Showing papers in "BJA: British Journal of Anaesthesia in 1992"
TL;DR: Before this report, anaesthetics alone were thought to be responsible for most postoperative nausea and vomiting (PONV), but now it is thought that opioids alone are responsible for some postoperative vomiting.
Abstract: Seventy-five years ago, Flagg suggested that post-operative vomiting may result from causes other than anaesthetics: «there are at least three kinds of vomiting », the first of which he attributed to anaesthetics such as ether, the second to reflex responses, that is pain or ovarian surgery, and the last to opioids, for example morphine [30]. Before this report, anaesthetics alone were thought to be responsible for most postoperative nausea and vomiting (PONV)
423 citations
TL;DR: It is concluded that the free radical scavenging properties of 2,6-diisopropylphenol resemble those of the endogenous antioxidant alpha-tocopherol (vitamin E).
Abstract: We have examined in vitro the antioxidant properties of 2,6-diisopropylphenol. In studies using electron spin resonance spectroscopy we have demonstrated that 2,6-diisopropylphenol acts as an antioxidant by reacting with free radicals to form a phenoxyl radical—a property common to all phenol-based free radical scavengers. In additional experiments, the antioxidant properties of the clinical formulation of 2,6-diisopropylphenol (propofol) have been measured using an assay of antioxidant potential. In these experiments, propofol, but not Intralipid, was found to exhibit significant antioxidant activity, such that in the range of propofol concentrations examined (10−6–10−5 mol litre−1), each molecule of 2,6-diisopropylphenol was able to scavenge two radical species. We conclude that the free radical scaveng ing properties of 2,6-diisopropylphenol resemble those of the endogenous antioxidant α-tocopherol (vitamin E).
360 citations
TL;DR: The metabolic and acute phase responses (glucose, leucocytosis, C-reactive protein) were less after laparoscopy compared with laparotomy, and after surgery interleukin-6 concentrations were less in the laparoscopic group.
Abstract: SUMMARY We have compared metabolic and respiratory changes after laparoscopic cholecystectomy (n = 15) with those after open cholecystectomy (n = 15). The durations of postoperative i.v. therapy, fasting and hospital stay were significantly shorter in the laparoscopy group. During the first and second days after operation, analgesic consumption but not pain scores (visual analogue scale) were significantly smaller after laparoscopy, while vital capacity, forced expiratory volume in 1 s, and Pa02 were significantly greater. The metabolic and acute phase responses (glucose, leucocytosis, C-reactive protein) were less after laparoscopy compared with laparotomy. Although plasma cortisol and catecholamine concentrations were not significantly different between the two groups, after surgery interleukin-6 concentrations were less in the laparoscopy group.
324 citations
289 citations
282 citations
TL;DR: The effects of the new, highly selective alpha 2-adrenergic agonist, dexmedetomidine, were studied in a randomized, placebo-controlled, double-blind trial in 24 ASA I patients, finding the drug attenuated the cardiovascular responses to laryngoscopy and tracheal intubation.
Abstract: SUMMARY The effects of the new, highly selective alpha2-adrenergic agonist, dexmedetomidine, were studied in a randomized, placebo-controlled, double-blind trial in 24 ASA I patients. Dexmedetomidine 0.6 μg kg−1 or saline was given i.v. 10 min before induction of anaesthesia. The required dose of thiopentone was significantly (P
280 citations
TL;DR: Intubating conditions after administration of Org 9426 (rocuronium) 600 micrograms kg-1 at 60 or 90 s in groups of 20 patients anaesthetized with thiopentone, nitrous oxide in oxygen and small doses of fentanyl were assessed and prior administration of suxamethonium did not appear to influence the potency of OrG 9426.
Abstract: We have assessed intubating conditions after administration of Org 9426 (rocuronium) 600 fig kg−1 at 60 or 90s in groups of 20 patients anaesthetized with thiopentone, nitrous oxide in oxygen and small doses of fentanyl, and compared the data with those obtained after suxamethonium 1 mg kg−1 in similar groups of patients. The influence of prior suxamethonium administration on the potency of Org 9426 was studied also by constructing a dose-response curve. Intubating conditions after Org 9426 were found to be clinically acceptable (good or excellent) in 95% of patients at 60 s and in all patients at 90 s and in all patients at both times after suxamethonium. The average time for the onset of block following Org 9426 at this dose was 89 s (which is shorter than with any of the currently available non-depolarizing neuromuscular blocking drugs); the duration of clinical relaxation (25% recovery of twitch height) 30 min. Prior administration of suxamethonium did not appear to influence the potency of Org 9426.
