bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship of blood lactate concentrations, oxygen delivery and oxygen consumption in septic shock and the adult respiratory distress syndrome
Authors: NIMMO G. R. , MACKENZIE S. J. , WALKER S. W. , CATNACH J. , NICOL M. , ARMSTRONG I. R. , GRANT I. S. 
Published: February 2007

SummaryTissue hypoxia is thought to be pivotal to the development of multiple organ failure, but cannot be measured directly in clinical practice. We assessed the relationship between initial arterial blood lactate concentrations and the presence of the phenomenon of delivery‐dependent oxygen consumption, both of which may indicate tissue hypoxia. Twenty‐three critically ill patients with septic shock and adult respiratory distress syndrome were studied prospectively and allocated to one of two groups according to blood lactate concentrations. In group 1, blood lactate concentration was less than the level widely accepted as significant (2 mmol.l−1); in group 2, the concentration exceeded 2 mmol.l−1. In both groups, resuscitation with colloid, blood and vasoactive drugs resulted in significant increases in oxygen delivery; in group 1 (n = 13), mean (SEM) oxygen delivery increased from 484 (36) to 730 (44) ml.min−1.m−2 (p < 0.005) and in group 2 (n = 10) from 550 (54) to 780 (54) ml.min−1.m−2 (p < 0.05). In neither group was there a significant change in oxygen consumption. However, there were individuals in both groups who exhibited pathological delivery dependence. This suggests that the absence of hyperlactataemia does not preclude delivery dependence of oxygen consumption with the attendant potential for tissue hypoxia.
Anaesthesia for thoracoscopic pleurectomy and ligation of bullae
Authors: Millar F. A. , Hutchison G. L. , Wood R. A. B. 
Published: February 2007

SummaryA patient is described who, despite severe pre‐operative respiratory disability, had her persistent pneumothorax successfully managed by thoracoscopic pleurectomy. The technique causes considerably less pain and interference with respiratory function postoperatively than does conventional thoracotomy. Potential anaesthetic problems arise because of the necessity of insufflating carbon dioxide at pressures of up to 1 kPa to maintain a pneumothorax during surgery.
EMLA for postoperative analgesia for day case circumcision in children
Authors: Lee J. J. , Forrester P. 
Published: February 2007

SummaryA randomised study was designed to evaluate and compare the analgesic efficacy of EMLA with dorsal nerve of penis block, in children undergoing day case circumcision. The mean (SD) duration of analgesia for EMLA and dorsal nerve block were 0.5 (0.1) h and 6.4 (1.2) h respectively (p < 0.001). It is concluded that EMLA is not as effective as dorsal nerve of penis block with regard to postoperative analgesia. No adverse effects were observed.
Brainstem auditory evoked response during propofol anaesthesia in children
Authors: PURDIE J. A. M. , CULLEN P. M. 
Published: February 2007

SummaryThe effect of propofol on the brainstem auditory response was studied in 10 healthy children presenting for elective general surgery. A computer‐controlled infusion of propofol was used to induce and maintain anaesthesia. Basal brainstem auditory evoked responses were recorded in the awake child and at different infusion rates of propofol. Significant increases in the latencies of the brainstem waves III and V and the interpeak intervals I‐V and III‐V were seen and were dose dependent. The changes were small and would not preclude the use of propofol anaesthesia for brainstem auditory evoked response testing in children.
Continuous spinal anaesthesia in acute respiratory failure
Authors: GRACE D. , ORR D. A. 
Published: February 2007

SummaryA patient with an obstructed femoral hernia and intercurrent respiratory failure was successfully anaesthetised with a continuous spinal technique. The technique provided excellent intra‐operative anaesthesia and early postoperative analgesia, whilst avoiding further respiratory compromise. Disconnection of the catheter hub from the catheter prevented prolonged provision of postoperative analgesia by this route. Fixing of both the catheter and the hub to the patient are advocated to avoid this problem.
A very small dose of suxamethonium relieves laryngospasm
Authors: CHUNG D. C. , ROWBOTTOM S. J. 
Published: February 2007

