bluuebunny/crossref_metadata_2025 huggingface dataset:
Intermaxillary Fixation: How Practicable is Emergency Jaw Release?
Authors: Goss A. N. , Chau K. K. , Mayne L. H.
Published: January 2019

Intermaxillary fixation as part of management of facial fractures or following osteotomy for facial deformity presents unique problems to the anaesthetist. It is traditional practice to keep wire cutters available by the patient at all times to enable quick release of the jaws in emergency. The efficiency of release was tested by timing various members of the management team. The time taken to release the jaws was an average 35.3 seconds by experienced oral surgeons and an average 2 minutes 9 seconds by hospital staff involved in caring for these patients and was not a practical proposition for a lay person. Thus the value of releasing fixation is questionable in the initial care of obstruction or vomiting. Techniques of avoiding and managing these problems are discussed.
A New Tube for Microlaryngeal Surgery
Authors: Benjamin Bruce , Gronow David
Published: January 2019

A technique of anaesthesia for microlaryngeal surgery is described utilizing a new catheter and the venturi jet injector. Access and exposure for the surgeon are excellent and the laser can be used without special precautions. The central position and lack of movement of the distal end of the tube in the trachea prevent the potential complication of rupture of the trachea or of a bronchus.
Case Report: Althesin in Status Epilepticus
Authors: Saady Albert , Wong D. , Hicks R. G.
Published: January 2019

A case of status epilepticus, resistant to conventional anti-epileptic treatment is described. Althesin rapidly abolished the epileptic activity, and control was achieved by a continuous infusion of Althesin.
An Ether Anaesthesia at Stroud in 1847 a Report in Search of a Date
Authors: James O. F. , Vidler P.
Published: January 2019

About the middle of 1847, Doctor Buchanan of the Australian Agricultural Company ligated a popliteal aneurysm under ether anaesthesia at Stroud, N.S.W. This paper summarises the results of a search for matters related to what must have been one of the first anaesthetics given in Australia.
Intensive Care Data — II: A New Unit's First Two Years
Authors: Phillips G. D. , Austin K. L.
Published: January 2019

Intensive care units now exist in a large number of hospitals. They vary from one another in many respects, but have one thing in common — high running costs. There are few published reports in recent years of the workload, results and effectiveness of intensive care units. This paper presents data obtained from a new unit in 1977 and 1978, using a computer-controlled system of data storage and analysis. This has provided useful information of an administrative and clinical nature, and has enabled us to compare data from year to year, as well as allowing comparisons with data from other units. The potential exists for such a system to be used in evaluating criteria for admission and termination of care, and for cost-effectiveness studies.
Neonatal Tetanus
Authors: Krishna S. Radha
Published: January 2019

Forty-eight babies were treated for neonatal tetanus and there were ten deaths. Twenty-seven patients were treated with neuromuscular blockade, nasotracheal intubation and intermittent positive pressure ventilation. In this group there were five deaths and three of these were the direct or indirect result of respiratory complications.

A management regime for neonatal tetanus is outlined and the complications are discussed.
Volume Replacement in Acute Anaphylactoid Reactions
Authors: Fisher M. McD. , Dicks I.
Published: January 2019

Two patients who experienced cardiovascular collapse due to anaphylactoid reactions are described.

The first patient showed haemoconcentration which was rapidly restored with colloid solutions and vasoconstrictors. The second patient showed haemoconcentration in spite of massive infusion of crystalloid and repeated adrenaline; her circulatory status was restored with colloid solution.

In acute anaphylactoid reactions both sympathomimetics and colloid solutions are necessary to restore circulation.
An Introducer to Facilitate Nasotracheal Intubation
Authors: Sleeman K. W.
Published: January 2019

An introducer to facilitate nasotracheal intubation is described. The instrument is passed orally and a distal hook engages in the Murphy foramen of a P.V.C. nasal tube to direct it atraumatically into the trachea.
Dosage Patterns of Non-Depolarizing Neuromuscular Blockers in the Sheep
Authors: Cass N. , Brown W. A. , Ng K. C. , Lampard D. G.
Published: January 2019

Eighty per cent paralysis was induced and maintained for 90 minutes in the sheep by computer-controlled injection of gallamine, pancuronium, alcuronium or d-tubocurarine, using the integrated electromyogram as a measure of neuromuscular transmission. The dosage pattern consisted of a loading phase before any IEMG depression was detected, an onset phase during which a moderate amount of drug was required to achieve increasing paralysis, and a maintenance phase during which a substantially constant and relatively low infusion rate was required. The steady state rates of infusion in μg/kg/min during “maintenance” was found to be 6.0 for gallamine, 0.15 for pancuronium, 0.2 for alcuronium and 0.5 for d-tubocurarine.
Potentiation by Gentamicin of Non-Depolarizing Neuromuscular Block in the Cat
Authors: Potter Julia M. , Edeson R. O. , Campbell R. J. , Forbes A. M.
Published: January 2019

