bluuebunny/crossref_metadata_2025 huggingface dataset:
Temperature Maintenance in Infants Undergoing Anaesthesia and Surgery
Authors: Gauntlett I. , Barnes J. , Brown T. C. K. , Bell B. J.
Published: January 2019

A study has been conducted on infants under six months of age during induction and anaesthesia to compare the effect on heat loss when a warming blanket, a humidifier and an overhead heater were used. The combination of all three was associated with significantly less heat loss than when the blanket was used alone.

The particular benefit of the overhead heater during prolonged preparation for neurosurgery was also demonstrated. It is recommended that overhead heaters should be used during induction of anaesthesia in infants.
Cutaneous Sensitivity to Atracurium and Vecuronium in Patients Suffering Anaphylactoid Reactions to Neuromuscular Blockers
Authors: Galletly D. C. , Treuren B. C.
Published: January 2019

Using an ordinal measure of cutaneous sensitivity to intradermal injections of atracurium and vecuronium, 40 nonreacting subjects were compared with a group of 24 patients previously suffering life-threatening anaphylactoid reactions to other muscle relaxants. Enhanced cutaneous sensitivity to vecuronium was found in three, and to atracurium in two of the previously reacting group. With the exception of those showing abnormal reactivity, no significant difference was found in the distribution of cutaneous sensitivity in the control and reacting group. A concentration of vecuronium 8.75 times that of atracurium was required to produce an equivalent intradermal wheal response.
Safe Intubation in Cervical Spine Injury
Authors: Doolan L. A. , O'Brien J. F.
Published: January 2019

Traumatic spinal injury is an ongoing community problem. Anatomical stability of the cervical spine depends on the integrity of the bony and ligamentous structures forming the cervical spine. Such stabilising structures are divided into two groups. These are designated anterior and posterior columns. One or both columns may be damaged during traumatic spinal injury. Not all spinal injuries are unstable. Instability may be predicted by viewing anterior-posterior and lateral X-rays of the cervical spine. C1 and C2 injury necessitates special through-mouth views. Instability of the neck requires a different intubation technique. A safe intubation technique is described, the essence of which is to stabilise the neck with longitudinal traction and avoid extension at the fracture site.
Anaesthesia in an Australian Private Hospital: The Consumer's View
Authors: Dodds C. Peter , Harding M. Ignatius , More David G.
Published: January 2019

A survey of the patients’ view of anaesthesia was carried out in a medium-sized metropolitan private hospital. The study was performed using a postoperative questionnaire. A two-week period was investigated, and data was obtained from 121 of 124 patients anaesthetised during that period. The results showed a very high degree of satisfaction with the anaesthetic services provided, although specific questioning revealed many minor complaints. The results are compared with previous studies done in public hospitals and show that from the patients’ perspective, there were fewer complaints than have been noted in the other studies.
Computer-Controlled Muscle Paralysis with Atracurium in the Sheep
Authors: Lampard D. G. , Brown W. A. , Cass N. M. , Ng K. C.
Published: January 2019

Paralysis was maintained in sheep by computer-controlled infusion of atracurium, using the integrated electromyogram as a measure of neuromuscular transmission. A number of experiments were conducted to ascertain the average infusion rate required to achieve a given level of paralysis for one hour. Each experiment yielded a point on a plot of paralysis versus infusion rate. A dose-response curve based upon a simple model of drug receptor interaction at the neuromuscular junction was fitted to the experimental points by least squares and is able to provide a useful explanation of clinically observed behaviour. The recovery time was also measured in each experiment and plotted against both prior level of paralysis and prior average infusion rate.
Clinical Observations on the Pathophysiology and Treatment of Anaphylactic Cardiovascular Collapse
Authors: Fisher M. McD.
Published: January 2019

Observations in 205 patients with cardiovascular manifestations of anaphylactic shock confirmed the belief that adrenaline is the drug of first choice in management and that colloid solutions are preferable to crystalloid solutions in volume replacement. Arrhythmias and elevated filling pressures are more common in patients with cardiac disease but the sympathetic response appears to override the cardiac effects of histamine in healthy patients.
Thiopentone Cerebral Protection under EEG Control during Carotid Endarterectomy
Authors: Hicks R. G. , Kerr D. R. , Horton D. A.
Published: January 2019

Seventy patients who underwent a total of 77 consecutive carotid endarterectomies were given thiopentone (mean dose 19 mg/kg) under EEG control for cerebral protection during the period of carotid clamping. This technique was used instead of elective insertion of a temporary bypass shunt in response to adverse EEG changes occurring after clamping. The EEG was monitored continuously throughout operation. The EEG burst-suppression pattern with electrically inactive periods of 30-60 seconds was taken as indicating a depth of barbiturate anaesthesia adequate to provide brain protection. Patients exhibited a drop in blood pressure during barbiturate administration: in most the pressure recovered spontaneously but in twenty operations metaraminol was needed to re-establish an adequate pressure before clamping. No adverse cardiological effects were associated with the administration of thiopentone or metaraminol. There was no mortality and no neurological morbidity in this series.
Unexplained Acute Membrane Pulmonary Oedema Related to Anaesthesia
Authors: Fisher M. McD , Stevenson I. F.
Published: January 2019

