bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular responses to insertion of the laryngeal mask
Authors: WILSON I. G. , FELL D. , ROBINSON S. L. , SMITH G. 
Published: February 2007

SummaryWe have compared, in 40 healthy patients, the cardiovascular responses induced by laryngoscopy and intubation with those produced by insertion of a laryngeal mask. Anaesthesia was induced with thiopentone and maintained with enflurane and nitrous oxide in oxygen; vecuronium was used for muscle relaxation. Arterial pressure was measured with a Finapres monitor. The mean maximum increase in systolic arterial pressure after laryngoscopy and tracheal intubation was 51.3% compared with 22.9% for laryngeal mask insertion (p < 0.01). Increases in maximum heart rate were similar, (26.6% v 25.7%) although heart rate remained elevated for longer after tracheal intubation. We conclude that insertion of the laryngeal mask airway is accompanied by smaller cardiovascular responses than those after laryngoscopy and intubation and that its use may be indicated in those patients in whom a marked pressor response would be deleterious.
Resistance and additional inspiratory work imposed by the laryngeal mask airway
Authors: BHATT S. B. , KENDALL A. P. , LIN E. S. , OH T. E. 
Published: February 2007

SummaryLaryngeal mask airways and tracheal tubes were studied to determine both their resistance to constant gas flows and additional inspiratory work during simulated inspiration. Laryngeal mask airways imposed less resistance and required lower additional inspiratory work compared with the corresponding sized tracheal tubes. If inspiratory loading during anaesthesia is an important consideration, then the laryngeal mask airway may be preferable to a tracheal tube.
Upper oesophageal sphincter pressure and the intravenous induction of anaesthesia
Authors: VANNER R. G. , PRYLE B. J. , O'DWYER J. P. , REYNOLDS F. 
Published: February 2007

SummaryThe upper oesophageal sphincter can prevent regurgitation of oesophageal contents into the pharynx following gastro‐oesophageal reflux in the awake patient. Upper oesophageal sphincter pressure was recorded with a Dent sleeve after hypnosis with midazolam (n = 7) and also during the rapid intravenous induction of anaesthesia with thiopentone (n = 16) or ketamine (n = 7). Thiopentone decreased mean(SD) sphincter pressure from an awake value of 43(19) to 9(7) mmHg (p < 0.001) and midazolam from 38(25) to 7(3) mmHg (p<0.02). Mean(SD) sphincter pressures before and after ketamine were not significantly different at 29(15) and 32(21) mmHg respectively. After suxamethonium mean(SD) sphincter pressure in all patients (n = 30) was 7(4) mmHg. Laryngoscopy (n = 30) caused a small increase in mean(SD) sphincter pressure to 13(10) mmHg (p < 0.001). Thiopentone caused a rapid fall in upper oesophageal sphincter pressure which usually started before loss of consciousness. These findings have implications for the timing of cricoid pressure application.
Patient‐controlled analgesia
Authors: GROVER E. R. , HEATH M. L. 
Published: February 2007

SummaryA patient received a massive overdose of papaveretum intravenously (estimated to be 180 mg) when the glass syringe of a patient‐controlled analgesia machine disengaged from the drive mechanism. She was successfully resuscitated. The pump, on loan from the supplier, had passed a brief evaluation by the infusion pump test house designated by the Medical Devices Directorate of the Department of Health; it has since been withdrawn. It is recommended that patient‐controlled analgesia equipment should be placed at or below patient heart level. The Department of Health is called on to institute a full, independent evaluation scheme for patient‐controlled analgesia equipment.
The effect of music on ketamine induced emergence phenomena
Authors: Kumar A. , Bajaj A. , Sarkar Purnima , Grover V. K. 
Published: February 2007

SummaryThe purpose of this investigation was to assess the influence of music on emergence phenomena after ketamine anaesthesia. Fifty ASA 1 patients undergoing minor gynaecological procedures were randomly divided into two equal groups. Patients in the treated group were played music of their choice through headphones from 5 min before induction of anaesthesia to 15 min postoperatively. Although the incidence of emergence phenomena was similar in both groups the effects tended to be more pleasant and acceptable in those to whom music was played. The majority of patients in the study group (80%) expressed their willingness to have a similar anaesthetic in the future compared to 52% in the control group (p < 0.05).
The absence of teratogenic effects of some analgesics used in anaesthesia
Authors: MARTIN L.V.H. , JURAND A. 
Published: February 2007

