bluuebunny/crossref_metadata_2025_split huggingface dataset:
Propofol in total intravenous anaesthesia without nitrous oxide
Authors: Steegers P. A. , Foster P. A. 
Published: February 2007

SummaryPropofol and methohexitone were evaluated as hypnotics in a total intravenous anaesthesia technique without nitrous oxide in 50 patients of ASA grade 1 or 2. Analgesia was provided by a constant alfentanil infusion and the depth of anaesthesia was controlled by varying the infusion rate of propofol or methohexitone. Induction and intubation responses were smooth and moderate in the propofol group and side effects were few. Control of depth of anaesthesia, blood pressure and pulse rate was relatively easy in this group but more difficult and sometimes inadequate in the methohexitone group, in which side effects were more frequent. The mean infusion rate for propofol was 0.12 mg/kg/minute, similar to those found in studies using nitrous oxide without an opioid. Recovery times were short in both groups but those in the propofol group tended to be shorter. Postoperatively 96% of the propofol patients were clear‐headed within 20 minutes, in contrast to only 48% in the methohexitone group.We conclude that propofol together with alfentanil, both given by a bolus plus infusion technique, provide controllable and satisfactory total intravenous anaesthesia without recourse to nitrous oxide or other inhalational agents. Methohexitone was not as satisfactory as propofol.
An open comparison of propofol and enflurane for prolonged abdominal operations
Authors: Hartung E. , Freye E. 
Published: February 2007

SummaryAnaesthesia in 15 patients scheduled for prolonged abdominal surgery was induced with hexobarbitone and maintained with nitrous oxide and enflurane, while in a further 15 patients propofol was used for induction and maintenance. Three patients in the latter group required additional fentanyl but cardiovascular responses were, otherwise similar in the two groups. Return of consciousness, response to verbal command, ability to answer questions and adequate spontaneous ventilation was more rapid in the propofol patients. EEG power spectra also returned to baseline more rapidly in the propofol group.
Emergency resection of phaeochromocytoma presenting with hyperamylasaemia and pulmonary oedema after abdominal trauma
Authors: GREAVES D. J. , BARROW P. M. 
Published: February 2007

SummaryPhaeochromocytoma may present as an acute emergency with a perplexing variety of symptoms. We report a case in which a tumour of the organ of Zuckerkandl was removed after its unexpected discovery during laparotomy for abdominal trauma. A patient is described in whom a history of abdominal trauma coupled with collapse, pulmonary oedema, raised serum amylase and a positive peritoneal tap for blood, led to laparotomy at which an extramedullary phaeochromocytoma was found unexpectedly. The tumour was successfully resected, but immediate hypotension was life threatening. The inadvisability of resecting a phaeochromocytoma discovered at operation is discussed.
The detection of intra‐operative myocardial ischaemia Preliminary experience with the right‐sided precordial lead
Authors: DE HERT S. G. , DE JONGH R. F. , VAN DEN BOSSCHE A. O. , DEBYRNE P. L. , ADRIAENSEN H. F. 
Published: February 2007

SummaryThe value of monitoring the right precordial lead, V4R, to detect peri‐operative ischaemic events during coronary artery surgery was studied in 60 patients. Thirty‐four patients had only left‐sided coronary disease (Group I). The other 26 patients had both left‐sided occlusive coronary artery disease and significant right‐sided occlusive lesions on coronary angiography (Group 2). Lead sensitivity was estimated, assuming that all ST segment changes were true positive responses. Sensitivity using a single lead was greatest for lead V5 in the two groups (73% for Group I and 69% for Group 2). Sensitivity in Group I for lead II was intermediate (55%), whereas sensitivity for lead V4R was only 9%. In Group 2, on the other hand, lead V4R was 54% sensitive and lead 11 only 31%. The combination of leads V4R and V5 increased the sensitivity to 92% in Group 2, whereas lead II or V5 combined with V4R failed to improve sensitivity in Group 1. The monitoring of lead V4R allowed detection of 23% of the ischaemic episodes in Group 2 that would have passed undetected if only lead II and V5 were monitored. These results demonstrate the value of an additional right precordial lead during coronary artery bypass grafting in patients with right‐sided occlusive disease.
Postoperative analgesia for haemorrhoidectomy
Authors: PRYN S. J. , CROSSE M. M. , MURISON M. S. C. , McGINN F. P. 
Published: February 2007