SummaryIntravenous suxamethonium, in a dose as small as 0.1 mg.kg−1, has been found to be reliable in the treatment of laryngeal spasm. Three episodes of vocal cord spasm observed during direct laryngoscopy were relieved by this dose of suxamethonium.
A comparison of the laryngeal mask airway and Guedel airway, bag and facemask for manual ventilation following formal training
Authors: ALEXANDER R. , HODGSON P. , LOMAX D. , BULLEN C. 
Published: February 2007

SummaryTen volunteers, with no previous experience of resuscitation, were formally trained in the use of the laryngeal mask airway and the oropharyngeal airway (Guedel), bag and facemask for manual ventilation of the lungs in 104 fit, anaesthetised adults. They then used both airways in turn. The order of insertion was randomly allocated, and the times taken for insertion were also recorded. Ventilation for each airway was deemed to be successful if an increase in end‐tidal carbon dioxide partial pressure did not occur and arterial oxygen saturation remained greater than 90%. Success rates for the laryngeal mask airway and the Guedel airway, bag and facemask were 87% and 43% respectively (p < 0.001) and the average insertion times were 27.4 s (SEM 1.5) and 15.8 s (SEM 0.50) (no significant difference), respectively. The laryngeal mask airway proved to be easier to use for manual ventilation than the Guedel airway, bag and mask for inexperienced personnel who had received a period of formal training in both techniques.
Patient‐controlled analgesia with and without background infusion. Analgesia assessed using the demand: delivery ratio
Authors: McCoy E. P. , Furness G. , Wright P. M. C. 
Published: February 2007

SummarySixty adult patients following general surgical operation were treated with patient‐controlled analgesia using morphine. Patients were allocated into three groups to receive: no background infusion, a 1 mg.h−1 or a 2 mg.h−1 background infusion. The other controls on the patient‐controlled analgesia machine were set to allow a maximum dose of morphine of 6 mg.h−1 to each group. Analgesia was assessed after 4 and 24 h using a 100 mm horizontal visual analogue scale. The number of analgesic requests made by the patient and the number of those requests which resulted in successful deliveries was recorded. Patients who received a regimen including a background infusion had improved pain relief, particularly in the first 4 h of treatment (p < 0.05). Patients who received a background infusion of 2 mg.h−1 had an increased incidence of nausea (p < 0.05). A background infusion of I mg.h−1, with a 1 mg bolus dose and a 12 min lockout interval provided acceptable pain relief without excessive nausea. In all three groups the ratio of analgesic requests to successful deliveries correlated with the degree of pain reported by visual analogue score (p = 0.0001).
Delayed cutaneous fluid leak from the puncture hole after removal of an epidural catheter
Authors: EENNIS M. , BROCK‐UTNE J. G. 
Published: February 2007

SummaryA case of a delayed but persistent cutaneous fluid leak from a puncture hole following removal of an epidural catheter is presented. The fluid was subsequentlv found not to be cerebrospinal but interstitial oedema fluid. This case demonstrates the importance of performing simple investigations on any such fluid before ordering more complex tests.
Intermittent thiopentone for teaching fibreoptic nasotracheal intubation
Authors: Yentis S. M. , Jankowski S. , Gregory I. C. 
Published: February 2007

SummaryA technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubating fibrescope. During endoscopy patients breathed spontaneously oxygen‐enriched air and passage of the tracheal tube was facilitated by suxamethonium. Arterial blood pressure, heart rate and arterial oxygen saturation were monitored continuously. Time from loss of eyelash reflex to successful intubation was 113 (90) (35–480) s (mean (SD) (range)). Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients: the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.
Anaesthesia for airway obstruction in laryngo‐onycho‐cutaneous syndrome
Authors: HODGES U. M. , LLOYD‐THOMAS A. 
Published: February 2007

SummaryA 4‐year‐old boy with laryngo‐onycho‐cutaneous syndrome underwent excision of an obstructive vocal cord lesion. There is only one previous case report of laryngeal involvement in this syndrome but the anaesthetic management has not been reported. The anaesthetic management for microlaryngobronchoscopy and laser surgery in this child with upper airway obstruction is described.
Fresh frozen plasma and edrophonium in a patient with a plasma cholinesterase deficiency
Authors: SMITH D. C. , RIDLEY S. A. , DONALDSON K. F. 
Published: February 2007