231 citations
TL;DR: The results do not show pre-emptive analgesia with a conventional inguinal field block to be of clinical importance compared with a similar block administered after operation.
Abstract: The analgesic effects of an identical inguinal field block, performed before or immediately after inguinal herniorrhaphy, were evaluated in 32 healthy patients in a double-blind, randomized study. During surgery, all patients received a light general anaesthesia with thiopentone, alfentanil and nitrous oxide in oxygen. After inducation of general anaesthesia, patients were allocated randomly to receive an inguinal field block with lignocaine, either 15 min before operation or immediately after operation, after closure of the surgical wound, but before the patients were awake. Pain score on a visual analogue scale and on a verbal scale at rest, during mobilization from supine into sitting position and during cough was assessed 1, 2, 4, 6, 8 and 24 h, and 7 days after operation. No significant differences between the groups were observed in VAS scores or verbal pain scores during rest or ambulation at any time. There was no significant difference in time to first request for morphine or total morphine consumption. These results do not show pre-emptive analgesia with a conventional inguinal field block to be of clinical importance compared with a similar block administered after operation.
181 citations
TL;DR: It is suggested that dexmedetomidine may be a useful anaesthetic adjunct in ophthalmic surgery.
Abstract: We studied the effects of a single i.v. dose of dexmedetomidine, a highly selective and specific alpha2 adrenoceptor agonist, on intraocular pressure (IOP), haemodynamic and sympathoadrenal responses to laryngoscopy and tracheal intubation, and on anaesthetic requirements in ophthalmic surgery. Thirty ASA I–II patients undergoing cataract surgery were allocated randomly to receive either dexmedetomidine 0.6 μg kg−1 or saline placebo i.v. 10 min before induction of anaesthesia in a double-blind design. After dexmedetomidine there was a 34% (95% confidence interval (Cl) 27–43%) reduction in IOP (P
181 citations
TL;DR: It is concluded that the mechanism of extension of spinal anaesthesia by extradural injection of local anaesthesia is largely a volume effect.
Abstract: We have examined the effect of extradural injection of 0.5% bupivacaine or normal saline on the progression of spinal anaesthesia in 28 patients undergoing Caesarean section. Three groups were studied. Subarachnoid anaesthesia was established in all patients. Group A (n = 10), the control, received no extradural injection for 20 min. Group B (u= 9) received extradural bupivacaine 10 ml and group C (n = 9) received extradural saline 10 ml 5 min after the subarachnoid injection. Sensory levels were compared at 5-min intervals and extension of the block was found to be similar in groups B and C and significantly faster than the control (P
167 citations
TL;DR: Interactions between midazolam, propofol and alfentanil using two end-points of light sedation (hypnosis) and anaesthesia showed significant interactions for hypnosis and for anaesthesia, dose-related effects could not be demonstrated for midAZolam or alfENTanil when used alone.
Abstract: We have examined interactions between mid-azolam, propofol and alfentanil using two end-points of light sedation (hypnosis) and anaesthesia. Quantal dose-response curves were determined in 400 female patients for the drugs individually and in combination. At the hypnotic end-point, interactions were analysed by fitting the data to a mathematical model where the response depended on the doses of the three drugs with additional terms included to describe non-additive interactions of the various combinations of the three drugs. There were significant interactions for hypnosis; the decrease in expected ED50 for the various combinations were: midazolam-propofol = 37%, midazolam-alfentanil = 46% propofol-alfentanil = 20% midazolam-propofol-alfentanil = 42% Whilst all responses to the two-drug combinations were synergistic, the three-drug combination led to a response that was less than that expected from the effects of the individual agents and their two drug interactions. For anaesthesia, dose-related effects could not be demonstrated for midazolam or alfentanil when used alone. The decrease in ED50 of propofol in the presence of the other compounds was propofol-midazolam = 52%, propofol-alfentanil = 73%, propofol-midazolam-alfentanil = 82%. When comparing the different combinations, the responses varied markedly at each end-point assessed and could not be predicted from the responses of the individual agents.
