bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of propofol and thiopentone for induction of anaesthesia in premedicated patients
Authors: ROLLY G. , VERSICHELEN L. 
Published: February 2007

SummaryThirty premedicated ASA I or II patients scheduled for minor gynaecological surgery, were randomly allocated to receive either 1.5 mg/kg or 2 mg/kg propofol of the new emulsion formulation, or 4 mg/kg thiopentone, given over 20 seconds. Anaesthesia was successfully induced in all 30 patients. The mean (SEM) induction times were for propofol 1.5 mg/kg 33.3(3.2) second.7, for 2 mg/kg 30.5(2.7) seconds and for thiopentone 34.6(2.7) seconds. The incidence of apnoeu greater than 10 seconds, was respectively 60, 80 and 80%, and the mean duration of apnoea 30.8(5.3). 37.1(5.0) and 23.7(5.0) seconds. The mean systolic blood pressure decreased after propofol 1.5 mg/kg by 16.0 mmHg, after 2 mg/kg by 18.6 mmHg, and increased after thiopentone by 1 mmHg, 2 minutes after injection. Heart rate increased significantly 2 minutes after thiopentone by an average of 15.1 beats/minute, but not after propogol. Pain was not reported during or after the injection. No major adverse reactions occurred at induction or during maintenance of anaesthesia with an inhalation agent. One patient who received 2 mg/kg propofol and isoflurane vomited for 24 hours. The recovery of anaesthesia after propofol induction, was quicker than after thiopentone.
Rectal premedication in children
Authors: HAAGENSEN R. E. 
Published: February 2007

SummaryTwo hundred and eight healthy children who were to undergo minor elective surgery during halothane, nitrous oxide, oxygen anaesthesia were studied in a double blind investigation to evaluate the sedative and anticholinergic effects of two rectal premedications. Group I received diazepam 0.75 mg/kg rectally; Group II received a mixture of diazepam 0.5 mg/kg, morphine 0.15 mg/kg and hyoscine 0.01 mg/kg rectally. No significant difference was found between the two groups in sedative or anticholinergic effects during induction of anaesthesia or in the postoperative period. No adverse effects were seen.
Anaesthesia for bullectomy
Authors: HASENBOS M. A. W. M. , GIELEN M. J. M. 
Published: February 2007

SummaryA patient with severe bullous emphysema in whom one bulla occupied more than 25% of the hemithorax. with a shift of the mediastinum to the opposite side, was anaesthetised for bullectomy with a combination of intravenous gamma‐hydroxybutyric acid and a high thoracic extradural catheter technique. During the operation the patient breathed 100% oxygen through a double‐lumen endobronchial tube in the lateral thoracotomy position. Extradural analgesia during the operation was provided by bupivacaine 0.25%, with adrenaline 1:200 000 and, postoperatively, with nicomorphine diluted in dextrose 5%. The advantages of this technique are described.
Extradural block. Confirmation of the injection site by X‐ray monitoring
Authors: Mehta M. , Salmon N. 
Published: February 2007

SummaryX‐ray monitoring was used to confirm the accuracy of extradural block in 100 patients who attended the Pain Relief Clinic for treatment of a variety of different conditions. A Tuohy needle was introduced by the central or paramedian approach and conventional physical signs, notably loss of resistance, used to identify entry into the estradural space. A radio‐opaque dye was introduced prior to the analgesic solution, to display the injection site. X‐ray screening confirmed the accuracy of the block in 83 patients, but unexpectedly in 17 the point of the needle was either just outside the spinal canal or only partly in the extradural space. There was no difficulty in correcting the needle position with the X‐ray facilities available. Imprecise needle siting is only partially explained by technical problems. Imprecise siting of the needle may be responsible for at least some cases of inadequate analgesia or unexpected complications. In our view X‐ray confirmation of site is essential for difficult extradural blocks, or when neurolytic solutions are introduced into the spinal canal. It may also be useful in teaching and research.
Anaesthesia for extracorporeal shock wave lithotripsy
Authors: ABBOTT M. A. , SAMUEL J. R. , WEBB D. R. 
Published: February 2007

