bluuebunny/crossref_metadata_2025 huggingface dataset:
Paediatric Neurosurgical and Neuroradiological Anaesthesia
Authors: Brophy Tess
Published: January 2019

Summary Anaesthesia for paediatric neurosurgery and neuroradiology involves all the problems pertinent to

(i) management of infants and small children during procedures which may be relatively protracted;

(ii) avoidance or correction of disturbances of intracranial pressure and cerebral perfusion;

(iii) assessment of patients with depression of consciousness or of other neurological functions;

(iv) adoption of unusual positions for the conduct of procedures with special risks and limited access for the anaesthetist;

(v) providing optimum conditions for radiologists and avoiding radiation risks.
Chest Injury: The Indications for Artificial Ventilation
Authors: James Owen , Quail Anthony , Gibbons Jennifer
Published: January 2019

During the period April, 1968, to April, 1973, all patients admitted to Royal Newcastle Hospital with respiratory failure following chest injury were managed in the Acute Respiratory Unit. The great majority resulted from motor vehicle accidents.

A total of 130 patients suffered respiratory failure following chest injury, and were all seen by at least one of us. Only 21 patients had isolated chest injury, 109 having multiple injuries. Twenty-four patients died, nine from associated cerebral contusion.

The place of artificial ventilation in the proper management of chest injuries is discussed and particular stress is laid on those patients with conditions or injuries likely to lead to respiratory failure. In this category are those patients with significant flail segment, associated head or abdominal injury, the obese, and those with pre-existing chest disease.
Cerebral Effects of Circulatory Arrest at 20° C in the Infant Pig
Authors: Fisk G. C. , Wright J. S. , Turner B. B. , Baker W. de C. , Hicks R. G. , Lethlean A. K. , Stacey R. B. , Lawrence J. C. , Lawrie G. M. , Kalnins I. , Rose Margaret
Published: January 2019

Circulatory arrest at 20° C is used during open heart surgery in infants. It has been stated that significant brain damage does not occur.

Piglets between two and six weeks of age were cooled to 20° C using extracorporeal circulation and a membrane oxygenator. After one hour of circulatory arrest the perfusion system was used to rewarm the animals and restore normal circulation. Electroencephalogram was monitored throughout perfusion and surgery, and repeated on surviving animals on the third, fifth, seventh and tenth postoperative days. On the tenth day the animals were killed by injection of pentobarbitone. Other groups were subjected to

Continuous perfusion at 20° C,

Continuous perfusion at 37° C,

Thoracotomy and cannulation,

Ischaemia, and

Hypoxia. The return of E.E.G. activity was delayed after circulatory arrest compared with those continuously perfused. Lesions were found in the cerebral cortex in all the animals which had circulatory arrest and those subjected to ischaemia and hypoxia. The brains of animals of the other groups were indistinguishable from those killed without any experimental procedure.

Despite apparent recovery, brain damage following hypothermic arrest during open heart surgery remains possible.
Radiation Sterilization and the Anaesthetist
Authors: Rainey H. B.
Published: January 2019

This survey presents, in simple terms, some theoretical and practical aspects of radiation sterilization of particular interest to the anaesthetist. Although radiation is linked emotionally with destruction, its lethal effects, particularly on micro-organisms, can be used to present to the anaesthetist a safe, practical product.
Coronary Artery Disease and Anaesthesia: Principles of Management in the Patient Presenting for General Surgery
Authors: Juno P.
Published: January 2019

Some of the physiological consequences of coronary artery disease are outlined. The management of patients with coronary artery disease is discussed from the point of view of the anaesthetist with emphasis on preoperative assessment and the avoidance of cardiac complications during anaesthesia.
Atropine Premedication
Authors: Kessell J.
Published: January 2019

A double blind trial on a selected group of 125 adult patients investigated the effect of atropine in premedication.

The addition of atropine to premedication of pethidine and promethazine made no statistical difference in the incidence of

(a) secretory problems, cough, laryngeal spasm, and vomiting during induction and recovery,

(b) arrhythmias during induction,

(c) bradycardia during operation.
The Effects of Modified Electroconvulsive Therapy and Four Induction Agent-Relaxant Regimes on Plasma Potassium
Authors: Pilditch F. D. , Baker A. B.
Published: January 2019

Changes in plasma potassium following modified electroconvulsive therapy ‘were investigated using four induction agent-relaxant combinations. Small rises were found for three of the four regimes, but only methohexitone-suxamethonium was associated with a rise significantly greater than that in the control group. There was no correlation between the changes in plasma potassium and the degree of modification of the seizure. In no patient was a dangerous level of hyperkalemia found to occur.
Changes in Serum Potassium after Suxamethonium in Children
Authors: Keneally J. P. , Bush G. H.
Published: January 2019

The effect of the administration of intravenous suxamethonium (1 · 5 mg/kg) on serum potassium was measured in 37 children, whose ages ranged from one month to 16 years. In all patients anaesthesia was induced with thiopentone, and maintained with nitrous oxide and oxygen.

Serum potassium concentrations were estimated using venous blood taken immediately after induction and at one, two, three and four minutes after suxamethonium.

No significant changes were found in the groups aged six to 10 years and 11 to 16 years. However, in the group aged five years and less, a small, but significant, mean increase of 0·23 mEq/l was found. Individual children in each group had significant increases in serum potassium, but this phenomenon was less common than has been reported in adults.