TL;DR: The tone of the lower oesophageal sphincter (LOS) in 40 adults undergoing routine body surface surgery and allocated randomly to receive anaesthesia either by face mask and Guedel airway or by laryngeal mask airway is studied.
Abstract: SUMMARY We have studied the tone of the lower oesophageal sphincter (LOS) in 40 adults undergoing routine body surface surgery and allocated randomly to receive anaesthesia either by face mask and Guedel airway or by laryngeal mask airway. In the laryngeal mask group there was a mean (SEM) decrease in barrier pressure (LOS minus gastric pressure) of 3.6 (1.4) cm H 2 , compared with a mean increase of 2.2 (1.2) cm H2O in the face mask group (P
TL;DR: Serial haemodynamic investigations were performed in 32 women who were allocated randomly to receive either spinal or extradural anaesthesia for elective Caesarean section, finding that cardiac output remained increased in the extradural group, but decreased in the spinal group.
Abstract: Serial haemodynamic investigations were performed in 32 women who were allocated randomly to receive either spinal or extradural anaesthesia for elective Caesarean section. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. Doppler flow velocity waveforms were recorded also from the umbilical artery. Preloading with Ringer lactate solution 1 litre increased cardiac output in both groups. After injection of bupivacaine, cardiac output remained increased in the extradural group, but decreased in the spinal group. This was associated with an increase in umbilical artery pulsatility index in the spinal group. Umbilical artery pH was less in the spinal group (7.22 vs 7.27), although no neonate was depressed at birth. The maximum percentage change in cardiac output and umbilical artery pulsatility index correlated with umbilical artery pH (r = 0.54, r = 0.72, respectively). There was no significant correlation with change in arterial pressure.
TL;DR: It is demonstrated that rapid administration of crystalloid preload before spinal anaesthesia did not decrease the incidence or severity of hypotension, and the role of crystalloids preload is questioned.
Abstract: Twenty parturients undergoing elective Caesarean section were allocated randomly to receive crystalloid preload 20 ml kg-1 over either 20 min or 10 min before spinal anaesthesia. Significant hypotension (systolic arterial pressure less than 100 mm Hg and less than 80% of baseline value) occurred in six of the 10 patients in the 20-min preload group and seven of 10 patients in the 10-min preload group (ns). Both groups had a significant (P less than 0.05) increase in central venous pressure during the preload period. The mean central venous pressure in the 10-min group was 11.9 mm Hg (range 6-19 mm Hg), which was significantly greater (P less than 0.05) than that in the 20-min group (mean 7.3 mm Hg, range 2-13 mm Hg). Three patients in the 10-min group had clinically unacceptable increases in central venous pressure. This study has demonstrated that rapid administration of crystalloid preload before spinal anaesthesia did not decrease the incidence or severity of hypotension, and questions the role of crystalloid preload.
TL;DR: Before specific antiemetic agents became available, various techniques, including olive oil and insulin-glucose infusions, were reported to be effective in reducing the incidence of postoperative nausea and vomiting (PONV).
Abstract: Before specific antiemetic agents became available, various techniques, including olive oil [51] and insulin-glucose infusions [122], were reported to be effective in reducing the incidence of postoperative nausea and vomiting (PONV). Robert Ferguson [51] described the use of olive oil in 1912. The oil was administered «by mouth immediately after partial restoration of consciousness» and he postulated that oil in the stomach «absorbed any ether that might be there»
TL;DR: Nerve injury induced by short bevelled needles was associated with persisting signs of injury 28 days after the injury, suggesting that the current practice of using short beveled needles to prevent nerve injury complicating regional anaesthesia be reassessed.
