bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Brain laryngeal mask
Authors: BAILIE R. , BARNETT M. B. , FRASER J. F. 
Published: February 2007

SummaryFifty ASA grade 1 children, who presented for dental outpatient extraction were studied. They were randomly allocated to two groups after induction: group 1 had conventional nasal mask anaesthesia and group 2 anaesthesia with a laryngeal mask. Group 2 had fewer hypoxic episodes and significantly better arterial oxygen saturations (p < 0.01). There was no difference between the groups as regards surgical access, difficulty of extraction or bleeding. The laryngeal mask appears to provide an alternative to conventional nasal mask anaesthesia, with better overall oxygenation and would seem particularly suitable for prolonged or difficult extractions.
Identification of the epidural space in children
Authors: YAMASHITA M. , TSUJI M. 
Published: February 2007

SummaryWe have used an intravenous micro‐drip infusion set to identify the epidural space in 350 infants and children. The infusion set was prepared with saline and connected to the hub of an epidural needle. Free dripping of saline was regarded as a sign that the needle tip had entered the epidural space. The overall success rate of this method was 97.7%.
Immunological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of nitrous oxide and halothane
Authors: PERIĆ M. , VRANEŠ Z. , MARUŠIĆ M. 
Published: February 2007

SummaryImmunological changes in anaesthetic personnel exposed to occupational concentrations of holothane and nitrous oxide 10—60 times greater than the advised maximum were studied during routine work and after 3—4 weeks holiday. Red cell count, haemoglobin concentration and haematocrit decreased during exposure although not significantly, in comparison with a control group, but all had increased significantly after the holidays. Other changes were altered neutrophils and lymphocyte counts. Basophils disappeared from the blood during the exposure. Monocytes were not affected during the exposure, but increased after its cessation. Percentages of CD2 and CD4 lymphocytes increased significantly, but numbers of cells in T lymphocyte subpopulations (total, helper and cytotoxic/supressor lymphocytes) ‐were not significantly altered. B lymphocytes were most strongly affected: they decreased during working periods and did not recover after holidays. Natural killer (NK) cells, on the other hand, decreased significantly during exposure, but fully recovered during holidays. After stimulation with mitogens, phytohaemaglutin, concanavalin A, and pokeweed, lymphocytes from exposed personnel incorporated significantly more 3H‐thymidine than those from control subjects, but stimulation indices did not differ. The natural killer‐cell activity, serum Ig concentrations and phagocytosis by granulocytes were not altered.
Fatal theophylline poisoning with rhabdomyolysis
Authors: PARR M. J. A. , WILLATTS S. M. 
Published: February 2007

SummaryA fatal case of theophylline poisoning is described. The patient developed rhabdomyolysis, renal failure and compartment syndrome, as well as the more usual features of severe theophylline poisoning. Dantrolene appeared to be useful in controlling the hypermetabolic state associated with the overdose and may have a role in future treatment.
Tracheal tube resistance and airway and alveolar pressures during mechanical ventilation in the neonate
Authors: TIPPING T. R. , SYKES M. K. 
Published: February 2007

SummaryThe relationship between peak airway pressure, alveolar pressure and respiratory frequency was calculated for the range of compliances and airway resistances which might be encountered during mechanical ventilation of a 3‐kg neonate. The pressure/flow relationships of 2.5, 3.0, 3.5 and 4‐mm tracheal tubes were determined at a series of flows from 0.5 to 4 litres/minute. Peak airway and alveolar pressures were then measured at various frequencies and inspiratory: expiratory ratios with the tubes incorporated in a model lung. Large differences between peak airway and alveolar pressures developed when frequency was increased or inspiratory time decreased; the differences were greatest with the smaller tubes. Shortening expiratory time by increasing the frequency or altering the inspiratory: expiratory ratio resulted in increased end‐expiratory pressure because of incomplete emptying of the lung.
The effects of intravenous clonidine on ventilation
Authors: OOI R. , PATTISON J. , FELDMAN S. A. 
Published: February 2007