Gentamicin 1–5 mg/kg was injected into 14 anaesthetised cats in the presence of a constant, partial, non-depolarizing neuromuscular block. Twitch response in tibialis anterior was significantly depressed from 83% to 71% of control by a dose of 1.0 mg/kg. In soleus the same dose reduced twitch response from 76% to 71%. After a cumulative dose of 10 mg/kg twitch response in tibialis anterior and soleus was 34% and 37% of control respectively. Calcium chloride 20 mg/kg restored twitch response to 66% in both muscles. Smaller doses of calcium chloride caused partial reversal which was maintained for five minutes in only 50% of instances.
Salbutamol, Obstetrics and Anaesthesia: A Review and Case Discussion
Authors: Crowhurst John A.
Published: January 2019

Salbutamol and related beta-2 sympathomimetic drugs have been used in Australia recently for the inhibition of premature labour and also to prevent uterine activity in acute foetal emergencies during labour. General anaesthesia in these situations presents the anaesthetist with a number of pharmacological difficulties, which can have profound effects on both mother and neonate. The use of beta-blockers to correct the cardiovascular and metabolic instability is discussed and recommendations are made for their use in association with anaesthesia for operative delivery. Ante-natal beta-blockade of mother may increase the morbidity and possibly the mortality of an already at risk pre-term neonate.

The case report illustrates some of the hazards associated with salbutamol, obstetrics and anaesthesia.
Total Intravenous Anaesthesia for Major Gynaecological Surgery
Authors: Rocke D. A. , Rubin J. , Brock-Utne J. G. , Downing J. W.
Published: January 2019

A technique of total intravenous anaesthesia using etomidate by bolus intravenous (IV) injection for induction and by continuous intravenous infusion for maintenance of anaesthesia, with supplementary intravenous fentanyl analgesia, is described. Muscle relaxation was provided by competitive neuromuscular blockade, allowing controlled ventilation of the lungs with oxygen-enriched air.

Arterial blood pressure, heart rate and rhythm remained stable throughout the procedure. Few complications were encountered of which the most significant was a 13% incidence of nausea and/or vomiting. Pain on injection, abnormal muscular movements on induction, and post operative venous sequelae were uncommon. Patients were easily rousable shortly after termination of drug infusion.

The technique proved acceptable to the patient, surgeon and experienced anaesthetist and, thereby, would appear to offer a reasonable alternative to the more conventional inhalational anaesthetic technique.
An Evaluation of the Hellige Transoxode (Servomed Oxymonitor SM 361 System): Response to Halothane and Enflurane in Vitro
Authors: Downing J. W. , Mankowitz M. , Brock-Utne J. G. , Holloway A. M.
Published: January 2019

The effects of halothane (0.5-2%) and enflurane (1-4%) on two Transoxode transcutaneous oxygen (TcPO2) electrodes (Hellige Servomed Oxymonitor SM.361 system) were serially tested in atmospheres of nitrogen, air and 50% nitrous oxide in oxygen.

Both TcPO2 electrodes reduced and “read” halothane but not enflurane. Calibration drift was significantly greater (p < 0.05) after electrode exposure to halothane; 5.40 s.e.m. 1.37 kPa vs enflurane; – 0.60 s.e.m. 0.93 kPa.

Halothane has a direct effect in rendering the Transoxode inaccurate, which is probably clinically less important than the indirect cardiovascularly medicated influence of both halothane and enflurane on TcPO2 levels. A reduction in the electrode polarisation voltage is recommended to obviate the direct effect of halothane on Transoxode performance.
Protamine Sulphate Hypersensitivity
Authors: Doolan L. , McKenzie I. , Krafchek J. , Parsons B. , Buxton B.
Published: January 2019

Protamine hypersensitivity has been documented by intra-dermal skin testing in three patients who demonstrated sudden cardiovascular collapse and bronchospasm following the use of intravenous protamine sulphate. All patients had been given protamine previously. The effects of the anaphylactic response were terminated quickly by the administration of intravenous adrenaline associated with plasma volume expansion. Intra-dermal skin testing against all anaesthetic agents is recommended so that the specific allergen can be identified. In patients who are shown to be allergic to protamine sulphate and who require cardiac or vascular surgery careful monitoring of heparin dosage and neutralisation with hexadimethrine (Polybrene) intravenously appears to be a safe alternative.
Circle System Failure Induced by Gastric Suction
Authors: Stirt Joseph A. , Lewenstein Leonard N.
Published: January 2019

Blind passage of a nasogastric suction catheter during anaesthesia resulted in sudden inability to ventilate the patient. Passage of the catheter into the trachea was diagnosed and ventilation restored following catheter removal. Misdiagnosis of this situation can result in potentially disastrous attempted remedies.
An Evaluation of Blood Pressure Measurement
Authors: Runciman W. B. , Rutten A. J. , Ilsley A. H.
Published: January 2019

The accuracy of routine measurements by nursing staff of systemic arterial, central venous, pulmonary artery and pulmonary capillary wedge pressures was determined. There was a significant difference between direct mean arterial blood pressure measurements and routine indirect measurements by the nursing staff in the pressure range of 50-100 mmHg, whereas there was no significant difference between direct and indirect measurements when indirect measurements were made by specially trained hypertension clinic personnel. However, there was a good correlation between direct and indirect measurements in each instance, indicating that changes in blood pressure could be adequately followed by both groups. Systems commonly used to measure blood pressure directly were tested.