SummaryA 35‐year‐old woman undergoing laparoscopic sterilisation developed prolonged apnoea after suxamethonium. Fresh frozen plasma was given to replenish plasma cholinesterase, but recovery of neuromuscular transmission was not accelerated. Routine use of quantitative neuromuscular monitoring simplified her postoperative management.
Bacterial filters protect anaesthetic equipment in a low‐flow system
Authors: LUTTROPP H. H. , BERNTMAN L. 
Published: February 2007

SummaryWe have recently described a low‐flow system with mechanical ventilation in which there was an open connection between the circle and ventilator. In the present study bacterial contamination and the role of bacterial filters at different points in the system were studied. Filters between the tracheal tube and circle are an effective barrier, but their absence did not increase contamination of either the circle or the ventilator. Some filters are also effective as heat and moisture exchangers if situated at the tracheal tube. Because of the lack of bacterial contamination, a prolonged interval between disinfection of the open connection and ventilator is acceptable, which reduces wear and costs.
The nasopharyngeal airway
Authors: STONEHAM M. D. 
Published: February 2007

SummaryArtificial nasopharyngeal airway position and performance were assessed in 120 anaesthetised adult patients. Using a fibreoptic laryngoscope mean distances from nares to larynx were measured at 209 mm (SD 11) in males and 180 mm (SD 11) in females; those from nares to epiglottis were 159 mm (SD 12) in males and 140 mm (SD 11) in females. Nasopharyngeal airways were frequently misplaced, 60% lying beyond the tip of the epiglottis and 13% lodged in the vallecula. Forty‐two percent of subjects had clinical evidence of respiratory obstruction. Nasopharyngeal airway compression in the nasopharynx and obstruction by the tongue and soft palate were common causes of respiratory obstruction. Regression analysis revealed that nares‐epiglottis length correlated significantly with subject height (t = 3.9, p = 0.0002), but not with three external measurements made around the head and neck. Head flexion and extension resulted in comparatively little relative movement of the nasopharyngeal airway. Nasopharyngeal airway length and diameter should be standardised to optimise performance.
The Genius infrared tympanic thermometer
Authors: EDGE G. , MORGAN M. 
Published: February 2007

SummaryA clinical tympanic thermometer was evaluated. In vitro it was found to be accurate over the temperature range 28°C to 40°C. Clinical assessment was made during the cooling and rewarming phases of patients undergoing surgery with the aid of cardiopulmonary bypass and compared with the results obtained with an Ellab thermocouple thermometer. It was also used in patients in the intensive care unit in whom core temperature was being measured using the thermistor incorporated in a pulmonary artery catheter. The infrared thermometer was found to be accurate, rapidly responding and easy to use.
Noninvasive monitoring of respiratory volume
Authors: AMIN H. M. , CICADA M. , FORDYCE W. E. , CAMPORESI E. M. 
Published: February 2007

SummaryThe authors studied the accuracy of the noninvasive breath monitor (Voltek Enterprise, Willowdale, Ontario, Canada) in predicting the tidal volumes in five healthy human volunteers. The signals of the breath monitor were compared with the volumes estimated by a calibrated pneumotachograph. The results show that the breath monitor is considerably accurate and can be accepted as a reliable device for clinical applications.
Breast feeding and anaesthesia
Authors: LEE J. J. , RUBIN A. P. 
Published: February 2007

SummaryAnaesthetists require a good knowledge of the excretion of drugs in breast milk and the potential hazards to suckling infants of drug ingestion via breast milk. A brief account of the physiology of lactation is given. The mechanisms of drug passage into breast milk are discussed followed by a review of the excretion in breast milk of drugs used in anaesthetic practice. Suggestions for the management of anaesthesia in breast feeding mothers are offered.
Myalgia and biochemical changes following suxamethonium after induction of anaesthesia with thiopentone or propofol
Authors: Maddineni V. R. , Mirakhur R. K. , Cooper A. R. 
Published: February 2007

