bluuebunny/crossref_metadata_2025 huggingface dataset:
Haematological Aspects of Renal Disease
Authors: Dodds Anthony , Nicholls Maryann
Published: January 2019

Renal diseases are associated with a variety of haemopoietic changes. Anaemia parallels the degree of renal impairment and its most important cause is failure of renal erythropoietin secretion. Other factors include depressed red cell production and reduced red cell survival. Purpura and bleeding are predominantly due to platelet dysfunction and usually respond to dialysis. Cryoprecipitate and 1-deamino-8-d-arginine vasopressin may be of value in the bleeding patient. Abnormal coagulation with fibrin deposition in the microcirculation is now recognised as a mechanism of renal impairment. Plasma infusion and anticoagulants may be useful in the therapy of conditions in which this occurs. Plasma exchange is now used in the investigation and management of some varieties of immunologically mediated renal disease. Blood transfusion has been found to improve graft survival if given prior to renal transplantation and this effect is currently under active investigation.
Nerve Blocks around the Knee in Children
Authors: Kempthorne P. M. , Brown T. C. K.
Published: January 2019

Analgesia below the knee can be achieved by blocking the tibial nerve and the common peroneal nerve in the popliteal fossa, and the saphenous nerve adjacent to the knee. The anatomy and technique of nerve block in the popliteal fossa is described, the nerve being located prior to blockade using a peripheral nerve stimulator. The block as described has been used in children for postoperative analgesia, as a diagnostic block, and as an adjunct to the physiotherapy management of severe equinus deformity after brain injury.
Medical Diseases in Surgical Patients in Hong Kong
Authors: Yeung M. L.
Published: January 2019

The incidence of medical diseases in surgical patients was assessed using data gathered from 5944 consecutive anaesthetics.

Medical disease which might affect anaesthetic management was present in 23.2% of patients. The commonest diseases were hypertension, anaemia, chronic obstructive airway disease, diabetes mellitus, and pulmonary tuberculosis. No significant difference was detected in sex incidence for ischaemic heart disease and cerebrovascular disease. There was a disproportionate preponderance of males with respiratory diseases.

It is suggested that anaesthetics should be administered only by qualified anaesthetists, that the establishment of anaesthetic outpatient clinics is desirable, and that internal medicine should be included in anaesthetic training.
Air Leak in Neonatal Respiratory Distress Syndrome
Authors: Sly P. D. , Drew J. H.
Published: January 2019

A review of 9401 consecutive live births at the Mercy Maternity Hospital, Melbourne, was performed to determine the incidence of air leak in those with respiratory distress syndrome. Respiratory distress was detected in 552 (5.9%) infants and hyaline membrane disease was the most common cause occurring in 238 (2.5%) infants. Air leak developed in 22% of infants with respiratory distress, 8% had pulmonary interstitial emphysema alone, 14% had pneumomediastinum or pneumothorax and 7% had emphysema with pneumomediastinum or pneumothorax. Mortality increased from 12% in infants without air leak to 31% (p < 0.001) in infants with air leak. Ninety-five per cent of air leak developed in infants with hyaline membrane, and these were smaller, less mature and sicker than those without air leak. Eighty-seven per cent of air leak developed in infants treated with assisted ventilation and was commoner with mechanical ventilators with a more rapid rise in inspiratory pressure.
Fasting and Non-fasting Serum Amino Acid Values in three Home Parenteral Nutrition Patients: A Comparison between Synthamin 17R and Vamin N 7%R
Authors: Worthley L. I. G. , Philcox J. C. , Hartley T. F.
Published: January 2019

Serum amino acid concentrations were measured during the fasting and non-fasting stages of nutrition in three home parenteral nutrition patients who received their nitrogen requirement as Synthamin 17R for 12 months then Vamin N 7%R for 12 months.

When the patients received Synthamin 17R, the fasting serum amino acid values revealed consistently elevated levels of glycine, phenylalanine, methionine and alanine and low levels of leucine, iso-leucine, valine, lysine, histidine, cystine and serine. When the patients received Vamin N 7%R, the fasting serum amino acid levels showed consistently elevated levels of proline, phenylalanine, glutamate, alanine, cystine and valine and low levels of arginine.

Many of the serum amino acid abnormalities observed reflected the differences in the amino acid profiles of Vamin N 7%R and Synthamin 17R when compared with a normal diet.
Intensive Care — is it Possible in a Private Hospital?
Authors: Cade D. C. , Clegg E. A. , Cade J. F.
Published: January 2019

Although sophisticated intensive care units have become universal in major public hospitals in Australia, this complex and expensive form of patient care is usually not available in independent private hospitals. Such a unit was recently established in a large private hospital which had expanded its facilities to encourage major surgery and its admission policies to include complex specialist medical problems. The unit's organisation included an appropriate physical area, comprehensive equipment, skilled nursing staff, resident medical staff, accredited medical specialists, and a common set of policies and protocols. In its first 12 months, the unit had 301 admissions, 82% of whom were surgical. Unit mortality was 3.3% and hospital mortality 6%. Patients were similar in age and sex distribution to those admitted to an intensive care unit in a public hospital but their numbers, type of illness, duration of admission and mortality differed. Despite the feasibility of establishing a sophisticated intensive care unit in a private hospital, there were potential problems related to staffing (especially insufficient numbers of trained nurses), funding (especially inadequacy of hospital and medical insurance and unavailability of many drugs on the Government's Schedule of Pharmaceutical Benefits) and relations with medical staff outside the unit.
A Technique for the Insertion of an Implantable Portal System for the Long-Term Epidural Administration of Opioids in the Treatment of Cancer Pain
Authors: Cherry David A. , Gourlay Geoffrey K. , Cousins Michael J. , Gannon Bren J.
Published: January 2019