Limits in frequency response preclude the routine direct measurement of systolic or diastolic blood pressures. If direct systolic and diastolic pressure measurements are required, it is necessary to check the performance of the amplifier and recording system, attach the transducer to the patient, and determine and adjust, if necessary, the natural frequency and damping coefficient of each system before each measurement. However, it is suggested that a knowledge of systolic and diastolic pressure measurements seldom improves patient management, and if mean pressures are accepted, reliable routine measurements may be obtained by the nursing staff. The digital display of the systems tested may be accepted for mean arterial pressure, but for accurate mean central venous and pulmonary capillary wedge pressure measurements, it is necessary to interpret the trace on a chart recorder; pulmonary artery pressure can often only be estimated.
Spinal Anaesthesia or General Anaesthesia for Emergency Hip Surgery in Elderly Patients
Authors: Davis F. M. , Laurenson V. G.
Published: January 2019

One hundred and thirty-two elderly patients undergoing emergency hip surgery were randomly allocated to receive subarachnoid block (SAB) or general anaesthesia (GA). Using the 125-I fibrinogen uptake test, deep vein thrombosis was found to occur in 17 of 37 patients in the SAB group and 30 of 39 patients in the GA group (P 0.05). Blood loss was 513 ml (± SEM 44) in the SAB group and 714 ml (± SEM 67) in the GA group (P < 0.01). Hypoxaemia was present preoperatively (mean PaO2 9.2 kPa). Immediately following general anaesthesia, the mean fall in PaO2 was 0.86 kPa compared with preoperative values but only 0.16 kPa following subarachnoid block (P < 0.01). At 24 hours postoperatively the fall in PaO2 was similar in both groups and recovered only slowly during the first week. Twelve patients died, three in the SAB group and nine in the GA group. This difference in mortality was not statistically significant.
Intradermal Drug Testing following Anaphylactoid Reactions during Anaesthesia
Authors: Sage David
Published: January 2019

Intradermal testing of intravenous anaesthetic drugs was performed on 34 patients following acute anaphylactoid reactions during anaesthesia. Twenty-three patients had positive skin tests and 18 of these were positive for a single drug. Muscle relaxants were the drugs implicated most commonly. Intradermal testing is safe and provides useful and often specific positive information, but false-negative results probably occur.
Case Report: Intravenous Anaesthesia Using Althesin in a Patient with Dystrophia Myotonica
Authors: Yee K. F. , Milliss D. M. , Lah F.
Published: January 2019

A case report of anaesthesia for a patient with dystrophia myotonica undergoing insertion of an endocardial permanent pacemaker is presented. The value of Althesin as the major anaesthetic agent in these patients is outlined, especially with respect to its cardiovascular stability and rapid recovery.
A Report on the Use of Five Bubble Oxygenators for Cardiopulmonary Bypass Surgery
Authors: Newland P. E. , Pastoriza-Pinol J. V. , McMillan J. , Stirling G. R.
Published: January 2019

Bubble oxygenators available for cardiopulmonary bypass vary in design and in price. Choice of oxygenator is often made on the basis of price, or an empirical assessment of performance. This paper reports our clinical experience with five “hard shell” bubble oxygenators — Harvey H 1500, Harvey H 1000, Shiley S100A, Cobe Optiflo II and Bentley BOS 10. Data relating to gas transfer, heat exchanger performance, haematological changes and oxygenator design is presented and some comparisons made.
Immediate Problems Associated with Infraclavicular Subclavian Catheterisation; A Comparison between Left and Right Sides
Authors: Matthews N. T. , Worthley L. I. G.
Published: January 2019

A comparison was made between 126 left and 126 right percutaneous infraclavicular subclavian vein cannulations. Compared with the right side, insertion of the cannula on the left side resulted in significantly (p < 0.01) fewer catheter tip misplacements although both sides showed the same incidence of cannulation failures and immediate complications.

Using the infraclavicular approach to the subclavian vein for central venous cannulation, the left side is to be preferred.
Transmitters Involved in Central Processing of Nociceptive Information
Authors: Duggan Arthur W.
Published: January 2019

Distribution studies suggest that substance P is a transmitter released by nociceptive primary afferent fibres. Acceptance of this role, however, needs more electro-physiological comparisons of the effects of substance P and the transmitter released by primary afferents on the membrane properties of dorsal horn neurones. The transmission of impulses from nociceptive afferents to supraspinal areas is subject to inhibition of both segmental and supraspinal origin. Segmental inhibition probably involves glycine and γ-aminobutyric acid as transmitters. Of supraspinal inhibitions investigated in the cat none have been shown to involve amino acids, enkephalins or 5-hydroxytryptamine but there is evidence to suggest a role for noradrenaline.
The Computer as a Teaching Aid: With Particular Reference to Anaesthesia
Authors: Gibbs J. M. , Burke D. P.
Published: January 2019

Computers have been used by a few anaesthetists for teaching purposes for a number of years. Well constructed programs have the capacity to realistically present material which would not be available by other teaching methods. The advent of small portable computers has made this powerful teaching aid potentially available to a much larger group. It is likely that computer aided learning has a significant future in anaesthetic training and, in particular, for continuing medical education.
Clinical Audit of an Intensive Care Unit
Authors: Pybus D. A. , Gatt S. , Torda T. A.
Published: January 2019

