bluuebunny/crossref_metadata_2025_split huggingface dataset:
The new generation gelatins
Authors: SADDLER J. M. , HORSEY P. J. 
Published: February 2007

SummaryGelatin solutions of various kinds have been used as intravenous infusions since the First World War and belong to a heterogeneous group of fluids which tend to maintain the colloid osmotic pressure. They are produced by the breakdown of bovine collagen to yield solutions with a range of molecular weights. Anaphylactoid reactions are a rare but well‐recognised complication of their use. The solutions help to fill a hiatus that exists between crystalloids and blood products.
The control of intra‐ocular pressure during the induction of anaesthesia for emergency eye surgery. A high‐dose vecuronium technique
Authors: Abbott M. A. , Samuel J. R. 
Published: February 2007

SummaryA technique of rapid sequence induction of anaesthesia for use in patients with penetrating eye injuries is described. This utilises a three maximal breaths method of pre‐oxygenation, the intravenous injection of thiopentone and high dose vecuronium (0.2 mg/kg). Using the loss of eyelash reflex as the starting point for timing, all patients were intubated after 60 seconds without coughing and bucking. No postintubation increases in intra‐ocular pressure were seen in 70% of patients and in no patient did the increase in intra‐ocular pressure exceed 5 mmHg. After 3 minutes of apnoea, the minimum haemoglobin oxygen saturation was 94% with a mean value of 97.6%.
The effects of thiopentone and propofol on upper airway integrity
Authors: McKEATING K. , BALI I. M. , DUNDEE J. W. 
Published: February 2007

SummaryOne hundred and fifty‐eight unpremedicated patients scheduled for elective surgery were allocated randomly to receive an unsupplemented induction dose of thiopentone or propofol. Visualisation of the vocal cords by standard laryngoscopy was possible more often after propofol (p < 0.01). Pharyngeal and laryngeal reactivity was similarity depressed more frequently.
Anti‐adrenal action of a subanaesthetic dose of etomidate
Authors: DIAGO M. C. , AMADO J. A. , OTERO M. , LOPEZ‐CORDOVILLA J. J. 
Published: February 2007

SummaryThe effects of subanaesthetic doses of etomidate on corticosteroid synthesis have been studied in vivo. In the group of patients who received etomidate (n = 10), cortisol and aldosterone responses to adrenocorticotrophic hormone were blunted, while 11 de‐oxycortisol response was increased, as compared to a control group (n = 10). These results suggest that a single bolus of 0.04 mg/kg etomidate, which produces sedation, without loss of consciousness, is able to block adrenal 11 hydroxylase.
Comparison between propofol and thiopentone for induction of anaesthesia in children
Authors: Valtonen M. , Iisalo E. , Kanto J. , Tikkanen J. 
Published: February 2007

SummaryPropofol 2.5 mg/kg was compared with thiopentone 5 mg/kg in a randomised open study, as an induction agent in paediatric anaesthesia. One hundred and twenty children who were to undergo elective surgery were included in the study. Both propofol and thiopentone produced a rapid and smooth induction with a low incidence of side effects. A similar decrease (10%) in mean arterial pressure was observed with both agents, hut propofol showed better suppression of the haemodynamic response to tracheal intubation. Respiratory upsets occurred less frequently with propofol than with thiopentone, but propofol frequently induced discomfort on injection. Both agents provided satisfactory and controllable induction of anaesthesia and no major adverse reactions occurred during or after anaesthesia. We conclude that propofol is a useful alternative as an induction agent in children.
The Oxford Miniature Vaporizer in paediatric anaesthesia. An experimental study
Authors: Wilson I. H. , Page R. J. E. , Yeats M. J. H. 
Published: February 2007

SummaryAn experimental study of the Oxford Miniature Vaporizer in combination with a paediatric resuscitation bag has demonstrated efficient halothane vaporization at small tidal volumes. This technique will be appropriate in paediatric anaesthesia with the Triservice apparatus.
Halothane and isoflurane in outpatient anaesthesia
Authors: MILLIGAN K. R. , HOWE J. P. , DUNDEE J. W. 
Published: February 2007

SummaryThe speed and quality of recovery after anaesthesia were studied in 60 outpatients. Anaesthesia was induced using propofol and maintained by nitrous oxide in oxygen supplemented with either halothane or isoflurane. Initial clinical recovery was significantly faster in the halothane group hut no differences were found during subsequent psychomotor testing. Minor postoperative side effects were common in both groups.
Isoflurane and primary pulmonary hypertension
Authors: CHENG D. C. H. , EDELIST G. 
Published: February 2007