The feasibility of using a subcutaneously implanted portal system attached to a conventional 16-gauge epidural catheter has been evaluated in 50 patients with severe pain associated with cancer. This technique allowed for the percutaneous epidural administration of morphine at 8-12-hourly intervals for pain control. The mean duration of implantation was 12 weeks and the longest period a portal remained in situ was 36 weeks. Five portals had to be removed for various reasons. The injection system has blocked on eight occasions due to catheter blockage (six times) and portal blockage (two occasions). These patients have continued to obtain excellent analgesia when either catheter or portal were replaced.

In a cadaver, 300 injections were simulated using either 22-gauge Huber point needles or disposable needles (25 gauge) and the injectate examined by both light and scanning electron microscopy. Both needle types resulted in particulate contamination which was greater with the recommended Huber point needles.
1. Description of a Device Providing Several Mapleson Functions
Authors: Salkield Iain M.
Published: January 2019

A device which provides for analogues of the Mapleson A, D and E anaesthetic breathing circuits in a compact and reasonably robust form is described. It incorporates a single lever for switching between Mapleson modes and uses a Heidbrink valve in the same way as the familiar CO2 absorbers. The breathing hose attachment points are similar to those on the CIG (BOC) Mark 3 absorber. This allows use with standard breathing tubes for non-coaxial purposes and, with the Mera F attachment, provides a coaxial circuit. Anaesthetic gas scavenging facilities are incorporated.
Platelet Function in Platelet Concentrates and in Whole Blood
Authors: Rodgers S. E. , Lloyd J. V. , Russell W. J.
Published: January 2019

Platelet function was studied in CPD whole blood stored at 4°C for one and three days and in platelet concentrates stored at room temperature for the same periods of time. Comparisons were made of platelet shape, nucleotide content, β-thromboglobulin (βTG) liberated during storage, and platelet aggregation in response to ADP, collagen, sodium arachidonate and ristocetin.

It was found that in whole blood the shape of the platelets was less discoid than in platelet concentrates. However, platelet aggregation in response to ADP, collagen, and sodium arachidonate was preserved better in whole blood than in platelet concentrates. Platelet nucleotides were the same in whole blood as in platelet concentrates, but the plasma levels of βTG were less in whole blood.

The results show that as judged by aggregation, βTG release and nucleotide content, platelets from whole blood were at least as functional as those from platelet concentrates. However, platelets from whole blood had lost their discoid shape, which suggests that they would have a short survival in the circulation.
Patient Comfort and Plasma Lignocaine Concentrations during Fibreoptic Bronchoscopy
Authors: Sutherland A. D. , Santamaria J. D. , Nana A.
Published: January 2019

In a preliminary prospective study, eleven outpatients undergoing fibreoptic bronchoscopy using a titrated dose of topical lignocaine anaesthesia were studied. Patient comfort, lignocaine dosage and resultant plasma concentrations were measured at four stages during the procedure. Large total doses, mean 512 (SD 55) mg lignocaine, were frequent and systemic absorption was unpredictable with two patients having plasma concentrations in the toxic range (>5μg/ml). Peak plasma concentrations, mean 2.3 (SD 1.4) μg/ml, occurred 30 to 40 minutes after commencement of topical application and coincided with completion of the procedure. No correlation was found between the individual dose of lignocaine administered and either the resultant plasma concentration or patient comfort scores. In an effort to minimise potential lignocaine toxicity, a fixed total dose technique (lignocaine 370 mg) was studied in a further twenty-one patients. No change in patient comfort scores and no toxic plasma concentrations were observed. Mean completion plasma concentration was 2.0 (SD 1.0) μg/ml. No clinical toxicity was observed in either group. Fibreoptic bronchoscopy in both groups using topical lignocaine anaesthesia without premedication or intravenous supplementation was well tolerated.
Steroids and Postoperative Analgesia
Authors: Korman B. , McKay R. J.
Published: January 2019

The postoperative analgesic requirements of a group of patients receiving high doses of corticosteroids for 48 hours postoperatively were studied. It was found that the opioid requirement of the group was significantly less than that of a control group undergoing similar surgery but not receiving steroids (p<0.001). The steriod group required approximately half the opioid dose of the control group. Possible explanations of the effect include the anti-inflammatory action of steriods and competitive inhibition of a common metabolic pathway in the liver.
Mental Nerve Block Revisited — A Simplified Technique for Surgery of the Lower Lip
Authors: Smith J. S. , Dwyer B. E. , Rigg D. L.
Published: January 2019

Modification of techniques of mental nerve block which provide both soft tissue and dental anaesthesia results in a simple, safe technique which should be more frequently considered as an alternative to general anaesthesia for use in soft tissue surgery of the lower lip.
Paediatric Retrievals in South Australia
Authors: Sweeney D. B. , Turtle M. J.
Published: January 2019

Since the early 1970s there has been a co-ordinated retrieval service in South Australia for adult, paediatric and neonatal patients. The paediatric service has been mounted from the Adelaide Children's Hospital and to the end of 1983 numbers 379 patients, including 90 patients in 1983. This is now providing a considerable workload on the Anaesthetic and Intensive Care Departments.

