N. Nandwani

Leicester Royal Infirmary

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R. Caranza

Marymount University

Jacob Raphael

Thomas Jefferson University Hospital

M Tidmarsh

Alexandra Hospital

Jonathan P. Thompson

Medical College of Wisconsin

George Davey Smith

University of Bristol

Henry James

Dalhousie University

D N Quinton

Leicester Royal Infirmary

C.D. Hanning

Media Working Group

J. P. Tring

University Hospitals of Leicester NHS Trust

Andrew P. Hall

University Hospitals of Leicester NHS Trust

Cooperative Institutions

Leicester Royal Infirmary

University of Leicester

University Hospitals of Leicester NHS Trust

Leicester General Hospital

Queen's Medical Centre

Alexandra Hospital

NIHR Leicester Biomedical Research Centre

GlaxoSmithKline (United States)

Queen Elizabeth Central Hospital

University of Malawi

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Effect of nebulised lignocaine on the quality of induction of anaesthesia in cigarette smokers

Anaesthesia (1997)

R. Caranza Jacob Raphael N. Nandwani Josephine Langton

We have assessed the effect of nebulised lignocaine, given pre‐operatively, upon the quality of induction of anaesthesia in cigarette smokers. Seventy‐five patients were studied in a double‐blind randomised fashion, receiving a nebuliser of either 4 ml 0.9% NaCl or 4 ml 4% lignocaine. All patients received a standardised anaesthetic consisting of thiopentone followed by progressive increments of enflurane. Thirty‐three out of 38 patients (87%) who received nebulised lignocaine had induction without adverse events, compared with 25 out of 37 patients (68%) in the nebulised saline group (Chi‐squared test p < 0.05). We conclude that the use of nebulised lignocaine, administered pre‐operatively, improves the quality of induction of anaesthesia in cigarette smokers.

Enflurane

Local anaesthetic

10.1111/j.1365-2044.1997.200-az0335.x

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Citations (10)

Upper airway reflex sensitivity following general anaesthesia for day‐case surgery

Anaesthesia (2000)

R. Caranza N. Nandwani J. P. Tring Jonathan P. Thompson George Davey Smith

We have studied changes in upper airway reflex sensitivity following general anaesthesia using dilute ammonia vapour as a chemical stimulant in 16 patients undergoing elective laparoscopic gynaecological surgery. We measured the threshold concentration of ammonia vapour required to elicit a transient reduction of inspiratory flow caused by glottic closure, defined as a glottic stop. Measurements of upper airway reflex sensitivity and auditory reaction time were obtained before surgery, and at 60 and 120 min after recovery. Auditory reaction time was depressed significantly at 60 min but was similar to baseline values 120 min after recovery. Upper airway reflex sensitivity remained significantly reduced at 60 and 120 min despite the return of auditory reaction time to normal. The lack of correlation between upper airway reflex sensitivity and auditory reaction time suggests that central nervous system depression alone does not explain the delayed recovery in airway reactivity.

10.1046/j.1365-2044.2000.00806.x

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Citations (24)

Obstructive sleep apnoea and upper airway reactivity

Journal of Sleep Research (1998)

N. Nandwani R. Caranza C.D. Hanning

Upper airway reactivity was measured in 13 patients with obstructive sleep apnoea (OSA), using transient reflex laryngeal closure in response to dilute inhaled ammonia vapour. Upper airway reactivity was measured before and after 3 months of treatment with nasal continuous positive airway pressure (CPAP). Upper airway reactivity decreased significantly after treatment with nasal CPAP to values which were similar to those seen in normal subjects. We hypothesise that patients with OSA have increased upper airway reactivity, secondary to inflammation of the epithelial lining of the upper airway following the repeated injury of nocturnal airway obstruction, allowing the facilitated passage of inhaled irritants to the subepithelial receptors. Treatment of OSA with nasal CPAP may reverse these changes, although in the absence of a control group, these findings are provisional.

