bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic pain management training for senior registrars in anaesthesia
Authors: Parris M. R. , Warner J. A. , Clark C. 
Published: February 2007

SummaryIn 1985 and 1990 postal questionnaires were sent to anaesthetic senior registrars in training in the United Kingdom to determine the extent of higher specialist training in chronic pain management. There were wide variations in training and experience amongst senior registrars. Overall there was little change between 1985 and 1990. In particular the number of anaesthetic senior registrars who felt equipped to undertake a consultant post with an interest in chronic pain management had not increased.
Ventricular fibrillation after accidental injection of bupivacaine into the pericardium
Authors: EVEN B. J. , DE JONGH R. F. , DE HERT S. G. 
Published: February 2007

SummaryA postoperative cardiac surgical patient developed ventricular fibrillation immediately after accidental pericardial injection of bupivacaine at room temperature. The possible causes, which include systemic toxicity, local vasoconstriction with myocardial ischaemia, local toxic effect of bupivacaine or local hypothermia, are discussed.
Transoesophageal echocardiography during removal of a caval filter in a patient at high risk of massive pulmonary thromboembolism
Authors: Metzler H. , Lammer J. , Berger J. , Rigler B. , Gombotz H. 
Published: February 2007

SummaryA new type of vena caval filler was to be removed from a woman who had a high risk of massive pulmonary thromboembolism because of extensive thrombus in the iliac vein incorporating the filter. The removal was performed under general anaesthesia in the cardiac operating theatre using transoesophageal echocardiography to monitor the right heart and the pulmonary artery during the critical phase of removal. The manoeuvre succeeded with only insignificant embolisation occurring, and that was identified by transoesophageal echocardiography.
An evaluation of the behaviour of children undergoing dental extraction under general anaesthesia
Authors: Burns M. T. , Blinkhorn A. S. , Asbury A. J. 
Published: February 2007

SummaryThe cooperation of a random sample of 190 children with an average age of 5 years (range 1–17 years), presenting with a dental emergency requiring tooth extraction under general anaesthesia, was evaluated using the Frankl Behaviour Scale. The results showed that 60% of the children cooperated in the operating theatre. Furthermore, removal of only one or two teeth per patient accounted for 40% of the cases. This survey has identified a group of child dental patients who might benefit from conscious sedation and local anaesthetic techniques.
The effect of paracetamol or diclofenac administered before operation on postoperative pain and behaviour after adenoidectomy in small children
Authors: Baer G. A. , Rorarius M. G. F. , Kolehmainen S. , Selin S. 
Published: February 2007

SummaryWe compared the effects of rectally administered diclofenac (12.5 mg) with paracetamol (125 mg) on pre‐ and postoperative behaviour and the need for supplementary analgesia in 44 children scheduled for adenoidectomy (with or without myringotomy). The study drugs were given in combination with diazepam (0.5 mg.kg1) about 20 min before the children were taken to the operating theatre. On arrival there, the children who had received diclofenac were significantly quieter (<0.05), easier to handle (p < 0.01) and cried less (p < 0.05) than those in the paracetamol group. During recovery, children in the diclofenac group needed fewer supplementary doses of intravenous pethidine than those receiving paracetamol (p < 0.001). There were no obvious differences between the groups in intra‐operative bleeding (as estimated by the surgeon), or in measured blood loss. No postoperative complications became evident. The pre‐operative rectal administration of diclofenac for pain relief after adenotomy is safe and effective.
Administration of vancomycin during cardiopulmonary bypass
Authors: Baraka A. , Taha S. , Bijjani A. , Arab W. , Mashefedjian G. 
Published: February 2007

SummaryVancomycin was given during cardiopulmonary bypass to 12 anaesthetised patients undergoing open heart surgery. Injection of vancomycin 1 g within 60 s via the venous inlet of the oxygenator resulted in a moderate and transient decrease of mean arterial pressure. This minimal reaction may be attributed to dilution of vancomycin by the extracorporeal circuit volume, to the bypassing of the lungs which are a major site of storage of vasoactive substances, or to the maintenance of adequate perfusion flow during cardiopulmonary bypass. The results suggest that the haemodynamic adverse reactions to vancomycin, given as antibiotic prophylaxis, may be decreased by its administration after initiation of cardiopulmonary bypass.
Pharmocokinetic model‐controlled infusion of midazolam
Authors: SHORT T. G. , TAM Y. H. , TAN P. , OH T. E. 
Published: February 2007