The records have been entered into a file program in a microcomputer and analysed. The results of this analysis are presented and discussed.
Analgesic and Gastrointestinal Effects of Nalbuphine — A Comparison with Pethidine
Authors: Slattery P. J. , Mark A. , Couch R. A. F.
Published: January 2019

A double-blind comparison of some analgesic and gastrointestinal effects of nalbuphine and pethidine was performed in 28 women undergoing laparoscopic sterilisation. The opioid was given as an initial loading dose prior to the induction of general anaesthesia and further doses were given on demand in the postoperative period to achieve and maintain adequate pain relief. Gastric emptying in the immediate postoperative period was also assessed in each patient by measuring the rate of absorption of orally administered paracetamol. Nalbuphine was equally effective as pethidine as a postoperative analgesic, but may have been a less effective supplement to anaesthesia in the doses used in this study. Gastric emptying was profoundly depressed in all patients irrespective of which analgesic was used.
A New Approach to Lateral Cutaneous Nerve of Thigh Block
Authors: Brown T. C. K. , Dickens D. R. V.
Published: January 2019

A new approach to the lateral cutaneous nerve of thigh is described. It depends on locating the depth of the canal through which the nerve passes immediately medial to the anterior superior iliac spine. Anatomical dissections show that it lies deep to the attachments of external oblique aponeurosis, the internal oblique muscle, and a deep fascial layer. Two district ‘pops’ or loss of resistance can be identified during insertion of a short-bevelled needle. Location of the canal by the technique described has been confirmed radiographically.
The Influence of Age on Lignocaine Pharmacokinetics in Young Puppies
Authors: Hastings C. L. , Brown T. C. K. , Eyres R. L. , Oppenheim R. C.
Published: January 2019

Eight mongrel puppies were studied at intervals of a few weeks. Lignocaine 4mg/kg was infused over 60 seconds. Frequent samples were taken over 30 minutes for plasma lignocaine assay. Initially the concentrations were significantly higher in the oldest group (178–191 days) but after 10 minutes the youngest group (3–16 days) had significantly higher levels than the other groups.

Pharmacokinetic data derived included the rate constants k21, k12 (drug movement between two compartments), k10 (elimination from the central compartment), and the volume of distribution (Vβ). The elimination rate constant k10 was significantly lower in Group 1 (3–16 days) than all other groups and Group 2 (37–57 days) was lower than Group 4 (178–191 days). The calculated β half-life was significantly longer in the youngest group than the others. There was no significant difference in the volume of distribution between these age groups — up to 6 months.
The Effect of Single and Repeated Doses of Thiopentone and Fentanyl on Liver Function in the Rat
Authors: Fassoulaki A. , Andreopoulou K. , Williams G. , Pateras Ch.
Published: January 2019

Single doses (0.3 MAC) of thiopentone or fentanyl did not affect the serum liver enzyme concentrations (SGPT, SGOT) in the rat. 0.3 MAC of fentanyl but not of thiopentone given for six consecutive days led to significantly higher SGPT levels (P<0.01) versus the control group. Rats that received repeated injections of thiopentone or fentanyl had significantly higher SGPT levels versus the groups that received one injection (P<0.05 and P<0.01 respectively). Rats that had repeated injections of thiopentone showed a significantly higher SGOT versus the groups that had one injection of thiopentone, fentanyl or normal saline (P<0.01, P<0.05 and P<0.05 respectively).
An Investigation of the Effectiveness of Bupivacaine Applied to the Abdominal Wall and Fallopian Tubes in Reducing Pain after Laparoscopic Tubal Ligation
Authors: Cook P. T. , Lambert T. F.
Published: January 2019

Sixty women having laparoscopic sterilisation performed under general anaesthesia were randomly allocated to one of two groups. Intraoperatively, one group had bupivacaine applied topically to the fallopian tubes and injected into the skin wounds, while the other group received no local anaesthetic. A double-blind investigation utilising a visual analogue scale failed to demonstrate a statistically significant difference in postoperative pain between the two groups. In both groups there was a significant reduction in mean pain scores between ½ and 7 hours, but there was no further reduction between 7 hours and 17 hours. At 7 hours, only 10% of patients scored their pain as 3 or greater (out of a possible 10). It is concluded that the use of bupivacaine as described is not a useful adjuvant to general anaesthesia and that the low incidence of even moderate pain at 7 hours confirms the view that these patients are suitable for management in the day-stay unit.
Surgery without Pain — Part II: 1800–1847
Authors: Smith W. D. A.
Published: January 2019

This paper was commissioned to cover the beginning of anaesthesia: the transition from surgical operations with pain to those without. It reviews some previous pre-anaesthetic histories (Part I): it focuses upon attitudes to pain; and it seeks evidence from the one hundred years before the discovery of anaesthesia. Finally (Part II) it outlines the introduction of nitrous oxide and of ether anaesthesia.
Maximum Transfusion Rates in Neonates and Infants
Authors: Gibbs N. , Murphy T. , Campbell R.
Published: January 2019

