region were sent a questionnaire asking about their peri‐operative management of patients with diabetes mellitus. One hundred and seventy two valid returns were received. The results of this survey were compared with those of a similar survey conducted in 1985. A greater proportion of anaesthetists in 1993 would maintain their diabetic patients with a peri‐operative blood glucose concentration of less than 10 mmol.l ‐1. Anaesthetists are more likely to be interventional in their management of diabetic patients than in 1985 and the methods used have changed in relative popularity. In 1993 diabetic patients undergoing major surgery were most commonly managed with separate infusions of insulin and glucose, while in 1985 the combined infusion of glucose, insulin and potassium was the most popular technique. The use of protocols in hospitals may increase the degree of uniformity of practice between anaesthetists.
A practical evaluation of four human‐powered portable airway aspirators
Authors: ARNSTEIN F.E. 
Published: February 2007

SummaryThe establishment of a clear airway is a vital part of basic life support and mechanical devices are available to assist the clearance of the upper airway during resuscitation. The performances of four human‐powered devices, currently available in the United Kingdom, were compared with the relevant British Standard. The ease of use of the devices by 20 experienced and 20 novice resuscitators was assessed. Three of the four devices met all British Standard criteria tested whereas the fourth failed on one test only. These devices are generally simple to use. However, two devices (‘Res‐Q‐Vac’and'Ambu Maxi Suction Pump’) were more user friendly. The incidence of airway contamination during resuscitation and the current recommended resuscitation protocols suggest that there is a need for increased emphasis on these airway adjuncts in life‐support training. Wider access to basic life support equipment inside and outside hospital premises may improve resuscitation outcome.
Modification of pain on injection of propofol
Authors: Lyons B. , Lohan D. , Flynn C. , McCarroll M. 
Published: February 2007

SummaryOne hundred and fifty ASA 1 and 2 patients were randomly allocated to receive pethidine 25 mg (1 ml), lignocaine Wing (1 ml) or 0.9% saline (1 ml) on a double‐blind basis, as pretreatment to reduce pain on injection of propofol. Both active treatments were significantly better than placebo at preventing pain (p<0.01). Lignocaine was most effective in preventing pain in men (p<0.05) whilst pethidine was more effective in women (p<0.05).
Wearing of masks for obstetric regional anaesthesia
Authors: Panikkar K. K. , Yentis S. M. 
Published: February 2007

SummaryA postal survey of 801 members of the Obstetric Anaesthetists Association was carried out in the United Kingdom and Ireland to investigate the use of surgical facemasks whilst performing spinal and epidural blocks. Two hundred and twenty three out of 539 respondents (41.3%) routinely wore masks for both spinals and epidurals; 22 (4.1%) wore masks only for epidurals; 21 (3.9%) wore masks only for spinals and 273 (50.6%) did not wear masks for either spinals or epidurals. Fifty out of 240 (21%) of those who routinely wore masks did not believe that wearing a mask reduced the risk of infection. Only 83 out of 259 (32%) mask wearers changed their masks between cases.
Dose—response and minimum time to satisfactory intubation conditions after mivacurium in children
Authors: McCLUSKEY A. , MEAKIN G. 
Published: February 2007

SummaryWe assessed neuromuscular blocking effects and tracheal intubation conditions following mivacurium in 121 anaesthetised children aged 1–10 years. The study was conducted in three parts. Parts 1 and 2 were undertaken during thiopentone—alfentanil—nitrous oxide anaesthesia; neuromuscular blockade was evaluated by recording the force of contraction of the adductor pollicis in response to train‐of‐four stimulation at 0.I Hz. In part 1 the potency of mivacurium was determined in 15 children using a single dose‐response technique; in part 2 onset and recovery times were determined in six children following a dose of mivacurium 0.2mg.kg‐1. In part 3 of the study, clinical intubation conditions were assessed in two groups of 50 children whose tracheas were intubated 60 or 90s after injection of mivacurium 0.2mg.kg‐1 during thiopentone—nitrous oxide anaesthesia. The ED50 and ED95; of mivacurium were 54 and 105 ug.kg‐1 respectively. The times to 90% and 100% depression of control twitch were 1.3 (0.3) and 1.9 (0.5) min; times to 5%, 25%, 75% and 90% recovery were 6.4 (1.0), 8.4 (1.1), 12.5 (1.1) and 14.4 (1.9) min, respectively. Intubation conditions were rated satisfactory in 33/50 children (0.66, 95% confidence interval 0.51–0.79) at 60s and in 49/50 children (0.98, 95% confidence interval 0.89–1.0) at 90s (p = 0.0001). Intubation conditions 90s after mivacurium 0.2mg.kg‐1 were significantly better than those obtained in 10 patients given anaesthetic drugs alone (p = 0.002).
The importance of the expiratory pause
Authors: COOK L. B. 
Published: February 2007

SummaryA physical lung model simulating spontaneous respiration was used to investigate the influence of the respiratory pattern on the efficiency of the Mapleson A, C and D breathing systems. It is shown that the Mapleson A system is always the most efficient breathing system and that its performance is relatively independent of the respiratory pattern. When the expiratory pause is minimal, the Mapleson C system is almost as efficient as the Mapleson A, but becomes ever less efficient as the expiratory pause increases. The Mapleson D system is very inefficient when the expiratory pause is short. With a longer expiratory pause, this system's efficiency approaches that of the Mapleson A. The experimental results are compared with predictions generated by a mathematical model. There is good agreement between the two, validating the mathematics used.
Anaesthesia for Cockayne syndrome
Authors: Wooldridge W. J. , Dearlove O. R. , Khan A. A. 
Published: February 2007