SummaryThe anaesthetic considerations of patients presenting for extracorporeal shock wave lithotripsy are described. Regional anaesthesia with sedation may be preferable to general anaesthesia for patients undergoing this form of therapy. If regional anaesthesia is contra‐indicated, general anaesthesia using controlled ventilation with muscle relaxation, supplemented with a narcotic and a low concentration of volatile anaesthetic has been found to be a suitable alternative. The additional epidural preparation time has to be balanced against the benefits of easier patient transfer. especially during multi‐stage procedures, and better postoperative analgesia. The epidural catheter can be left in situ in patients who require multiple treatments or who may experience severe ureteric pain as the resulting ‘sand mass’ is passed. Epidural space localisation using a ‘loss of resistance to saline’ technique is recommended, in order to avoid the possible risk of damage to the spinal cord and emerging nerves (due to the presence of an air‐water interface). Patients with cardiac insufficiency need special consideration, in view of the effects of immersion on right and left heart filling pressures.
A comparison of nalbuphine and morphine as premedication agents for minor gynaecological surgery
Authors: PINNOCK C. A. , BELL A. , SMITH G. 
Published: February 2007

SummaryNalbuphine 10 mg and morphine 10 mg were compared in a randomised double‐blind trial as intramuscular premedication in 50 patients undergoing minor gynaecological surgery. Both nalbuphine and morphine produced significant sedation without anxiolysis as assessed by patient linear analogue scales, but there were no significant differences between the two drugs. Observer ratings demonstrated that nalbuphine produced calm/sleepy patients to a greater extent than morphine. There were no differences in untoward effects produced by each drug.
Continuous subcutaneous infusion of morphine for postoperative pain relief
Authors: GOUDIE T. A. , ALLAN M. W. B. , LONSDALE M. , BURROW L. M. , MACRAE W. A. , GRANT I. S. 
Published: February 2007

SummaryA double‐blind randomised study of 48 patients in whom continuous subcutaneous infusion and regular intramuscular injection of morphine were compared as analgesic regimens after upper abdominal surgery, is described. Over a 48‐hour period, no difference in pain intensity between the two groups was found by comparing linear analogue scores, assessments on a four‐point rank scale, peak expiratory flow rates or requirement for additional analgesia. Nausea and sedation were assessed using a four‐point rank scale. These side effects were less frequent with subcutaneous infusion (p<0.05). Two patients from each group were judged to have received an overdose. The infusion apparatus was simple and convenient to use. Continuous subcutaneous infusion of morphine is a practical and effective means of achieving postoperative analgesia but, as with other mandatory dosing regimens, relative overdosage may occur.
The first anaesthetic in Central Africa
Authors: CONACHER I. D. 
Published: February 2007

SummaryThe Reverend Doctor Robert Laws (1851–1934) followed in the footsteps of David Livingstone to Central Africa. At the beginning of a long and distinguished career as a medical missionary in Christian service to the country that has since become the Republic of Malawi, he was a prime mover in the setting up of a mission station at Cape Maclear, on the shores of Lake Malawi (formerly known as Lake Nyasa and closely associated with the discoveries of Doctor Livingstone). There, on 2 March 1876, Laws used chloroform to produce surgical anaesthesia when he operated on a young African male who had a cystic tumour above his left eye.
Anaesthesia for carotid body tumour resection in a patient with the Eisenmenger syndrome
Authors: KRAAYENBRINK M. A. , STEVEN C. M. 
Published: February 2007

SummaryA patient with the Eisenmenger syndrome presented for removal of a carotid body tumour under general anaesthesia. The presentation and management of the case are described and some of the anaesthetic problems associated with these two uncommon conditions are discussed. The case is reported because of its rarity and because some of the complications of carotid body surgery may be particularly hazardous in the presence of the Eisenmenger syndrome. The importance of monitoring, of maintaining a stable heart rate and blood volume, and the danger of paradoxical systemic air embolism are stressed.
The Afya anaesthesia system
Authors: SWAI E.A. , BROOKS A.M. , MECKLENBURGH J.S. 
Published: February 2007

SummaryThe design of and the results of laboratory performance tests on the Afya anaesthesia system are described. The system has a low inspiratory and expiratory resistance and the concentrations of ether delivered ranged from 75 to 130% of the vaporizer setting. The error was maximum at vaporizer settings of between 15 to 20%. The system is suitable for spontaneous and controlled ventilation of the lungs in both adults and infants.
Some maternal complications of epidural analgesia for labour
Authors: CRAWFORD J. S. 
Published: February 2007

