bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular changes at antagonism of atracurium
Authors: Suresh D. , Carter J. A. , Whitehead J. P. , Goldhill D. R. , Flynn P. J. 
Published: February 2007

SummaryThe cardiovascular changes in the 10 minutes following antagonism of an atracurium‐induced block were studied in 32 patients. A 5: 1 ratio combination of either 15, 35, 55 or 75 μg/kg neostigmine, with a corresponding dose of 3, 7, 11, or 15 μg/kg of glycopyrronium was used for antagonism. The least change in heart rate was with neostigmine 15 μg/kg with an increase of more than 15 beats/minute found in only one patient. Antagonism with 35, 55 and 75 μg/kg neostigmine mixture produced the greatest increase in heart rate at one minute and this was significantly different from the effect of the 15 μg/kg dose. Twenty out of 24 patients given the larger doses had heart rate increases in excess of 15 beats/minute and in nine patients this ranged from 30 to 52 beats/minute, representing increases of 46–80% above baseline values. Arterial pressure increases after antagonism were statistically significant in all four groups, with no between‐group difference; these were clinically unimportant. When antagonising an atracurium‐induced block with clinically useful doses of neostigmine, the standard 5: 1 ratio combination with glycopyrronium will result in an initial tachycardia.
Cost of intensive therapy
Authors: RIDLEY S. , BIGGAM M. , STONE P. 
Published: February 2007

SummaryA preliminary study was performed to calculate the cost of intensive therapy on an individual patient basis. The fixed (equipment, supporting services and land opportunity), semi‐fixed (staff) and marginal (treatment) costs of 20 critically ill patients were calculated individually. The results show that there is wide variation in intensive therapy costs. The average daily cost for a spontaneously breathing patient was £399 (95% confidence intervals £388–£460) while that for a ventilated patient was £726 (£656–£795). The mean total cost per patient was £1980, but the cost per survivor increased by 16% (£347) because of four deaths on the intensive care unit. High total costs are associated with increased severity of illness and higher marginal (treatment) costs are associated with increased semi‐fixed (staff) costs. The cost of intensive therapy was three to five times that for general ward care.
Intubation through the laryngeal mask
Authors: HEATH M. L. , ALLAGAIN J. 
Published: February 2007

SummaryUnexpected difficulty with tracheal intubation contributes to anaesthetic mortality. The laryngeal mask can almost always be placed satisfactorily and its position should facilitate blind intubation. A 6‐mm cuffed tube will pass through both adult sizes of the mask and this study tested the feasibility of intubation through the mask. The effect of the application of cricoid pressure on the technique was also investigated. Intubation via the laryngeal mask was attempted in 100 routine patients: of the first 50 (group 1, no cricoid pressure), 45 (90%) were successfully intubated. Maintenance of cricoid pressure throughout the manoeuvre (group 2) reduced the success rate significantly to 56% (p < 0.05). Despite the possibility that cricoid pressure may have to be interrupted momentarily, the ease with which the technique can be learnt, and the immediate availability of the necessary apparatus suggest that it should be considered for inclusion in failed intubation drill.
Epidural bupivacaine dilution for labour
Authors: NOBLE H. A. , ENEVER G. R. , THOMAS T. A. 
Published: February 2007

SummaryWe have compared the effects of three epidural infusions in a randomised, double‐blind study of 56 primigravid mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by infusion of either bupivacaine 0.125%, 0.062% or 0.031%. All solutions contained fentanyl 0.0002% and were run at 7.5 ml/hour. Women receiving the most dilute solution had significantly less analgesia (p < 0.001) for the first 4 hours of the study, but pain scores were then similar for the three groups. No obvious benefit was gained by using very dilute bupivacaine.
Epidural analgesia in Eaton‐Lambert myasthenic syndrome
Authors: SAKURA S. , SAITO Y. , MAEDA M. , KOSAKA Y. 
Published: February 2007

SummaryThe anaesthetic management of a patient with Eaton‐Lambert myasthenic syndrome undergoing thoracotomy is described. Epidural anaesthesia, in combination with a light level of general anaesthesia, provided good operating conditions and postoperative analgesia. Pulmonary function and ventilatory responses to carbon dioxide and hypoxia were measured before operation. These tests were repeated after the epidural administration of 8 ml 2% lignocaine before surgery and after 2 mg morphine sulphate in 10 ml saline postoperatively. Minor reductions in some of the ventilatory parameters were observed. The epidural technique appears to be a useful and safe method by which to manage patients with Eaton–Lambert syndrome undergoing thoracotomy.
Extradural vein puncture—an avoidable complication
Authors: Mannion D. , Walker R. , Clayton K. 
Published: February 2007