SummaryThe accuracy of a computer‐controlled infusion of midazolam, based on previously published pharmacokinetic parameters, was tested prospectively in 12 adult female patients undergoing general anaesthesia. Anaesthesia consisted of an initial bolus followed by an exponetially decreasing infusion of midazolam given according to body weight, fentanyl, nitrous oxide and vecuronium. Venous blood samples were taken at 15 min‐intervals throughout the procedures and for 1–2 h postoperatively. The bias of the model was – 5.1% (95% C1 –11.3 to 1.2%) and precision 24.8% (95%CI 20.9 to 28.6%). Least squares regression analysis decreased the bias to—2.8% but did not alter precision. Retrospective fitting of an alternative set of published parameters for midazolam resulted in significant deterioration of the model. The precision was similar to that found in past studies of intravenous anaesthetic agents. Further improvement in the accuracy of midazolam infusion awaits improved understanding of the causes of pharmocokinetic variability.
Extending a pipecuronium neuromuscular block
Authors: ROBERTS S.P. , RAMSAY T.M. , HEALY T.E.J. , WILSON A. , POLLARD B.J. 
Published: February 2007

SummaryTen patients received increasing doses of pipecuronium at induction of anaesthesia. A dose response relationship was then constructed from which ED90 and ED95 values were measured as 43.4 μ.kg−1 and 50.5 μ.kg−1 respectively. A further 30 patients received pipecuronium in a dose sufficient to produce greater than 90% neuromuscular block. When the first contraction of the train‐of‐four had returned to 10% of control, a small increment of atracurium (1.1 mg), vercuronium (0.25 mg) or pipecuronium (0.21 mg) was administered, and this was repeated subsequently using the same criterion of recovery on each occasion. The duration and intensity of the block with pipecuronium increments remained constant. The duration of the block following atracurium or vecuronium was progressively less with subsequent increments until steady state was reached. The final mean durations at steady state were pipecuronium 7.37 min, atracurium 6.99 min, and vecuronium 5.15 min.
Closed loop control of arterial hypertension following intracranial surgery using sodium nitroprusside
Authors: MACKENZIE A. F. , COLVIN J. R. , KENNY G. N. C. , BISSET W. I. K. 
Published: February 2007

SummaryForty patients were chosen at random to receive halothane or isoflurane anaesthesia during craniotomy and a comparison of the postoperative hypertensive response was made using a microcomputer‐based closed‐loop arterial pressure control system with sodium nitroprusside to control and assess arterial pressure during the first 6 postoperative hours. A desired target systolic pressure was chosen for each patient and the frequency of hypertension, sodium nitroprusside requirements and quality of arterial pressure control were compared between the two groups. Thirty‐five patients required sodium nitroprusside. The halothane group required a median dose of 15.2 mg (range 0–72) compared to 3.4 mg (range 0–87) in the isoflurane group. This difference is not statistically significant. Quality of arterial pressure control was satisfactory in both groups. In conclusion, arterial hypertension occurs frequently following intracranial surgery and is uninfluenced by the choice of halothane or isoflurane intra‐operatively. This closed‐loop arterial pressure control system functioned safely and effectively in this context.
The effect of oral ondansetron in the prevention of postoperative nausea and vomiting after major gynaecological surgery performed under general anaesthesia
Authors: DUPEYRON J. P. , CONSEILLER C. , LEVARLET M. , HEMMINGSEN C. , SCHOEFFLER P. , PEDERSEN F. M. , GRIBOMONT B. , KAPLAN L. A. 
Published: February 2007

SummaryThe efficacy and safety of ondansetron in preventing postoperative nausea and vomiting following major gynaecological surgery was evaluated in this multicentre, double‐blind study. A total of 243 patients were randomised to receive three doses of oral ondansetron 8 mg or matching placebo at 8‐hourly intervals, with the first dose being given an hour before surgery. A standard general anaesthetic technique was employed throughout. Nausea, vomiting and safety assessments were performed continuously during the 24 h postrecovery period. Of the 237 patients evaluated for efficacy, significantly fewer ondansetron 8 mg treated patients (65/117: 56%) experienced postoperative nausea and/or vomiting compared with placebo‐treated patients (94/120; 78%) during the study period (p < 0.001). In addition, ondansetron 8 mg reduced the severity of nausea (p < 0.001) and the total number of vomiting episodes experienced (p < 0.001). Overall, ondansetron 8 mg was well tolerated and effective in preventing postoperative nausea and vomiting in this surgical setting.
The effect of the anaesthetist's attire on patient attitudes
Authors: HENNESSY N. , HARRISON D. A. , AITKENHEAD A. R. 
Published: February 2007