SummaryPrimary pulmonary hypertension is a rare and fatal disease. These patients represent an anaesthetic challenge because of the high mortality associated with the marked intra‐operative increase in pulmonary vascular resistance and right ventricular de‐compensation. This is a first case report which demonstrates the safe and beneficial effects of isoflurane in lowering pulmonary arterial pressure and pulmonary vascular resistance in such a patient for a short surgical procedure. The anaesthetic considerations in these patients are discussed.
The oesophageal detector device
Authors: WEE M. Y. K. 
Published: February 2007

SummaryA new method to distinguish oesophageal from tracheal intubation using the oesophageal detector device was evaluated. In 100 healthy adults, observers of differing experience reliably and rapidly detected 51 oesophageal and 49 tracheal intubations in a randomised, single‐blind trial. In one case, blockage of the tracheal tube was detected swiftly and allowed corrective steps to be taken. This method can be used in patients with bronchospasm to detect correct tracheal placement when auscultation and decreased compliance of the chest may make clinical confirmation difficult. It can be concluded from this study that the oesophageal detector device is a reliable, rapid, inexpensive and easy to use method for the detection of oesophageal intubation and its very low cost should make it readily available in all situations where tracheal intubation is carried out.
Anaesthetic induction with isoflurane or halothane
Authors: PHILLIPS A. J. , BRIMACOMBE J. R. , SIMPSON D. L. 
Published: February 2007

SummaryThe authors performed a randomised, prospective trial in which one junior anaesthetist administered gaseous induction of anaesthesia to 50 unpremedicated children with either isoflurane or halothane in nitrous oxide and oxygen. Arterial oxygen saturation and the electrocardiogram were monitored and the incidence of complications noted. Desaturation below 85% occurred in six children, but only with isoflurane. The incidences of complications and desaturation events did not alter throughout the 25 isoflurane inductions. Coughing, movement, laryngospasm and sinus tachycardia occurred more frequently with isoflurane. Isoflurane inductions took longer (7.9 as compared with 5.4 minutes, p < 0.001) and had 4.25 times the number of complications.
Antagonism of neuromuscular blockade
Authors: GOLDHILL D. R. , PYNE A. , JONES C. J. 
Published: February 2007

SummaryGlycopyrronium 5 or 10 μg/kg was administered either simultaneously with, or 1 minute before, edrophonium 1 mg/kg in order to antagonise competitive neuromuscular blockade in 80 children. Both doses of glycopyrronium given before the edrophonium resulted in an initial significant (p < 0.01) increase in heart rate. Heart rate decreased significantly (p < 0.01) in all groups after the edrophonium was given, and only glycopyrronium 10 μg/kg administered before edrophonium prevented a substantial decrease below baseline. Initial heart rate responses to glycopyrronium or edrophonium are rapid, and measurements at intervals of 30 seconds may be necessary to record these changes.
Induction dose of propofol in children
Authors: PATEL D. K. , KEELING P. A. , NEWMAN G. B. , RADFORD P. 
Published: February 2007

SummaryIn a study of 144 children aged 1–12 years, attempts were made to assess the ED50 and ED90 of the intravenous induction agent, propofol. The doses required for loss of eyelash reflex and tolerance of facemask, in 50% of unpremedicated children, were 1.6 mg/kg and 2.5 mg/kg respectively. In children premedicated with oral trimeprazine the corresponding values of ED50 were 1.1 mg/kg and 2.0 mg/kg. Doses of 2.8 mg/kg in unpremedicated and 2.0 mg/kg for those who received trimeprazine were required for loss of eyelash reflex in 90% of children. This probably corresponds to an effective induction dose. Pain and movement on induction were common; the incidence was 27% and 21.5% respectively.
Anaphylactoid reaction following the use of etomidate
Authors: FAZACKERLEY E. J. , MARTIN A. J. , TOLHURST‐CLEAVER C. L. , WATKINS J. 
Published: February 2007

SummaryA 13‐year‐old female suffered urticaria and severe bronchospasm sufficient to cause hypoxic cardiac arrest after intravenous induction of anaesthesia. Etomidate was strongly implicated in the reaction. The management and mechanism of the reaction are described and discussed, together with consideration of future anaesthesia in the patient.
The prolonged use of atracurium in a patient with tetanus
Authors: PEAT S. J. , POTTER D. R. , HUNTER J. M. 
Published: February 2007