Different premedications had no effect on serum potassium, and changes could not be related to the presence or degree of muscular fasciculations.
Post-Operative Respiratory Dysfunction: An X-Ray Study
Authors: Morton Anthony , Ebert Bryan
Published: January 2019

A group of patients having upper abdominal surgery were studied post-operatively for radiological evidence of early pulmonary congestion and interstitial pulmonary oedema. In addition, arterial oxygen tensions were measured. It is postulated that the accumulation of pulmonary interstitial fluid may be important in the development of post-operative hypoxaemia.
Administration of Oxygen with a Catheter through an Oropharyngeal Airway: A Comparison with the Nasal Route
Authors: Komesaroff David
Published: January 2019

With an oropharyngeal airway in place administration of oxygen through the nose does not always result in a rise in arterial oxygen tension. It appears that air inspired through the low resistance oropharyngeal airway can bypass the nasopharyngeal pool of oxygen. This study demonstrates that consistent rises of arterial PO2 occur only when the oxygen catheter is placed within the oropharyngeal airway.
An Aid for Teaching Acid-Base Balance
Authors: Melley D. M. , Harrison G. A.
Published: January 2019

An electrical analogue has been constructed and used to assist in the teaching of principles of acid-base balance.
Design of the Boyle Absorber
Authors: Ringrose N. H.
Published: January 2019

Bilateral Pneumothorax occurred during anaesthesia as the result of incorrect connection of hoses to a Boyle Circle Absorber. Attention is drawn to the design of the machine which allows such an accident to occur and suggestions are made for correction of this serious hazard.
Acute Iron Poisoning—Clinical Features and Management
Authors: Barker G. A. , Brown T. C. K. , Hosking C. S.
Published: January 2019

The patients admitted to the Royal Children's Hospital with iron ingestion between 1964 and 1973 are reviewed and the case histories of eight serious ingestions are summarized.

The clinical features of vomiting, diarrhoea, cardiovascular collapse, increasing central depression leading to coma, and hepatic necrosis are discussed. The management, including the use of sodium bicarbonate, intravenous fluids and the specific antidote desferrioxamine, is discussed.
Case Report: Thioridazine Overdose
Authors: Hollow V. M. , Clarke G. M. , Weekes J. W. N.
Published: January 2019

The case history of a patient with severe cardiac arrhythmias following overdose with thioridazine is reported. Management is outlined and discussed.
Radial Artery Cannulation
Authors: Oh T. E. , Davis N. J.
Published: January 2019

The status of radial artery cannulation is reviewed. The technique of percutaneous puncture, equipment in use, and known complications are discussed. Recommendations are made for precautionary measures to reduce the complication rate. It is concluded that radial artery cannulation is a safe and useful procedure in certain anaesthetic and intensive care situations.
Unilateral Pulmonary Oedema following Re-Expansion of Pneumothorax
Authors: Shanahan M. X. , Monk Ian , Richards H. J.
Published: January 2019

Unilateral pulmonary oedema is a rare complication in the routine management of spontaneous pneumothorax. Previous reports have emphasized excessive negative intrapleural pressure, rapid re-expansion of the lung and bronchial obstruction as major factors in the pathogenesis. We have encountered four cases, and at least one of these factors have been absent in each case. Review of the literature, and our own experience suggests that the major factor is chronic and total lung collapse resulting in hypoxia and increased alveolar-capillary membrane permeability. Other factors which may be contributory are discussed.
Management of Tracheal Rupture Involving both Bronchi
Authors: McCleave D. J. , Fenwick D. G. , MacDonald R. R.
Published: January 2019

A patient with a rupture of the lower trachea and both bronchi is presented. A review of the significant clinical findings is presented, and the anaesthetic management is discussed. The necessity of early bronchoscopy in these patients and the ready availability of experienced medical staff in assessing all severe trauma is emphasized.
A Prospective Study of Coronary Care in a Rural City
Authors: Clubb J. C. , Stathers G. M.
Published: January 2019

The results of a two-year prospective study of myocardial infarction in a rural city is reported. In the under 70 years age group there was a 10 per cent mortality of patients whilst being nursed in the coronary care area. Later deaths after transfer to the general wards raised the overall hospital mortality rate to 15 per cent. These figures compare favourably with other series.
Some Observations on Infective Shock
Authors: Morton A.
Published: January 2019

The nature of infective shock is considered with reference to a group of patients. Current management is outlined.
Control of Heat Balance during Arterial Surgery
Authors: Shanks C. A.
Published: January 2019

Patients were studied to quantitate methods used to prevent heat loss during vascular surgery A combination of techniques limiting heat loss were shown to prevent hypothermia. In addition it was shown that heat balance in patients undergoing vascular surgery did not differ from that in patients undergoing other forms of surgery.
An Intensive Care Unit in a Rural Area
Authors: Krishna S. Radha
Published: January 2019

Factors that governed the setting up of a multipurpose, temporary Intensive Care Unit of six beds, in a remote area of Malaysia and the experience of operating it for more than two and a half years are outlined.
Fiberoptic Endoscopy of the Respiratory Tract in the Intensive Care Ward
Authors: O'Donnell John E.
Published: January 2019