SummaryThe possibility exists that agents used in anaesthesia may have adverse teratogenic effects on staff, patients, and developing fetuses. It has been shown that a range of neurotropic drugs, when injected into pregnant mice on the 9th day of gestation, produce a characteristic group of central nervous system malformations in their fetuses. We have studied the possible teratogenicity ofpethidine, fentanyl, phenoperidine and lignocaine when tested in this way and conclude that they appear to have less effect than other neurotropic drugs previously tested.
Anaesthesia for intraperitoneal hyperthermic perfusion
Authors: SUDARSHAN G. , CRAWFORD D. 
Published: February 2007

SummaryIntraperitoneal hyperthermic perfusion is a method of regional chemotherapy shown to be effective in the prevention and treatment of peritoneal metastases. General anaesthesia for a patient who required this procedure is described. Guidelines for management are suggested, with particular emphasis on temperature control, fluid and electrolyte balance and postoperative care.
Hypotension following valve replacement surgery in carcinoid heart disease
Authors: HAMID S. K. , HARRIS D. N. F. 
Published: February 2007

SummaryWe report the use of adrenaline in a 62‐year‐old woman with carcinoid heart disease who underwent double valve replacement. She was given an intravenous infusion of octreotide throughout the peri‐operative period. Following the termination of cardiopulmonary bypass she developed profound hypotension which proved to be refractory to various therapies but responded to adrenaline. Adrenaline is said to be contraindicated in carcinoid syndrome, but we would suggest the consideration of its use in such cases where the hypotension may result from myocardial depression rather than from a carcinoid crisis.
Caudal blockade in the management of aortic thrombosis following umbilical artery catheterisation
Authors: HARGREAVES D. M. , SPARGO P. M. , WHEELER R. A. 
Published: February 2007

SummaryA neonate, with a postconceptual age of 29 weeks, suffered thrombosis of the aorta as a consequence of umbilical artery catheterisation. This resulted in ischaemic lesions of the lower limbs and buttocks. Part of the management consisted of the insertion of an extradural catheter, via the caudal route, which provided good pain relief and may have improved lower limb blood flow.
Thoracic epidural anaesthesia and primary pulmonary hypertension
Authors: ARMSTRONG P. 
Published: February 2007

SummaryPatients with primary pulmonary hypertension occasionally present for surgery. Anaesthesia requires continuous cardiovascular monitoring and maintenance of stable pulmonary and systemic haemodynamics. The management of a patient with severe pulmonary hypertension, undergoing open lung biopsy under a combination of general anaesthesia and thoracic epidural analgesia is reported and the problems of primary pulmonary hypertension are discussed.
Magnetic resonance for the anaesthetist
Authors: PEDEN C. J. , MENON D. K. , HALL A. S. , SARGENTONI J. , WHITWAM J. G. 
Published: February 2007

SummaryAnaesthetists are increasingly involved in patient care during magnetic resonance imaging and spectroscopy. This paper describes a system which has been developed for the management of critically ill patients and the conduct of anaesthesia in a magnetic resonance unit with a 1.6 tesla whole body magnet. Difficulties which arise from working in a confined space in a high magnetic field are highlighted. Different approaches to anaesthesia, sedation and the modification of equipment for use in this environment are reviewed. The problems associated with patient monitoring within a magnetic field are discussed and some solutions are suggested. A transport system for critically ill patients is described and a protocol for management is outlined.
Pre‐registration house surgeons
Authors: Power K. J. 
Published: February 2007

SummaryA group of newly qualified preregistration House Officers completed a questionnaire relating to their knowledge of anaesthetic drugs and to their appreciation of complications which may, in whole or in part, have required some knowledge of anaesthesia. Considerable gaps in knowledge were demonstrable, not only in matters that might arguably be regarded as strictly within the province of anaesthesia, but also in respect of basic pharmacology. The same House Officers were also questioned as to the necessity for various basic pre‐operative investigations prior to six everyday surgical procedures. This demonstrated a marked propensity for House Officers to overinvestigate patients as compared to the requirements of practising anaesthetists. The discrepancy was most marked with respect to pre‐operative chest X rays. However, considerable disparity was also demonstrable amongst a group of experienced anaesthetists as to their requirements for pre‐operative investigations. Permitting students greater exposure to anaesthesia in the undergraduate curriculum could go a long way towards improving this situation.
Ventilatory effects of subarachnoid fentanyl in the elderly
Authors: VARRASSI G. , CELLENO D. , CAPOGNA G. , COSTANTINO P. , EMANUELLI M. , SEBASTIANI M. , PESCE A. F. , NIV D. 
Published: February 2007