SummaryThe effects of clonidine, an alpha 2 adrenergic agonist, on ventilation were studied in a group of adult volunteers. The ventilatory variables measured were minute ventilation, respiratory rate, end‐tidal carbon dioxide tension and the response to carbon dioxide challenge. We found no differences in minute ventilation, respiratory rate and end‐tidal carbon dioxide tension, before and after clonidine administration. However, the ventilatory response to carbon dioxide was significantly attenuated following clonidine, suggesting that clonidine has respiratory depressant effects.
A comparison of dopexamine and dopamine to prevent renal impairment in patients undergoing orthotopic liver transplantation
Authors: GRAY P. A. , BODENHAM A. R. , PARK G. R. 
Published: February 2007

SummaryThe efficacy of low‐dose dopamine as a renal protective agent was compared with that of dopexamine in patients who underwent orthotopic liver transplantation. Twelve patients who received a continuous infusion of dopexamine (1–3 μg/kg/minute) were matched for age, diagnosis, pre‐operative creatinine clearance and blood loss with 12 patients who received a low‐dose infusion of dopamine (2 μg/kg/minute). The catecholamine infusion was started after induction of anaesthesia and continued for 48 hours after surgery. Patients in the dopexamine group had less evidence of renal impairment and failure than those in the dopamine group during 7 days after the operation, although the differences between groups did not achieve statistical significance. Similarly there were no significant differences between the two groups in peri‐operative urine output, urine/plasma osmolality ratio or creatinine clearance. Dopexamine is at least as effective as dopamine for renal protection in patients who undergo liver transplantation.
The laryngeal mask airway
Authors: MILLER A. C. , BICKLER P. 
Published: February 2007

SummaryThe laryngeal mask airway is an important addition to the anaesthetist's armamentarium, but its use is not without the possibility for misfortune. We encountered an unusual and potentially serious complication. A patient's epiglottis became trapped between the pliable grates in the mask portion of the laryngeal mask and partially obstructed his airway. Should this problem occur and remain unnoticed, in addition to the problem of airway obstruction during the anaesthetic, the oedematous epiglottis could be severely injured upon removal of the laryngeal mask. This, in turn, could result in airway obstruction requiring emergency treatment.
Awake intubation: a new technique
Authors: McCRIRRICK A. , PRACILIO J. A. 
Published: February 2007

SummaryA 46‐year‐old male with a known history of difficult intubation presented for elective surgery. It was considered prudent to perform an awake intubation and a size 3 laryngeal mask was introduced under topical anaesthesia. A gum elastic bougie was then passed, enabling the laryngeal mask to be removed and a tracheal tube to be inserted.
Faulty Superset plastic catheter mounts
Authors: HANNINGTON‐KIFF J. G. 
Published: February 2007

SummaryNine Superset (Intersurgical Ltd) single‐use corrugated plastic catheter mounts were found to be faulty in a boxed batch of 75. The manufacturer's meticulous system of batch coding enabled the source of the problem to be traced quickly. Sporadic faults must be expected to occur in mass‐produced disposable equipment and the unusual origin of the defect reported in these catheter mounts is testimony to the way unexpected events can prejudice the most carefully regulated quality control. It is emphasised that the user can help safeguard the community by ensuring that stock is used in strict rotation and that batch numbers are accurately reported when faults arise.
Whole blood electrolyte assay using ChemPro 500
Authors: THOMPSON J. M. , EMMETT C. , SMITH S. C. H. , CRAMB R. , HUTTON P. 
Published: February 2007

SummaryThe ChemPro 500‘near‐the‐patient’analyser, with ChemPro‘Ion Profile’sensor cards, was evalutated for the assay of pH, Ca2+, K+ and Na+ in whole blood samples from patients in the intensive care unit or during surgery for heart or major blood vessel disease, or for liver transplantation. Imprecisions estimated from replicate whole blood measurements were much greater for all four ions than even the least stringent of the generally accepted analytical goals, and much greater than those estimated using quality assurance materials. Comparisons of assayed values with those obtained using standard laboratory instruments showed significant constant and proportional biases. The performance of the ChemPro 500 with the Ion Profile cards gave us no confidence in recommending their use to anaesthetists and intensivists.
Pain on intradermal injection with lignocaine
Authors: Criswell J. , Gauntlett I.S. 
Published: February 2007