SummaryCockayne syndrome is a rare autosomal recessive condition producing a dwarfed, mentally retarded infant or child. Problems with airway management and an increased risk of gastric aspiration are the main anaesthetic concerns. Anaesthetics given to three patients with Cockayne syndrome are described. In two of these, tracheal intubation was difficult and the use of a laryngeal mask airway proved invaluable.
Changing the management of low‐back and nerve‐damage pain
Authors: DAVIES H. T. O. , CROMBIE I. K. , MACRAE W. A. , ROGERS K. M. , CHARLTON J. E. 
Published: February 2007

SummaryThis audit study took place in ten outpatient pain clinics and focused on the management of low back pain and nerve‐damage pain. The objective was to identify and promote appropriate changes in management. An analysis of the treatment of 1236 patients with low back pain and/or nerve‐damage pain highlighted wide variations in practice. Presentation of these data to the clinics was used as a means of promoting change. Data on a further 1791 patients were used to assess the extent of any changes in practice. Prior to the audit feedback, treatments were used often in some clinics, but only rarely in other clinics, for seemingly similar patients. During the feedback sessions three treatments were identified for more frequent use by several of the clinics: antidepressant and anticonvulsant drugs, and transcutaneous electrical nerve stimulation. Many changes in practice occurred after the audit intervention, with large increases in the utilisation of these three treatments. Since there is reasonable evidence to support the use of these treatments for chronic pain this represents an improvement in the process of care. The audit demonstrated that patient management can be improved by a combination of active feedback and discussions based around comparisons between centres.
Anaesthesia and the Internet
Authors: YENTIS S. M. , OOI R. 
Published: February 2007

SummaryThe Internet is a network of computers that allows rapid transfer of information throughout the world. The number of medical, and particularly anaesthetic, resources is rapidly increasing. This article briefly describes the Internet and its features which may be of interest to anaesthetists and intensivists in the United Kingdom, together with some of the tools for working with them.
Compartment syndrome with severe rhabdomyolysis in the postoperative period following major vascular surgery
Authors: Ferreira T. A. , Pensado A. , Dominguez L. , Aymerich H. , Molins N. 
Published: February 2007

SummaryWe report a case of compartment syndrome with marked rhabdomyolysis in the immediate postoperative period following major vascular surgery. Early and aggressive treatment, based on intravenous fluids, sodium bicarbonate, mannitol and fasciotomy, resulted in satisfactory management of the patient and prevented the onset of severe complications, such as acute renal failure in a patient who presented several factors that predisposed him to this disorder.
Topical lignocaine and thiopentone for the insertion of a laryngeal mask airway
Authors: Seavell C. R. , Cook T. M. , Cox C. M. 
Published: February 2007

SummaryWe assessed conditions for insertion of a laryngeal mask airway in 90 unpremedicated adult patients who received either thiopentone 5mg.kg‐1 preceded by 40 mg of topical lignocaine spray to the posterior pharyngeal wall or propofol 2.5 mg.kg‐1 alone in a randomised, single‐blinded trial. All patients received fentanyl 1 μg.kg‐1. Gagging, coughing and laryngospasm following laryngeal mask insertion were graded and haemodynamic data and apnoea times were recorded. There were no significant differences between the two groups with regard to the incidence of gagging, coughing and laryngospasm, but the apnoea time was significantly less in the thiopentone group (p < 0.005). The decrease in systolic and diastolic blood pressure, following induction and the insertion of a laryngeal mask with propofol was significantly greater than following thiopentone (p < 0.05—systolic, p < 0.01—diastolic). We conclude that thiopentone preceded by topical lignocaine spray provides conditions for insertion of a laryngeal mask equal to those of propofol, with more haemodynamic stability and a shorter period of apnoea.
Plasma concentrations of bupivacaine following single needle lumbar sympathectomy using two volumes of 0.25% bupivacaine plain solution
Authors: DICK A. M. , GABBOTT D. A. , HARDY P. A. J. 
Published: February 2007

SummaryPlasma buipvacaine concentrations were measured in 10 patients after lumbar sympathectomy using 10ml or 20ml of 0.25% bupivacaine plain solution. A single needle technique was employed, positioned at the L3 level. Mean peak concentrations were greater in the larger volume group and were statistically significant at 20, 30, 60, 90 and 120 min. Plasma bupivacaine levels peaked earlier in the smaller volume group. Some patients in the larger volume group still had plasma bupivacaine levels at or near peak values at 120 min. No patient approached toxic plasma levels of bupivacaine.
The effects of hypoxaemia and recommendations for postoperative oxygen therapy
Authors: POWELL J. F. , MENON D. K. , JONES J. G. 
Published: February 2007

SummaryHypoxaemia following surgery is common and may be prolonged and severe. The thresholds for deleterious effects of hypoxaemia on the heart and central nervous system are reviewed and the problems of assessment of the adequacy of tissue oxygenation are outlined. Recommendations for postoperative oxygen therapy are made.