SummaryTwenty‐eight elderly patients scheduled for urological surgery were randomly assigned to receive, in a double‐blind study, subarachnoidhyperbaric bupivacaine 15 mg with 50 μg (group A, n = 7), 25 μg (group B, n = 7), or 12.5 μg (group C, n = 7) of fentanyl or 1 ml of saline (group D, n = 7) in a total volume of 4 ml. The pattern of breathing and the ventilatory response to CO2 were studied before and 90, 150 and 480 min after the subarachnoid injection. In group A, mild pruritus and sedation occurred in five patients, while nausea, vomiting and periodic breathing occurred in two. In group B, mild pruritus and sedation were observed in four patients, while nausea and vomiting occurred in two. No significant differences in minute ventilation, respiratory drive and respiratory timing were observed between the groups. Patients receiving fentanyl 50 ug showed a percentual change from baseline values as function of time (slope V̇E/PE'co2 significantly below baseline at 90 and 150 min (p < 0.05). However, the baseline values in this group reverted after 480 min. No side effects were observed in groups C or D. It is concluded that subarachnoid fentanyl 50 μg can cause an early respiratory depression and its use as a postoperative analgesic should be avoided in the elderly.
Carbon dioxide pneumothorax occurring during laparoscopic cholecystectomy
Authors: GABBOTT D. A. , DUNKLEY A. B. , ROBERTS F. L. 
Published: February 2007

SummaryA previously fit patient underwent laparoscopic cholecystectomy. During the procedure arterial oxygen saturation fell and clinical examination revealed signs of a right pneumothorax confirmed by chest X ray. Aspiration of the pleural cavity and analysis of the gas removed showed it to be composed entirely of carbon dioxide. Possible mechanisms of entry of carbon dioxide into the pleural space are discussed.
An evaluation of oxygen delivery using nasal prongs
Authors: OOI R. , JOSHI P. , SONI N. 
Published: February 2007

SummaryOxygen delivery using nasal prongs was assessed using a lung model for spontaneous ventilation. The analogue lung was attached to a manikin, which provided a model of the ‘face and pharynx’ to which the nasal prongs were applied. Oxygen concentrations were measured in the model trachea at varying fresh gas inflow and peak inspiratory flows. The study demonstrated enormous variability in the both the peak‐inspired (26.3–90.0%) and end‐expired concentrations (25.2–78.6%) of oxygen delivered to the trachea. There was a regular relationship between the ratio of peak inspiratory flows, expressed over fresh gas inflow and the end‐expired oxygen concentrations which could allow estimation of inspired oxygen concentration.
The effect of pre‐induction glycopyrronium on the haemodynamic response of elderly patients to anaesthesia with propofol
Authors: Sneyd J. R. , Mayall R. 
Published: February 2007

SummaryThis study investigated whether pretreatment with glycopyrronium can attenuate the hypotension caused by anaesthesia of the elderly with propofol. Twenty elderly patients (77.1 ± 2.44 years, mean±SEM) of ASA physical status 2 or 3 scheduled for elective urological procedures were given glycopyrronium 0 (n = 10) or 5 μ.kg−1 (n = 10) in a randomised, double‐blind manner, 5 min before induction of anaesthesia with propofol infused at 600 ml.h−1 (average induction dose 1.7±0.06 mg.kg−1, mean±SEM) followed by maintenance with a propofol infusion at 10 mg.kg−1.h−1. Although glycopyrronium significantly increased heart rate (p < 0.01, AOVA), the decrease in blood pressure 2 and 5 min after induction was similar in both groups. The study had a power of 80% to detect a 20 mmHg difference in systolic arterial pressure between treatment groups with p < 0.05.
Mivacurium chloride: a study to evaluate its use during propofol–nitrous oxide anaesthesia
Authors: WRIGLEY S. R. , JONES R. M. , HARROP‐GRIFFITHS A. W. , PLATT M. W. 
Published: February 2007