A computer-based data storage and analysis system has been used to examine data obtained from 1257 patients admitted to an intensive care unit. The system readily provides administrative and clinical information which can be used to assess the workload, therapeutic efficiency and cost-effectiveness of such a unit. As the data-base expands, we expect that we will be able to identify sensitive predictors of both complications and mortality and thereby permit the more efficient use of intensive therapy.
The Patient/Computer Interface — A Problem Area
Authors: Parkin W. G.
Published: January 2019

In disease states, loss of homeostatic control may be countered by the provision of external inputs or therapy. Where the variables of interest may change rapidly and respond predictably to therapy, a patient/computer interface may be used to enhance data collection and/or in the formation of appropriate therapeutic responses. Ultimately, if appropriate dynamic responses are achieved, the patient therapy loop may be closed. Realisation of problem-free interfaces requires careful design of input transducers, computing hardware and software, output therapeutic devices and their integration. This process will require ingenuity, engineering competence and a thorough understanding of medicine and the clinical environment. In addition to sound technological solutions, the designer must be cognisant of the human aspects, for both patient and user of interface operation.
Dose-Response Curves for Alcuronium and Pancuronium Alone and in Combination
Authors: Shanks C. A.
Published: January 2019

Simultaneous administration of pancuronium and alcuronium was used in surgical patients during nitrous oxide — narcotic — barbiturate anaesthesia in order to determine the intensity of neuromuscular blockade. When compared with the results obtained when each of the drugs was given alone, the effect was not greater than the additive. The mean effective dose of pancuronium to produce 95% paralysis was 76 μg per kg for the mechanical twitch response and 70 μg per kg for the electrical response. The respective mean doses of alcuronium producing that degree of paralysis were 285 and 244 μg per kg. Usually the curve derived for the mechanical twitch response was to the right of, and roughly parallel to, that for the electrical response.
Nurse Staffing in Intensive Care Units
Authors: Phillips G. D. , Chong C. , Gordon P. J.
Published: January 2019

Allocation of nursing staff to patient care in our teaching hospital Intensive Care Unit is based on providing the care considered necessary, bearing in mind the experience of the nursing staff and the care requirements of the patients. A detailed study of the nurse:patient ratio over a two month period has been carried out. It was found that there was considerable variation in both hours of care required and hours of care delivered from shift to shift. The study supported the principles used in staff allocation based on professional judgement, namely the acceptance of a high nurse: patient ratio, with other staff available for special duties, administration and education.
Patient Attitudes to Postoperative Pain Relief
Authors: Donovan B. D.
Published: January 2019

A study of the attitudes of general surgical patients to the management of their postoperative pain showed that although 86% initially expressed satisfaction with their postoperative pain relief, a quarter of these did in fact have moderate, severe or unbearable, unalleviated pain. These, together with those who expressed dissatisfaction with their pain relief, constituted one third of the total number, indicating that a problem of postoperative analgesic management existed in the hospital. As a result, techniques of continuous intravenous infusion of narcotics and more frequent use of regional analgesia have been introduced.
Epidural Morphine after Caesarean Section
Authors: Binsted R. J.
Published: January 2019

Morphine sulphate 5 mg and placebo administered epidurally after caesarean section under epidural analgesia were compared in a double-blind fashion.

Morphine was significantly superior to placebo for pain relief, duration of pain relief, and reduction of parenteral narcotic requirements. Pruritis was the most commonly encountered side-effect. There was no statistical difference between morphine and placebo in the incidence of urinary catheterisation, vomiting, nausea, dizziness or drowsiness. No serious respiratory depression requiring treatment was observed.
Accurate Measurement of Functional Residual Capacity and Oxygen Consumption of Patients on Mechanical Ventilation
Authors: Cooper Kevin R. , Boswell Peter A.
Published: January 2019

We developed an apparatus and technique for the simultaneous measurement of functional residual capacity and oxygen uptake (V̇O2) for use in intensive care unit (ICU) patients. The accuracy of the functional residual capacity measurement was proven using an in vitro lung model and the reproducibility of this measurement was established by use in ICU patients. We tested the accuracy of the V̇O2 measurement in comparison with two other methods in common use among ICU patients and our method proved accurate. We conclude that this technique for measurement of functional residual capacity and V̇O2 is highly accurate and easily applied to patients on any mode of mechanical ventilation.
A New Endotracheal Tube for Neonatal Use
Authors: Wark H. , Overton J. H. , Berry A.
Published: January 2019

A new endotracheal tube for neonatal use is described in which a 5FG pressure measuring catheter is attached to the convex surf ace of a conventional polyvinylchloride endotracheal tube. Using this modified endotracheal tube intratracheal pressure can be measured. Preliminary studies were undertaken in three infants. It was found that at high ventilatory rates (above 80/min) pressures measured within the trachea were different from those measured in the ventilator circuit.
Perioperative Management of Tetralogy of Fallot Repair
Authors: Jones R. D. M.
Published: January 2019

Understanding the morphological and haemodynamic changes associated with surgical correction of tetralogy of Fallot is vital in planning a rational basis for the postoperative management. The past five years have seen a fall in mortality figures from more than 10% to 2% and the reasons for this improvement are reviewed.

There have been changes in the preoperative assessment and therapy, but perhaps the most significant change has been in operative technique. The correction now is performed by a transatrial approach, whereas in the past a large ventriculotomy was used.