SummaryAccidental cannulation of an extradural vein is a troublesome and potentially serious complication of extradural catheter insertion. This study was conducted to assess the influence of posture, catheter size and the injection of saline before catheter insertion, on its occurrence. Eight different techniques were studied based on combinations of these three factors. There was no difference in incidence with respect to posture. The use of 18‐gauge catheters, after injection of 10 ml of 0.9% saline, resulted in a significant (p < 0.01) reduction in the incidence of extradural vein cannulation. This technique is recommended in obstetric patients as a means of avoiding accidental intravenous injection of local analgesic.
Unilateral pulmonary oedema of the contralateral lung following transaxillary sympathectomy
Authors: COHEN J. D. , LOEWINGER J. , ZELIKOVSKI A. , GASSNER S. 
Published: February 2007

SummaryA previously healthy young male developed unilateral pulmonary oedema immediately after re‐expansion of an intentionally collapsed lung after transaxillary sympathectomy. The pulmonary oedema was localised to the contralateral, uncollapsed lung.
Comparison of two techniques for sedation in dental surgery
Authors: Church J.A. , Pollock J.S.S. , Still D.M. , Parbrook G.D. 
Published: February 2007

SummaryForty‐eight patients were randomised to receive sedation for outpatient dental surgery with midazolam. Sedation was given using the Verrill technique (24 patients) and the Glasgow Dental Hospital technique (24 patients). The differences in recovery and patient acceptability were assessed. There was no statistical difference in mean recovery times between the two groups. Memory function was examined using the Warrington memory test. Fewer patients in the Verrill group recalled the injection of local anaesthetic but they demonstrated memory defects 4 hours after sedation for words and 3 hours for faces. The Glasgow Dental Hospital group demonstrated memory defects for words up to 2 hours following sedation, but not for faces at any time. Thirty‐eight patients would have dental surgery again with similar sedation. The dental surgeon found conditions for surgery inadequate in two patients. In view of the shorter duration of amnesia we recommend the Glasgow Dental Hospital technique.
Acute tolerance from benzodiazepine night sedation
Authors: SHORT T. G. , GALLETLY D. C. 
Published: February 2007

SummaryThe hypothesis that benzodiazepine night sedation causes acute tolerance to benzodiazepine sedation given the following morning was examined in six volunteers in a double blind, randomised, crossover study. Before each of three study days, subjects received midazolam 15 mg or flunitrazepam 2 mg or placebo as oral night sedation. They were then given intravenous midazolam 5 mg the following morning and the resulting sedative effects examined, using an observers sedation scale and a psychomotor test battery (critical flicker fusion frequency, digit‐symbol substitution, reflex time, tapping test and a visual analogue sedation scale). Although a consistent pattern emerged with the greatest degree of sedation following the placebo night sedation and the least degree of sedation following the midazolam, with flunitrazepam intermediate, no statistically significant differences were present between the three treatment groups. The results indicate that single use of benzodiazepine night sedation is not an important influence on benzodiazepine requirements for intravenous sedation.
Doxapram after general anaesthesia
Authors: SARMA V. , FRY E. N. S. 
Published: February 2007

SummaryA group of patients who developed postoperative shivering after receiving inhalational anaesthesia were assigned, at random, to receive either doxapram or a placebo under double‐blind conditions. A significantly higher proportion of patients stopped shivering after being given doxapram than after the placebo.
Vocal cord paralysis in the Shy‐Drager syndrome
Authors: DRURY P. M. E. , WILLIAMS E. G. N. 
Published: February 2007

SummaryA case is presented in which unexpected and persistent postoperative respiratory problems led to the finding of bilateral abductor vocal cord paralysis and confirmed the diagnosis of the Shy‐Drager syndrome. Anaesthetists should be aware that vocal cord paralysis may be a feature of this uncommon condition, and should consider the possibility of glottic obstruction as a cause of ventilatory difficulties.
Minitracheotomy Seldinger—assessment of a new technique
Authors: JACKSON I. J. B. , CHOUDHRY A. K. , RYAN D. W. , MATTHEWS H. R. , CORKE C. F. 
Published: February 2007