SummaryA case of u patient with tetanus is reported in whom an atracurium infusion and artificial ventilation were needed in addition to sedation to control the muscle spasms. The atracurium infusion was used for 71 days, the longest time ever recorded, at a mean rate of 1.3 mg/kg/hour at the end of infusion. The plasma atracurium and laudanosine concentrations were 1.5 μg/ml and 0.985 μg/ml respectively. Subsequently there was an exponential decline in the serum laudanosine concentration which had decreased to 0.014 μg/ml 24 hours later. These results suggest that prolonged use of atracurium by infusion is not associated with excessive cumulation of laudanosine when renal and hepatic function are normal.
Hypoxaemia during recovery from anaesthesia—an audit of children after general anaesthesia for routine elective surgery
Authors: Laycock G.J.A. , McNicol L.R. 
Published: February 2007

SummaryArterial oxygen saturation was measured by pulse oximetry in 105 children (aged 2 weeks‐14 years) during recovery from general anaesthesia. Oxygen saturation was monitored continuously from the time that anaesthesia ended in the operating theatre until the children were fit to leave the recovery ward. All children breathed room air during transfer to the recovery area; 81 children continued to breathe room air in the recovery ward while the remainder received supplementary oxygen. Fifty‐six children became significantly hypoxaemic (oxygen saturation < 90%) at some stage. Hypoxaemia occurred most frequently after termination of anaesthesia (immediate postoperative period) and then later in the recovery ward when the children began to wake up (post‐waking period). The administration of 100% oxygen at the end of anaesthesia had no effect on the incidence of early hypoxaemia which was greatest in children whose trachea had been intubated. Late hypoxaemia was associated most commonly with crying and breath‐holding and was reduced significantly by supplemental oxygen. The oxygen saturation of children on return to the ward was significantly lower than the pre‐operative value (p < 0.001).
Blood pressure response of neonates to tracheal intubation
Authors: CHARLTON A. J. , GREENHOUGH S. G. 
Published: February 2007

SummaryBlood pressure and pulse rate responses to tracheal intubation were studied by oscillotonometric technique in 45 term neonates and 15 infants of similar postconceptual age. No hypertensive response was found in neonates intubated awake and pressures did not differ from those of babies intubated under halothane or after thiopentone and muscle relaxant. The infants did however show a significant increase in systolic and diastolic pressures which indicates that this response may develop after the first month of life.
Patient‐controlled analgesia—the need for caution
Authors: THOMAS D. W. , OWEN H. 
Published: February 2007

SummaryRespiratory depression and oversedation occurred during the administration of patient‐controlled analgesia because of a broken syringe barrel. Possible complications in the use of patient‐controlled analgesia are reviewed. These may be because of prescription or provision errors, patient factors or equipment problems.
The first use of physostigmine in the treatment of atropine poisoning
Authors: NICKALLS R. W. D. , NICKALLS E. A. 
Published: February 2007

SummaryThis paper describes a clinical experiment performed by Drs Kleinwachter and Niemetschek in Prague in 1864, which showed for the first time that oral Calabar bean extract (which contains physostigmine) reverses the toxic effects of atropine. Kleinwachter's original paper is translated from the German.
Reversal of pancuronium
Authors: GOLDHILL D. R. , EMBREE P. B. , ALI H. H. , SAVARESE J. J. 
Published: February 2007

SummaryModerate to deep (67–99% single twitch depression) pancuronium‐induced neuromuscular blockade was antagonised with neostigmine (30 μg/kg, 60 μg/kg, or 80 μg/kg) in combination with glycopyrronium. Twenty‐seven patients were reversed from 91%‐99% twitch depression. Recovery of the first twitch of a train‐of‐four to 95% of control twitch took at least 20 minutes with neostigmine 30 μg/kg. The higher doses were significantly faster (60 μg/kg p < 0.05, 80 μg/kg p < 0.01) and took 15.8 and 14.8 minutes respectively. Reversal to a train of four ratio of 0.75 was not consistently achieved in under 30 minutes with any dose of neostigmine.Nineteen patients were antagonised from a 67%‐80% depression of first twitch and in all but two recovery to 95% of control took under 10 minutes. To achieve a train of four ratio of 0.75 took less than 12.5 minutes except in three patients, two of whom, both given neostigmine 30 μg/kg, took longer than 20 minutes. Neostigmine 60 μg/kg produced as rapid a degree of antagonism as SOμg/kg. Heart rates after reversal decreased gradually in all groups, although the decrease was initially greater in the low dose neostigmine (30 μg/kg) group. A fixed 5:1 ratio of neostigmine and glycopyrronium will usually antagonise a moderate (70%‐80%) pancuronium block to a train of four of greater than 75% within 12.5 minutes if at least 60 μg/kg of neostigmine is administered. More than 30 minutes may be required for reversal whatever the dose of neostigmine, for antagonism from greater than 90% twitch depression.
Isoflurane in the treatment of asthma
Authors: REVELL S. , GREENHALGH D. , ABSALOM S. R. , SONI N. 
Published: February 2007