A common method of rapid transfusion in neonates and infants is to manually inject an appropriate volume of blood using a syringe connected to a 3-way tap in the infusion tubing. We measured the maximum infusion rates this technique could generate through small bore cannulae (22 ga-25 mm, 24 ga-19 mm), and compared the efficiency of a range of syringe sizes. We also compared infusion rates generated by this technique with those obtained using a pressure pump chamber in the giving set. The manual syringing technique using a 10 ml syringe was the most efficient for all the fluids tested, providing infusion rates through the 22 ga cannulae of 64 ml/min for packed cells, 73 ml/min for whole blood and 105 ml/min for 0.9% saline.
Relationship between Methaemoglobin Production and Methylene Blue Plasma Concentrations under General Anaesthesia
Authors: Lamont A. S. M. , Roberts M. S. , Holdsworth D. G. , Atherton A. , Shepherd J. J.
Published: January 2019

Recently, a family tree with a predisposition for the gene of multiple endocrine neoplasia Type 1 has been identified in Tasmania. As the surgical identification and localisation of parathyroid adenomas is facilitated by the administration of methylene blue, an opportunity has presented to measure the plasma concentration of methylene blue and methaemoglobin production.

The study was undertaken to establish whether significant methaemoglobin concentrations were generated during the infusion and whether these concentrations could be related to the corresponding methylene blue concentrations.

Mean peak methylene blue concentrations of 3.72 μgl−1, mean percentage methaemoglobin of 10.0 and a Pa.O2 within acceptable clinical ranges were found. No apparent relationship between methylene blue concentration and methaemoglobin production was found.
Comparative Cutaneous Histamine Release by Neuromuscular Blocking Agents
Authors: Galletly D. C.
Published: January 2019

Normal values of cutaneous wheal diameter following intradermal injection of six neuromuscular blocking drugs were determined. The relative cutaneous histamine-releasing ability of each drug was derived from calculated dose-response relationships. Equipotent neuromuscular blocking doses were found to have a cutaneous histamine releasing ability relative to pancuronium (=1) of vecuronium 1.1; suxamethonium 1.7; alcuronium 5; atracurium 52; d-tubocurarine 172.

A significant (P<.001) variation was found between the dose-response slopes perhaps suggesting a variation in the mechanism of histamine release.
A Study of Intravenous Sedation with Diazepam and Midazolam for Dentistry in Hong Kong Chinese
Authors: Rodrigo M. R. C. , Clark R. N. W.
Published: January 2019

Fifty Hong Kong Chinese patients between 20-40 years, of ASA Gd I, undergoing third molar extraction were randomly allocated into two groups. For conscious sedation, to supplement local anaesthesia, one group received intravenous diazepam and the other intravenous midazolam. The majority in the study had never heard of intravenous sedation being available to supplement local anaesthesia during dental surgery and when given the chance to experience this method the majority found it highly acceptable. None preferred general anaesthesia for dental surgery. In this study midazolam had more advantages to the patient than diazepam; quicker onset of sedation, less pain during injection, profound anterograde amnesia and fewer postoperative complications being the main features. However, both drugs produced good operating conditions. Incidence of thrombophlebitis was low with both drugs, and may be so in Chinse compared with non-Chinese.
Problems with Automating Anaesthetic Records
Authors: Roessler P. , Brenton M. W. , Lambert T. F.
Published: January 2019

A truly automated recording system is one which measures the parameters selected and requires nothing more than attaching the monitors to the patient. It should be capable of being easily and rapidly started when appropriate. The user should then be able to enter quantitative and qualitative information about drug and fluid therapy in a manner which is less distracting than the present long-hand method.

A system is described which has gone a considerable way towards achieving good automated physiological monitoring. The system has not resolved the problems of data entry which must be overcome before such equipment is made available for general use. The problems of automation which we encountered are presented and some possible solutions considered.
Postanaesthetic Patterns of Care in Minor Gynaecological Surgery
Authors: Hann G. J. , Ross A. W.
Published: January 2019

A survey of 408 patients undergoing minor gynaecological procedures was undertaken to determine the optimal pattern of postoperative observation and feeding in the general surgical ward setting. Sixty per cent of all complications occurred within the first two hours after return to the ward. The rest were all of a visible nature, not requiring vital sign recording for detection. Oral intake was tolerated as soon as patients were conscious and co-operative.

It is concluded that routine observations need not be recorded for more than two hours after return to the ward after minor gynaecological surgery.
A Clinical Comparison of Atracurium and Vecuronium in Women Undergoing Laparoscopy
Authors: Raynes M. A. , Chisholm R. , Woolner D. F. , Gibbs J. M.
Published: January 2019

In a double blind, prospective, randomised trial in 30 women undergoing laparoscopy, atracurium and vecuronium were compared in equipotent (2 X ED95) doses. In the atracurium group, first twitch depression was significantly greater at one minute, and degree of fade significantly greater at one and two minutes, but thereafter neuromuscular monitoring showed no significant difference between the groups. Clinically there was no significant difference between the drugs. Mild intraoperative hypotension was equally common in both groups as was sinus bradycardia. Reversal and recovery were comparable in the two groups. Neostigmine was required in all patients and in three (one atracurium, two vecuronium) a second dose was administered on clinical grounds. Antagonism of the neuromuscular block is required with surgery of this duration despite the intermediate duration of action of the relaxant drugs.
Monitoring Neuromuscular Blockade with Calf Stimulators
Authors: Beemer G. H.
Published: January 2019

