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  • 1
    Electronic Resource
    Electronic Resource
    Patient-controlled alfentanil (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 51 (1996), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We have compared the opioid effects of a patient-demand, target-controlled infusion of alfentanil (n = 10), with patient-controlled bolus administration of morphine (n = 10) following major spinal surgery in Chinese patients aged from 11 to 67 years. The same general anaesthesia regimen was used in all patients. One group of patients were given intra-operative morphine analgesia followed by postoperative intravenous morphine patient-controlled analgesia, while the other group received an intra-operative target-controlled infusion of alfentanil. Following surgery, the alfentanil group were given control of a handset and were able to increase the target alfentanil plasma level in 5ng.ml-1 increments with a 2-min lockout interval. If analgesia was not demanded within a 15-min period, the computer reduced the target concentration by 5ng.ml-1. All patients had continuous pulse oximetry monitoring and hourly recording of pain, sedation, nausea scores and respiratory rate. Patients receiving alfentanil had the target concentration noted hourly and four blood samples taken during the first 24 h for measurement of plasma alfentanil concentrations by high performance liquid chromatography. The alfentanil infusion system was equally effective as an analgesic technique when compared with morphine patient-controlled analgesia. There were no hypoxaemic episodes (oxygen saturation 〈94%), no difference in sedation scores and the incidence of nausea (30%) was the same in both groups. There was a significantly (p 〈 0.001) lower respiratory rate in the alfentanil group compared with patients receiving morphine at, clinically assessed, equianalgesia. The predicted plasma alfentanil concentrations increased rapidly from about 30ng.ml-1 during the first 4 h to around 100ng.ml-1 at the end of the 24-h study period. The precision of the target-controlled infusion system was 75.4% and the mean prediction error (bias) 58.1%, suggesting an underestimation of the measured alfentanil concentrations by the alfentanil infusion system in these Chinese patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1996.tb07784.x
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    The Finapres 2300e finger cuff (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 48 (1993), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Blood pressure measurements associated with malapplication of a finger cuff were compared with contemporaneous intra-arterial pressure data in seven volunteers to determine the influence of cuff application on the accuracy of the Finapres 2300e. Systolic readings in all cuff positions differed from arterial line data by more than the recommended standard and tight and loose cuff applications under and over-read respectively, in all subjects. The results show the Finapres to be sensitive to small degrees of finger cuff malapplication which contribute to the bias on direct arterial comparison and limit the reliability of the instrument in clinical practice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1993.tb07129.x
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Comparison of the Williams Airway Intubator and Ovassapian Fibreoptic Intubating Airway for fibreoptic orotracheal intubation (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: A randomised study was carried out in 60 anaesthetised patients with no evidence of airway difficulties, to compare the Williams Airway Intubator and the Ovassapian Fibreoptic Intubating Airway for bronchoscopic view and ease of railroading a tracheal tube during fibreoptic orotracheal intubation. The Williams Airway Intubator provided a better view of the glottis (41 (68.3%) unobstructed views) than the Ovassapian Fibreoptic Intubating Airway (15 (25%) unobstructed views; p 〈 0.0001) and a shorter time was needed to complete bronchoscopy (median (95% CI) difference 4 s (1–7); p = 0.01). Four (6.7%) bronchoscopies failed using the Williams Airway Intubator compared with 26 (43.3%) using the Ovassapian Fibreoptic Intubating Airway (p 〈 0.0001). Both airways provided similar intubating conditions when the glottis was visible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03527.x
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  • 4
    Electronic Resource
    Electronic Resource
    The effect of celecoxib on intrathecal morphine-induced pruritus in patients undergoing Caesarean section (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: Pruritus associated with intrathecal opioid administration is particularly common in pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the severity of this pruritus but have undesirable side effects. The recent development of drugs that can specifically inhibit the cyclooxygenase 2 isoenzyme have become an attractive alternative. This study was designed to evaluate the efficacy of such a drug (celecoxib) in reducing intrathecal opioid-induced pruritus in a randomised double-blinded study of 60 women undergoing Caesarean section. All of them received spinal anaesthesia with 3 ml of 0.5% hyperbaric bupivacaine and 0.3 mg preservative-free morphine. After delivery of the baby, they received either oral celecoxib 200 mg or placebo. Visual analogue scores for pain and pruritus were measured at 30 min, 2, 4, 8, and 24 h. There was no difference in the severity and onset of pain and pruritus between the two groups. Timing of administration, inadequate dosing and possible altered pharmacokinetics in pregnancy may explain the lack of efficacy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03797.x
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  • 5
    Electronic Resource
    Electronic Resource
    Propofol effective concentration 50 and its relationship to bispectral index (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sixty unpremedicated healthy adult patients were studied during induction of anaesthesia with intravenous propofol delivered by a ‘Diprifusor’ target-controlled infusion. Bispectral index (BIS) and spectral edge frequency (SEF95) were measured concurrently with the predicted blood and effect site propofol concentrations. Logistic regression was used to calculate the predicted propofol blood and effect site concentrations required to produce unconsciousness and no response to a noxious stimulus in 50% and 95% of patients and to correlate BIS with these end-points. The Diprifusor TCI software produces anaesthesia at consistent target concentrations. Bispectral index correlates well with clinical end-points and may be useful during propofol anaesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.0003-2409.2001.02446.x