SummaryTwenty ASA 1 volunteers were each injected intradermally with four solutions containing 0.2 ml of 0.5%, 1%, and 2% lignocaine and 0.9% saline to determine whether the pain experienced on injection was related to the concentration of local anaesthetic. A 10 cm linear analogue pain scoring system was used, and the solutions were ranked from most painful to least painful. There were no differences between the different concentrations of lignocaine and 0.9% saline in the severity of pain experienced. We conclude that any concentration of lignocaine may be used intradermally before inserting intravenous catheters without affecting the degree of pain experienced by that injection.
Continuous thoracic epidural fentanyl for post‐thoracotomy pain relief: with or without bupivacaine?
Authors: GEORGE K. A. , WRIGHT P. M. C. , CHISAKUTA A. 
Published: February 2007

SummaryTwenty‐five ASA 1 or 2 patients undergoing thoracotomy were entered into a prospective, randomised, double‐blind study comparing thoracic epidural fentanyl alone and thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief, pulmonary function and cardiovascular stability were assessed. Pain relief was superior in the bupivacaine series (p < 0.05) during the first day after operation and this was accompanied by better oxygenation (p < 0.05); the difference did not persist into the second day. Forced expiratory variables were reduced in both series to 50–60% of the values before operation throughout the study (p < 0.05) and differences did not occur between the groups. The incidence of side effects attributable to epidural fentanyl was high, but hypotension did not occur. Small doses of bupivacaine administered together with fentanyl into the thoracic epidural space improve analgesia without causing hypotension.
Transient blindness following epidural analgesia
Authors: VICTORY R. A. , HASSETT P. , MORRISON G. 
Published: February 2007

SummaryA 43‐year‐old woman was given an epidural injection of steroid mixed with local anaesthetic, under general anaesthesia, for treatment of low back pain. In the recovery room she complained of blindness in one eye. Fundoscopy revealed retinal and vitreous haemorrhages in both eyes. Retinal haemorrhages can be caused by an increase in intracranial pressure and are therefore a possible complication of epidural anaesthesia.
Mortality associated with anaesthesia
Authors: GANNON K. 
Published: February 2007

SummaryThe review is based on an analysis of anonymous case record material at the Medical Protection Society's London Office for the 5‐year period 1982–1986, in which death was associated with anaesthetic procedures. A total of 25 cases were analysed. The principal events which resulted in death were failed intubation, drug‐related problems and problems with equipment. The principal contributory factors were inadequate supervision, inadequate pre‐operative assessment and failure of communication. The present review suggests that supervision and training of junior staff, decision‐making by senior staff and patterns of communication both within and between specialities are areas which should be selected for further research.
The impact of the appearance of the anaesthetist on the patient's perception of the pre‐operative visit
Authors: Sanders L. D. , Gildersleve C. D. , Rees L. T. , White M. 
Published: February 2007

SummaryThe clinician's appearance is often considered a symbol which identifies and defines specific characteristics of the individual. Opinion of both lay and medical personnel on appropriate clothing inclines towards formal dress. Our aim was to assess the effect of the anaesthetist's appearance during a ward visit on the patient's evaluation of either the visit or the anesthetist himself. In our sample of 66 patients we found no evidence that the style of dress (formal: suit and tie, informal: jeans and open‐necked shirt) affected that evaluation. However, when 138 patients were asked to rate the desirability of items of clothing for a male hospital doctor they expressed a preference for traditional clothing; a suit was rated as desirable and jeans as one of the four most undesirable items. We conclude that despite the conservatism of expressed opinions, the clothing worn by the anaesthetist is irrelevant to the patient's satisfaction with the visit.
Policies for oral intake during labour
Authors: Michael S. , Reilly C. S. , Caunt J. A. 
Published: February 2007

SummaryA postal survey was conducted to gain information on the use of policies on oral intake, selection of mothers and type of intake given during established labour by all maternity units in England and Wales. A response rate of 91.6% (351 out of 383) was achieved; 79.5% of units had a written policy for oral intake, 96.4% of units allowed mothers some form of oral intake and 68.3% of these units selected mothers according to risk categories. Of the 268 units allowing oral intake, 67.2% gave drink only and 32.8% drink and food. Of those allowing food, all but 13.6% had a selection policy. Of the 85 units not selecting mothers, 78.8% gave water only; the remaining 21.2% gave water and other drink or food. This survey demonstrates a wide variation in policies for oral intake during labour.
The pharmacodynamics of alcuronium in the elderly
Authors: KENT A. P. , HUNTER J. M. 
Published: February 2007