An outline is given of the use of fiberoptic instruments in the management of some respiratory problems in the Intensive Care Ward. In particular, bronchoscopy and inspection of the trachea and larynx prior to closure of tracheostomy are described.
Autonomic Manifestations of Tetanus
Authors: Hollow V. M. , Clarke G. M.
Published: January 2019

Two patients with tetanus are reported to illustrate the involvement of the sympathetic and parasympathetic nervous system respectively. Aspects of the autonomic manifestations of tetanus are illustrated and discussed.
Hypermagnesaemia Caused by Parenteral Nutrition in Patients with Renal Failure
Authors: Havill J. H.
Published: January 2019

Iatrogenic hypermaguesaemia may occur when magnesium is infused in the presence of compromized renal function. Three cases are described and the renal control of magnesium is discussed. If magnesium is considered necessary in the presence of decreased renal function, reduction in dosage and frequent monitoring of serum magnesium levels should be undertaken.
An Infusion Set for Parenteral Nutrition
Authors: Ahmed Nazir , Miller Ian C. , Marinovich Norman
Published: January 2019

An attachment for a standard intravenous infusion set is described. It allows delivery of carbohydrate and amino-acid solutions in a manner that favours maximum utilization and reduces the risks of metabolic complications. It also permits, with ease, repeated alterations of infusion regimes when this is considered necessary.
Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation
Authors: Fisk G. C. , Baker W. de C.
Published: January 2019

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur.

Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated.

Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen.

It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.
Acute Respiratory Failure in Acute Pancreatitis
Authors: Cameron A. G.
Published: January 2019

The respiratory complications of acute pancreatitis are discussed, with particular reference to the incidence, pathophysiology and management of acute respiratory distress.
A Scavenging Device for the Bennett BA-4 “Anaesthesia Ventilator”
Authors: Gibb David B.
Published: January 2019

A scavenging device for the Bennett BA–4 “Anaesthesia Ventilator “is described. Anaesthetic gases are vented outside the operating theatres by means of Venturi-type suction apparatus. The unit is very efficient under normal working conditions and no interference with ventilator function has been observed.
Errors in Pneumotachography with Intermittent Positive Pressure Ventilation
Authors: Abrahams N. , Fisk G. C. , Churches A. E. , Loughman J. , Vonwiller J. B. , Agzarian J. , Harrison G. A.
Published: January 2019

Instrument errors that can occur when pneumotachography is used during Intermittent Positive Pressure Ventilation (IPPV) have been described previously (Kafer 1973). Our efforts to eliminate these errors led to the discovery of further inaccuracies, which appear to be due to the design of the differential pressure transducers used with the pneumotachograph head. A system was used in which a sine-wave pump delivered a constant tidal volume to a dummy lung, the tidal volume being measured by means of a pneumotachograph. Using Grass, Statham and Devices differential pressure transducers, the volume recorded as leaving the dummy lung was consistently greater than that recorded as entering, and changing the pneumatic polarity of the differential pressure transducer produced large differences in the recorded volume. In some cases the error was greater than the volume being measured. There would seem to be several causes of such errors. The Sanborn 270 differential pressure transducer and the Greer micromanometer appeared to be free of these artifacts.

The results of this study throw into doubt much previously published work using pneumotachography during IPPV.
Anaesthesia and Clinical Pharmacology: Related Disciplines
Authors: Jellett L. B. , Oh T. E.
Published: January 2019

The disciplines of anaesthesia and clinical pharmacology are related in as much as both have a mutual interest in the safe and conservative use of drugs in man. Anaesthetists have effectively been practising rational therapeutics for many years and they have much to offer academic departments of clinical pharmacology in terms of teaching and research programmes. Similarly, the clinical pharmacologist can usefully contribute to anaesthetic training and research programmes in relation to aspects such as education, precise analytical methods, data-handling and clinical trial techniques. The inter-relationship of the two disciplines can be of mutual advantage and has the potential to provide a stronger basis for sound therapeutic practice.
Diazepam Prophylaxis for Lignocaine Induced Convulsions
Authors: Jain P. D. , Pandey K. , Chandra H. K.
Published: January 2019

The effectiveness of intraperitoneal phenobarbitone (4 mg/kg), pentobarbitone (6 mg/kg) and diazepam (2·5, 5 and 7·5 mg/kg) in preventing lignocaine-induced seizures was studied in rats. Although the barbiturates exerted a marked depressant action on wakefulness and gait of the rats, they were still associated with a very high incidence of convulsions and deaths following 100 mg/kg intraperitoneal lignocaine hydrochloride. Diazepam, however, even in doses (2·5 and 5 mg/kg) which did not produce marked sedation was able to completely prevent convulsions. Mortality was not completely prevented as one animal in each of the groups receiving these doses died without convulsing. Diazepam in the dose of 7·5 mg/kg completely prevented the seizures as well as the mortality but exerted a more profound effect on wakefulness and gait of the animals. The effectiveness of diazepam pretreatment in preventing lignocaine-induced seizures in rats is confirmed.
A New Compact, Versatile, Fluidic Controlled Ventilator
Authors: Campbell D. I.
Published: January 2019

A new fluidic controlled ventilator has been designed. The construction, functional analysis and use of the ventilator are described.
The Establishment of a Mobile Intensive Care Unit
Authors: James Owen , Coombs J. H.
Published: January 2019

The need for a Mobile Intensive Care Unit is discussed and the planning and construction of such a vehicle for use in the Hunter Region of New South Wales is described.

