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  • 1
    Electronic Resource
    Electronic Resource
    Manual versus target-controlled infusions of propofol (2004)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 59 (2004), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Target-controlled infusion systems have been shown to result in the administration of larger doses of propofol, which may result in delayed emergence and recovery from anaesthesia. The aim of this study was to investigate if this was due to a difference in the depth of hypnosis (using the bispectral index monitoring) between the manual and target controlled systems of administration. Fifty unpremedicated patients undergoing elective surgery were randomly allocated to have their anaesthesia maintained with manual or target-controlled propofol infusion schemes. In both groups, the rate of propofol administration was adjusted according to standard clinical criteria while bispectral index scores were recorded by an observer not involved in the delivery of anaesthesia. The total dose of propofol used was higher in the target controlled group (mean 9.9 [standard deviation 1.6] compared with 8.1 [1.0] mg.kg−1.h−1 in the manual group [p 〈 0.0001]). The times to emergence and recovery end-points were comparable between the two groups. The difference in the total dosage of propofol was mainly due to higher rate of propofol administration in the first 30 min in the target controlled infusion group. The bispectral index scores were lower in the target controlled group during this time, being significantly so over the first 15 min of anaesthesia. We conclude that propofol administration by a target controlled infusion system results in the administration of higher doses of propofol and lower bispectral index values mainly in the initial period of anaesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03870.x
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  • 2
    Electronic Resource
    Electronic Resource
    Comparison of recovery following rapacuronium, with and without neostigmine, and succinylcholine (2000)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 55 (2000), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The neuromuscular blocking effects of a single dose of rapacuronium 1.5 mg.kg−1 with or without reversal with neostigmine have been examined in the present study and compared with a dose of succinylcholine 1.0 mg.kg−1. Neuromuscular block was measured mechanomyographically using train-of-four stimulation. Complete block occurred within 1 min with both agents. Twenty-five per cent recovery of the first response of the train-of-four occurred in a median [range] time of 7.6 [5.7–11.3] min in the succinylcholine group and in 14.2 [8.8–23.6] and 15.1 [9.6–23.4] min in the rapacuronium groups with and without neostigmine reversal, respectively. Spontaneous recovery to a train-of-four ratio of 0.8 took 33.4 [20.0–79.0] min with rapacuronium but this was reduced to about 21.2 [13.9–33.7] min when neostigmine was administered at 25% recovery of first twitch of the train-of-four.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2000.01541.x
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  • 3
    Electronic Resource
    Electronic Resource
    Postoperative residual block after intermediate-acting neuromuscular blocking drugs (2001)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 56 (2001), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n = 50), atracurium (n = 50) and rocuronium (n = 50) were recorded. Residual block was defined as a train-of-four ratio of 〈0.8. An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia. The incidence of postoperative residual neuromuscular block was 64%, 52% and 39% after the use of vecuronium, atracurium and rocuronium, respectively. Similar numbers of patients were not able to maintain a sustained head or leg lift for 5 s on arrival in the recovery ward. The mean [range] times to attaining a train-of-four ratio of ≥0.8 after arrival in the recovery ward were 9.2 [1–61], 6.9 [1–24] and 14.7 [1.5–83] min for vecuronium, atracurium and rocuronium, respectively. None of the 10 patients who did not receive neuromuscular blocking drugs had train-of-four ratios 〈0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train-of-four ratio 〈0.8, even with the use of intermediate-acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2001.01921.x
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  • 4
    Electronic Resource
    Electronic Resource
    Sevoflurane – nitrous oxide anaesthesia supplemented with remifentanil: effect on recovery and cognitive function (2001)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 56 (2001), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aim of this study was to compare recovery and psychomotor performance after maintenance of anaesthesia with sevoflurane or sevoflurane supplemented with remifentanil. Sixty-six per cent nitrous oxide was used in all patients. Twenty patients each were randomly allocated to maintenance of anaesthesia with sevoflurane only in concentrations necessary to maintain adequate anaesthesia or with 1.5, 1.0 or 0.5 MAC (end-tidal) of sevoflurane supplemented with remifentanil. The median dosage of remifentanil required in the last three groups was 0.21, 0.25 and 0.34 µg.kg−1.min−1, respectively (p 〈 0.05). The median times to eye opening were 10.3, 12.7, 11.0 and 6.5 min in the four groups (p 〈 0.05 between the 0.5 MAC and the other groups) and for orientation 12.1, 14.9, 12.3 and 8.3 min, respectively (p 〈 0.05 between 0.5 and 1.5 MAC groups). There was no significant difference in the mini-mental state assessment scores or the actual discharge times from the recovery ward among the groups. Significantly greater numbers of patients could perform the critical flicker fusion test at 15 min in the group receiving the lowest concentration of sevoflurane and the highest dosage of remifentanil (p 〈 0.05). Patients in this group also showed the highest incidence of chest wall rigidity (p 〈 0.003). We conclude that, while the use of remifentanil with lower concentrations of sevoflurane facilitates early recovery, it does not influence discharge time from recovery ward and may be associated with side-effects such as chest wall rigidity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2001.01795.x