SummaryA multicentre, prospective study of 26 patients was undertaken for the assessment of insertion of minitracheotomy tubes by the Seldinger technique. The technique of insertion is described. There were two misplacements, three blockages of the inserting Tuohy needle with fat, and six cases of difficulty in passing the minitracheotomy tube.
End‐tidal CO2 monitoring in mitral stenosis patients undergoing closed mitral commissurotomy
Authors: Puri G. D. , Venkatraman R. , Singh H. 
Published: February 2007

SummaryArterial to end‐tidal carbon dioxide difference (P(a‐E)co2) was recorded in 20 mitral stenosis patients (group A) for closed mitral commissurotomy and 20 healthy individuals (group B) for elective limb surgery. Mitral stenosis patients showed a greater difference than group B patients. Repeated measurements of P(a‐E)co2 in mitral stenosis patients at various stages of closed mitral commissurotomy not only showed a mean increase from before thoracotomy but there was also no correlation between P(a‐E)co2 before thoracotomy with that after thoracotomy, after commissurotomy or after chest closure. This indicated that end‐tidal CO2 monitoring was unsuitable to measure adequacy of ventilation during closed mitral commissurotomy.
Failure of continuous three‐channel Holter monitoring to detect acute peri‐operative myocardial infarction
Authors: MARSCH S. C. U. , CASTELLI I. , SCHAEFER H.‐G. , SKARVAN K. 
Published: February 2007

SummaryContinuous peri‐operative three‐channel Holter monitoring in a 70‐year‐old patient undergoing elective hip arthroplasty failed to show onset and progression of a lethal postoperative myocardial infarction, which was clearly visible in a 12‐lead electrocardiogram. The modified bipolar leads used for Holter monitoring differed from the corresponding leads of the 12‐lead electrocardiogram. The limitations of Holter monitoring applied to clinical management and research are highlighted.
Anaesthetic problems in a child with ectrodactyly, ectodermal dysplasia and cleft lip/palate
Authors: MIZUSHIMA A. , SATOYOSHI M. 
Published: February 2007

SummaryThe EEC syndrome is a congenital anomaly complex associated with ectrodactyly, ectodermal dysplasia, and cleft lip and palate. We present a patient with the complete form of this syndrome who had undergone eight operations in childhood. The main problems encountered by the anaesthetists were malnutrition, difficulty with control of body temperature related to hypohidrosis and persistent infection of the respiratory tract.
Oxygen saturation and cardiovascular changes during fibreoptic intubation under general anaesthesia
Authors: Smith M. , Calder I. , Crockard A. , Isert P. , Nicol M. E. 
Published: February 2007

SummarySixty patients who required fibreoptic nasotracheal intubation were studied. Arterial oxygen saturation, arterial blood pressure and heart rate were monitored continuously during fibreoptic intubation under deep halothane anaesthesia. There were significant decreases (p < 0.00]) in arterial blood pressure and heart rate despite administration of intravenous colloid and atropine. Almost one third of the patients (18 out of 60) suffered a decrease in arterial oxygen saturation below 90% during the intubation sequence and in five patients the saturation fell below 80%. The episodes of desaturation were not related to the induction‐intubation time or to the grade of laryngeal visibility at direct laryngoscopy.
Reversal of streptokinase induced bleeding with aprotinin for emergency cardiac surgery
Authors: AKHTAR T. M. , GOODCHILD C. S. , BOYLAN M. K. G. 
Published: February 2007

SummaryTwo patients requiring emergency cardiac surgery following the administration of streptokinase are described. In each case aprotinin was given to counteract the haemorrhagic effects of the streptokinase.
Pregnanolone: a new steroid intravenous anaesthetic
Authors: POWELL H. , MORGAN M. , SEAR J. W. 
Published: February 2007