SummaryA 22‐month‐old child developed severe bronchospasm. Prolonged ventilation of the lungs with isoflurane for 102 hours was used as treatment. The metabolism and fluoride levels obtained are discussed.
Acute localised pulmonary oedema
Authors: KHOO S. T. , CHEN F. G. 
Published: February 2007

SummaryRe‐expansion pulmonary oedema is a rare complication to follow the treatment of pneumothorax or pleural effusion. A unique ease is described here which occurred in a young man immediately after the surgical repair of a ruptured diaphragm. The possible causative mechanisms are discussed.
Midwive's assessment of the upper sensory level after epidural blockade
Authors: JONES M. J. T. , BOGOD D. G. , REES G. A. D. , ROSEN M. 
Published: February 2007

SummaryThe ability of midwives to assess accurately the level of epidural blockade after a short period of instruction was examined. Seventy‐two midwives estimated the upper level bilaterally in 100 patients, by detection of the loss of sensation to a cold stimulus. The midwife and anaesthetist were in complete agreement over the level of block in 71.5% of cases; the midwife overestimated the height of the block in 9.5% of cases, and underestimated in 19%. The midwife underestimated by three spinal segments in 1.5% of cases, and never by more. The technique was acceptable to patients and midwives alike. This procedure should enable safe management of obstetric analgesia, whoever administers top‐ups; accurate detection of a block that recedes below therapeutic levels should facilitate earlier top‐ups and thus reduce pain for the patient in labour.
Intra‐articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients
Authors: MILLIGAN K. A. , MOWBRAY M. J. , MULROONEY L. , STANDEN P. J. 
Published: February 2007

SummaryA randomised double‐blind study was conducted to compare the influence on postoperative pain of equal volumes of one of two concentrations of bupivacaine (0.25%, 0.5%), or saline 0.9%, injected into the knee joint after arthroscopy. The results showed that intra‐articular bupivacaine had no significant analgesic effect in either concentration. Plasma bupivacaine concentrations were measured 20 minutes after injection in order to determine the extent of systemic absorption.
Suxamethonium induced myalgia and the effect of pre‐operative administration of oral aspirin
Authors: McLOUGHLIN C. , NESBITT G. A. , HOWE J. P. 
Published: February 2007

SummaryEighty‐four fit, unpremedicated patients who presented for routine surgery and received a standard anaesthetic technique were allocated randomly to three equal groups. Group 1 received tubocurarine 0.05 mg/kg before induction of anaesthesia. Group 2 received soluble aspirin 600 mg orally one hour before surgery, while Group 3 received no pretreatment. Aspirin prophylaxis produced a significant reduction in the incidence of subsequent suxamethonium‐induced myalgia and the improvement was similar to that achieved with tubocurarine pretreatment. Pre‐operative oral administration of aspirin effectively reduces muscle pains and avoids many of the complications associated with pretreatment with non‐depolarising agents.
Pulse oximetry and postoperative hypothermia
Authors: GABRIELCZYK M. R. , BUIST R. J. 
Published: February 2007

SummaryThe accuracy of the Nellcor N‐100 pulse oximeter was evaluated in hypothermic patients (core temperature ≤ 35.0°C) after cardiac surgery. The pulse oximeter overestimated oxygen saturation in comparison to values obtained by direct in vitro oximetry with a mean bias of 0.6% saturation. The 95% predictability limits for individual measurements were ±3.9% oxygen saturation. No demonstrable loss of accuracy was caused by skin pigmentation, the concurrent administration of low doses of dopamine or vasodilators, or the intra‐operative intravascular administration of Patent Blue V dye.
Total intravenous anaesthesia with propofol and alfentanil by computer‐assisted infusion
Authors: SCHÜTTLER J. , KLOOS S. , SCHWILDEN H. , STOECKEL H. 
Published: February 2007