Reactivity

Airway obstruction

Sleep

10.1046/j.1365-2869.1998.00096.x

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Citations (15)

Upper airway reactivity and upper respiratory tract infection: effect of nebulized lidocaine

British Journal of Anaesthesia (1999)

Andrew P. Hall Andrew J. Fox Jacob Raphael N. Nandwani George Davey Smith

Respiratory tract

Convalescence

Lidocaine Hydrochloride

10.1093/bja/82.6.857

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Citations (13)

Configuration of the SCOTI device with different tracheal tubes

Anaesthesia (1996)

N. Nandwani R. Caranza E.S. LIN Jacob Raphael

Summary We have evaluated the Sonomatic Confirmation of Tracheal Intubation device (SCOTI) by testing its ability to be correctly configured with a variety of tracheal tubes of differing internal diameter and length. The device only configured correctly for RAE tubes with internal diameter of 7.0 mm or greater and for armoured tubes of internal diameter 8.5 mm. For conventional tubes of varying internal diameter cut to different lengths, configuration was only successful with certain dimensions. The inability to configure the device correctly with all types and lengths of tracheal tubes limits its usefulness as a indicator of tracheal intubation.

Tracheal tube

10.1111/j.1365-2044.1996.tb14960.x

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Citations (6)

Port systems can safely be used for anaesthesia

BMJ (1996)

M Tidmarsh N. Nandwani J.G. Wandless

of this treatment.

Venous access

Port (circuit theory)

Central venous catheter

10.1136/bmj.312.7044.1477b

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Citations (1)

Effect of an upper respiratory tract infection on upper airway reactivity

British Journal of Anaesthesia (1997)

N. Nandwani Jacob Raphael Josephine Langton

Respiratory tract

Reactivity

10.1093/bja/78.4.352

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Citations (22)

Reporting of critical incidents shows how errors occur

BMJ (1995)

N. Nandwani

EDITOR,--R E Ferner draws attention to the confusion that can be caused when different drugs are labelled in an identical manner.1 I would like to draw attention to another problem. Drugs may be presented in two or more strengths in identically sized and labelled ampoules. …

10.1136/bmj.311.7016.1368

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Citations (2)

The effect of laryngeal mask airway insertion on the position of the internal jugular vein

Anaesthesia (1997)

N. Nandwani Melissa Fairfield K. Krarup Jonathan P. Thompson

A high‐quality ultrasound system (Dyasonics Prisma) was used to study the effect of laryngeal mask airway insertion and cuff inflation on the position and relations of the internal jugular vein in eight healthy young patients undergoing elective surgery. On insertion of the laryngeal mask, with the cuff pre‐inflated with 10 ml of air, some minor movement was discernible in the larynx. Neither the larynx nor surrounding structures changed significantly in position. However, on full inflation of the laryngeal mask cuff there was a more noticeable movement of the larynx, which visibly distended in an anterior direction. The mean anterior displacement was 0.8 cm (range 0.6–1.1 cm). There was no significant lateral displacement of the carotid artery or internal jugular vein and there was no significant compression of these structures. We conclude that in the presence of a laryngeal mask airway fixed landmarks such as the sternal notch and angle of the jaw should be used to identify the likely position of the internal jugular vein. Difficulty in cannulation may be experienced if the mobile laryngeal structures are used as landmarks.

Internal jugular vein

Cuff

External jugular vein

10.1111/j.1365-2044.1997.012-az012.x

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Citations (40)

Fasting before Bier's block.

Emergency Medicine Journal (1997)

N. Nandwani M Tidmarsh D N Quinton Henry James

marginal effect.As for the validity of comparing percentages, the conclusions are reason- able in the context of unequal total numbers between the groups.The main aim of our study was to raise the profile of school safety and trigger further studies by the A&E practitioners on this very important national and international issue.We are pleased with the response, even if it is critical.

10.1136/emj.14.1.59-c

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Citations (1)