SummaryThe incidence and severity of muscle pains and changes in creatine kinase were assessed following administration of 1 mg.kg−1 suxamethonium either immediately or 2 min after induction of anaesthesia with propofol or thiopentone in patients undergoing elective dental and ophthalmic surgery. The incidence of muscle pains was 35 and 60% respectively in the groups given suxamethonium immediately and 2 min after propofol, and 35 and 55% when given immediately and 2 min after thiopentone, with no statistically significant differences among the groups. Creatine kinase levels increased in all the groups after operation with the least average increase in the group receiving suxamethonium immediately after propofol and the highest increase in the group receiving suxamethonium 2 min after thiopentone. There was no correlation between the incidence and severity of fasciculations, muscle pains and changes in creatine kinase within or between the groups. It is concluded that neither the induction agent nor the time between the induction agent and suxamethonium administration has any significant influence on the incidence of muscle pains or creatine kinase elevation following suxamethonium.
Implicit memory during balanced anaesthesia
Authors: BONEBAKKER A. E. , BONKE B. , KLEIN J. , WOLTERS G. , HOP W. C. J. 
Published: February 2007

SummaryThe effect of the number of presentations on implicit memory for words was studied in anaesthetised patients. During standardised, balanced anaesthesia, 81 surgical patients were presented with less common specimens of familiar word categories. For each of three word categories the number of word presentations varied between the patients (0 (control), 5, or 30 presentations). Postoperatively, repetition priming was tested by asking patients to generate exemplars for each of the word categories. No implicit memory for the words presented during anaesthesia was found and consequently no effect of number of word presentations could be demonstrated. It is suggested that this finding, which contradicts previous results, may be caused by the relatively low familiarity of the words used.
Propofol‐fentanyl anaesthesia in cardiac surgery: a comparison in patients with good and impaired ventricular function
Authors: PHILLIPS A. S. , McMURRAY T. J. , MIRAKHUR R. K. , GIBSON F. M. , ELLIOTT P. 
Published: February 2007

SummaryThe haemodynamic effects of propofol‐fentanyl anaesthesia for elective cardiac surgery were compared in 24 patients with good left ventricular function (ejection fraction > 45%, left ventricular end‐diastolic pressure < 16 mmHg) and nine patients with impaired function. Anaesthesia was induced withfentanyl 25 μg.kg−1 and pancuronium 0.1 mg.kg−1 and was maintained with a variable rate propofol infusion, mean rate 2.61 mg.kg−1.h−1 in the good ventricular function group and 2.71 mg.kg−1.h−1 in the impaired function group. Additional fentanyl 7.5 μg.kg−1 was given before sternotomy. Ventilation to normocarbia was with air and oxygen (Fio2 0.6). Haemodynamic measurements were made before induction, after tracheal intubation, before and after sternotomy and before aortic cannulation. There were no significant differences between the groups in any haemodynamic variables during the study. Twenty minutes after intubation both groups showed a decrease from pre‐induction values in mean arterial pressure (p < 0.05) and left ventricular stroke work index (p < 0.05), the reduction in left ventricular stroke work index remaining significant during the prebypass period in both groups. There were no significant changes in right or left sided filling pressures, systemic vascular resistance or heart rate. The technique decreased cardiac work and effectively controlled the autonomic responses to sternotomy in both groups. This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with impaired ventricular function having cardiac surgery.
Laryngeal mask airway insertion
Authors: BRIMACOMBE J. , BERRY A. 
Published: February 2007

SummaryThe ease of insertion of the laryngeal mask airway with the patient's head in the standard position and the neutral position was compared, in a study of 80 healthy patients. Successful insertion was assessed byfibreoptic bronchoscopy and the functioning of the airway. In terms of function the successful insertion rate for the standard position was 100% (40/40) and for the neutral position 95% (38/40). There were no significant differences in scores as assessed by fibreoptic bronchoscopy. The laryngeal mask airway may have a role in the management of some patients with cervical spine instability, although confirmation of this ultimately depends on the results of outcome studies.
Evaluation of pulse oximetry during cardiopulmonary resuscitation
Authors: SPITTAL M. J. 
Published: February 2007

SummaryThis study evaluates whether the pulse oximeter is useful during cardiopulmonary resuscitation. The instrument was of undoubted benefit in the management of primary respiratory arrest, but of equivocable value in cardiac arrest. Data were displayed during external chest compressions, but were generally unreliable. The ear probe was not able to produce a consistently good signal during cardiopulmonary resuscitation. Nevertheless, the provision of an oximeter amongst the first‐line resuscitation equipment available at a cardiopulmonary arrest significantly altered the management of seven out of 20 patients, five of whom survived.
The uptake of isoflurane during anaesthesia
Authors: LOCKWOOD G. G. , CHAKRABARTI M. K. , WHITWAM J. G. 
Published: February 2007