SummaryThis study compared the analgesic effectiveness of local infiltration of bupivacaine with caudal extradural bupivacaine in the first 48 hours after haemorrhoidectomy. Surgical and anaesthetic protocol was rigidly standardised. The caudal group had significantly less pain in the first 6 hours after haemorrhoidectomy. and on first bowel opening, when compared to those who received local infiltration of bupivacaine. There was no significant difference between the two groups with respect to further analgesic requirements, complications, time to first bowel action, and duration of hospital stay. The definite advantage of caudal extradural bupivacaine for haemorrhoidectomy must be balanced against the rare but potentially serious complications associated with its use.
Oropharyngeal volumes
Authors: NEWCOMBE G. N. , RUSSELL W. J. 
Published: February 2007

SummaryThe volume of the mouth and pharynx was measured in 20 cadavers and ranged from 25 to 202 ml with a median value of 87 ml, a mean of 90.7 ml and a geometric (logarithmic) mean of 78.3 ml. The volume that encompasses 99% of the normal population is estimated as 215 ml if the assumption of a normal Gaussian distribution is made, or 349 ml if a log‐normal distribution is assumed. Collection containers in suction equipment intended for removing vomit from the pharynx and mouth in adults should have a useable volume of at least 500 ml.
Recovery from anaesthesia in children
Authors: McConachie I. W. , Day A. 
Published: February 2007

SummaryThere are no published comprehensive surveys of paediatric recovery room experience and the incidence of complications. A prospective survey was made of 16 700 consecutive admissions to the recovery room at the Royal Manchester Children's Hospital during the years 1985–1988. The incidence of respiratory complications was low, with laryngospasm 0.85%. The incidence of hypotension was higher than that in adult studies; over 50% of children recorded a decrease in blood pressure in the recovery room of more than 20%, compared to values before operation. The incidence of vomiting in the recovery room was also lower than in comparable adult studies, Certain aspects of recovery room practice changed during the 4 years of the study; these included routine oxygen administration, parents in the recovery room, and our approach to postoperative analgesia. The implications of these changes are discussed.
Comparison of propofol and thiopentone for induction of anaesthesia for elective Caesarean section
Authors: VALTONEN M. , KANTO J. , ROSENBERG P. 
Published: February 2007

SummaryPropofol 2.5 mg/kg was compared with thiopentone 5 mg/kg as an induction agent for elective Caesarean section. Thirty‐two healthy women with cephalopelvic disproportion were included in an open randomised study. The placental transfer of propofol was also studied in 10 other mothers given a single dose of 2.5 mg/kg. The induction characteristics and haemodynamic response to propofol and thiopentone were similar. Side effects were rare with both agents, but propofol caused more discomfort on injection compared to thiopentone. Recovery times were shorter after propofol as evaluated by time to orientation, recovery scoring after anaesthesia and measurements with the Maddox wing. Rapid placental transfer and significant fetal uptake were detected for propofol. There was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. Propofol appears to be a suitable alternative to thiopentone as an induction agent for anaesthesia in elective Caesarean section.
Suxamethonium—the relation between dose and response
Authors: CRESTNUT R. J. , HEALY T. E. J. , HARPER N. J. N. , FARAGHER E. B. 
Published: February 2007

SummaryIn a study which involved 120 adult patients, the ED95 of suxamethonium was shown to be 0.51 mg/kg, using an electromyographic technique. Marked individual variation in response was noted, for example a dose of 0.3 mg/kg produced a range of blockade from 4%–90%. Body surface area was shown to be more significantly related to blockade than lean body mass or total body weight.
Prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy An assessment of prophylactic epidural blood patching
Authors: Sengupta P. , Bagley G. , Lim M. 
Published: February 2007

SummaryThe prevention of postdural puncture headache after spinal anaesthesia for extracorporeal shockwave lithotripsy was investigated by a controlled clinical trial which compared epidural injection of 10 ml of autologous blood with 10 ml of normal saline immediately after intrathecal injection of local anaesthetic. The incidence of postdural puncture headache was 8.3% in the group that received blood compared with 45% in the group that received saline, a significant reduction (p < 0.01). The incidences of backache and lower limb paraesthesiae were similar in both groups. No serious complications were reported.
Anaphylaxis due to suxamethonium in a 7‐year‐old child: a 14‐year follow‐up with allergy testing
Authors: ASSEM E. S. K. , SYMONS I. E. 
Published: February 2007