SummaryWe assessed the neuromuscular and cardiovascular effects of mivacurium chloride, a neuromuscular blocking agent, in 33 patients during propofol‐nitrous oxide anaesthesia. Neuromuscular function was assessed with supramaximal stimuli of the ulnar nerve, using surface electrodes at the wrist, with repeat trains of four. Mivacurium given as a bolus of 0.15 mg.kg−1 (ED95× 2) was found to be haemodynamically stable. Intubating conditions assessed at 2 and 2.5 min were either good or excellent. All patients developed a block of 100% in a mean (SD) time of 105 (34) s. There were mean (SD) intervals of 12 (2.4) min before the reappearance of the first twitch of the train of four (T1) following the bolus dose, and 15.8 (3.1) min for the Tl to reach 25% of its control value (TC). Seventeen patients received an infusion of mivacurium to maintain neuromuscular blockade (T1: TC 10–20%) with a mean (SD) infusion rate of 6.9 (2.2) μ.kg−1 min−1. Recovery from neuromuscular blockade was assessed with spontaneous offset or augmented with edrophonium following either the initial bolus or an infusion. Following a bolus it took a mean (SD) of 26.2 (3.7) min for the fourth twitch of the train of four (T4): T1 ratio to reach 0.7. In patients receiving an infusion with spontaneous offset it took a mean (SD) time of 12.0 (2.2) min to reach the T4: T1 ratio of 0. 7 from a Tl: TC value of 8.8. Edrophonium significantly decreased the recovery time in both groups. It took a mean (SD) time of 5.4 (2.2) min to reach a T4:Tl of 0.7froma T1:TC of 17.1% in the group receiving an infusion and 4.0 (0.7) min for the T4.T1 to reach 0.7 from a T1:TC value of 14.3% in the patients receiving a bolus only. We conclude that mivacurium is a suitable agent for neuromusccular relaxation and may have advantages over existing agents.
Upper respiratory tract infections and general anaesthesia in children
Authors: LEVY L. , PANDIT U. A. , RANDEL G. I. , LEWIS I. H. , TAIT A. R. 
Published: February 2007

SummaryConflicting reports regarding the hazards of anaesthesia in children presenting for surgery with an upper respiratory tract infection have appeared in the literature. In the present study 130 children undergoing general anaesthesia with face mask for myringotomy and grommet insertion were graded as having either an acute or recent upper respiratory tract infection or were asymptomatic according to predetermined clinical symptoms and signs. The severity of respiratory and related complications were scored during induction, emergence and recovery. The peripheral oxygen saturation was recorded during induction, emergence, transfer to the recovery ward and in the recovery ward itself. There were no significant differences (p > 0.05) in the complication scores between the three groups of children. However, the incidence of hypoxaemia (oxygen saturation ± 93%) was significantly greater during transfer in the acute infection group (p = 0.001) and the recent infection group (p = 0.02), as well as during recovery in the acute group (p = 0.03) compared with asymptomatic children.
The laryngeal mask airway
Authors: GREENE M. K. , RODEN R. , HINCHLEY G. 
Published: February 2007

SummaryTwo cases of emergency prehospital airway control using the laryngeal mask are described. The patients were trapped following road traffic accidents and limited access prevented tracheal intubation. The laryngeal mask airway may be a useful alternative to tracheal intubation in some cases of prehospital trauma care.
Laryngeal mask and anaesthetic waste gas exposure
Authors: LAMBERT‐JENSEN P. , CHRISTENSEN N. E. , BRYNNUM J. 
Published: February 2007

SummaryIn recent years there has been a growing awareness of the possible hazards caused by anaesthetic gases in operating theatres. The laryngeal mask airway provides an alternative both to tracheal intubation and the face mask although the implications for operating theatre contamination have not been quantified. This paper describes the incidence and magnitude of exposure of theatre personnel to waste anaesthetic gases during laryngeal mask airway anaesthesia. The leakage of anaesthetic gases to the anaesthetist's breathing zone was monitored using a Bruel & Kjaer Multi Gas Monitor, Type 1302 during 50 general anaesthetics employing either spontaneous (n = 24) or controlled (n = 26) ventilation. All patients were anaesthetised with propofol, alfentanil and nitrous oxide. There was no statistically significant association between the amount of anaesthetic gas leakage and ventilation method. The laryngeal mask airway meets occupational safety requirements on nitrous oxide concentrations in the operating theatre environment.
The upgraded Finapres 2300e
Authors: JONES R. D. M. , BROWN A. G. , ROULSON C. J. , SMITH I. D. , CHAN S. C. 
Published: February 2007