SummaryThe combination of propofol and alfentanil was administered to 20 patients for total intravenous anaesthesia during general surgery. The infusion rates for both drugs were controlled by microprocessors in order to institute constant blood levels adapted to the patients' varying needs. The mean blood level of propofol required for adequate hypnosis during anaesthesia was 2.42 μg/ml (SD 0.43). Awakening occurred 7.9 minutes (SD 3.4) after the end of the infusion, at a propofol blood level of 1.59 μg/ml (SD 0.34). The plasma level of alfentanil was 285 ng/ml (SD 72) during major noxious stimulation and 148 ng/ml (SD 56) during minor stimulation. The computer‐assisted infusions showed a measured/predicted ratio of 1.01 (SD 0.28) for alfentanil and 0.88 (SD 0.22) for propofol. This indicates that the administration device used in this study is reasonably reliable. The technique of total intravenous anaesthesia was characterised by a smooth induction without significant haemodynamic alterations, by good control during anaesthesia and by a very fast recovery without major side effects.
Disposition kinetics of propofol during alfentanil anaesthesia
Authors: GEPTS E. , JONCKHEER K. , MAES V. , SONCK W. , CAMU F. 
Published: February 2007

SummaryThe pharmacokinetics of a constant rate infusion of propofol were studied in 11 patients who received total intravenous anaesthesia for ENT surgery. Alfentanil was administered as an exponentially decreasing infusion using a computer‐assisted infusion device with a constant target plasma alfentanil concentration of 300 ng/ml. Propofol was infused at a constant rate of 6 mg/kg/hours. Plasma alfentanil concentrations were determined by gas chromatography and whole blood propofol concentrations by high‐performance liquid chromatography in arterial blood samples collected at selected times during and up to 8 hours after infusion. Pharmacokinetic modelling of the blood propofol concentration‐time data indicated that a three‐compartment open model with central elimination was most appropriate. Derived pharmacokinetic parameters were in agreement with previous studies on the pharmacokinetics of propofol. The plasma alfentanil concentrations in 10 patients significantly exceeded the expected values at any time during the infusion. The population mean bias amounted to 20.2% (S D 12.6). Only three data sets were significantly underestimated after the infusion was stopped (mean bias 11.9% (SD 25.5)). The elimination half‐life of alfentanil was approximately 75 minutes (SD 21). We conclude that alfentanil does not interfere with the pharmacokinetic profile of propofol but that propofol induces higher plasma alfentanil concentrations than expected.
Induction and maintenance of propofol anaesthesia
Authors: ROBERTS F. L. , DIXON J. , LEWIS G. T. R. , TACKLEY R. M. , PRYS‐ROBERTS C. 
Published: February 2007

SummaryA simple, manually controlled infusion scheme for continuous administration of propofol was derived by simulation of a computer algorithm designed to achieve a predetermined blood concentration of propofol within 2 minutes and to maintain a constant blood level for the duration of surgery. The manual infusion scheme for a target blood propofol concentration of 3 μg/ml, consisted of a loading dose of 1 mg/kg followed immediately by an infusion of 10 mg/kg/hour for 10 minutes, 8 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour thereafter. An overall mean blood propofol concentration of 3.67 μg/ml was achieved within 2 minutes and maintained stable for the subsequent 80–90 minutes of surgery. The decrease of systolic and diastolic arterial pressures at induction was much less than that previously described after larger induction doses of propofol and there was a negligible haemodynamic response to largyngoscopy and intubation or to the subsequent surgery. The quality of induction and maintenance of anaesthesia was satisfactory in every patient.
Infusions of propofol to supplement nitrous oxide‐oxygen for the maintenance of anaesthesia
Authors: SEAR J. W. , SHAW I. , WOLF A. , KAY N. H. 
Published: February 2007

SummaryThe peri‐operative and postoperative effects of propofol given by infusion were compared with halothane as a supplement to nitrous oxide‐oxygen anaesthesia for body surface surgery in patients who breathed spontaneously. Anaesthesia was induced after opioid premedication, with either propofol 2.5 mg/kg or thiopentone 4–5 mg/kg which were followed respectively by an infusion of propofol 12 mg/kg/hour for 10 minutes and at a variable rate thereafter, or by halothane at a mean inspired concentration of 1.2%. Maintenance of anaesthesia required a median rate of infusion of propofol of 149.4 mg/kg/minute. The cardiovascular effects during induction and maintenance of anaesthesia were similar in the two groups. The overall incidence of side effects was low but immediate recovery was significantly faster in patients who received propofol.