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  • 5
    Electronic Resource
    Electronic Resource
    Anasthesia in myotubular (centronuclear) myopathy (2000)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 55 (2000), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A patient with a known history of myotubular myopathy presented for surgery for insertion of a tibial nail. Anasthesia was induced and maintained using an intravenous anasthetic technique. Neuromuscular function was assessed using mechanomyography, which showed a profound reduction in muscle contractility. In view of this, the use of muscle relaxants was avoided altogether. Nerve conduction was normal but electromyography showed small motor units, with generalised distribution, suggesting mild to moderately severe myopathy. The patient made a slow but uneventful recovery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2000.01323.x
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  • 6
    Electronic Resource
    Electronic Resource
    Implicit Scaling of Linear Least Squares Problems (2000)
    Springer
    BIT 40 (2000), S. 146-157 
    Details
    ISSN: 1572-9125
    Keywords: Weighted linear least squares ; QR factorization ; backward errors ; iterative refinement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Mathematics
    Notes: Abstract We consider the solution of weighted linear least squares problems by Householder transformations with implicit scaling, that is, with the weights stored separately. By holding inverse weights, the constrained case can be accommodated. The error analysis of the weighted and unconstrained case is readily extended and we show that iterative refinement may be applied.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1022374520140
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  • 7
    Electronic Resource
    Electronic Resource
    The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung's disease after the neonatal period (2000)
    Springer
    Pediatric radiology 30 (2000), S. 681-684 
    Details
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. The diagnosis of Hirschsprung's disease is usually made in neonates but often considered in older infants and children with constipation: these children may be referred for barium enema. Since it is widely accepted that a normal barium enema does not exclude Hirschsprung's disease, some children, after a normal enema, undergo more invasive procedures such as rectal manometry or biopsy. Our study asked how frequently a diagnosis of Hirschsprung's disease was made by biopsy or manometry in children who had normal barium enema.¶Materials and methods. We reviewed the medical records and barium enemas of 54 patients older than 28 days with constipation or difficulty passing stool who had a barium enema followed by manometry and/or biopsy.¶Results. Forty-eight patients had normal enemas: 24 of those patients had biopsies, 16 had manometry, and 8 both manometry and biopsy. Only 1 had manometry suggestive of Hirschsprung's disease, confirmed by biopsy. Six patients had abnormal enemas. Five had biopsy and manometry compatible with Hirschsprung's disease; one had a normal biopsy and manometry study.¶Conclusion. The barium enema is a good initial screening test for Hirschsprung's disease in severely constipated children since it correlates well with manometry and biopsy. The enema is particularly useful in centers without easy access to pediatric gastroenterology services, and a normal enema in this setting allows the continuation of medical therapy with further evaluation only if there is a lack of response. An abnormal enema, however, requires referral to a facility equipped to perform confirmatory manometry or biopsy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002470000298
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  • 8
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    The Cadet Movement (1926)
    London : Periodicals Archive Online (PAO)
    The RUSI journal. 71 (1926:Feb./Nov.) 791 
    Details
    ISSN: 0307-1847
    Topics: Political Science
    URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pao:&rft_dat=xri:pao:article:p225-1926-071-00-000019
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  • 9
    Electronic Resource
    Electronic Resource
    Accuracy of hospital discharge data for cancer registration and epidemiological research in Northern Ireland (2000)
    Springer
    Cancer causes & control 11 (2000), S. 899-905 
    Details
    ISSN: 1573-7225
    Keywords: cancer registration ; data quality ; electronic data capture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Cancer registries provide a basis for many epidemiological studies in cancer. Electronic data provide for prompt, economical data capture for disease registries; doubts, however, exist about their data quality. Materials and methods: We examined the accuracy for cancer registration of a subset of 7043 electronically captured hospital discharge data. Results: Note availability was 82%. Of the notes available for examination demographic data accuracy was high; however, 7.4% of cases coded on discharge as cancer had no malignancy recorded in case notes while 4.1% had in-situ or benign tumors. Almost a third had some inaccuracy in coding tumor site. Prevalent cases accounted for 17.2% of cases examined reflecting a new registry. Electronic data capture reduces time spent examining notes; only 40% of cases notified from PAS required a quick validation check. It enhances data completeness; without electronic discharge data 11.5% of the final database would have been missed. The validation check prevented over-inflation of the cancer registration database by 7.5%. Measures of accuracy in the final database were high. Conclusion: This study shows that discharge data are a valuable data source for cancer registries but require a targeted note review aimed at cases without corroborating data.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1026543100223
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