SummaryTwo groups of adult patients (55 each) were visited pre‐operatively by an anaesthetist who was dressed either formally or casually. Their response to this visit, their opinions regarding anaesthetists and their knowledge of anaesthetic work were elicited afterwards by means of a questionnaire. Patients' satisfaction with the anaesthetist and his/her visit was not influenced by dress. The anaesthetist was awarded a high level of prestige and the length of his/her training was recognised to be comparable to that of other professionals: 81.8% of patients thought that anaesthetists held a medical degree but only 35.4% thought that they worked in the intensive care unit. Patients expressed a preference for doctors to wear name tags, white coats and short hair but disapproved of clogs, jeans, trainers and earrings.
Laboratory assessment of the Baxter disposable patient‐controlled analgesia system
Authors: DAVIDSON J. A. H. , DRYDEN C. M. , SMITH D. D. 
Published: February 2007

SummaryThe performance of the Baxter patient‐controlled analgesia infusor system was assessed in the laboratory. The flow of the 5 ml.h−1 infusor was measured gravimetrically with the flow restrictor maintained at 31°C and the reservoir at either 20°C or 25°C. At 25°C the mean flow was 4.98 (Sem 0.06) ml.h−1 and at 20°C the mean flow was 4.32 (0.05) ml.h−1. The patient‐control module performed reliably, delivering a mean of 0.42 (0.001) ml following depression of the button, slighly less than the manufacturer's quoted value of 0.5 ml.
Anaesthesia for procedures on the larynx and pharynx
Authors: Mendel P. , Bristow A. 
Published: February 2007

SummaryTwenty patients undergoing elective procedures on the larynx and pharynx were anaesthetised using a propofol infusion and a bolus of vecuronium. High frequency jet ventilation was employed via a 7 French gauge catheter, with a second catheter being used to measure expired carbon dioxide levels. The Bullard laryngoscope was compared with the Macintosh instrument both for visualising the larynx and subsequently inserting a catheter. One catheter was left in place until the patient was fully awake, and in one case this enabled gas exchange to be maintained in the presence of laryngospasm. Using the Bullard laryngoscope, intubation was possible in all 20 patients, in a mean time of 22 (6.8) s. Using the Macintosh laryngoscope only 16 patients could be intubated and this took significantly longer at 34 (18.3) s (p < 0.05). The Bullard laryngoscope and high frequency jet ventilation offer a reliable method of intubating and anaesthetising patients with upper airways pathology and further benefits may accrue in the recovery period.
The effect of cardiopulmonary bypass on cholinesterase activity
Authors: SHEARER E. S. , RUSSELL G. N. 
Published: February 2007

SummaryCholinesterase activity was determined in 18 patients who had undergone either hypothermic (n = 9) or normothermic (n = 9) cardiopulmonary bypass. The anaesthetic technique was standardised to avoid agents known to affect cholinesterase. Activity was determined in blood samples taken before the induction of anaesthesia, during cardiopulmonary bypass and far at least 7 days postoperatively. In six patients cholinesterase activity was also measured at 6 weeks postoperatively. All the patients were of normal cholinesterase genotype. In both groups cholinesterase activity fell by approximately 60% coinciding with the start of cardiopulmonary bypass, from a mean of 5976 to 2636 IU.l−1 in the hypothermic group, and from 5901 to 2615 IU.l−1 in the normothermic group (p < 0.001 in both instances) (normal range 4300–10 500 IU.l−1). Cholinesterase activity remained at this reduced level for at least 7 days postoperatively. By 6 weeks, activity had returned to within 7% of pre‐induction values. There were no differences in cholinesterase activity between the hypothermic and normothermic groups at any of the sampling times.
The measurement of right ventricular ejection fraction by thermodilution
Authors: COCKROFT S. , WITHINGTON P. S. 
Published: February 2007

SummaryThermodilution measurements of cardiac output and right ventricular ejection fraction were obtained using a rapid response pulmonary artery catheter. Values were compared when injectate was administered via either a cannula within the right internal jugular vein or the dedicated right atrial port of the pulmonary artery catheter. Mean (SD) bias for cardiac output and right ventricular ejection fraction measurements were 0.08 (0.32) l.min−1 and 2.6 (6.6)% respectively. We therefore conclude that both injectate techniques will provide similar values for cardiac output but dissimilar values for right ventricular ejection fraction measurement.
The effect of low dose aspirin on bleeding times
Authors: Williams H. D. , Howard R. , O'Donnell N. , Findley I. 
Published: February 2007