SummaryAlcuronium (0.2 mg/kg) was given to 12 elderly patients, mean age 77 years (range 70–88 years) and 12 young patients, mean age 24 years (range 18–32 years) undergoing general anaesthesia. A compound muscle action potential was monitored continuously throughout anaesthesia, using an electromyograph and the train‐of‐four twitch technique. The rate of onset and maximum block achieved were similar in both the young and elderly patients, as were the times to 20% recovery of the first twitch compared with control (T1: T0) and fourth twitch compared with the first, (T4: T1). In contrast, the time to 70% recovery of T1: T0 was significantly prolonged in the elderly (138 as compared with 89 minutes: p < 0.01) as was the recovery index (25–75%) for T1: T0 (95 as compared with 46 minutes: p < 0.01) and the time to 70% recovery of T4: T1 (181 as compared with 131 minutes: p < 0.05). The recovery curves for T1: T0 and T4: T1 were also significantly different in the elderly from the young group (p < 0.01 in both instances). These results show that the duration of action of alcuronium is significantly prolonged in the elderly.
Assessment of a hygroscopic heat and moisture exchanger for paediatric use
Authors: WILKINSON K. A. , CRANSTON A. , HATCH D. J. , FLETCHER M. E. 
Published: February 2007

SummaryA laboratory study of a widely available heat and moisture exchanger marketed for paediatric use was undertaken. The deadspace, measured by volume displacement, was 12 ml, similar to that of a standard catheter mount for paediatric use. Pressure drop across the device was measured at several different flows in five samples of the device in both the dry and wet state. Calculated resistance proved to be markedly lower when compared with that of other anaesthetic equipment such as tracheal tubes, and with similar humidification devices for paediatric use.
Intubation with propofol augmented with intravenous lignocaine
Authors: Mulholland D. , Carlisle R. J. T. 
Published: February 2007

SummarySixty patients of ASA grade 1 and aged 18 to 55 years were admitted to a double‐blind study. Anaesthesia was induced with propofol 2.5 mg/kg after intravenous pretreatment with lignocaine 1.5 mg/kg or a similar volume of isotonic saline. The quality of subsequent tracheal intubation was graded and the pressor response to tracheal intubation assessed. There were no significant differences between treatment groups.
Evaluation of the Graseby PCAS
Authors: JACKSON I. J. B. , SEMPLE P. , STEVENS J. D. 
Published: February 2007

SummaryThe Graseby patient‐controlled analgesia system was evaluated in the laboratory and in clinical use. The problems encountered with eight examples used to treat 510 patients are reported. Laboratory performance revealed the unit to be accurate at infusion volumes of 1 and 2 ml.
Visual evoked potentials and visual acuity after transurethral resection of the prostate
Authors: Mantha S. , Rao S. M. , Singh A. K. , Mohandas S. , Prakas Rao B. Surya , Joshi N. 
Published: February 2007

SummaryChanges in visual evoked potentials, visual acuity, blood ammonia levels and serum electrolytes (Na+ and K+) after transurethral resection of the prostate using glycine as an irrigating fluid performed under subarachnoid block were studied in 12 patients, in the pre‐operative and immediate postoperative periods. Visual evoked potentials (p100 latency), recorded by shift of a checkerboard pattern, increased significantly from a pre‐operative value of mean (SEM) 101.18 (1.63) msec in the right eye, and 102.5 (1.47) msec in the left eye to 108.91 (1.8) msec (p < 0.01) and 108.08 (2.53) msec (p < 0.01) respectively in the postoperative phase. There were no changes in visual acuity as assessed by a Snellen's chart, blood ammonia levels and serum electrolyte concentrations. The amount of glycine used intra‐operatively for irrigation ranged from 3 to 31 litres.
Pulmonary embolism confirmed by transoesophageal echocardiography
Authors: SERMEUS L. , VAN HEMELRIJCK J. , VANDOMMELE J. , VAN AKEN H. 
Published: February 2007

SummaryA 60‐year‐old patient suffered a pulmonary embolism following the application of an Esmarch and pneumatic tourniquet before arthroscopy of the knee. The diagnosis was suspected because of sudden hypotension, ECG changes, a decrease in end‐expiratory carbon dioxide concentration and oxygen desaturation as indicated by pulse oximetry. Before performing a sternotomy and cardiopulmonary bypass for removal of pulmonary artery clots, the diagnosis was confirmed by the demonstration of severe right ventricular strain using transoesophageal echocardiography.
Inorganic fluoride in prolonged isoflurane sedation
Authors: Breheny F. X. 
Published: February 2007