SummaryMeasurements from the upgraded Finapres 2300e continuous noninvasive blood pressure monitor, the Finapres 2300 and Colin oscillometric noninvasive blood pressure monitor were compared with invasive arterial line blood pressure readings. Fifteen young Chinese patients undergoing elective spinal surgery of more than 2 h duration had contemporaneous blood pressure measurements digitally recorded every minute. Data were analysed using methods described by Bland and Altman to assess agreement of noninvasive devices with an arterial line. Results showed that although the Finapres 2300e was significantly more accurate than the Finapres 2300 and Colin noninvasive blood pressure monitors it could not be recommended as a substitute for continuous arterial line blood pressure monitoring. Both Finapres devices demonstrated reductions in accuracy related to time (drift) and over‐read diastolic and mean pressures by 5–8 mmHg throughout the range of mean arterial line pressures (bias). The Colin was consistently less accurate than the Finapress monitors and performed worst at low mean arterial line pressures.
A comparison of the pharmacodynamics of rocuronium and vecuronium during halothane anaesthesia
Authors: BOOTH M. G. , MARSH B. , BRYDEN F. M. M. , ROBERTSON E. N. , BAIRD W. L. M. 
Published: February 2007

SummaryThirty healthy patients were randomised to receive either a single bolus dose of rocuronium 0.6mg.kg−1 or vecuronium 0.1 mg.kg−1 during halothane anaesthesia. Onset time, duration 25, duration 75 and train‐of‐four 70 were measured. The onset of neuromuscular blockade following rocuronium was more rapid than vecuronium (p = 0.0001). All other pharmacodynamic parameters were similar. During the first minute following injection of the neuromuscular blocking agent, the heart rate increased by 36% in the rocuronium group but remained stable in those patients who received vecuronium (p = 0.0008). No adverse effects were noted in either group.
Cannulation of the internal jugular vein
Authors: MESSAHEL F. M. , AL‐MAZROA A. A. 
Published: February 2007

SummaryA new approach to internal jugular vein catheterisation in the neck (the ‘very high’ approach) was used in 335 patients over a 12‐month period. The success rate was 100% and there were no complications. It proved to be an easy technique to learn and may be particularly useful in difficult and emergency situations.
Six months of shivering in a district general hospital
Authors: CROSSLEY A. W. A. 
Published: February 2007

SummaryOf 2595 patients admitted to a recovery room in Derbyshire Royal Infirmary over a 6‐month period, 164 (6.3%) shivered postoperatively. Data regarding the anaesthetic techniques to which these patients had been subjected were gathered from the Derby Anaesthetic Audit System. Subsequent analysis demonstrated the importance of a number of factors that led to shivering, including male gender, anaesthetic techniques involving spontaneous ventilation, and anticholinergic premedication. The administration of pethidine, alfentanil or morphine intra‐operatively reduced the incidence of shivering postoperatively.
The laryngeal mask airway in infants
Authors: MIZUSHIMA A. , WARDALL G. J. , SIMPSON D. L. 
Published: February 2007

SummaryClinical and fibreoplic assessment of positioning of the size 1 laryngeal mask airway was performed in 50 infants. A clinically patent airway was obtained in 47 patients at the first attempt, but perfect positioning, as assessed by fibreoptic laryngoscopy, was found in only 22 instances. Despite an airway initially patent, delayed airway obstruction occurred in 12 infants. It is concluded that clinical airway patency does not guarantee ideal positioning of LMA in infants, and that care should be taken to ensure continued airway patency because of the tendency of the LMA position to deteriorate in this group of children.
Laryngospasm during transtracheal high frequency jet ventilation
Authors: SCHUMACHER P. , STOTZ G. , SCHNEIDER M. , URWYLER A. 
Published: February 2007

SummaryA 74‐year‐old woman developed severe cardiovascular depression during percutaneous transtracheal high frequency jet ventilation for laser surgery of the epiglottis. This was found to be caused by acute airway obstruction secondary to severe laryngospasm. We recommend profound neuromuscular blockade during percutaneous transtracheal jet ventilation, in order to prevent this complication.
An evaluation of the gum elastic bougie
Authors: Nolan J. P. , Wilson M. E. , NOLAN J. P. , WILSON M. E. 
Published: February 2007

SummaryThis study was designed to evaluate the routine use of a gum elastic bougie for tracheal intubation. The median time to intubation with the gum elastic bougie while simulating an ‘epiglottis only’ view was only 10 s longer than the time taken during conventional intubation with an optimum view. Three of the patients required a gum elastic bougie‐assisted intubation after attempts at conventional visual intubation had failed. There was no significant difference in the incidence of postoperative sore throat and hoarseness between the two groups. We recommend that anaesthetists should use the gum elastic bougie whenever a good view of the glottis is not immediately obtained.