There has been a change in emphasis in the various postoperative manoeuvres employed. Early low-dosage inotrope support, cavity drainage, intravenous hyperalimentation, peritoneal dialysis, sequential pacing and ventilation until cardio-respiratory stability is achieved, form the basis of our postoperative regime.
Anaesthesia for Renal Transplantation — 5 Years’ Experience
Authors: Marsland A. R. , Bradley J. P.
Published: January 2019

Two hundred and seventy patients underwent anaesthesia for 280 renal transplants between October 1977 and October 1982. Their medical records were studied retrospectively. These patients were representative of the end-stage chronic renal failure population, with the usual high incidence of cardiovascular and biochemical abnormalities. Most received general anaesthesia, with an intravenous barbiturate, muscle relaxant, narcotic and volatile supplement sequence being the most common. There were no intra-operative deaths. One postoperative death was felt to be influenced by the anaesthetic management. Four patients had life-threatening cardiac complications and a further four required postoperative respiratory support, three for delayed recovery of neuromuscular function and one for “recurarisation”. Less serious complications were considerably more common. General anaesthesia utilising suxamethonium and tubocurarine as the relaxants and halothane as the volatile supplement is least likely to result in complications. Changes to this anaesthetic sequence are likely with the introduction of new agents.
Medico-Legal Aspects of Renal Transplantation
Authors: Sheil A. G. R.
Published: January 2019

Advances in clinical tissue and organ transplantation have enforced changes in legislation concerning the disposal of bodies and their parts. With the evolution of cardiopulmonary support systems came the concept of brain death. To enable physicians to withdraw support without transgressing the law, recognition in law of brain death was necessary. To ensure that the diagnosis of brain death was certain, eminent doctors in advanced communities have drawn up criteria of brain death which are widely recognised and applied with confidence by the medical profession. Organs for transplantation are best obtained from “heart beating cadavers”. Despite public support for organ transplantation the requirements for organs to treat those presenting are not currently being met even though the number of patients who die and who could be suitable donors far exceeds that required. Increased public education to stimulate voluntary donation is necessary. Standardisation of care of comatose patients in hospitals is also required so that brain death may be diagnosed when it occurs. If the procedures for organ donation are familiar and well understood, suitable patients can then become donors according to their own or their relatives’ wishes.
Pacemaker Reversion for Suspected Supraventricular Tachycardia
Authors: Kuchar Dennis L. , Keogh Anne M. , Thorburn Charles W.
Published: January 2019

Overdrive atrial pacing was employed in twelve patients with suspected supraventricular tachycardia resistant to drug therapy. Eleven of these patients reverted to sinus rhythm with pacing either immediately or after a short episode of atrial fibrillation. In one patient, recordings from the atrial electrode indicated that a broad complex tachycardia was of ventricular rather than supraventricular origin. No complications were encountered and the procedure was well tolerated in all. Overdrive pacing is suggested as a safe alternative to DC cardioversion in drug-resistant supraventricular tachycardia, particularly in the presence of digitalis, in the elderly and in patients with chronic lung disease.
Implications for Vigilance of a Method for Evaluating Patterns of Change in Heart Rate during Anaesthesia
Authors: Lambert T. F. , Paget N. S. , McLelland J. L.
Published: January 2019

Instantaneous heart rate was recorded in five patients and analysed for change in rate using the criterion of percentage variation either side of the starting rate with resetting throughout the anaesthetic each time the permitted variation was exceeded. The number of occasions on which change occurred was counted, the patterns of change were analysed and the effect of two sampling methods (six-second sample and six-second average) on these patterns was compared. A large number of patients (131) was investigated using the six-second sampling method and the number of changes and patterns of change were evaluated. It is suggested that the six-second sampling technique, combined with the 10 or 15% variation, may be useful for the evaluation of vigilance, and has implications for the design of monitoring apparatus in the future.
Recovery from Day-Stay Anaesthesia — A Comparison of an Intravenous and Inhalational Technique of Maintenance
Authors: Yee P. , Galletly D. C.
Published: January 2019

In 60 patients undergoing minor day-stay surgical procedures, a standard inhalational technique of anaesthetic maintenance (halothane/nitrous oxide/oxygen) was compared with incremental dose methohexitone supplemented by nitrous oxide/oxygen. The methohexitone group showed faster immediate recovery but slower overall recovery at four hours. No difference was found in the incidence of minor sequelae up to 24 hours after anaesthesia.
Lower Limb Blood Flow during Transurethral Resection of the Prostate under Spinal or General Anaesthesia
Authors: Foate J. A. , Horton H. , Davis F. M.
Published: January 2019

Using venous occlusion impedance plethysmography, leg blood flow was measured in seventeen men undergoing transurethral prostatectomy under either amethocaine spinal anaesthesia (SAB) or nitrous oxide-halothane general anaesthesia (GA). Mean leg blood flow doubled (206% of preoperative control value) following induction of SAB, remained elevated throughout surgery (146% of control at the end of operation) and had returned to pre-operative levels (94%) by two hours postoperatively. Under GA, mean blood flow rose gradually during surgery to 136% of control by the end. However, mean blood flow was only 28% of control at one hour postoperatively, rising to 66% of control by two hours. Analysis of variance showed a significant difference in blood flow changes between the two groups (Greenhouse Geisser P = 0.005). The early postoperative fall in leg blood flow in the GA group might be important in the aetiology of postoperative deep vein thrombosis.
The Perioperative Management of Morbidly Obese Patients (a Surgeon's Perspective)
Authors: Ramsey-Stewart G.
Published: January 2019