SummaryIn 1973 a 7‐year‐old girl had anaphylactic reactions after two general anaesthetics. In‐vitro testing with the leucocyte challenge histamine release test showed a strong response to suxamethonium, and other tests indirectly suggested an allergic mechanism. The conclusion was that this was an allergy to suxamethonium. Further blood was sent for testing against a range of neuromuscular blockers, but the patient was‘lost’ until she re‐appeared 14 years later as an antenatal patient. In‐vitro testing was repeated against suxamethonium and all the available neuromuscular blockers after delivery. The radio‐allergosorbent test for allergen‐specific IgE antibodies was performed on newly collected serum and that which had been stored for 13‐14 years. Skin testing was also performed. The results remain positive and suggest a degree of allergy to all the neuromuscular blockers with the possible exception of vecuronium. The radio‐allergosorbent test was negative in the patient's baby.
Epidural anaesthesia for bilateral inguinal herniorrhaphy in Eisenmenger's syndrome
Authors: SELSBY D. S. , SUGDEN J. C. 
Published: February 2007

SummaryThe successful management of a patient with Eisenmenger's syndrome undergoing bilateral herniorrhaphy is described, and some of the anaesthetic problems associated with this condition are considered. The case is reported because epidural anaesthesia is performed rarely in these patients. The use of subcutaneous heparin, the level of monitoring required, and the value of pulse oximetry are also discussed.
Anaesthesia for patients over 90 years of age. Outcomes after regional and general anaesthetic techniques for two common surgical procedures
Authors: Hosking M. P. , Lobdell C. M. , Warner M. A. , Offord K. P. , Melton L. J. 
Published: February 2007

SummaryPeri‐operative morbidity and mortality and long term outcome of patients over 90 years of age who underwent either total hip arthroplasty or transurethral prostate resection were studied retrospectively. The outcomes of patients who received regional or general anaesthesia were compared. One hundred and forty‐one patients underwent total hip arthroplasty and 44 patients underwent transurethral prostate resection during the study period (1975‐1985). Overall in‐hospital mortality was 4.9%. Mortality at 30 days was 5.3% in patients who underwent hip arthroplasty during regional anaesthesia, compared with 6.8% in those who received general anaesthesia. Long term survival was similar for these two groups and was longer than projected for age and gender‐matched general population cohorts. The 30‐day mortality rate was 3.2% for patients who underwent prostatic resection under regional anaesthesia; no deaths occurred in the general anaesthesia group. This difference was not statistically significant. Long term survival was similar for patients in both groups and was better than predicted. Anaesthetic technique did not influence short term morbidity and mortality or long term outcome for these procedures.
Confidential professional reports A method of assessing the career progress and prospects of anaesthetic senior house officers
Authors: Jago R. H. 
Published: February 2007

SummaryA proforma is described which is used at 6‐monthly intervals to assess the professional progress of anaesthetic senior house ofjcers. The administration of a reporting system as part of the career counselling process is outlined, and its potential for determining the future prospects of junior staff is discussed.
Effect of vecuronium on atropine‐induced changes in heart rate
Authors: RIDLEY S. , GAYLARD D. G. , LIM M. 
Published: February 2007

SummaryThe effect of vecuronium on the heart rate response to atropine has been studied by comparing dose‐response relationships in two groups of patients who underwent extracorporeal shock wave lithotripsy. One group received vecuronium (0.1 mg/kg) and the other acted as control. Incremental doses of atropine (1.8, 1.8, 3.6, 7.2 and 14.4 μg/kg) were administered and changes in heart rate recorded. No significant differences were observed between the two groups following each incremental dose of atropine.
Stridor in an adult
Authors: MORTON N. S. , BARR G. W. 
Published: February 2007

SummaryA 34‐year‐old woman with a recent history of a influenza‐like illness and signs of bronchopneumonia presented with many of the features of acute epiglottitis, a condition which still carries a high mortality in adults. Urgent laryngoscopy and bronchoscopy under inhalational anaesthesia were negative. The results of arterial blood gases, taken when stridor was at its worst, revealed marked hypocapnia and respiratory alkalosis. We conclude that the resultant acute reduction of serum ionised calcium produced stridor as a result of tetany of the vocal cords. Similar cases from the literature and the role of emotional factors in the aetiology are discussed.
Obstructive sleep apnoea
Authors: TIERNEY N.M. , POLLARD B.J. , DORAN B.R.H. 
Published: February 2007