The staffing, method of mobilization and utilization over its initial eighteen months is presented.
Continuous Flush System for Radial Artery Cannulation
Authors: Oh T. , Opie N. J. , Davis N. J.
Published: January 2019

A prospective study of 50 radial artery cannulations was carried out using the Intraflo continuous flushing device. Functional patency was maintained in all cannulations. No serious complications were seen. It is concluded that this method of continuous flushing is preferable to intermittent manual flushing.
Computer Controlled Studies in Surface Cooling Hypothermia: The Effect of Carbon Dioxide on Brain Temperature
Authors: Brown T. C. K. , Lampard D. G. , Brown W. A. , Coles J. R.
Published: January 2019

A computer controlled ventilation system was employed to maintain a constant end-expired CO2 percentage ( F E CO2) during a series of studies on young dogs aimed at measuring brain temperature differences during surface cooling hypothermia. The conclusion is that an F E CO2 of six per cent or more is desirable if brain temperature differences are to be minimized. Additional experiments showed that ethyl alcohol and sodium nitroprusside infusions during cooling did not decrease brain temperature differences.
The Guillain-Barré Syndrome in Intensive Care
Authors: McCleave D. J. , Fletcher J. , Cruden L. C.
Published: January 2019

The history, clinical presentation and pathological findings of the Guillain-Barré Syndrome are presented. An analysis is made of patients with this syndrome admitted to an intensive care ward over a six year period. Results and management are discussed.
A New Disposable Nerve Block Needle
Authors: Schweitzer S. A.
Published: January 2019

A new needle is described. It is cheap, disposable and designed particularly for nerve blocks. The attributes of an ideal needle are discussed.
The Influence of Duration of Circulatory Arrest at 20°C on Cerebral Changes
Authors: Fisk G. C. , Wright J. S. , Hicks R. G. , Anderson R. McD. , Turner B. B. , Baker W. de C. , Lawrence J. C. , Stacey R. B. , Lawrie G. M. , Kalnins I. , Rose Margaret
Published: January 2019

In infants and piglets subjected to periods of circulatory arrest at 20°C there was close correlation between duration of arrest and delay in return of electroencephalographic activity. Post mortem studies demonstrated histological evidence of brain damage in patients after circulatory arrest at 20°C. Similar histological changes were demonstrated in piglets, including some who had complete E.E.G. and clinical recovery from circulatory arrest.
Awake Tracheal Intubation in Anaesthesia
Authors: Mircea Nicolae , Jianu Emilian , David Stefan , Alexiu Oreste
Published: January 2019

Endotracheal intubation in the awake patient was used on 500 occasions Indications and results are discussed and analysed.
Preoperative Magnesium Trisilicate in Infants
Authors: Hutchinson B. R.
Published: January 2019

Three groups, each of forty children aged less than Jive years and prepared for elective surgery, had their gastric contents’ volume and pH measured. The control group showed an incidence of 67·5 per cent with high acidity (pH equal to or less than 2·5). In the second and third groups magnesium trisilicate mixture was given within thirty minutes prior to induction of anaesthesia. The second group, sampled after induction of anaesthesia, showed a marked reduction in acidity, while the third group, sampled at the termination of anaesthesia and surgery, demonstrated that in most cases the neutralization of gastric acidity was still effective.
Effect of Barbiturates on Synaptic Currents
Authors: Torda T. A. , Gage P. W.
Published: January 2019

Thiopentone and pentobarbitone reduce the time constant of decay of miniature end-plate currents when applied in anaesthetic concentrations to the neuromuscular junction. Such an effect at central synapses would lead to failure of synaptic transmission in the central nervous system and may reflect a common mode of action of many anaesthetic drugs.
Post-Operative Respiratory Function a Ventilation-Perfusion Study
Authors: Morton A. , Mahoney P. , Hansen P. , McBride M. , Baker A. B.
Published: January 2019

Many studies have shown that after uncomplicated abdominal surgery arterial hypoxaemia frequently occurs because of regional underventilation in relation to perfusion.

This paper produces evidence that shows a small increase in physiological dead space to tidal volume ratio following general anaesthesia for abdominal surgery. This increase is thought to be due to tachypnoea rather than alteration in pulmonary blood flow.
A New Humidifier
Authors: Grant G. C. , Dawson J. J. W. , Roberts B. E.
Published: January 2019

A new heated water-bath humidifier operates on a new basic principle which overcomes the practical disadvantages of existing systems.

A heated hose is used to control a temperature drop along the whole length of the delivery line instead of raising the temperature of the gases in the delivery line as in previous systems. Therefore the tank does not have to fully saturate the gases and a simple, totally cleanable design is possible. A temperature sensor at the delivery point controls the hose heater, constituting a rapid response, low thermal inertia system and delivery temperature is displayed on the unit. Compensation for varying gas flows and ambient temperature changes is inherent and the unit is suitable for neonatal/paediatric and adult use without special adjustment.

The tank has a separate reservoir chamber which feeds an evaporation chamber via a cleanable float valve, conferring many advantages including clearly visible water levels, easy filling without breaking the circuit and constant compression volume.