SummaryThe intravenous steroid anaesthetic pregnanolone has been investigated as an induction agent in 60 fit adults premedicated with morphine and atropine. The drug was given in a stepwise fashion starting with 0.5 mg.kg−1; following a successful induction, the next patient received 15% less, while the subsequent patient received 15% more if anaesthesia was not achieved. Taking loss of eyelash reflex as the end point, 31 patients were satisfactorily induced; the AD50 in these patients was 0.44 mg.kg−1 (95% CI 0.41–0.47). A further 23 patients were induced satisfactorily as assessed by cessation of counting. Induction was trouble free with minimal changes in heart rate and arterial blood pressure, a low incidence of apnoea and few involuntary movements; pain on injection was not a feature. Loss of eyelash reflex is not a good end point for assessment of loss of consciousness following pregnanolone.
A clinical evaluation of the ‘Rapitrach’
Authors: BODENHAM A. , COHEN A. , WEBSTER N. 
Published: February 2007

SummaryA number of percutaneous tracheostomy devices are now available commercially. We report a preliminary clinical study of the use of the ‘Rapitrach’ kit (Fresenius, Runcorn, Cheshire, UK). Twenty critically ill adult patients underwent tracheostomy using the kit. Nineteen of the procedures were carried out at the bedside in the intensive therapy unit. Correct tube placement was achieved in all cases.
Epidural pethidine and bupivacaine in labour
Authors: Edwards N. D. , Hartley M. , Clyburn P. , Harmer M. 
Published: February 2007

SummaryA double‐blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty‐nine patients received either I ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.
Hyperkalaemic periodic paralysis and anaesthesia
Authors: ASHWOOD E. M. , RUSSELL W. J. , BURROW D. D. 
Published: February 2007

SummaryHyperkalaemic periodic paralysis is the rarer of the two forms of potassium‐associated familial paralysis. We report a family with hyperkalaemic periodic paralysis with paramyotonia and the anaesthetic management of four affected members. In three of these, paralytic episodes had been precipitated by previous anaesthesia, but this was avoided in the anaesthetics described. We conclude from our experiences that with depletion of potassium before surgery, prevention of carbohydrate depletion, avoidance of potassium‐releasing anaesthetic drugs and maintenance of normothermia, patients with hyperkalaemic periodic paralysis can be anaesthetised without complications. We have no evidence that they exhibit abnormal sensitivity to nondepolarising neuromuscular relaxants.
An analogue approach to audit in anaesthesia
Authors: SCOTT P. V. , HADEN R. M. , PINNOCK C. A. , BRIDGE H. S. , LAWRANCE A. J. 
Published: February 2007

SummaryThe predicted outcome of anaesthesia and surgery was compared with the immediate outcome in 508 patients by means of two 100 mm linear analogue scales. The results were used to obtain a statistically based rule by which the anaesthetist may consistently select three groups of patients for audit: group l, patients in whom immediate outcome of anaesthesia and surgery is worse than predicted; group 2, patients whose outcome is better than predicted; and group 3, the remaining patients. The rule, which is simply adapted to departmental audit, does not necessarily need a computer but is suited to the computer as it is numerically based.
A comparison of laryngeal mask airway with tracheal tube for intra‐ocular ophthalmic surgery
Authors: AKHTAR T. M. , McMURRAY P. , KERR W. J. , KENNY G. N. C. 
Published: February 2007

SummaryThe use of the laryngeal mask was compared with tracheal intubation in 30 patients who underwent intra‐ocular ophthalmic surgery and who received intravenous anaesthesia with propofol. Changes in intra‐ocular pressure, heart rate and mean arterial pressure after the insertion of the laryngeal mask airway or the tracheal tube were not significantly different. However, at the end of the procedure, a significantly higher percentage of patients with a tracheal tube coughed, reacted to head movement and suffered breath‐holding. In addition, significantly more patients in this group complained of a sore throat (p<0.05). During intravenous propofol anaesthesia, the laryngeal mask airway does not offer any advantage over tracheal intubation in the control of intra‐ocular pressure for intra‐ocular ophthalmic surgery. However, there were fewer complications immediately following surgery in the laryngeal mask group.
An overdose of ecstasy
Authors: SINGARAJAH C. , LAVIES N. G. 
Published: February 2007

SummaryAn overdose of the semisynthetic, hallucinogenic amphetamine 3,4‐methylenedioxymethamphetamine resulted in convulsions, hyperthermia, hyperkalaemia and rhabdomoy lysis. The patient's management, which included the use of dantrolene, is discussed.
Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula?
Authors: Langham B. T. , Harrison D. A. 
Published: February 2007