One hundred and thirteen morbidly obese patients underwent bariatric surgery. Mean preoperative percentage above ideal weight was 98.3% (SD 30.0%). Mean percentage above ideal weight eighteen months after operation was 19.5% (SD 23.8%). Fifteen patients (13.3%) required pre-operative weight loss because of respiratory dysfunction and raised PaCO2. One patient developed asthma in the postoperative period. There were no other clinical postoperative respiratory complications. 40% of patients however did show radiological evidence of basal pulmonary atelectasis on the initial postoperative chest X-ray. All patients had pre-operative cardiological screening: there were no cardiac complications except one case of atrial fibrillation. One patient suffered a proven pulmonary embolus and recovered. Six patients (5.3%) required correction of a pre-operative potassium deficit. No episode of gastric acid aspiration syndrome occurred. 58% of patients presenting for obesity surgery had identifiable psychopathology. Despite strict pre-operative psychiatric screening, 15% of patients coming to operation required postoperative psychiatric management.
Plasma Bupivacaine Concentrations after Axillary Block in Children
Authors: Campbell R. J. , Ilett K. F. , Dusci L.
Published: January 2019

Venous plasma concentrations of bupivacaine were measured in children following axillary brachial plexus block with either 2mg/kg (n = 21) or 3mg/kg (n = 20) of bupivacaine. Absorption was very rapid with a mean time to peak concentrations of 0.37 hours for both doses. Mean peak plasma concentration was 1.35mg/l after the 2mg/kg dose and 1.84mg/kg after the 3mg/kg dose. Even after a 30% allowance for anticipated higher arterial concentrations, the plasma levels found in the present study were well below those at which toxicity is considered likely (>4 mg/l).
The Effect of Different Pre-Operative Feeding Regimens on Plasma Glucose and Gastric Volume and pH in Infancy
Authors: Van Der Walt J. H. , Carter J. A.
Published: January 2019

The effects of four different pre-operative feeding regimens were studied in 123 children below the age of one year presenting for surgery. Plasma glucose concentrations, blood acid-base values, gastric volume and gastric pH were measured before and after induction of anaesthesia. No patient was found to be hypoglycaemic and there were no significant differences in plasma glucose concentration and acid-base values between the groups. No correlation was demonstrated between the age and weight of the patients and the duration of fasting and the plasma glucose concentration. There was a significant elevation of plasma glucose concentration in all four groups after induction of anaesthesia (P<001) compared with the pre-induction level which is a reflection of the stress of blood sampling and induction of anaesthesia. Infants less than three months of age in the milk-feed group had a significantly higher gastric volume with low pH (P< 0.05) signifying a potentially greater risk of pulmonary acid aspiration. The practice of timing the last pre-operative feed in infancy according to the infant's normal feeding pattern does not appear to increase the risk factors for pulmonary aspiration, if milk is avoided.
Anaesthesia for Patients with Arthrogryposis Multiplex Congenita: What is the Risk of Malignant Hyperthermia?
Authors: Baines D. B. , Douglas I. D. , Overton J. H.
Published: January 2019

Arthrogryposis multiplex congenita has been linked with malignant hyperthermia. A review of the anaesthetic experience at the Royal Alexandra Hospital for Children over a 32-year period revealed no episode of malignant hyperthermia occurring in patients with arthrogryposis multiplex congenita despite many and varied exposures to known triggering agents.
Costs, Severity of Illness and Outcome in Intensive Care
Authors: Slatyer M. A. , James O. F. , Moore P. G. , Leeder S. R.
Published: January 2019

Severity of illness (Therapeutic Index Severity Score, Classes 1-4) and direct clinical costs (labour costs, diagnostic costs, drugs, disposables, etc.) were determined for 100 consecutive patients admitted to Royal Newcastle Hospital Intensive Care Unit over six weeks. Outcome was assessed using mortality, quality of life, functional status, productivity and mental status one month after separation from the Unit.

The mean total admission cost was $1,357 (Class 4 mean = $3,706) but for over 70% of patients costs were less than $1,000. The main component of cost was labour (about 60% for all classes). TISS proved a strong predictor (P<0.001) of total admission costs. Survival to one month was 89% and optimal association between cost and survival was found with those with low costs more likely to survive (P<0.001). On the other hand, no association was found between total admission cost and resulting quality of life. However, there was an association between pre-admission and follow-up quality of life (P<0.0005).
Shivering Related to Epidural Blockade with Bupivacaine in Labour, and the Influence of Epidural Pethidine
Authors: Brownridge P.
Published: January 2019

A prospective survey of two hundred patients who received an epidural block in labour was performed in order to determine the incidence and severity of shivering, and the influence of likely associated factors. Twenty-two of the patients who shivered took part in a double-blind trial to see if epidural pethidine 25 mg, versus saline, had any effect upon shivering.

Fifty per cent of patients shivered soon after the initial dose of bupivacaine. Shivering was more common among patients who had experienced shivering before epidural block, and in those who had received nitrous oxide (P<0.005). Prior intramuscular injection of pethidine did not significantly affect the incidence of shivering, and it was not influenced by the concentration of epidural bupivacaine used (0.5 or 0.25%). Shiverers were more likely to feel cold than non- shiverers (P<0.001) but shivering was generally regarded by patients as a trivial symptom, only 13 % describing it as very irritating.