Full fail-safe alarm systems are incorporated.
Thrombus Formation on Indwelling Venous Cannulae in Sheep: Effects of Time, Size and Materials
Authors: Spanos H. G. , Hecker J. F.
Published: January 2019

Three experiments were performed to measure thrombus formation on plastic cannulae inserted by cut-down into veins of sheep. On polyethylene tubing, considerable thrombus was present after one day and the amount increased in the subsequent 13 days. When different sized polyethylene tubings were tested, thrombus tended to form in relation to the surface area. Smaller tubings had smaller proportions of their lengths covered with thrombus. There were differences between types of plastics with one batch of polyvinylchloride tubing being virtually non-thrombogenic.
Measurement of Thrombus Formation on Intravascular Catheters
Authors: Hecker J. F. , Fisk G. C. , Farrell P. C.
Published: January 2019

Relative thrombogenicities of several brands of intravascular catheters were measured in the saphenous and cephalic veins of sheep. Differences in thrombogenicity between brands of up to eleven fold were found. At least one brand contained an ingredient which was locally toxic to sheep and which caused phlebitis in cannulated vessels. The brands tested were made from six types of plastics. It is suggested that differences in manufacturing technique may be more important than the type of plastic in determining the thrombogenicity of catheters.
Bicarbonate Requirements during Hypothermic Cardiopulmonary Bypass the Relative Effects of Pulsatile Flow
Authors: Black A. M. S.
Published: January 2019

An analysis of 541 patients having total body perfusion under hypothermia (30°–33°C) showed that the use of pulsatile as against constant flow perfusion was not associated with a reduction in bicarbonate requirement, though the use of a vasodilator was. The implications of this are discussed.
A Diagram to Facilitate the Understanding and Therapy of Mixed Acid Base Disorders
Authors: Worthley L. I. G.
Published: January 2019

A diagram based on in-vivo relationships between arterial hydrogen ion activity (H+) and carbon dioxide tension (PCO2 ) in primary abnormalities of acid base homeostasis is presented.

It is designed to facilitate the interpretation of pH data by including the 95% confidence limits described in patients with simple metabolic and respiratory acid base disorders. These bands have been formulated from observation of simple acid base abnormalities and indicate the appropriate respiratory or renal compensatory response to the primary pH defect. A plot which falls outside these limits therefore indicates the presence of a mixed acid base disorder.

The diagram presents a physiological approach to clinical disorders of pH regulation demonstrating maintenance of intra-cellular fluid homeostasis during primary extracellular fluid disturbances.

Diagnostic and therapeutic advantages are further illustrated and discussed in six case reports.
Teaching Aids
Authors: Paull John D.
Published: January 2019

A teaching aid is exactly what it says it is—an aid to teaching. No matter how exciting the aid may be, its production is not an end in itself, merely a means to an end. Teaching aids are most effective and can be best justified when a need for them has been demonstrated and when they can be shown to clarify the teaching of points and problems which students have formerly found difficult to understand.

The best teaching aids are the result of a combination of imagination and enthusiasm. Aids should always be evaluated to determine whether the costs of production are justified by an improvement in learning.
Medical Writing
Authors: Cass Noel , Waldie I. A.
Published: January 2019

Attempts to transfer information are often frustrated by errors in English. A few of these are analysed and some suggestions are made for avoiding them.
Continuing Education
Authors: Cousins M. J. , Dreosti A. V.
Published: January 2019

One view of the aims and objectives of continuing education is presented. Problems in the form of educational material and access to present educational opportunities arc outlined together with some suggestions for overcoming these problems. Self evaluation is emphasised as an important means of maintaining educational standards rather than “re-licensure”. Several new approaches are presented which attempt to increase access and acceptability in continuing education.
Insulin Loss in Parenteral Nutrition Systems
Authors: Oh T. E. , Dyer H. , Wall B. P. , Hall R. A. , Jellett L. B.
Published: January 2019

This study investigated insulin adsorptive loss occurring in various infusion systems used in regimens of parenteral nutrition. The results suggested early and considerable insulin loss in dextrose infusion solutions with doses of insulin used clinically. Maximum percentage loss occurred within 30 seconds following administration of insulin to infusion bottles of 5% and 50% dextrose. Mean insulin loss over eight hours amounted to 47·6%± 2·0 s.e.m. in 5% dextrose and 34 · 8% ± 1· 5 s.e.m. in 50% dextrose. The combination of infusion bottle and infusion set further increased the mean insulin loss in 50% dextrose to 43 ·6%± 1·7 s.e.m.

Percentage insulin loss in bottles of 5% dextrose decreased with increasing insulin concentration, however, insulin loss in 50% dextrose was unaffected by varying insulin concentration. The addition of human serum albumin (0·05% w/v) to 50% dextrose lessened insulin loss to a small but significant extent and mean insulin loss in solutions of Aminofusin 600 was only 14·0% ± 1·6 s.e.m. over 30 minutes.