SummaryA review of the maternal complications encountered in a consecutive series of over 27000 lumbar epidural blocks (exclusive ofepidurals administered for elective Caesarean section and complications of a relatively minor or fleeting nature) in a single obstetric unit is presented. There were nine potentially life threatening complications. of which only three caused real concern for the mother's safety. Six of these occurred with the jirst top‐up, as given by the anaesthetist. The others were the result of three out of the approximately 100000 top‐ups administered by midwives. There were two serious, but not life‐threatening complications. each of which led to the requirement of a laminectomy. In addition, there were 13 moderately serious and 17 mildly disturbing complications. All the mothers concerned made a full recovery. There was a large number of inconsequential or pseudocomplications which, although initially blamed upon the epidural, were later demonstrated to have been of a dyferent origin. Consideration of this experience leah to the conclusion that is the rules of management are rigorously followed, epidural analgesia for labour and delivery, including topping‐up by well‐informed midwives, is characterised by an extremely high level of safety for the mother.
Free‐standing vaporizers
Authors: KELLY D. A. 
Published: February 2007

SummaryA previously unreported hazard of free‐standing ‘Tec’ type vaporizers relating to their positioning downstream of the oxygen jlush is presented. Three Enfluratec Mark III vaporizers were studied; measurement of delivered enjlurane concentration was performed at a flow rate of 8 litres/minute, during and after the application of the oxygen flush upstream of the vaporizer. The maximum difference between the dial setting and the measured vapour concentration occurred when a 5‐second flush was applied to a vaporizer set at 0.2 volume %, the peak vapour concentration recorded being 2.3%. Other hazards of free‐standing vaporizers are discussed and ways of avoiding these hazards considered.
Mental function and morbidity after acute hip surgery during spinal and general anaesthesia
Authors: Bigler D. , Adelhøj B. , Petring O.U. , Pederson N.O. , Busch P. , Kalhke P. 
Published: February 2007

SummaryForty elderly patients (mean age 78.9 years) undergoing acute surgery for hip fracture were given at random either spinal analgesia with bupivacaine 0.75% or general anaesthesia with diazepam, fentanly and N2O/O2. Mental function was studied pre‐operatively with an abbreviated mental test and 1 week and 3 months postoperatively in both groups. Mortality and number of complications was similar in the two groups, but a shorter time of ambulation was seen in the spinal group compared to the general anaesthetic group. No persistent impairment in mental function was found after acute hip surgery under spinal or general anaesthesia and the only advantage of regional technique was a shorter time of ambulation.
Anaesthesia for translumbar aortography
Authors: Smith M. , Myatt J. K. , Harris M. N. E. , Plantevin O. M. 
Published: February 2007

SummaryFifty patients presenting for elective translumbar aortography were randomly allocated to one of two groups receiving either enflurane or isoflurane. Premedication was with oral lorazepam. The patients' tracheas were intubated and they were allowed to breathe spontaneously in the prone position during the procedure. There was no significant difference in heart rate during the investigation but there was a statistically significant fall in the blood pressure from its pre‐induction level. Arterial oxygenation was adequate throughout the procedure. Arterial carbon dioxide tension was significantly lower in the isoflurane group at the beginning and at end of the procedure (p < 0.01), but there was no significant change in carbon dioxide tension within the groups during the procedure. Spontaneous ventilation with enflurane or isoflurane is a satisfactory anaesthetic technique for translumbar aortography.
Antagonism of fentanyl and alfentanil by intravenous plus subcutaneous naloxone
Authors: VALGARDSSON A. , WERNER O. , SVENSSON G. 
Published: February 2007

SummaryTwenty patients undergoing microlaryngoscopy were anaesthetised with thiopentone. Half received fentanyl supplementation (about 8.5 μg/kg) and the other half alfentanil (about 65 μg/kg). Both groups were given naloxone 0.4 mg intravenously plus 0.4 mg subcutaneously shortly after the procedure which lasted some 12 minutes. The degree of ventilatory depression was assessed by a CO2 rebreathing test. The ventilation at an end‐tidal Pco2 of 8.0 κPa (V̇8.0) was noted, and the findings related to u control value obtained on the day before anaesthesia. In the fentanyl group, V̇8.0 was significantly (p < 0.05) less one hour after naloxone than 15 minutes after, and remained significantly below the control value for the first 8 hours after microlaryngoscopy. A second peak in plasma fentanyl concentration was observed four hours postoperatively in three patients. Respiratory depression in the alfentanil group was less pronounced and of shorter duration than in the fentanyl group. Postoperative plasma alfentanil concentration decreased progressively with time in every patient.
Atracurium in clinical anaesthesia: effect of dosage on onset, duration and conditions for tracheal intubation
Authors: Mirakhur R.K. , Lavery G.G. , Clarke R.S.J. , Lavery G. G. , Clarke R.S.J. , Gibson F.M. , McAteer E. 
Published: February 2007