The efficacy of monitoring neuromuscular blockade during surgery based on visual assessment of the response to calf stimulation was determined in twenty-five patients. The calf stimulator was adjusted before the administration of any muscle relaxant to produce a brisk ankle jerk. Following an initial bolus dose of atracurium (0.5 mg/kg), further incremental doses (0.2 mg/kg) were administered when the response to calf stimulation was small and obvious. The resultant neuromuscular blockade was judged to be adequate throughout the surgical procedures, with an average of five incremental doses of atracurium being administered. In the presence of neuromuscular blockade the response to calf muscle stimulation was often greater than that produced by supramaximal stimulation of the ulnar nerve with a peripheral nerve stimulator. The response to calf muscle stimulation often persisted after that resulting from ulnar nerve stimulation was abolished. The technique has only limited accuracy in assessing neuromuscular blockade. However, it may be useful in helping to avoid the wide fluctuations in blockade which are prone to occur with the intermediate duration competitive neuromuscular blocking agents.
The Use of Electrical Conductivity Measurement in the Calculation of Ion-Free Water Loss in Urine
Authors: Parkin W. G. , Dickinson R. W.
Published: January 2019

The urine electrical conductivity is a practical guide to the ion-to-water ratio of urine. It may be used to assess the influence of urinary loss upon the total body ion-to-water ratio. It is suggested that the total body ion-to-water ratio is the object of control in water therapy, commonly administered as 5% dextrose. The total body ion-to-water ratio closely accords with the ratio in the extracellular fluid. Since sodium is the predominant extracellular cation, the plasma sodium concentration closely reflects the extracellular and total body ion-to-water ratio. As a consequence the urine electrical conductivity may be used as a continuous signal in the open or closed loop control of water balance as reflected by the plasma sodium concentration.
Improving Autologous Blood Harvest: Recovery of Red Cells from Sponges and Suction
Authors: Ronai A. K. , Glass J. J. , Shapiro A. S.
Published: January 2019

The efficacy of red cell salvage was assessed under circumstances which simulated blood loss managed with sponges or suction. Expired banked blood was equally divided and processed by either suction, or absorbing the blood on a sponge followed by rinsing the sponge in saline. These two techniques were used to harvest washed, centrifuged erythrocytes. The volume, haematocrit and free haemoglobin concentration of the banked blood and the processed units were measured, and smears from all units were examined microscopically. The red cell mass was calculated as the product of the volume and haematocrit. The red cell mass recovered by suction and from sponges averaged 93% and 87% respectively. Blood lost in sponges can be recovered and used to increase the available autologous blood, thereby reducing the need for donor blood.
Plasma Bupivacaine Concentrations during Postoperative Continuous Epidural Analgesia
Authors: Schweitzer S. A. , Morgan D. J.
Published: January 2019

Postoperative analgesia and plasma concentrations of bupivacaine were evaluated in six patients receiving intermittent epidural bupivacaine for a period of 72 hours following large bowel surgery. Repeated doses were administered every hour by a new automatic, specially designed pump. Venous plasma bupivacaine concentrations showed accumulation for up to 48–60 hours during administration and were mostly less than 2 μg/ml except in an elderly, frail patient in whom a peak of 3.9 μg/ml was observed. This convenient, low-dose, pulsed technique provided excellent analgesia although special care may be necessary in the elderly and frail patient if potentially toxic levels are to be avoided.
The Influence of Age on the Cardiovascular Toxicity of Intravenous Bupivacaine in Young Dogs
Authors: Riquelme C. M. , Bell B. , Edwards J. , Brown T. C. K.
Published: January 2019

A study in anaesthetised dogs aged 2, 6, 13, 26 and 52 weeks or older was done to determine the dose of IV bupivacaine given by infusion required to produce severe cardiovascular depression as measured by a drop in mean blood pressure to about 25 mmHg or the development of life-threatening dysrrhythmias. Plasma local anaesthetic concentration was analysed at the time of ceasing the infusion. The toxic dose was significantly less in the six-week-old group than younger or older animals. The plasma concentrations associated with toxicity in the groups 13 weeks and younger were significantly lower than in the older dogs. Treatment of the induced toxicity included hyperventilation, adrenaline infusion, bretylium and/or cardioversion. The response to treatment was better in young dogs than adult dogs.
Fentanyl Pretreatment Modifies Anaesthetic Induction with Etomidate
Authors: Stockham R. J. , Stanley T. H. , Pace N. L. , Gillmor S. , Groen F. , Hilkens P.
Published: January 2019