With a regimen of parenteral nutrition in any one patient, it would seem logical where possible to add insulin to one type of parenteral nutrition solution only, so that the variability of insulin adsorptive loss seen with different solutions may be minimized.
Reversal of the Anaesthetic Action of Sodium Gamma-Hydroxybutyrate
Authors: Henderson R. S. , Holmes C. McK.
Published: January 2019

Physostigmine was administered intravenously to 25 patients, anaesthetised with sodium gamma-hydroxybutyrate (GHB), and their emergence from anaesthesia was studied. Physostigmine (2 mg) brought about rapid, safe, reliable and sustained awakening after a “latent period “varying from 2–10 minutes (mean 6·2 minutes ±S.D. 2·2) in 24 patients. In the one patient not awake at 10 minutes, a second dose of physostigmine produced awakening in an additional 8 minutes. No serious side effects were attributable to the physostigmine. This finding may warrant a reconsideration of the place of GHB in anaesthetic practice.
A New Blood Administration Set
Authors: Hood John W.
Published: January 2019

A new blood administration set is described. It incorporates an in-line hand pump and a heat exchange coil and has a number of advantages over separate heating coils. The blood warming efficiency of the unit has been measured.
Severe Bronchial Asthma: Factors Influencing Intensive Care Management and Outcome
Authors: James O. F. , Mills R. M. , Allen K. Murree
Published: January 2019

Over a seven year period 2933 patients were admitted with asthma. Respiratory failure occurred on 106 occasions. A total of 26 patients died including 11 of the 106 who developed respiratory failure. The intra-hospital management of asthma is outlined. The experience is analysed to indicate those patients particularly at risk. These include those who develop pneumothorax, have associated chest infections or have recently ceased steroid therapy.
Historical Note: Drumine—A New Australian Local Anaesthetic
Authors: Bailey Richard J.
Published: January 2019

An article in the Australasian Medical Gazette of October, 1886 indicates the method of extraction, experimentation and therapeutic application of an active principle, prepared from Euphorbia Drummondii.

Further correspondence is noted, refining the method of extraction, reporting cases, answering criticisms, and announcing eventually, drumine's commercial preparation.

Despite enthusiastic support, the drug soon disappears from the therapeutic scene.
Bronchodilators and Physiotherapy during Long Term Mechanical Ventilation of the Lungs
Authors: Winning T. J. , Brock-Utne J. G. , Goodwin N. M.
Published: January 2019

The effects of physiotherapy and hexaprenaline sulphate administration were studied on 10 patients requiring mechanical ventilation. No significant changes in arterial oxygen tension were noted, but alveolar pressure fell significantly after treatment, indicating improvement in pulmonary compliance.
Application of the New Australian Standard for Clinical Lighting
Authors: Hood John W.
Published: January 2019

A new Australian Standard “AS 1765–1975 Artificial Lighting for Clinical Observation “has recently been published. This specifies the quality of light necessary to accurately assess a patient's colour. The physical principles and terminology used in modern lighting are discussed, and the experimental work on which the new Standard is based is outlined.

The only readily available fluorescent tubes which conform to the Standard are the imported Philips “TL40W/37” and the more efficient locally made “White Deluxe “tubes.
Case Report: Anaesthesia in Myotonic Dystrophy
Authors: Muller Jacques , Suppan Peter
Published: January 2019

Pancuronium and a continuous infusion of althesin was used to produce muscular relaxation in a patient with myotonic dystrophy. Excellent muscle relaxation with absence of percussion or surgically induced myotonia was obtained but the EMG was not modified; an intracellular site of action of althesin is postulated. Cardiovascular stability was remarkable peroperatively; postoperatively an increased myocardial susceptibility to hypokalaemia was noticed.
Case Report: Hazards Associated with Cervico-Thoracic Sympathectomy
Authors: Zee R. F. Y.
Published: January 2019

A case report of bradycardia and cardiac arrest which occurred during a Cervico-Thoracic sympathectomy. Hazards associated with this operation are discussed.
Effect of Buprenorphine on the Ventilatory Response to Carbon Dioxide
Authors: Baster T. J. , Gibbs J. M. , Richardson T.
Published: January 2019

Buprenorphine is a potent synthetic opioid-partial antagonist analgesic drug currently under clinical trial. When administered intravenously to human volunteers buprenorphine produced a significant depression of the ventilatory response to carbon dioxide stimulus for a period in excess of six hours.
Endogenous Opiates—A Progress Report
Authors: Henderson R. S.
Published: January 2019

The “opiate receptor “has become a well-accepted entity, stimulating the search for an endogenous agonist. This has successfully revealed several different endogenous peptide opiates whose physiological role is under intense investigation, contributing to our understanding of pain and of opiate tolerance and dependence. A review of the current literature is presented.
Post-Operative Flow-Volume Loops
Authors: Morton A. , Hansen P. , Baker A. B.
Published: January 2019

A study of flow-volume curves pre- and post-operatively demonstrated a marked difference between bronchitic and non-bronchitic patients. All bronchitic patients showed lower flow rates at low lung volumes post-operatively, when compared with their pre-operative values. Non-bronchitic patients all had higher flow rates for the same comparison.
Flow through Venous Cannulae
Authors: Selwyn A. , Russell W. J.
Published: January 2019

Fluid flow through modern cannulae is not simple and cannot be expressed in classical terms. Progressively increasing the length of a cannula diminishes flow predictably but altering the bore of the cannula does not give a fourth power improvement in flow but rather a linear one. A reasonable working value for the relative viscosity of ACT) blood in infusions would seem to be 2·6 below about 125 ml/minute flow (saline). The decline in relative viscosity above this may be caused by turbulence in the saline flow.
Functional Classification of Anaesthesia Circuits
Authors: Baraka Amis
Published: January 2019