SummaryA recent study performed in this department showed that a subcutaneous injection of local anaesthetic was significantly less painful than the insertion of a 22‐gauge venous cannula. However, our colleagues remained sceptical that local anaesthetic infiltration would eliminate the pain of cannulation. Consequently a further study was undertaken to compare the pain of cannulation with and without the use of local anaesthetic. The results show that pain of cannulation is significantly (p < 0.003) reduced after subcutaneous infiltration with 1% lignocaine when compared to cannulation without local infiltration. Persistent discomfort at the site of cannulation was eliminated by the use of local anaesthetic.
The occupational hazard of human immunodeficiency virus and hepatitis B virus infection
Authors: O'Donnell N. G. , Asbury A. J. 
Published: February 2007

SummaryThe effect of grade, age, sex and region of employment on the attitude of anaesthetists to the possible risk of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) infection and the measures adopted to minimise the risk were assessed. As a group, anaesthetists in training were more concerned than consultants about the risk of HIV or HBV infection and, as a consequence, were more likely to adopt protective measures. A similar variation was seen with age, younger anaesthetists being more concerned about the risk of infection and adopting preventive measures in greater numbers than their older colleagues. The sex of the anaesthetist had minimal effect on their attitude. Despite the marked variation in the incidence of both HIV and HBV, the attitude of anaesthetists to the risk of infection and the numbers adopting simple preventive measures did not vary significantly on a regional basis throughout the country. However, there was a significant inter‐regional variation in the availability and uptake of HBV immunisation (p < 0.01) and knowledge of the existence of local policy guidelines for the management of known HIV or HBV positive patients (p < 0.01).
The Laerdal pocket mask: effects of increasing supplementary oxygen flow
Authors: Thomas A. N. , Hyatt J. , Chen J. L. , Barker S. J. 
Published: February 2007

SummaryTo determine the effect of increasing supplementary oxygen flow during ventilation with the Laerdal pocket mask 24 subjects ventilated a modified recording mannikin for four 90 s periods using the mask with oxygen flows of 5 l, 10 l, 15 l and 20 l.min−1. Oxygen concentration increased and carbon dioxide concentration decreased with increasing oxygen flow. Tidal volume also increased with oxygen flow. The delivered oxygen concentrations were lower than previously reported at all four rates; however, mask function improved with increasing flow up to 20 l.
Use of adrenaline in obstetric analgesia
Authors: Holdcroft A. 
Published: February 2007

SummaryA questionnaire on the use of adrenaline in obstetric analgesia was completed by 87 obstetric anaesthetists: 71% of consultants in teaching hospitals were prepared to use adrenaline mixed with local anaesthetics compared with 33% of consultants in district hospitals; they had a similar duration of obstetric anaesthetic experience. Test doses containing adrenaline were not commonly used in labour, but were more often used prior to elective Caesarean section. Adrenaline was used with either lignocaine or bupivacaine; few consultants used both solutions. Contraindications to the use of adrenaline in the nonuser group were in decreasing order of rank: neurological damage, pregnancy‐induced hypertension, stenotic valvular heart disease, sickle cell disease or trait and fetal distress. Overall, the contraindications related to the systemic absorption of adrenaline were most common.
Modified parallel ‘Lack’ breathing system for use in dental anaesthesia
Authors: Blumgart C. H. , Hargrave S. A. 
Published: February 2007

SummaryA twin‐lube breathing system for inhalational anaesthesia in dental surgery is described. The system is a modification of a parallel Mapleson ‘A’ breathing system and is suitable for use with continuous flow anaesthetic machines. Resistance to airflow has been evaluated and is within the recommended ranges at all flows likely to be experienced in normal clinical conditions. The system is suitable for children and adults, easy to use and efficient. The expiratory valve is located remote from the face and the system is suitable for scavenging by active, assisted or passive systems.
The Gulf war: anaesthetic experience at 32 Field Hospital Department of Anaesthesia and Resuscitation
Authors: Adley R. , Evans D. H. C. , Mahoney P. F. , Riley B. , Rodgers C. R. , Shanks T. , Skinner T. A. , Swinhoe C. F. , Yoganathan S. 
Published: February 2007

SummaryThe organisation and the workload of the anaesthetic department of a Field Hospital deployed during the Gulf war were described. Suggestions are made as to how the problems encountered might be overcome in the future.