SummaryThe uptake of isoflurane at a constant end‐expired concentration of 1.5% in oxygen was studied in 15 women, ASA 1 or 2, undergoing elective total abdominal hysterectomy. The anaesthetic was administered by a simple computer‐controlled to‐and‐fro closed system. After an initial period of wash‐in to the system, the rate of uptake of isoflurane decreased bi‐exponentially with a rapid reduction during the first 15 min. Perturbations from this bi‐exponential decline reflect changes in cardiac output. The mean (SD) cumulative use of isoflurane was 4.5 (0.43) ml after 30 min and 7.3 (0.79) ml after 60 min.
Implicit learning during enflurane anaesthesia in spontaneously breathing patients?
Authors: JELICIC M. , ASBURY A. J. , MILLAR K. , BONKE B. 
Published: February 2007

SummaryForty‐one patients breathing spontaneously during enflurane anaesthesia were presented (via headphones) either with statements about common facts of some years ago, or new verbal associations, i.e. names of fictitious people. Postoperatively, there were no differences between the two groups in the responses to questions about the common facts or attribution of fame to the fictitious people. This finding suggests that unconscious learning and activation may not occur during enflurane anaesthesia without neuromuscular block.
Repeated doses of suxamethonium in the myasthenic patient
Authors: BARAKA A. , BAROODY M. , YAZBECK V. 
Published: February 2007

SummaryThe neuromuscular block of successive doses of suxamethonium 100 mg, monitored by electromyography, was investigated in a myasthenic patient (class IIB), undergoing thymectomy. The results suggest that successive doses of suxamethonium in the myasthenic patient are followed by a progressive prolongation of the neuromuscular block. This may be attributed to rapid desensitisation of the myasthenic endplate receptors and the rapid development of phase II block, as evidenced by a progressive decrease of the T4/T1 ratio.
A new epidural catheter
Authors: COLLIER C. B. , GATT S. P. 
Published: February 2007

SummaryA new design of epidural catheter with three lateral eyes placed in close proximity to its closed end is described. Prototype models of this catheter were tested in 200 obstetric and surgical patients. In a single‐blind randomised study it was found to be easy to insert and highly satisfactory in use, when compared to the current catheter type, with three widely spaced lateral eyes. It is hoped that the close spacing of the eyes will eliminate the complication of multicompartment block, as seen with earlier multihole catheters, and improve the safety of epidural block.
Epidural bupivacaine for aortic surgery The effect of dilution on the quality of analgesia
Authors: SLADE J. M. 
Published: February 2007

SummaryTwenty patients undergoing elective abdominal aortic aneurysm repair were randomly allocated to two groups and studied for 24 h following surgery. Postoperative analgesia was provided by epidural bupivacaine infusion and intravenous patient‐controlled 0.05 mg boluses of alfentanil. One treatment group received 7 ml.h‐1 of a 0.25% solution of bupivacaine, the other 25 ml.h‐1 of a 0.07% solution. The rate of infusion was thus 17.5 mg.h‐1 in both groups. Patients receiving 7 ml.h‐1 of epidural infusate required more doses of alfentanil (median 26.5, range 0‐50) than the group receiving 25 ml.h‐1 of the dilute infusion (median 3.0, range 0–16). It is concluded that 17.5 mg.h‐1 of bupivacaine infused into the epidural space produces better analgesia when infused in a volume of 25 ml.h‐1 (0.07%) than when given in a volume of 7ml.h‐1 of solution (0.25%).
Laryngotracheal stenosis: a serious complication of percutaneous tracheostomy
Authors: McFARLANE C. , DENHOLM S. W. , SUDLOW C. L. M. , MORALEE S. J. , GRANT I. S. , LEE A. 
Published: February 2007

SummaryTracheostomy in patients requiring prolonged artificial ventilation in intensive care is increasingly being performed by a percutaneous dilatational technique, in preference to the standard surgical method. Since its introduction numerous series have reported favourably on its general safety in the short‐term, but there have been few reports of longer term follow‐up of patients. We present four cases of laryngotracheal stenosis, a previously unreported complication associated with the technique, and discuss the relevance of these to the future practice of percutaneous tracheostomy.