SummaryAn 18‐year‐old girl received isoflurane sedation for 48 h to facilitate mechanical ventilation. This resulted in a serum inorganic fluoride level of 37.3 μmol.l−1 when the isoflurane was stopped. As the serum fluoride level may continue to rise after isoflurane and as this level is approaching toxicity, the role of isoflurane sedation in the critically ill should be approached cautiously.
Oesophageal achalasia causing respiratory obstruction
Authors: WESTBROOK J. L. 
Published: February 2007

SummaryA patient with complete respiratory obstruction due to massive oesophageal dilatation is described. Immediate relief of symptoms and disappearance of the oesophageal swelling occurred after administration of sublingual glyceryl trinitrate. Nitrates cause a reduction in the lower oesophageal sphincter pressure in patients with oesophageal achalasia and in this case it is presumed that spasm of the lower oesophageal sphincter had been a major factor preventing decompression of the dilated oesophagus.
The occurrence of bacteraemia associated with the use of oral and nasopharyngeal airways
Authors: Ali M. T. , Tremewen D. R. , Hay A. J. , Wilkinson D. J. 
Published: February 2007

SummaryIn order to determine whether placement of oral or nasopharyngeal airways during anaesthesia induces a significant bacteraemia, 36 ASA grade 1 or 2 patients undergoing body surface surgery, in whom it was anticipated that spontaneous respiration would be maintained, were randomly allocated to one of two groups. One group was given oral airways and the other, nasopharyngeal. A series of blood samples, which were taken before and after airway insertion, were cultured aerobically and anaerobically. Nasal and oral swabs were taken at the same time. Single isolates of Corynebacterium species and Acinetobacter species, together with two isolates of Staphylococcus epidermidis were grown from one culture bottle from 4 of the 36 patients studied. None of the oral or nasal swabs, or any of the subsequent or previous blood samples produced positive cultures for these organisms in these four patients. We believe that these results represent skin commensal contamination rather than bacteraemia in these four patients, and that bacteriological considerations should not influence decisions about the type of airway used during anaesthesia. However, prophylactic antibiotic therapy should still be provided for all high risk cases.
Muscle pains and biochemical changes following suxamethonium administration after six pretreatment regimens
Authors: McLOUGHLIN C. , ELLIOTT P. , McCARTHY G. , MIRAKHUR R. K. 
Published: February 2007

SummaryThe incidence of muscle pains and changes in serum concentrations of potassium, calcium and creatine kinase following suxamethonium were investigated after no pretreatment or pretreatment with intravenous tubocurarine 0.05 mg.kg−1, intravenous chlorpromazine 0.1 mg.kg−1, alphatocopherol (vitamin E) 600 mg in three divided doses orally, aspirin 600 mg orally or intravenous calcium chloride 5 mg.kg−1 in groups of 20 patients each. The incidence of myalgia was reduced significantly by tubocurarine, chlorpromazine and alphatocopherol. However, the increase in creatine kinase was attenuated only in the groups of patients who received tubocurarine and chlorpromazine. The changes in serum potassium and calcium concentrations were within acceptable limits. The intubating conditions were not as good in the patients who received tubocurarine as in the other groups. Effectiveness of chlorpromazine in preventing both the myalgia and the biochemical changes suggests the involvement of phospholipases in the pathogenesis of suxamethonium‐induced muscle damage.
Suxamethonium block in the myasthenic patient
Authors: BARAKA A. 
Published: February 2007

SummaryThe neuromuscular block of suxamethonium 1.5 mg.kg−1 was investigated in three myasthenic patients (Class HA), undergoing thymectomy. Two of the patients were receiving pre‐operative pyridostigmine therapy. In the three patients, plasma cholinesterase activity was determined on the morning of surgery and was correlated with the neuromuscular response to suxamethonium as monitored by electromyography. The results suggest that the response to suxamethonium in the myasthenic patients can show wide variations according to the level of their plasma cholinesterase activity. The degree and duration of suxamethonium block is inversely related to the plasma cholinesterase activity.