Haemodynamic changes and side-effects of induction of anaesthesia with etomidate were evaluated in 60 ASA Class I or II patients. The objective was to find an optimal pre-induction dose of fentanyl which eliminated haemodynamic changes and side-effects during induction and intubation without introducing other problems. Patients were randomly assigned to four groups according to the pretreatment dose of fentanyl (Group I= 2 ml normal saline; Group II= 100 μg of fentanyl; Group III= 250μg of fentanyl; Group IV = 500 μg of fentanyl) administered intravenously five minutes prior to induction of anaesthesia with etomidate, 0.3 mg/kg. There was an increasing incidence of apnoea (53, 87, 87 and 100% in Groups I-IV respectively) and a decreasing incidence of myoclonus (60, 33, 13 and 0% in Groups I-IV respectively) and injection pain (53, 13, 7 and 0% in Groups I-IV respectively), P< 0.002 chi-square test for linear trends, with increasing fentanyl dosage. The incidences of postoperative nausea and vomiting were similar in the four groups. There were also significant linear regression relationships (P< 0.01 ANOVA for linear regression) between increasing doses of fentanyl administered before etomidate and the prevention of increases in systolic blood pressure and heart rate during the induction-intubation sequence. The data demonstrate that increasing pre-induction doses of fentanyl are more effective at minimising side-effects and preventing increases in systolic arterial blood pressure and heart rate but also increase the incidence of apnoea during induction. The results suggest that 500 μg of fentanyl is an ideal pretreatment dose in fit patients prior to anaesthetic induction with etomidate.
Arterial Oxygen Saturation in Anaesthetised Patients during Transfer from Induction Room to Operating Room
Authors: Riley R. H. , Davis N. J. , Finucane K. E. , Christmas P.
Published: January 2019

There is no published study that examines oxygenation of anaesthetised patients during transport from anaesthesia induction room to operating room. Arterial oxygen saturation (S a O 2 ) was measured in twenty-five anaesthetised patients before and during transfer to an adjacent operating room and continuously recorded on a calibrated chart recorder. A telemetry ECG recorder was used to detect cardiac dysrhythmias. All anaesthetists followed their usual anaesthetic practice. Patients ventilated via face-mask and via endotracheal tube were studied. During transfer patients were either apnoeic (n = 8) or breathing room air spontaneously (n= 17) Mean S a o 2 before induction was 95.4 (SD 2.5)%, was higher after induction of anaesthesia, 98.5 (SD 1.4)% and fell after transfer, 95.7 (SD 2.6)%. A fall in S a O 2 was recorded for 21 patients. No S a O 2 value below 90% was seen. The decrease in S a O 2 was related to the time taken to transfer the patients and spontaneous ventilation (Multiple regression analysis); it was not related to the body mass index although two of the greatest decreases were seen in obese patients. Transfer time averaged 51 seconds (range: 24–97 s). No changes in cardiac rhythm were seen.

Transfer of anaesthetised patients was accompanied by variable falls in S a O 2 which related to duration of transfer and spontaneous breathing of room air and which were not associated with new dysrhythmias.
The Effects of Calcium Channel Blocking Drugs on Halothane Initiation of Malignant Hyperthermia in MHS Swine and on the Established Syndrome
Authors: Harrison G. G. , Wright I. G. , Morrell D. F.
Published: January 2019

We have investigated in malignant hyperthermia susceptible swine in vivo the effects on halothane initiation of the MH syndrome and on the established syndrome of five calcium channel blocking drugs — nifedipine, nisoldipine, diltiazem, verapamil and flunarazine. Nifedipine alone caused attenuation of halothane-initiated malignant hyperthermia to the extent of blocking onset of the syndrome in 29% of animals for the 60 minute period of exposure. In the face of the established malignant hyperthermia syndrome, all the drugs tested were therapeutically completely ineffective.
Co-Administered Oral Metoclopramide Does Not Enhance the Rate of Absorption of Oral Diazepam
Authors: Chapman M. H. , Woolner D. F. , Begg E. J. , Atkinson H. C. , Sharman J. R.
Published: January 2019

Intravenous metoclopramide is known to increase the rate of absorption of oral diazepam if administered at the same time. It has been suggested that oral metoclopramide has the same effect. In this study, six healthy volunteers received oral diazepam (0.2 mg/kg) on two separate occasions, either alone or with oral metoclopramide (10 mg), given simultaneously. In contrast to the effects of intravenous metoclopramide, oral metoclopramide did not increase the rate of absorption of oral diazepam.
Percutaneous Dilational Tracheostomy Technique and Experience
Authors: Cook P. D. , Callanan V. I.
Published: January 2019

A technique for percutaneous insertion of an adult tracheostomy tube in the Intensive Care Unit is described. Experience with twenty-one insertions over an eight-month period is reviewed. No major complication was noted at insertion, during cannulation or after removal in any patient. We have found the percutaneous dilational technique to be an effective and safe procedure which can be used routinely for elective tracheostomy in intubated adult patients.
Studies on Australian Snake Venoms. Part 1: The Haemodynamic Effects of Brown Snake (Pseudonaja) Species in the Dog
Authors: Tibballs J. , Sutherland S. , Kerr S.
Published: January 2019

The haemodynanic effects of Brown Snake (Pseudonaja) species (textilis, nuchalis, affinis) were investigated in anaesthetised, mechanically ventilated dogs. Blood pressure decreased to minimal levels five minutes after intravenous envenomation. Hypotension was accompanied by significant decrements in cardiac output and stroke volume and a rise in peripheral vascular resistance. Heart rate increased transiently during 0.5-2.0 minutes after envenomation but had declined below resting levels five minutes after envenomation. No statistically significant change was recorded in central venous pressure. Depression of myocardial contractility is postulated as the mechanism of venom induced hypotension.
Comparison of the Finapres Blood Pressure Monitor with Intra-arterial Manometry during Induction of Anaesthesia
Authors: Kermode J. L. , Davis N. J. , Thompson W. R.
Published: January 2019