SummaryConditions for tracheal intubation at 90 seconds, time to onset of maximum block and duration of clinical relaxation after jive different doses of atracurium, which ranged from 0.4 to 1.0 mg/kg were studied in 200 adult patients who were anaesthetised with nitrous oxide, oxygen and halothane or fentanyl. The conditions for intubation improved significantly with increasing doses, and were acceptable in 55% patients with a 0.4 mg/kg dose and in about 90% of those who received the two higher doses. The time to onset of complete block was 257 seconds with 0.4 mg/kg and decreased progressively to 124 seconds with 1.0 mg/kg. The duration of clinical relaxation under fentanyl anaesthesia averaged 29 minutes with 0.4 mg/kg and increased in a dose‐related manner to 57 minutes with 1.0 mg/kg: halothane anaesthesia produced only a marginal increase. There was no evidence of cumulation with up to six repeat doses of 0.125 mglkg. The only side effect noticed was cutaneous flushing observed in 42% of patients. This was again dose dependent, being 18% with 0.4 mg/kg and increasing to 73% after 1.0 mg/kg. There was associated hypotension and bronchospasm in one patient.
Absorption of lignocaine through split‐skin donor sites
Authors: Bulmer J.N. 
Published: February 2007

SummarySeventeen patients undergoing split‐skin grafting each received 3 mg/kg of a sterile 1% lignocaine gel applied to an area of the donor site equal to 3 sq cm/kg. Serial venous blood samples were taken for one hour following application and analysed for serum lignocaine concentration by high pressure liquid chromatography. The concentrations in all the patients were well below those associated with systemic toxicity. Clinical assessment included haemodynamic monitoring during the procedure, and postoperative evaluation of possible central nervous effects and of the degree of donor site analgesia obtained. No untoward effects were noted and the degree of analgesia, although difficult to assess, appeared good.
Vecuronium in the myasthenic patient
Authors: HUNTER J. M. , BELL C. F. , FLORENCE A. M. , JONES R. S. , UTTING J. E. 
Published: February 2007

SummaryThe use of vecuronium in six patients with myasthenia gravis undergoing thymectomy is described; the train‐of‐four twitch technique was used to monitor neuromuscular function. The first two patients received an initial dose of 0.02 mg/kg and incremental doses of 4 μg/kg, which is in the order of one fifth of that normally used. Satisfactory depression of the first twitch of the train‐of‐four, however, was not obtained and, therefore, in the remaining four patients the doses were doubled. At this dose satisfactory depression of the first twitch was achieved. Neostigmine 5.0 mg produced adequate reversal of residual neuromuscular blockade and the train‐of‐four twitch response recovered to normal levels. With reduced dosage and with careful neuromuscular monitoring. vecuronium can be used safely in the myasthenic patient.
Maternal mortality and manpower
Authors: ROSEN M. , FUJIMORI M. 
Published: February 2007

SummaryIn 1982 maternal mortality in England and Wales was given seven per 100 000 compared to 18 per 100 000 total births in Japan. This represented 160 more deaths in Japan. Perinatal mortality rates were similar in England and Wales and Japan, being 11.3 and 10.1 per 1000 respectively. The prevalence of obstetricians and paediatricians per 100 000 total births are approximately similar in England and Wales and in Japan, whereas the rates for anaesthetists are jive times less in Japan. In England and Wales, 13% of maternal deaths were related to anaesthetic misadventures, but the Japanese incidence is not known. However, more than 50% of anaesthetics for Caesarean sections in district hospitals in Japan are administered by obstetricians. A pilot study in Japan would be necessary to determine the precise role of anaesthetic provision on maternal mortality. Maternal mortality may prove a useful indicator of anaesthetic service deficiency.
Sedation and cerebral angiography. The effects of pentazocine and midazolam on arterial carbon dioxide tension
Authors: Spargo P.M. , Howard W.V. , Saunders D.A. 
Published: February 2007