SummaryThis double‐blind, controlled study assessed the effect of low‐dose aspirin on bleeding times. Thirty patients, in the last trimester of their first pregnancy, who were also taking part in a trial to evaluate the effect of low‐dose aspirin on the development and progress of pregnancy‐induced hypertension, had their bleeding times measured using the Sirnplate 11 Bleeding Device. Our study showed there was no significant difference between the bleeding times of the two groups and all measurements fell within the normal range.
Continuous subarachnoid infusion of local anaesthetic
Authors: Morton C. P. J. , Armstrong P. J. , McClure J. H. 
Published: February 2007

SummaryWe observed the sensory, motor and cardiovascular changes occurring during subarachnoid infusion of bupivacaine 0.125% at 15 ml.h−1 in six patients. After I h, motor block and lower sensory levels were consistent and predictable but upper sensorv levels were variable. There was a moderate decrease in systolic blood pressure. Regular assessments of motor block are more likely to detect accidental subarachnoid infusion than assessments of upper sensory level or measurements of blood pressure.
Suxamethonium myalgia: an ethnic comparison with and without pancuronium pretreatment
Authors: HOUGHTON I. T. , AUN C. S. T. , GIN T. , LAU J. T. F. , OH T. E. 
Published: February 2007

SummaryThe incidence of myalgia after suxamethonium was determined in 200 fit military male dental patients of European, Chinese and Nepalese descent. Half received pancuronium 1 mg and the other half received saline pretreatment on a randomised double‐blind basis. The percentage incidence of postsuxamethonium myalgia after saline or pancuronium was found to be: Europeans 26%, 13%: Chinese 13%, 7%; Nepalese 20%, 14%. Although pancuronium reduced the incidence of myalgia by about 50% overall, these values were not significantly different from each other. The recovery of spontaneous ventilation following suxamethonium was quicker in the Europeans than in the Asians (p < 0.05). Pancuronium pretreatment also delayed the recovery of spontaneous ventilation and recovery from neuromuscular block (p < 0.05) but this was independent of ethnicity. The Europeans recovered from anaesthesia more quickly than the Asians. It was concluded that ethnicity affected recovery from suxamethonium and from anaesthesia but was not of clinical relevance to the incidence of myalgia in male Asians and Europeans.
Dermal patch anaesthesia: comparison of 10% lignocaine gel with absorption promoter and EMLA cream
Authors: SAKAMOTO M. , KANO T. , SACTANAGA M. , SHIMODA O. , MORIOKA T. , MISHIMA M. , NAKANO M. 
Published: February 2007

SummaryThe analgesic effects of transdermally applied 10% lignocaine aquagel containing 3% glycyrrhetinic acid monohemiphthalate disodium (as an absorption enhancer) and EMLA cream were compared on the forearms of 34 adult volunteers in a double‐blind fashion. The mean pinprick pain scores (graded by noting the number of painful pinpricks out of five) at 30, 60 and 90 min after application and 30 min after removal of the anaesthetics were 3.3 (0.3) (mean SE), 1.2 (0.3), 0.3 (0.1) and 0.3 (0.1) respectively, in the lignocaine gel group. Corresponding scores were 3.5 (0.3), 1.5 (0.3), 0.7 (0.2) and 0.1 (0.1) respectively, in the EMLA group. Insertion of a 26‐gauge needle into the treated skin to a depth of 1 mm at 90 min after application was not painful in 91% of the volunteers in the lignocaine gel group and 88% of those in the EMLA group. There was no significant difference in any of the corresponding pain scores between the two groups.
Zingiber officinale does not affect gastric emptying rate
Authors: PHILLIPS S. , HUTCHINSON S. , RUGGIER R. 
Published: February 2007

SummaryThe effect of the powdered rhizome of Zingiber officinale (ginger root) on the gastric emptying rate was investigated. In a double‐blind crossover trial, 16 healthy volunteers were randomly allocated to receive either 1 g of ginger or placebo. Gastric emptying was measured using the oral paracetamol absorption model. Ingestion of ginger did not effect gastric emptying. The antiemetic effect of ginger is not associated with an effect on gastric emptying. No adverse effects were noted.
Alfentanil in daycase anaesthesia
Authors: BAGSHAW O. N. T. , SINGH P. , AITKENHEAD A. R. 
Published: February 2007