Abstract: We have studied the immediate and long term (up to 28 days) effects of short and long bevelled needle impalement of the rat sciatic nerve. Three techniques were used to assess neural trauma and its consequences: stained longitudinal nerve sections were assessed by light microscopy and scored for injury; the extravasation of Evan's Blue dye, after antidromic electrical nerve stimulation, was used as a test of unmye/inated fibre function; the flexion withdrawal times from a noxious stimulus were measured. The results of all three experiments suggested that, should a nerve fascicle become accidentally impaled during regional anaesthesia, the lesions induced by short bevelled needles are more severe, more frequent and take longer to repair than those induced by long bevelled needles. Nerve injury induced by short bevelled needles was associated with persisting signs of injury 28 days after the injury. These results suggest that the current practice of using short bevelled needles to prevent nerve injury complicating regional anaesthesia be reassessed. (Br. J. Anaesth. 1992; 69: 433–438).
TL;DR: The results do not suggest that timing of analgesia with a conventional extradural regimen is of major clinical importance in patients undergoing colonic surgery, and all patients received similar general anaesthesia.
Abstract: We have studied the effect of continuous extradural analgesia with bupivacaine and morphine, initiated before or after colonic surgery, in a double-blind, randomized study. Thirty-two patients were allocated randomly to receive an identical extradural block initiated 40 min before surgical incision (n = 16) or at closure of the surgical wound (n = 16). The extradural regimen consisted of a bolus of 7 ml of plain bupivacaine 7.5 mg ml−1 plus morphine 2 mg and continuous extradural infusion of a mixture of bupivacaine 7.5mg ml−1 plus morphine 0.05 mg ml−1, 4 ml h−1 for 2 h, followed by a continuous extradural infusion of a mixture of bupivacaine 2.5mgml−1 plus morphine 0.05 mg ml−1, 4 ml−1 h−1, continued for 72 h after operation. In addition, all patients received similar general anaesthesia. There was no significant difference in request for additional morphine and no significant differences between the groups in pain scores (visual analogue scale or verbal) during rest or ambulation at any time of measurement. These results do not suggest that timing of analgesia with a conventional extradural regimen is of major clinical importance in patients undergoing colonic surgery
TL;DR: Recently it has become evident that among the many factors which are associated with PONV are included the experience of the anaesthetist and the phase of the menstrual cycle.
Abstract: Clinical investigators have been interested in factors related to postoperative nausea and vomiting (PONV) and in its assessment for several decades [10, 11, 13, 22]. It was reported as early as 1956 that the type of anaesthesia or operation, and also the administration of antiemetics was likely to influence the incidence and severity of PONV [8, 10, 22]. Recently it has become evident that among the many factors which are associated with PONV are included the experience of the anaesthetist [16] and the phase of the menstrual cycle [15]
TL;DR: VCO2 increased after insufflation of carbon dioxide with a mean (SD) maximum increase of 32 (28)% compared with the preinsufflation value, while VDphys and (PaCO2-PE' CO2) increased during laparoscopy, but this was not significant.
Abstract: SUMMARY We have studied 14 female patients undergoing elective laparoscopy under general anaesthesia with peritoneal insufflation of carbon dioxide in order to examine changes in physiological deadspace (VDphys), arterial to end-tidal carbon dioxide partial pressure difference (PaCO2-PE'CO2) and PaCO2. VCO2 increased after insufflation of carbon dioxide with a mean (SD) maximum increase of 32 (28) % compared with thepreinsufflation value. PaCO2increased also, with a mean (so) maximum increase of 0.6 (0.58) kPa immediately before carbon dioxide deflation. VDphys and (PaCO2- PECO2) increased during laparoscopy, but this was not significant (P > 0.05).
TL;DR: The results suggest a close correlation between the duration of hypoxaemia and myocardial ischaemia in the perioperative period in patients with cardiovascular disease.
Abstract: We have used continuous and concurrent monitoring of arterial oxygen saturation (Spo,) and ECG to study the relationship between hypoxaemia and silent myocardial ischaemia in the perioperative period in 11 patients with cardiovascular disease. Ischaemic and hypoxaemic events occurred in all patients. Many events were shortlived and occurred independently of each other. However, our results suggest a close correlation between the duration of hypoxaemia and myocardial ischaemia. Ischaemia is more likely to occur if an episode of hypoxaemia is prolonged (beyond 5 min; P
TL;DR: It is concluded that acid-base management did not affect cerebral metabolism, despite its influence on blood flow, and after rewarming, CBF and cerebral metabolism normalized independently of acid- base management during hypothermia.