The Finapres (Ohmeda, Madison, U.S.A.) is a non-invasive device which continuously measures the arterial blood pressure in a finger and produces a real-time display of the arterial pressure wave. It consists of a finger cuff with an infra-red transmission plethysmograph, a servo control box and a monitor unit. The device was compared with intra-arterial pressure monitoring in twenty patients during induction of anaesthesia for elective neurosurgical procedures. The differences between the two methods were considerable, ranging from −40 mmHg to +26 mmHg for mean pressure. While the Finapres has potential as a non-invasive continuous blood pressure monitor, the current model Finapres, as supplied, displays too great a variability for it to be used as an alternative to intra-arterial pressure monitoring.
Acid Aspiration Prophylaxis in Australian Obstetric Hospitals — A Survey
Authors: Burgess R. W. , Crowhurst J. A.
Published: January 2019

During 1987 a confidential survey of all hospitals in Australia providing obstetric services was undertaken to determine the antacid medications used routinely as prophylaxis against acid aspiration pneumonitis. Of the 567 hospitals surveyed, 379 (67%) responded. Of these, 243 hospitals provide an obstetric service which includes caesarean section, and 67% of these perform less than 500 deliveries per annum. Aspiration prophylaxis during labour was used in 22.4% of responding hospitals. Prior to elective caesarean section, 11.5% used no prophylaxis, and 39.4% used particulate antacids such as magnesium trisilicate mixture (33.3%) or Mylanta® (6.1%). Sodium citrate mixture was the most popular therapy (37%). Results were similar in the emergency caesarean section group. The use of cimetidine or ranitidine was uncommon in all groups.

Results of this survey suggest marked differences in attitudes towards acid aspiration prophylaxis between Australian and British obstetric anaesthetic practices.
Oral Ketamine Premedication for Paediatric Cardiac Surgery — A Comparison with Intramuscular Morphine (both after oral Trimeprazine)
Authors: Stewart K. G. , Rowbottom S. J. , Aitken A. W. , Rajendram S. , Sudhaman D. A.
Published: January 2019

In a single-blind controlled study, forty children with congenital heart disease were premedicated with oral trimeprazine 3 mg/kg and either intramuscular morphine 0.1 mg/kg or oral ketamine 10 mg/kg. Cardiovascular and respiratory effects of premedication and degree of sedation induced were similar in the two groups of patients. Oral ketamine is a safe and effective premedicant in this group of patients.
Oral Premedication in Children: A Comparison of Chloral Hydrate, Diazepam, Alprazolam, Midazolam and Placebo for Day Surgery
Authors: Anderson B. J. , Exarchos H. , Lee K. , Brown T. C. K.
Published: January 2019

A double-blind study consisting of 339 randomly selected children investigated the effects of several premedicants on the preoperative and postoperative behaviour of children who underwent day-stay surgery. Patients were allocated into two groups. Group 1 consisted of 165 children aged between 6 and 4 7 months. Group 2 consisted of 174 children aged four years and older to a body weight of 50 kg. Each child received one premedicant. Both groups included alprazolam 0.005 mg/kg, midazolam 0.3 mg/kg and placebo. In addition Group 1 included chloral hydrate 40 mg/kg and Group 2 diazepam 0.25 mg/kg. Chloral hydrate produced superior conditions (more patients calm or asleep) at induction of anaesthesia. Postoperative behaviour and incidence of vomiting were similar for all drugs. No premedicant reduced anxiety in the older group. The time to awaken postoperatively with diazepam was longer than with placebo. Alprazolam and midazolam were unpalatable for children over four years and conferred no advantage over placebo.
Steady-State Pharmacokinetics of Interpleural Bupivacaine in Patients after Cholecystectomy
Authors: Kastrissios H. , Triggs E. J. , Mogg G. A. , Sainsbury D. , Higbie J. , Leow K. , Sidhu J.
Published: January 2019

Venous plasma concentrations of bupivacaine were determined in eight cholecystectomy patients following multiple interpleural bolus instillations of bupivacaine 20 ml 0.5% with adrenaline (5 mg/l) administered at six- to eight-hour intervals. The mean steady-state peak plasma concentration was 2.3 mg/l (range 1.2–3.1 mg/l); however, in three of the eight patients peak plasma concentrations were greater than 3 mg/l. The mean accumulation ratio was found to be 1.6 (range 0.99–2.49), with steady-state occurring within the first 24 hours of drug administration. Mean apparent systemic plasma clearance was 0.16±0.07 l/kg/h with a mean terminal half-life of 5.8±2.3 hours measured at steady-state, values which were not significantly different (P > 0.05) from those values obtained following single interpleural bolus dose administration.
Carotid Endarterectomy under Cervical Plexus Block – A Prospective Clinical Audit
Authors: Davies M. J. , Murrell G. C. , Cronin K. D. , Meads A. C. , Dawson A.
Published: January 2019

One hundred and twenty-eight patients having carotid endarterectomy under superficial and deep cervical plexus blocks were prospectively audited. The aim of the audit was to determine the incidence of intra-operative and postoperative neurological and cardiovascular complications and to establish patient acceptance of the technique. Twenty-seven patients who had intraoperative neurological changes following carotid artery clamping responded to shunt insertion. Six patients had transient neurological changes after the operation but there were no permanent neurological complications. Tachycardia (55%) and hypertension (67%) were the most common intra-operative cardiovascular changes and there was one clinical postoperative myocardial infarction. Ninety-two per cent of patients who could be adequately assessed preferred to have the same method of anaesthesia for future carotid endarterectomy. The authors concluded that carotid endarterectomy under superficial and deep cervical plexus blocks was associated with a high patient acceptance, low neurological complication rate and an acceptable rate of cardiovascular complications.
Steroids in Croup: Do they Increase the Incidence of Successful Extubation?
Authors: Freezer N. , Butt W. , Phelan P.
Published: January 2019