SummaryThe effect of the addition of a single dose of 7 μg.kg−1 of alfentanil to a propofol/enflurane anaesthetic on the quality of anaesthesia and recovery was assessed. A total of 53 ASA grade 1 or 2 patients who underwent daycase dental surgery were allocated randomly to receive either alfentanil or saline. The study was blinded so that neither the anaesthetist nor the assessor was aware of which solution had been given. Patients in the alfentanil group took signficantly longer to recommence spontaneous ventilation (p = 0.035). Both techniques provided good quality of anaesthesia. Postoperative morbidity was common (45% of patients), but there was no difference between the groups. The rate of recovery was similar in the two groups and no patient required hospital admission after the final assessment at 3 h. Drowsiness was only mild to moderate in both groups at 24 h. A single dose of alfentanil can be administered safely as part of a daycase anaesthetic without increasing morbidity, although there appears to be little advantage in doing so.
The metabolic and hormonal response to cataract surgery
Authors: BARKER J. P. , VAFIDIS G. C. , ROBINSON P. N. , BURRIN J. M. , HALL G. M. 
Published: February 2007

SummaryWe studied the metabolic and hormonal responses of 30 elderly patients undergoing routine cataract surgery who were allocated randomly to receive either general anaesthesia, or local anaesthesia by means of either retrobulbar or peribulbar blockade. Both forms of local anaesthesia successfully prevented the increases in circulating cortisol and glucose concentrations seen in those patients who received general anaesthesia, there being no significant differences between retrobulbar and peribulbar blockade. The results show that the newer, and now more commonly performed peribulbar block, confers the same metabolic and hormonal stability as seen with the more traditional retrobulbar block.
The influence of diamorphine on spinal anaesthesia induced with isobaric 0.5% bupivacaine
Authors: ABUZAID H. , PRYS‐ROBERTS C. , WILKINS D. G. , TERRY D.M.S. 
Published: February 2007

SummaryIn a randomised, double‐blind study, the effect of addition of 1 mg of diamorphine to 4 ml of 0.5% bupivacaine for spinal anaesthesia was studied in two groups each of 30 patients presenting for either transurethral genito‐urinary surgery, or for lower limb arterial surgery or inguinal herniorrhaphy. Addition of 1 mg diamorphine to intrathecal 0.5% bupivacaine produced a prolonged and satisfactory analgesia in more than half the patients undergoing lower limb arterial or inguinal surgery, and the analgesic requirements of the remainder during the first postoperative 24 h were much less than those who received bupivacaine alone. In the urological surgery set there were no significant differences between the group who received bupivacaine and diamophine, and the group who received bupivacaine alone. The mixture of diamorphine I mg in 4 ml 0.5% bupivacaine was slightly less hypobaric (0.9981 at 37°C) than bupivacaine alone.
Atracurium after an anticholinesterase
Authors: Shorten G.D. , Ali H.A. 
Published: February 2007

SummaryThis study documents the response to atracurium (75 μg.kg−1) administered 30 min after a pancuronium‐ or tubocurarine‐ induced neuromuscular block has been reversed with either neostigmine (50 μg.kg−1) or edrophonium (0.5 μg.kg−1). Twenty‐one ASA 1 or 2 patients were studied, of whom H received neostigmine and 10 edrophonium. The degree of neuromuscular block was measured electromyographically from the first dorsal interosseous muscle of the hand using train‐of‐four stimulation of the ulnar nerve. When atracrium was administered, the single twitch response compared with control was 100% in all patients and the mean train‐of‐four ratios were 91% and 65% in the neostigmine and edrophonium groups respectively. After atracurium (75 μg.kg−1), minimum values for the single twitch response compared with control were 52% and 66% in the neostigmine and edrophonium groups respectively. Prior administration of atracurium appears to potentiate the neuromuscular blocking effects of atracurium administered 30 min later.
Evaluation of an alternative method of blood sampling from arterial cannulae
Authors: Alford A. M. , Kirton C. B. , Peacock J. E. 
Published: February 2007

SummaryA new system for sampling from arterial cannulae has been designed which avoids the need to aspirate flushing solution before taking a sample and limits blood loss. The new system was compared with a standard sampling system and direct arterial sampling using in vitro models. A series of haemoglobin concentrations wen‐ prepared and sampled using the three sampling methods. There were no clinically significant differences in the values obtained with the different sampling techniques.