Anaesthesia circuits are classified and discussed according to their functional characteristics.
Acid Aspiration during Laparoscopy
Authors: Tay H. S. , Chiu H. H.
Published: January 2019

The prophylactic efficacy of pre-operative antacid administration was shown by comparing the pH and volumes of gastric contents in 50 female patients treated with 10 ml of Mist. Magnesium Trisilicate B.P.C. with that of 50 controls. Routine antacid prophylaxis was advocated for all patients undergoing pelvic laparoscopy as intra-operative conditions increase the risk of pulmonary acid aspiration.
Infundibular Spasm in Fallot's Tetralogy — An Account and Its Management in Anaesthesia
Authors: Kam C. A.
Published: January 2019

The value of propranolol in relieving infundibular spasm is illustrated. The pathophysiology of infundibular spasm in Fallot's tetralogy and its management in anaesthesia is reviewed.
Cortical Blindness following Hypoxia during Cardiac Arrest
Authors: Kam C. A. , Yoong Florence F. Y. , Ganendran A.
Published: January 2019

Two patients with cortical blindness following hypoxic episodes are reported. The characteristics of the syndrome are described. Attention is drawn to the lack of awareness of this complication of hypoxia.
A Visual Monitor for Piped Oxygen Supply Systems to Anaesthetic Machines
Authors: Newson A. J. , Dyball L. A.
Published: January 2019

A pressure sensitive recording device for monitoring piped oxygen systems supplying anaesthetic machines is described. The monitor displays a colour change and is powered by pressure of oxygen from the piped oxygen supply line.
A Technical Aid to Performance of Neurolytic Lumbar Sympathectomy
Authors: Cherry D. A.
Published: January 2019

The injection of ten ml of air into the retroperitoneal space outlines the anterior margin of the psoas muscle. This been found to be useful, using an Image Intensifier, for the accurate location of needle tips in the performance of neurolytic lumbar sympathectomy.
The Stocks Suction Bullet
Authors: Kerr D. R. , Vonwiller J. B. , Abrahams N.
Published: January 2019

The Stocks suction bullet is a device allowing maintenance of positive pressure ventilation, continuous distending pressure and high inspired oxygen concentrations during tracheal toilet in intubated patients. The effectiveness of this device was studied using an experimental apparatus and a dummy lung to represent neonates being treated with either C.P.A.P. or I.P.P.V. and P.E.E.P.

By using appropriate combinations of suction catheter type and size, bullet lumen size, ventilator settings and suction pressure limit, it was possible to maintain during suctioning ventilation peak pressures between 50% and 100% of presuction levels and continuous distending pressures (P.E.E.P. or C.P.A.P.) at or in excess of 80% of presuction levels.
The Stocks Suction Bullet — Clinical Application
Authors: Vonwiller J. B. , Abrahams N. , Lawrence J. C.
Published: January 2019

Modifications to the original Stocks suction bullet and its use in ventilator circuits in both adult and paediatric situations are described.
A Study of Waste Gas Scavenging in Operating Theatres
Authors: Torda T. A. , Jones R. , Englert J.
Published: January 2019

Measurements of atmospheric nitrous oxide concentrations were made in eight hospitals, using 30 anaesthetic machines and locations, during 41 anaesthetic administrations or simulations. All areas were air conditioned, two by laminar flow devices. All anaesthetic machines and ventilators were fitted with commercially available gas collector (scavenger) valves. In all areas except one, venturi suction was used to exhaust gases. Pollution levels during endotracheal anaesthesia did not exceed the recommended 30 ppm. except where leaking anaesthetic machines or nitrous oxide supplies were used. In two instances where paediatric anaesthesia was administered through uncuffed endotracheal tubes nitrous oxide levels were also excessive. Of nine anaesthetics administered through face masks, only in one was the ambient nitrous oxide concentration acceptable. During induction of anaesthesia using nitrous oxide, unacceptable peaks of concentration were encountered. In two air conditioned recovery rooms tested, nitrous oxide concentration was acceptable. The collector valves performed their function satisfactorily, but laminar flow air conditioning was insufficient in itself to maintain acceptably low nitrous oxide concentration without the use of scavenging.
Prolonged Curarisation in the Presence of Renal Impairment
Authors: Havill J. H. , Mee A. D. , Wallace M. R. , Chin L. S. , Rothwell R. P. G.
Published: January 2019

Prolonged curarisation in the presence of renal failure occurred in six cases where pancuronium was used, and one case where alcuronium was used. The cases are presented with a brief review of the literature.

Pancuronium must be used with great caution if postoperative reversal problems are to be avoided. Greater use of adjuvants will reduce requirements and may eliminate the problems encountered in renal failure.
Arterial Blood Gas Analysis: Potential Errors due to the Addition of Heparin
Authors: Hamilton R. D. , Crockett A. J. , Alpers J. H.
Published: January 2019

The effect of sodium heparin on the determination of the major arterial blood gas parameters was studied. The addition of heparin produced errors in all three parameters tested, i.e. PO2, PCO2 and pH. The PCO2 determination was most affected, a 12% decrease being introduced into a 1.5 ml blood sample by the volume of heparin which fills the deadspace of a syringe and needle. Small but statistically significant errors were also produced in PO2 and pH by this heparin concentration.