SummaryA patient with obstructive sleep apnoea is described, who required admission to an intensive care unit on two separate occasions within 2 months. The first admission was after anaesthesia for operation on the upper airway. The second occurred after a relative overdose of an opioid analgesic was administered. The diagnosis, treatment and anaesthetic management of patients with this syndrome are discussed.
Pre‐operative assessment of anxiety and measurement of arterial plasma catecholamine concentrations The effect of oral β‐adrenergic blockade with metoprolol
Authors: Jakobsen C.‐J. , Blom L. 
Published: February 2007

SummaryA double‐blind study of 40 patients who underwent elective hysterectomy was conducted to evaluate the role of arterial plasma catecholamine concentrations as an objective index of anxiety, and to assess the effect of pre‐operative oral treatment with a beta‐adrenoceptor blocking drug. The patients were premedicated with diazepam and either metoprolol or placebo 2–3 hours before surgery, The effect on anxiety was evaluated by the anaesthetist and by visual analogue scoring by the patients. Using pooled data, a significant decrease in both adrenaline and noradrenaline concentrations was demonstrated after premedication, but no difference was found between the groups. In general, patients were less anxious after premedication, but patients who received metoprolol had greater relief of anxiety (p= 0.0007). A significant change in perceived anxiety was found in patients who received metoprolol, but there was no significant change in the placebo group. The correlation between the observers' assessment and the patients' visual analogue scores was poor, but some correlation was found between the assessed relief of anxiety and the changes in visual analogue score. We could not demonstrate any correlations between anxiety and catecholamine concentrations, between relief of anxiety and changes in catecholamine concentrations, or haemodynamics and catecholamine concentrations.
Termination of paroxysmal supraventricular tachycardia by intravenous adenosine in a child
Authors: CHOW A. E. , NOBLE‐JAMIESON C. 
Published: February 2007

SummaryA fit 6‐year‐old child developed paroxysmal supraventricular tachycardia at the end of an operation for adenotonsillectomy. Sinus rhythm was rapidly restored with intravenous adenosine.
Carbon dioxide—a survey of its use in anaesthesia in the UK
Authors: Razis P. A. 
Published: February 2007

SummaryA random postal survey of 1528 anaesthetists in the UK was performed to assess their use of carbon dioxide in anaesthesia and opinion on its safety. Of 1100 replies (72% response rate), 60.9% used it daily and 77.1% would object to its exclusion from future anaesthetic machines. There was no consistent age‐related trend with regard to its use or opinion on its removal. 62.9% of anaesthetists did not regard its presence on the anaesthetic machine as hazardous, but 81.8% agreed that a limit to the maximum flow of carbon dioxide delivered to one litre/minute would improve safety.
Daycase anaesthesia and anxiety A study of anxiety profiles amongst patients attending a Day Bed Unit
Authors: Mackenzie J. W. 
Published: February 2007

SummaryTwo hundred adult patients aged 16–65 years scheduled to undergo operation under general anaesthesia in a Day Bed Unit were assessed for anxiety at the time of booking and on the day of operation. The nature of previous anaesthetic experience was the prime determinant of the anxiety scores obtained at booking. The score at booking was the prime determinant of the score on the day of operation, with previous experience and type of operation as secondary independent factors. Patients scheduled to undergo oral surgery were particularly anxious. Nineteen percent of patients would have liked to have received something to relieve their anxiety.
Comparison of hyperbaric and plain bupivacaine with hyperbaric cinchocaine as spinal anaesthetic agents
Authors: ROBERTS F. L. , BROWN E. C. , DAVIS R. , COUSINS M. J. 
Published: February 2007