Abstract: In order to compare the effects of blood-gas management on cerebral blood flow, metabolism and neurological outcome after hypothermic cardio-pulmonary bypass (CPB) we have studied 65 patients undergoing aorto-coronary bypass surgery allocated randomly to either a pH-stat (temperature-corrected blood-gas management) or an α-stat (temperature-uncorrected blood-gas management) group. All patients were examined neurologically on the day before and the 7th day after operation. In 20 patients of the pH-stat group and in 15 patients of the α-stat group we measured cerebral blood flow (CBF), using the argon washin technique, and also cerebral oxygen (CMRo2) and glucose (CMRg) uptake. Measurements were performed in awake patients, after induction of anaesthesia with fentanyl, midazolam and pancuronium under normothermic conditions, during CPB at a venous blood temperature of 26 °C and at the end of surgery. Compared with postinduction values, hypothermia was associated with an 18% reduction in CBF and decreases in CMRo2 and CMRg of 61 % and 60%, respectively, in the α-stat group. In the pH-stat group, CMRo2 and CMRg decreased also, by 58% and 74%, respectively, whereas CBF increased by 191%, indicating uncoupling of flow and metabolism. As there were no statistically significant differences between the metabolic variables in both groups, we conclude that acid-base management did not affect cerebral metabolism, despite its influence on blood flow. After rewarming, CBF and cerebral metabolism normalized independently of acid-base management during hypothermia. Nevertheless, neurological dysfunction occurred more often in the pH-stat group (P = 0.036).
TL;DR: The pharmacokinetics of propofol administered as long term infusions were determined in intensive care unit patients requiring sedation during mechanical ventilation and one patient died during the infusion, from multi-organ failure secondary to a pre-existing septicaemia, and in one other patient no sampling was possible during the first 30 min after infusion.
Abstract: The pharmacokinetics of propofol administered as long term infusions were determined in 12 intensive care unit patients (two female; mean age 58 yr, mean weight 66.9 kg) requiring sedation during mechanical ventilation. Patients were recruited after having been administered propofol for 24 h. Blood samples for analysis of propofol were taken during the infusion (mean duration 85.6 h; mean rate 2.58 mg kg−1 h−1) and for up to about 42 h after its termination. The median propofol total body clearance, derived from the apparent steady state propofol blood concentrations during infusion, was 2.11 litre minr. One patient died during the infusion, from multi-organ failure secondary to a pre-existing septicaemia, and in one other patient no sampling was possible during the first 30 min after infusion; full elimination data were obtained for 10 patients. After termination of the infusion, propofol blood concentrations declined rapidly, with an overall mean decrease of 50% over the first 10 min; thereafter the decline was more gradual. The elimination profile was triphasic in seven patients and biphasic in three patients. Mean half-lives for the three phases were 1.81 (n = 10) min, 70.9 (n = 7) min and 1411 (n = 11) min. There was no apparent trend in the terminal phase half-life with the duration of sampling after infusion.
TL;DR: The pharmacokinetics and duration of action of a bolus dose of mivacurium (0.15 mg kg-1) during isoflurane and nitrous oxide anaesthesia in nine patients with normal renal and liver function, nine patients undergoing cadaveric kidney transplantation and nine Patients undergoing cADAveric liver transplantation are determined.
Abstract: We have determined the pharmacokinetics and duration of action of a bolus dose of mivacurium (0.15 mg kg−1) during isoflurane and nitrous oxide anaesthesia in nine patients with normal renal and liver function, nine patients undergoing cadaveric kidney transplantation and nine patients undergoing cadaveric liver transplantation. Total plasma concentrations of mivacurium were measured for 2.5 h after administration using a high-pressure liquid chromatographic assay. Plasma concentration vs time data for what were presumed to be the two active mivacurium isomers were analysed by a non-compartmental method based on statistical moments. Neuromuscular block was assessed by measuring the electromyographic evoked response of the adductor pollicis muscle to train-of-four stimulation of the ulnar nerve. The mean time to recovery of 25% neuromuscular transmission, T25, was greater in the patients with liver failure (57.2 min) than in control patients (18.7 min). The volume of distribution at steady rate (Vdss) was comparable in the three groups. Patients with impaired liver function had significantly longer mean residence time and smaller plasma clearance than did patients with renal failure or control patients. There were significant negative correlations between plasma cholinesterase activity and both T25 (r = 0.79) and mean residence time (x = 0.62)
TL;DR: The relationship between the auditory evoked response (AER) and simple tests of conscious awareness at four end-expiratory concentrations of isoflurane in oxygen and the AER fitted the response more closely than concentration was investigated.