The clinical implications of these findings are discussed and certain measures outlined to avoid such errors.
Anaesthetic Management of Insulinoma
Authors: Lamont A. S. M. , Jones D.
Published: January 2019

A patient having surgical removal of an insulinoma was managed by withholding glucose and monitoring blood glucose intra-operatively.
The Effect of EMG Biofeedback on Postoperative Pain following Abdominal Surgery
Authors: Madden Chris , Singer George , Peck Connie , Nayman Jack
Published: January 2019

To investigate the effects of electromyography (EMG)-biofeedback on pain experienced during the immediate post-operative period following abdominal surgery, twelve patients were randomly assigned to either (1) EMG-biofeedback from abdominal muscles; (2) EMG-biofeedback from the frontalis muscles; or (3) were given no EMG treatment.

EMG training consisted of one pre-operative 30 minute session, and three 30 minute postoperative sessions. All patients were able to reduce EMG activity. A within-sessions analysis of pain reports (on a 0–10 pain intensity scale) indicated that EMG biofeedback is an effective method of pain relief only when feedback is given to the muscle site involved in the operation.
Effects of Etomidate Given in Repeated Doses
Authors: Spanos A. , Chiu H. H. , Tye C. Y.
Published: January 2019

Fifty fit, female patients were given four consecutive intravenous doses of etomidate 10 mg, so as to maintain sleep, after establishment of epidural block for postpartum sterilization. A matched group was given four doses of thiopentone 125 mg. Cumulative hypnotic effect, as judged by increasing sleep duration with second and subsequent doses, was much less with etomidate than with thiopentone. Etomidate did not depress blood pressure, whereas it fell progressively with successive doses of thiopentone. Injection pain was reported in 68% of patients receiving etomidate, and this tended to increase with successive doses; 12 % also showed local inflammation at the injection site. Tremor, due to etomidate, was common, but did not increase with successive doses. Feelings of sleepiness, lasting several hours after waking, were more common after thiopentone than after etomidate.
Hypoxia with a Third Flowmeter Tube on the Anaesthetic Machine
Authors: Russell W. J. , Ward J. B.
Published: January 2019

Hypoxic mixtures of oxygen and nitrous oxide were demonstrated with three anaesthesia machines which had cyclopropane flowmeters. In one machine the bobbin did not prevent back flow and the hypoxic mixture occurred when the cyclopropane flow control was left open. Two other machines only delivered hypoxic mixtures if the cyclopropane bobbins were removed from their seats and the flow controls opened. The vaporizer on one machine increased the hypoxia when turned on.
D-Tubocurarine Requirement during Hypothermia
Authors: Lam H. S. , Brown T. C. K. , Lampard D. G.
Published: January 2019

The effect of hypothermia on the action of d-tubocurarine (d-TC) was studied under carefully controlled experimental conditions. It was found that with computer controlled infusion, 60% less d-TC was required to sustain 75% muscle paralysis in cats, during steady-state, in vivo, when the temperature was changed from 37°C to 30°C. The corresponding relaxant consumption rates were 0.136 ± 0.025 and 0.055 ± 0.012 mg/kg/1/2 hr respectively.

When there was no temperature change the maintenance dosage of d-TC remained constant for up to four hours denoting the equilibrium phase of the relaxant kinetics. Temperature transitions introduced dynamic changes in these kinetics and altered the constancy of the maintenance dosage.
Thrombus Formation on Catheters in New Born Lambs
Authors: Hecker J. F. , Fisk G. C. , Gupta J. M. , Abrahams N. , Cockington R. A. , Lewis B. R.
Published: January 2019

Catheters were inserted into the aorta and inferior vena cava of newborn lambs by cutdown on the femoral vessels and directly into the umbilical vein. The lambs were killed after six days and the amounts of thrombus surrounding the catheters were measured. Most catheters inserted into the umbilical vein looped within the liver and only a few passed directly into the portal vein or through the ductus venosus into the vena cava. On different types of catheters inserted via the femoral artery or femoral vein, there were significant differences both in the proportion with thrombus and the amount of thrombus. There were also significant differences in renal infarction caused by different types of catheters.
Effects of Heparin, Aspirin and Dipyridamole on Thrombus Formation on Venous Catheters
Authors: Spanos H. G. , Hecker J. F.
Published: January 2019

Heparin, aspirin and dipyridamole were given alone or in combination to groups of sheep which had polyethylene catheters inserted into facial and saphenous veins. Animals were killed after 3 or 9 days. Neither aspirin nor dipyridamole reduced the amounts of thrombus on the catheters at autopsy. Heparin reduced thrombus only when sufficient was given to reduce blood coagulation.
Silicone Elastomer for Nasojejunal Intubation and Central Venous Cannulation in Neonates
Authors: Cockington Richard A.
Published: January 2019

Modifications are described to two techniques using silicone elastomer tubing in neonatal nutrition. The first enables nasojejunal intubation to be performed easily for feeding by this route. The second provides a central venous line for parenteral alimentation. These modifications are suggested as improvements to the original techniques described.