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Transoesophageal acoustic quantification for evaluation of cardiac function during laparoscopic surgery (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: Pneumoperitoneum may be poorly tolerated in patients with marginal cardiopulmonary function. Transoesophageal echocardiography is a relatively non-invasive technique that can track changes in left ventricular cavity area using acoustic quantification and has been found to provide a reliable, real-time estimation of left ventricular function. We evaluated mid-papillary fractional area change during pneumoperitoneum in 17 healthy adult patients (group 1) and 17 with hypertension and/or ischaemic heart disease (group 2) undergoing laparoscopic cholecystectomy. Peritoneal insufflation led to significant (p 〈 0.01) decreases in fractional area change and an increase in mean blood pressure. There was no significant change in heart rate. Patients with cardiovascular disease who had a 〉 30% decrease in fractional area change following carbon dioxide insufflation (group 2B) were given an intravenous infusion of glyceryl trinitrate. In groups 1 and 2A, fractional area change improved slightly with head-up tilt and continued to improve over the course of surgery. Glyceryl trinitrate led to a significant increase in fractional area change and a decrease in mean blood pressure back to baseline values. We conclude that peritoneal insufflation of carbon dioxide results in a significant increase in cardiac workload that is well tolerated in patients with no cardiovascular disease. Coexisting cardiovascular disease can result in even more pronounced impairment of cardiac function, which may not be predictable by clinical assessment or adequately determined by routine monitoring. We recommend the use of transoesophageal acoustic quantification as a monitor in these patients and the administration of glyceryl trinitrate to ameliorate myocardial stress.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2001.01981.x
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  • 7
    Electronic Resource
    Electronic Resource
    Pre-operative parental anxiety (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 51 (1996), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study attempts to identify the incidence and specific sources of anxiety in the parents of children admitted to hospital for elective surgery, to isolate factors associated with increased anxiety and to identify useful ameliorative measures. One hundred parents were interviewed and completed a questionnaire before their child's surgery. Parental anxiety levels were measured using the Leeds scale for self-assessment of anxiety. Anxiety-related illness was identified in 47% of parents, who were significantly more concerned than others about all aspects of their children's hospitalisation. No factors were identified which could predict which parents were at high risk of developing an anxiety state. When questioned about educational and interventional measures which they felt would be reassuring, the same factors were identified by ‘anxious’ and ‘non-anxious’ parents. As all parents agree on useful ameliorative factors, a general advice and education programme would be appropriate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1996.tb14992.x
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    Paper (German National Licenses)
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  • 8
    Electronic Resource
    Electronic Resource
    Large venous air embolism in the sitting position despite monitoring with transoesophageal echocardiography (2005)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 60 (2005), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A 49-year-old male with neurofibromatosis type II was scheduled for posterior fossa craniotomy and excision of a right acoustic neuroma and placement of an auditory brainstem implant in the sitting position. Intra-operatively, the patient was monitored with transoesophageal echocardiography which detected two major episodes of venous air embolism. Despite immediate treatment the patient's gas exchange progressively worsened during surgery and a chest X-ray showed extensive bilateral pulmonary infiltrates. The patient developed acute respiratory distress syndrome and required inotropic support in the intensive care unit. Although transoesophageal echocardiography allowed rapid detection of venous air embolism, there was no evidence of therapeutic benefit.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2005.04237.x
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  • 9
    Electronic Resource
    Electronic Resource
    A randomised crossover comparison of patient-controlled sedation and patient-maintained sedation using propofol (2003)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 58 (2003), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary This randomised, crossover study compared patient-controlled sedation using boluses of propofol and patient-maintained sedation using a target-controlled infusion of propofol. Twenty-three patients aged 18–35 years having surgical removal of bilateral third molar teeth under local anaesthesia during two separate visits were studied. In the majority of patients, both techniques provided moderate sedation, good operating conditions, stable physiological parameters and a high degree of patient satisfaction. Two patients became over-sedated during patient-controlled sedation. The time taken for titration to adequate sedation was longer with patient-maintained sedation than with patient-controlled sedation [mean (SD) = 8.6 (3.7) min vs. 5.7 (3.1) min, p 〈 0.005]. The mean overall propofol consumption was similar with both techniques. The majority of patients preferred patient-maintained sedation to patient-controlled sedation, p 〈 0.05.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2003.03081.x
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  • 10
    Electronic Resource
    Electronic Resource
    Prevention of hypotension during spinal anaesthesia for Caesarean section: ephedrine infusion versus fluid preload (1997)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 52 (1997), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We compared the efficacy of prophylactic ephedrine infusion over fluid preloading in prevention of maternal hypotension during spinal anaesthesia for Caesarean section. Forty-six women undergoing elective Caesarean section at term were allocated randomly to receive either intravenous fluid preloading with Hartmann's solution 20 ml.kg−1 (fluid group) or prophylactic intravenous ephedrine 0.25 mgkg−1 (ephedrine group). Moderate hypotension was defined as ≥ 20% reduction in systolic blood pressure and severe hypotension as ≥ 30% reduction in systolic blood pressure. Maternal uterine circulation was measured using Doppler ultrasound in 11 parturients before and after spinal anaesthesia. There was a lower incidence of severe hypotension in the ephedrine group compared with the fluid group (35% vs. 65%, p = 0.04), although the incidence of moderate hypotension was similar. Mean umbilical venous pH was higher in the ephedrine group than in the fluid group (7.33 vs. 7.29, p = 0.02) and the number of patients shivering was lower in the ephedrine group (2 vs. 9, p = 0.02). No difference was found between pre- and postspinal uterine artery pulsatility indices in either group. We conclude that prophylactic ephedrine infusion alone is at least as good as fluid preload alone in combating the hypotension associated with spinal anaesthesia for Caesarean section.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1997.190-az0323.x
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