Between January 1983 and July 1988, 2623 patients with croup were admitted to the Royal Children's Hospital, Melbourne. A total of 416 patients (16%) were admitted to the Intensive Care Unit and 176 of these patients required intubation. Of these patients 117 patients were successfully extubated at the first attempt and 59 needed reintubation. Of the patients who were reintubated 35 were given steroids prior to subsequent extubation attempts. Only one patient who had received steroids failed extubation. Of those who did not receive steroids 59% required reintubation.

In patients with croup who fail the first extubation the results of this study suggest that steroids significantly increase the success of subsequent extubations.
The CareFlight Stretcher Bridge: A Compact Mobile Intensive Care Unit
Authors: Wishaw K. J. , Munford B. J. , Roby H. P.
Published: January 2019

A mobile intensive care module has been developed for aeromedical transport of the critical care patient. It incorporates monitoring, ventilator, oxygen and suction, and infusion pumps. The device clips to a lightweight stretcher, over the patient at hip to knee level. This system is compatible with nearly all patient transport vehicles and allows monitors to be run from vehicle power. An assessment of the system after more than 500 transports is that it represents a significant advance over systems used previously. The advantages and disadvantages of the system compared with unmounted or vehicle-mounted equipment are discussed.
Epidural Opioids in Obstetrics —003 A003 Review
Authors: Westmore M. D.
Published: January 2019

Epidural opioids have been used in obstetrics since 1980. Various opioids are reviewed in relation to their pharmacology, their efficacy in labour, during caesarean section and for postoperative analgesia, their side-effects and safety. In this patient population it appears safe to administer epidural opioids on the general ward provided that strict monitoring standards are maintained. Practical considerations of nursing management are discussed.
Monitoring Epidural Analgesia in the Parturient
Authors: Crowhurst J. A. , Burgess R. W. , Derham R. J.
Published: January 2019

Appropriate monitoring during obstetric epidural analgesia consists of:

1. Indirect BP and pulse monitoring before epidural insertion, frequently after every dose, and intermittently thereafter.

2. The aspiration test before all injections.

3. Frequent clinical monitoring for signs of intravascular injection during administration of small intermittent doses (not more than 3–5 ml at a time).

4. Frequent clinical monitoring for sympathetic, sensory and motor signs indicating upward extension of the block.

5. Frequent monitoring of the fetal heart rate (FHR) and other signs of fetal welfare.

In many instances continuous tocogram with fetal heart rate (CTG) monitoring is useful. We do not believe CTG use is mandatory for epidural analgesia in the uncomplicated pregnancy, but we do advocate that it (and other appropriate fetal monitoring techniques) be used when risk factors or complications, either fetal or maternal, are present or suspected. The anaesthetist should be familiar with fetal monitoring techniques, their use and interpretation. He or she should be prepared to recommend their use when it is considered appropriate to do so.
Intraocular Pressure during Rapid Sequence Induction: Use of Moderate-dose Sufentanil or Fentanyl and Vecuronium or Atracurium
Authors: Stirt J. A. , Chiu G. J.
Published: January 2019

We studied the effect of rapid sequence induction of anaesthesia on intraocular pressure in physically fit, ASA class I or II patients using combinations of sufentanil (1 μg/kg) or fentanyl (5 fig/kg) and vecuronium (0.2 mg/kg) or atracurium (1.0 mg/kg). All patients received thiopentone (5 mg/kg), following which those in group 1 received sufentanil and vecuronium, group 2 sufentanil and atracurium, group 3 fentanyl and vecuronium, and group 4 fentanyl and atracurium. Laryngoscopy and intubation were performed 60 seconds after induction. Intraocular pressure was measured prior to induction, 30 and 60 seconds after induction, immediately after intubation, and postintubation for 5 minutes. Postinduction and postintubation intraocular pressure values in all four groups did not exceed baseline values. We conclude that in fit patients, the combination of thiopentone, moderate dose narcotics, and an appropriate dose of vecuronium or atracurium produces satisfactory conditions for intubation following rapid sequence induction without increases in intraocular pressure. This technique should not, however, be employed when multiple other injuries are present, along with an open eye.
Accurate Monitoring of Neuromuscular Blockade Using a Peripheral Nerve Stimulator – A Review
Authors: Beemer G. H. , Reeves J. H. , Bjorksten A. R.
Published: January 2019

For normal anaesthetic practice, monitoring of neuromuscular blockade is best performed by stimulation of the ulnar nerve at the wrist with a peripheral nerve stimulator and evaluation of the response of the thumb. Determination of the initial threshold for stimulation in the awake patient to allow estimation of the current required for supramaximal stimulation is an important set-up procedure to improve accuracy. The degree of paralysis of specific muscle groups such as the diaphragm can be inferred from their sensitivity to neuromuscular blocking agents relative to adductor pollicis. Monitoring with different stimulation patterns allows a wide spectrum of muscle paralyses to be evaluated.