Abstract: We have investigated the relationship between the auditory evoked response (AER) and simple tests of conscious awareness at four end-expiratory concentrations (00 01 02 and 04 MAC) of iso-flurane in oxygen in each of eight anaesthetist volunteers, in random order, at least 1 week apart The early cortical AER was recorded from electrodes at the vertex and inion Amplitudes of the waves Pa, Nb and Pc and latencies of the waves Na, Pa, Nb, Pb and Nc were measured All the AER variables were highly significantly related to end-expiratory anaesthetic concentration Amplitudes decreased and latencies increased progressively with increasing anaesthetic concentration The AER variables were also highly significantly related to the level of response Amplitudes were greatest and the latencies shortest when there was full response to command (Nb latency increased from 475 to 545 ms between partial and no response) The close correlation between the effects of concentration and level of response, and between concentration and the AER implied that it was difficult to demonstrate those changes in the AER which specifically relate to changes in response At 02 MAC, however, which was the concentration at which all subjects showed some deficit, the response to a shock word was distinguished clearly by Nb latency In eight of 24 possible comparisons (eight AER variables and three types of psychological test) the AER fitted the response more closely than concentration
TL;DR: A probit regression model specifying a synergistic interaction between midazolam and propofol fitted the data significantly better than a model specifying no interaction.
Abstract: We gave either midazolam or propofol for induction of anaesthesia to 140 ASA I or II female patients (18–60 yr). ED50, values were obtained by probit analysis for three clinical end-points: loss of response to command; loss of eyelash reflex; failure to respond to application of an anaesthetic face mask delivering 1 % isoflurane. Propofol ED50 values (95% confidence intervals) were 1.25 (0.99–1.48) mgkg−1, 1.61 (1.29–1.94) mg kg−1 and1.51 (1.20–1.82) mg kg−1, respectively. ED50 values for midazolam were 0.26 (0.20–0.37) mg kg−1, 0.29 (0.23–0.47) mgkg−1 and 0.25 (0.20–0.32) mg kg−1, respectively. An additional 92 similar patients received one of nine dose combinations of midazolam and propofol for induction of anaesthesia, propofol being administered 2 min after midazolam. Success of induction was based on the clinical end-point of loss of response to command. Administration of 25% of the ED50 of midazolam followed by 50% of the ED50 of propofol resulted in loss of response to command in 50 % of patients, while 50 % of the ED50 of midazolam, followed by 25% of the ED50 of propofol had the same effect. A probit regression model specifying a synergistic interaction between midazolam and propofol fitted the data significantly better than a model specifying no interaction.
TL;DR: The presence of a propofol metabolite in urine when the liver was excluded from the circulation suggests that extrahepatic metabolism occurred.
Abstract: We have investigated extrahepatic metabolism of propofol in 10 patients undergoing orthotopic liver transplantation (group 1) (mean age 38 yr, mean weight 60 (SD 7) kg) and compared it with that in 10 patients without liver dysfunction undergoing extrahepatic abdominal surgery (group 2) (mean age 56 yr, mean weight 68 (11) kg). A single i.v. bolus dose of propofol 0.5 mg kg-1 was injected into a peripheral vein 5 min after the beginning of the anhepatic phase in group 1 and 60 min after the induction of anaesthesia in group 2. Arterial blood samples were obtained at 5, 10, 15, 20, 30, 40, 50 and 60 min after injection and urine samples were collected every 15 min. Propofol concentrations in whole blood and urine were measured by high performance liquid chromatography with fluorescence detection. Propofol glucuronide was measured in urine by incubation with a specific beta-glucuronidase. The area under the time-blood concentration curve from 0 to 60 min was found to be significantly greater in group 1 (13743 (2830) micrograms litre-1 h-1) than in group 2 (7992 (4895) micrograms litre-1 h-1) (P less than 0.05). Unchanged propofol was not detected in the urine of either group. No significant difference was found in the amount of propofol glucuronide excreted by patients in group 1 (457 (269) micrograms) and in group 2 (921 (672) micrograms). The presence of a propofol metabolite in urine when the liver was excluded from the circulation suggests that extrahepatic metabolism occurred.