Shivering was abolished or considerably diminished within ten minutes in all patients who received epidural pethidine 25 mg, whereas there was no change in eight out of eleven patients who received epidural saline. These results are significant (P<0.01), and demonstrate that shivering following epidural blockade can be effectively treated with small epidural doses of pethidine.
Positive End-Expiratory Pressure Increases Plasma Catecholamine Levels in Non-Volume Loaded Dogs
Authors: Chernow B. , Soldano S. , Cook D. , Lyons P. , Barton M. , Casey L. C. , Fletcher J. R. , Lake C. R.
Published: January 2019

Positive end-expiratory pressure (PEEP) is commonly used in the treatment of critically ill patients whose sympathetic nervous system is stressed; however, PEEP's actions on sympathetic nervous system activity are unknown. We therefore measured the plasma noradrenaline response (an index of sympathetic nervous system activity) to graded doses of PEEP in nine mongrel dogs. After 30 minutes at each level of PEEP, plasma noradrenaline concentrations increased from baseline mean values of 300 (SD 108) pg/ml to 388 (SD 225) pg/ml (P< 0.05) at 5 cm, 433 (SD 255) pg/ml (P <0.01) at 10 cm and 1194 (SD 882) pg/ml (P<0.01) at 20 cm water pressure of PEEP. The increases in plasma noradrenaline concentrations correlated inversely (r= - 0.43, P< 0.01) with PEEP-induced changes in cardiac output. Plasma adrenaline levels did not change significantly in response to 5 or 10 cm of PEEP; however, plasma adrenaline increased, while heart rate and mean arterial blood pressure fell, at 20 cm water pressure of PEEP (P < 0.05). Within 15 minutes after discontinuation of PEEP, the plasma catecholamine concentrations returned to baseline levels. Conclusions: 1. PEEP significantly increases sympathetic nervous system activity in a rapid, dose- dependent, reversible manner; 2. the PEEP-induced increases in sympathetic activity may explain the reductions in organ blood flow which others have observed following the initiation of PEEP; 3. PEEP-related changes in sympathetic nervous system activity are a consequence of PEEP- induced reductions in cardiac output.
Perspective Graphics as a Means of Portraying the Distribution of Radiolabelled Ligands in the Spinal Cord — A Pilot Study Using Intrathecally Administered 3H Morphine
Authors: Gregory M. A. , Brock-Utne J. G. , Gathiram P. , Bux S. , Brouckaert C. J.
Published: January 2019

Tritium-labelled morphine sulphate was injected into the lumbar (L4-5) subarachnoid space of an adult male baboon. Three hours after injection, the animal was sacrificed. Using quantitative light microscopic autoradiographic mapping techniques, contour and perspective diagrams were prepared that described the position of radiolabel and by inference the distribution of morphine binding sites within the spinal cord. High concentrations of 3H was found in the medial regions of laminae I, II (substantia gelatinosa) and III of the dorsal horns. Smaller, but significant levels were seen bilaterally in the spinal anterolateral quadrant. Minimal 3H activity was seen in the remainder of the spinal cord with the lowest level being recorded in the spinal canal. Perspective graphics proved a precise and attractive method for locating the position and quantifying the concentration of radiolabel in baboon spinal cord.
An Evaluation of Three Volatile Anaesthetic Agent Monitors
Authors: Ilsley A. H. , Plummer J. L. , Runciman W. B. , Cousins M. J.
Published: January 2019

Three volatile anaesthetic agent monitors (Datex Normac Anesthetic Agent Monitor, Engstrom Emma Multigas Monitor and Penlon Halothane Meter) were evaluated for the effects of nitrous oxide or water vapour, and for their linearity, stability, and rate of response to a change in concentration of various anaesthetic agents under simulated working conditions. None was affected by nitrous oxide, and only the Engstrom Emma was affected by water vapour. Linearity was satisfactory for all three devices but stability, with respect to zero and gain drift, was satisfactory only for the Datex Normac and Penlon Meter. Rates of response for 10% to 90% of source signal ranged from 0.8 seconds for the Datex Normac to about three seconds for the Penlon Meter.
Dental Damage during Anaesthesia and Surgery
Authors: Burton J. F. , Baker A. B.
Published: January 2019

A review of the Accident Compensation Corporation (ACC) files on dental damage following anaesthesia or surgery was undertaken along with a survey of New Zealand anaesthetists asking about their practice with respect to protection of teeth during anaesthesia. These results confirm that damage is relatively common and that the majority of damaged teeth (62%) were known to have been previously restored, or weakened through periodontal disease prior to the damage occurring. The anaesthetists surveyed thought that dental damage was even more common than shown from the ACC records, and yet the vast majority of them did not routinely use specific protective guards and 45% of them did not ever use protective guards of any type.
Early Experience in the Queensland Orthotopic Liver Transplantation Programme
Authors: Burrow B. J. , Board A. J. , Taske J. E. , Young R.
Published: January 2019

The cases of the first nine patients to receive orthotopic liver transplants in the Queensland Liver Transplant Programme are reported. Problems peculiar to this type of operation are discussed generally and in the light of this experience. The anaesthetic technique employed is described. There were no deaths attributable to anaesthesia.
Acute Cardiovascular Responses to Internal Carotid Artery Occlusion during Carotid Endarterectomy and to the Restoration of Internal Carotid Flow
Authors: Kane C. M. , Le Cheminant D. , Horan B. F.
Published: January 2019

Heart rate, central venous pressure, radial artery pressure and electrocardiograph were recorded in 14 patients undergoing carotid endarterectomy under general anaesthesia supplemented with fentanyl and halothane and muscle relaxation as required. Induction of anaesthesia was followed by a significant reduction in systolic arterial pressure and a rise in central venous pressure (CVP). Thereafter CVP did not vary significantly and heart rate did not change significantly at any stage.