SummaryA study of the effects of sedation on arterial blood gases in patients undergoing cerebral angiography was performed. Twenty‐one patients received pentazocine (30 mg) and midazolam (5–22.5 mg) and arterial carbon dioxide and oxygen tensions were measured from radial arler.v samples before and during the procedure. A statistically significant rise in arterial carbon dioxide tension was demonstrated. It is suggested that this may cause a rise in intracranial pressure by increasing cerebral blood flow in a group of patients in whom there is a high incidence of raised intracranial pressure. The clinical significance of this increase in arterial carbon dioxide tension is discussed.
Three years' anaesthetic experience with the Groningen Nd YAG laser coagulation technique
Authors: Sia R.L. , Edens E.Th. , van Overbeek J.J.M. , Rashkovsky O.M. 
Published: February 2007

SummaryThe use of the Neodymium YAG Laser technique in the palliative treatment of tracheo‐bronchial tumors in 47 patients is described and the merits of the coagulation and anaesthetic techniques are discussed.
Oral dantrolene prevents rise of myoglobin due to suxamethonium
Authors: Laurence S. 
Published: February 2007

SummaryForty patients were studied in a randomised trial to investigate the effect of pre‐operative oral dantrolene on the incease of serum myoglobin and creatinine kinase due to suxamethonium administration. Twenty patients in the treatment group were given 1.5 mg/kg dantrolene orally 4 hours pre‐operatively.Blood was drawn immediately pre‐induction and 5, 10 and 20 minutes after suxamethonium 1.2 mg/kg administration, following which surgery could commence. Myoglobin was measured by radioimmunoassay.The increase in mean myoglobin values was greatly reduced following suxamethonium in the treatment group (10.6 μg/litre at 20 minutes) compared to the control group (54.8 μg/litre at 20 minutes), (p < 0.01). Total fasciculation score was not significantly reduced by the dontrolene pretreatment. No increase in creatinine kinase values occurred in any patient and the changes in mean potassium values in both groups were negligible.The only side effect attributed to dantrolene was pre‐operative nausea in two patients. No interference with the action of suxamethonium, or difficulty with reversal was noticed. Oral dantrolene may be almost as effective as pretreatment with non‐depolarising neuromuscular blocking drugs in preventing suxamethonium‐induced increase in myoglobin with less interaction with other anaesthetic agents.
Lower limb blocks for children
Authors: Mcnicol L. R. 
Published: February 2007

SummaryFemoral and lateral cutaneous nerve of the thigh blocks have been performed in a group of 50 children; the method has not previously been described in paediatric practice. The technique was judged to have been successful in 48 (96%) of the children. There were no early or late complications. It is concluded that these blocks are easy to perform, even in small children and infants, and that they can produce reliable postoperative analgesia for a variety of orthopaedic and plastic procedures.
Longterm treatment with epidural opioids
Authors: CARL P. , CRAWFORD M. E. , RAVLO O. , BACH V. 
Published: February 2007

SummaryDuring a 2‐year period, 150 patients were treated with epidural opioids for more than 7 days; 89 received morphine and 61 buprenorphine. In 16 cases, medication was changed from morphine to buprenorphine. and in 6 from buprenorphine to morphine. In 19 patients in each group. the disease process was benign. The median daily dose of morphine was 17 mg given by an average of 2.9 injections; the corresponding figures in the buprenorphine group were 1.3 mg and 2.6 injections. The mean duration of treatment was 49 days (7‐397) in the morphine group and 53 days (7‐262) in the buprenorphine group. Satisfactory pain relief was achieved in 40 (45%) patients who received morphine and 41 (67%) patients given buprenorphine. Altering medication from morphine to buprenorphine improved analgesia in 32% of patients, while the reverse improved pain relief in a further 46% of the patients. Side effects were reported in 46% of patients given morphine and 20% given buprenorphine. Seventy‐one patients were treated on an outpatient basis. In these cases, buprenorphine was administered for 89% of the total duration of treatment and morphine chloride for 52%.
Acute upper airway obstruction
Authors: MACKENZIE J. W. , JELLICOE JILLIAN A. 
Published: February 2007

SummaryA case is described of retropharyngeal haematoma due to spontaneous bleeding from the inferior thyroid artery and causing acute upper airway obstruction. Results of the haematological investigations were suggestive of underlying polycythaemia rubra Vera. The presentation and findings in this case are discussed.