TL;DR: Clonic and tonic seizure-like movements of the extremities were observed during induction of anaesthesia with sevoflurane in a 9-yr-old girl and may have been the result of seizure activity in the central nervous system, or myoclonus of the Extremities.
Abstract: SUMMARY CIonic and tonic seizure-like movements of the extremities were observed during induction of anaesthesia with sevoflurane in a 9-yr-oldgirl. The tonic movements were associated with respiratory alkalosis and were not abolished by an i.v. injection of thiamylal 75 mg. Arterial pressure, heart rate and body temperature remained normal during the episode. Ventilation was assisted easily and then controlled via a face mask. No neurological abnormalities were obvious after the anaesthesia. The movements may have been the result of seizure activity in the central nervous system, or myoclonus of the extremities.
TL;DR: An abscess that developed 5 days after operation in a patient who had extradural anaesthesia for Caesarean section and postoperative analgesia is described, and the literature on extradural abscess complicating extradural catheterization is reviewed.
Abstract: Extradural abscess has been described infrequently as a complication of extradural anaesthesia and analgesia. We describe an abscess that developed 5 days after operation in a patient who had extradural anaesthesia for Caesarean section and postoperative analgesia, and review the literature on extradural abscess complicating extradural catheterization, including a discussion on patho-genesis, clinical presentation, diagnosis and management. There have now been 16 reported cases of extradural catheter-related extradural abscess. Only one previous case has been in obstetric practice, despite the widespread use of these techniques in this specialty. A disproportionate number of cases have involved thoracic catheters. Duration of catheterization ranged from 40 h to 6 weeks, the majority of catheters being in place for 5 days or less. The time from catheter placement to development of symptoms ranged from 72 h to 5 months. The causative organism was isolated in 11 cases: Staphylococcus aureus was identified in nine (82%) and Staphylococcus epidermidis in two (18%). Outcome was reported in 15 cases, of which seven (47%) had a full or near full recovery and eight (53%) had a persistent neurological deficit. One case was managed successfully without surgery. Fifty percent of all cases have been reported in the past 5 years. With the increasing use of extradural techniques for anaesthesia and analgesia, this serious complication may be seen more frequently in the future.
TL;DR: Of the 549 significant observations reported voluntarily during a period of 18 months, 82% involved occurrences which were considered preventable and 27% could have been fatal if they had not been recognized and corrected.
Abstract: We describe a prospective analysis, in one hospital, of reported significant observations involving unsafe practices and working conditions during anaesthesia. Of the 549 significant observations reported voluntarily during a period of 18 months, 82% involved occurrences which were considered preventable and 27% could have been fatal if they had not been recognized and corrected. Ninety-three percent of incidents did not lead to a negative outcome. Human error was responsible for 411 (75%) reports. Lack of vigilance and failure to check were the most frequently reported factors associated with human error. Significant observations involving errors in drugs administration were the most frequent. Forty-five percent of all reported significant observations were made during maintenance of anaesthesia.
TL;DR: A fresh face mask almost completely abolished bacterial contamination of agar plates 30 cm from the mouth, and after 15 min there was an increase in the level of contamination which was statistically insignificant.
Abstract: SUMMARY We have studied the effectiveness of surgical face masks in reducing bacterial contamination of a surface, produced by dispersal of organisms from the upper airway. Twenty-five volunteers were asked to speak at blood agar plates positioned in close proximity to the mouth, initially whilst not wearing a face mask and then wearing a surgical face mask over the mouth and nose. A fresh face mask almost completely abolished bacterial contamination of agar plates 30 cm from the mouth. After 15 min there was an increase in the level of contamination which was statistically insignificant.