SummaryIn a double‐blind study, 90 patients (ASA 1 or 2) received spinal anaesthesia with 2 ml hyperbaric cinchocaine 0.5%, 4 ml hyperbaric bupivacaine 0.5% or 4 ml plain bupivacaine 0.5%. All injections were made in the left lateral position, and the patients turned supine immediately. Hyperbaric bupivacaine produced a significantly faster and a higher dermatomal level of bilateral complete sensory blockade than the other solutions (p < 0.005 for each). The duration of sensory blockade was significantly longer with plain bupivacaine than with either hyperbaric solution (p < 0.0005). The intensity of sensory blockade was significantly greater with both bupivacaine solutions than with hyperbaric cinchocaine (p < 0.05). Onset and intensity of motor blockade were similar with all agents, but motor blockade was of significantly shorter duration with hyperbaric bupivacaine than the other agents (p < 0.0005). Hyperbaric bupivacaine appears to be the best agent for rapid and intense sensory blockade of intermediate duration. Plain bupivacaine is more appropriate if a longer duration of action but a lower height of blockade are required, and has the advantage of less cardiovascular disturbance.
Changes in cardiac output during epidural anaesthesia for Caesarean section
Authors: ROBSON S. , HUNTER S. , BOYS R. , DUNLOP W. , BRYSON M. 
Published: February 2007

SummarySerial haemodynamic investigations were performed in 20 women who had epidural anaesthesia before elective Caesarean section. Cardiac output was measured by Doppler and cross‐sectional echocardiography at the aortic valve. Measurements were performed after preloading the circulation with Ringer lactate solution (mean volume 805 ml) and then 10, 20, 30 and 40 minutes after administration of 0.5% bupivacaine. Preloading increased mean stroke volume from 84 to 94 ml and mean cardiac output from 7.01 to 7.70 litres/minute. Relative to basal values, mean arterial pressure decreased in all subjects after administration of bupivacaine (mean –14%, range –1 to –33%). Five subjects were given ephedrine because of hypotension. In three of these subjects hypotension was associated with a marked decrease in cardiac output. No significant changes in arterial blood pressure or cardiac output were demonstrated relative to basal values in the remaining 15 subjects. Ephedrine induced consistent increases in blood pressure and cardiac output.
Inheritance of low plasma cholinesterase activity in two families with a history of suxamethonium sensitivity
Authors: WHITTAKER M. , BERRY M. , BRITTEN J. J. 
Published: February 2007

SummaryAn hypothesis advanced in 1970 concerning family inheritance of low enzymic activities of plasma cholinesterase has been substantiated. The recognition of three E1kE1S genotypes is reported in this family after investigation of a new generation. A second family with similar genetic characteristics is described.
The management of Caesarean section in a patient with an intracranial arteriovenous malformation
Authors: LAIDLER J. A. , JACKSON I. J. , REDFERN N. 
Published: February 2007

SummaryThe anaesthetic management of elective Caesarean section in a 25‐year‐old woman with an inoperable intracranial arteriovenous malformation is described. The literature is reviewed.
Failure of repeated blood patch in the treatment of spinal headache
Authors: FRY R. A. , PERERA A. 
Published: February 2007

SummaryThe management of a persistent, incapacitating postdural puncture headache that required four consecutive autologous epidural blood patches is presented. Inadequate blood volumes, early patching and steroid in the epidural space are considered as possible causes of failure. Other associated problems and interventions are briefly discussed.
A new dual function nerve stimulator
Authors: SANSOME A. J. , de COURCY J. G. 
Published: February 2007

SummaryThe Duostim model TV02 is a new peripheral nerve stimulator designed both for nerve identijcation in the performance of regional anaesthesia and for monitoring neuromuscular blockade. The output pulses are unipolar and of adjustable constant current. The provision of single twitch (1 Hz and 1/15 Hz) trainof‐four and tetanic stimuli, together with indication of the current delivered and the small size of the unit, faciiitate its clinical use. Performance was assessed and found to be according to specijication.
Atracurium infusion during paediatric craniofacial surgery
Authors: WAIT C. M. , GOAT V. A. 
Published: February 2007

SummaryA simple feedback control system was used to administer atracurium to 10 infants aged between 5 and 36 months during craniofacial reconstruction. The purpose of the study was to establish whether the system, previously evaluated only in adults, would be efective in paediatric patients. The individuals studied underwent long procedures with substantial blood loss and the potential, for thermal and electrolyte disturbances. The system maintained the level of neuromuscular block successfully between 88 and 100% in all patients and between 90 and 100% in nine patients. The mean duration of feedback control was 179 (range 111–440) minutes. The mean (SD) dose of atracurium required was 0.40 (0.12) mg/kg/hour. The mean (SD) recovery time to a train‐of‐four ratio of 0.75 was 24.8 (9.9) minutes.