After internal carotid artery occlusion, mean systolic pressure at one minute, 143 (SD 17) mmHg, and three minutes, 160(SD27) mmHg, were both significantly higher than prior to occlusion, 132 (SD 17) mmHg (P< 0.01 and P< 0.002 respectively). Similar significant changes occurred in diastolic pressure after carotid occlusion (P< 0.02 and P <0.002 respectively). The restoration of flow through the internal carotid artery in patients operated on without a shunt was associated with a significant reduction in mean systolic pressure. The mean systolic pressure at one minute, 145 (SD 20) mmHg, and three minutes, 135 (SD 19) mmHg, were both significantly lower than that before restoration of flow, 159 (SD 17) mmHg (P < 0.02 and P< 0.05 respectively). Changes in mean diastolic pressure in this group at these times, while in the same direction, were not significant.

The observed hypertensive response to carotid occlusion may assist in preserving cerebral perfusion while the internal carotid artery is occluded, but may be hazardous for patients with ischaemic heart disease.
Placebo Controlled Comparison of Midazolam, Triazolam and Diazepam as Oral Premedicants for Outpatient Anaesthesia
Authors: Forrest P. , Galletly D. C. , Yee P.
Published: January 2019

Two short-acting benzodiazepines, midazolam 15 mg and triazolam 0.25 mg, were compared with diazepam 10 mg and placebo as oral premedicants in 120 patients presenting for minor urological surgery. Midazolam was found to produce the greatest degree of amnesia and sedation at the time of anaesthetic induction and triazolam was found to have the greatest degree of residual sedation at the time of discharge, four hours postoperatively. These effects are consistent with the greater potency and more rapid onset of action of midazolam at this dose compared with triazolam. The relative merits of the compounds as anxiolytics varied depending upon the observer, time and method of assessment. It was considered that the doses of midazolam and triazolam used were excessive for routine day case anaesthesia.
Reliability of Estimation of Pulmonary Artery Wedge Pressures during Coronary Artery Bypass Surgery
Authors: Davies M. J. , Beavis R. E. , Worner M. J. , Koumoundouros E.
Published: January 2019

The ability to reliably estimate pulmonary artery wedge pressure measurements using the clinical and basic cardiovascular parameters was assessed in fifty-six patients having elective coronary artery bypass surgery. The patients were divided into three groups: Group 1 had normal left ventricular function (22 patients), Group 2 had moderate left ventricular dysfunction (20 patients) and Group 3 had more severe left ventricular dysfunction (14 patients). The percentages of correct pulmonary artery wedge pressure estimations were 55%, 56% and 52% in Groups 1, 2 and 3 respectively. We conclude that pulmonary artery wedge pressure measurements can only be reliably estimated from the clinical situation and basic cardiovascular parameters on about 50% of occasions and that the reliability of the estimation does not vary between groups with different left ventricular performance.
Flow Properties of Modified Packed Red Cells
Authors: Lovric V. A. , Schuller M. , Rose G. , Raftos J. , Stewart M. , Berry G.
Published: January 2019

We investigated free gravitational blood flow of modified packed red cells. Variables affecting free flow included final haematocrit, duration of blood storage at 4–6°C and the centrifugal force required in preparation of this blood component. Irrespective of the duration of storage, free blood flow of modified packed red cells was not different from whole blood, provided the haematocrit did not exceed 0.63.
Nitrous Oxide and Cerebrospinal Fluid Markers of Ischaemia following Cardiopulmonary Bypass
Authors: Wells D. G. , Podolakin W. , Mohr M. , Buxton B. , Bray H.
Published: January 2019

Twenty patients with good ventricular function undergoing coronary artery bypass surgery were studied to determine whether the pre-bypass use of nitrous oxide resulted in any differences in cerebrospinal fluid markers indicative of cerebral ischaemia. All patients were anaesthetised with diazepam, fentanyl and pancuronium, after which ten patients received 50–60% nitrous oxide in oxygen until commencement of bypass, and the remaining patients 100% oxygen. Because of the known effect of nitrous oxide in expanding gaseous bubbles, any neurological dysfunction of gaseous microembolic origin may be worsened in the presence of nitrous oxide. Patients were lumbar punctured 24 hours after cardiopulmonary bypass and cerebrospinal fluid analysed for the following markers of central nervous system ischaemia: creatine kinase, lactate, total protein, noradrenaline, adrenaline and adenylate kinase. There was a statistically significant difference in cerebrospinal fluid lactate between the two groups. There were no statistically significant differences in the other cerebrospinal fluid markers of ischaemia.