Five patients developed severe pulmonary oedema in relationship to elective anaesthesia and surgery. The oedema was due to increased capillary permeability in four patients and probably due to increased capillary permeability in the other. No cause could be found in any patient.
Computerised EEG Monitoring for Carotid Endarterectomy
Authors: Baker A. B. , Roxburgh A. J.
Published: January 2019

A prospective study was undertaken in twenty patients undergoing carotid endarterectomy using computerised EEG monitoring in the form of a density-modulated spectral array, spectral edge frequency and integrated EEG power for monitoring cerebral ischaemia. This form of monitoring proved to be easy to use and understand. Because ischaemic EEG events longer than one minute were not necessarily followed by postoperative deficits, the definition of significant events that would cause ischaemia may need to be modified.
Extracorporeal CO2 Removal in Severe Adult Respiratory Distress Syndrome
Authors: Hickling K. G.
Published: January 2019

Sixty-five per cent survival has been achieved in a group of patients with severe ARDS and a predicted mortality of 92%, by the use of Gattinoni's technique of extracorporeal CO2 removal. In patients and animals the technique has usually resulted in rapid improvement in the radiographic appearance and lung function.

There are several possible mechanisms by which the technique may facilitate lung repair, including improvement of lung tissue oxygenation, the avoidance of high airway pressures and regional alkalosis in the lung, a reduction in oxygen toxicity, and the frequently observed reduction in pulmonary artery pressure.

The apparent effectiveness of the technique and other associated evidence have implications which should lead us to reconsider some aspects of our conventional management of patients with severe ARDS.
Ventilators — Reported Classifications and their Usefulness
Authors: Smallwood R. W.
Published: January 2019

In this paper, a number of reported systems for classifying ventilators are considered and their usefulness commented on. Most omit the concept of power, which is an important factor in how the ventilator will perform. It is recommended that a system of classification should be backed by bench tests and clinical trials. Not enough is known about high frequency ventilation to permit reasonable evaluation of the classifications proposed in this area.
Clinical Applications of Mechanical Ventilation
Authors: Henning R.
Published: January 2019

This paper reviews recent applications of mechanical ventilation such as controlled hypoventilation in acute asthma, domiciliary nocturnal ventilation in chronic respiratory failure due to neuromuscular disease and improvement of left ventricular performance by raised intrathoracic pressure. Established uses of mechanical ventilation include control of respiratory failure, intracranial pressure and pulmonary hypertension while other uses such as internal splinting of flail chest, simultaneous ventilation-compression cardiopulmonary resuscitation and prophylactic postoperative ventilation are more controversial.
Manual Resuscitators and Portable Ventilators
Authors: Phillips G. D. , Skowronski G. A.
Published: January 2019

This paper reviews the state of the art in Australia of manually operated, self-inflating bag resuscitators, including the Laerdal, Air Viva and Ambu; manually operated bags dependent upon an oxygen supply, including Mapleson B, C, E and F, the CIG Medishield Oxy-Saver and modified Oxy-Viva Resuscitator 3, and the Komesaroff Oxy-Resuscitator RD85; oxygen-powered resuscitators, including the Oxy-Viva Resuscitator 3 with Demand and RM2 Valves, and the Oxylife FM85; and portable ventilators, including the Drager Oxylog, and Ohmeda Logic 07.

Specific comment is made to the effect that the design of the resuscitator is often less important than the knowledge and ability of the operator in using the equipment to achieve adequate lung ventilation.

The simplest, cheapest, most useful resuscitators are the manually operated self-inflating bag assemblies. With special training, use of more complex equipment can be justified in some circumstances. The more complex the equipment, the greater the risk of inappropriate use, and the greater the risk of equipment malfunction unless a regular maintenance program is followed.
Epidural and Intrathecal Opioids
Authors: Morgan M.
Published: January 2019

Small doses of epidural and intrathecal opioids produce effective and prolonged analgesia postoperatively, although the quality of analgesia does not differ from when conventional routes are used. The different opioids differ only in the speed of onset and duration of action, and in the incidence of side-effects. ‘Minor’ complications such as nausea, vomiting, pruritis and retention of urine are relatively common. There is a small incidence of respiratory depression which is delayed for several hours after drug administration and which may be prolonged. It is commoner after morphine and after intrathecal administration, and is also associated with advanced age, concomitant use of other central depressant drugs, respiratory disease and large doses. Because of the potentially lethal nature of this complication, it is recommended that the epidural and intrathecal routes of administration are used only when patients can be closely and constantly observed postoperatively.
Pain Relief after Surgery
Authors: Nimmo W. S. , Duthie D. J. R.
Published: January 2019

Relief of pain after surgery remains poor for the majority of patients. The pain is unpleasant, and is associated with arterial hypoxaemia, venous thrombosis, myocardial ischaemia and a more florid hormonal response to surgery.

Regional analgesia, systemic, subarachnoid or extradural opioids and antiprostaglandin drugs are all used to treat pain after surgery. Systemic opioids are used usually, because regional and axial techniques are labour intensive and antiprostaglandin drugs ineffective.

Opioids given orally undergo extensive first pass metabolism and intramuscular doses are absorbed unpredictably. Intravenous administration avoids both problems and excellent results have been obtained using Patient Controlled Analgesia devices, but these machines are expensive. A simple regimen suitable for application to large numbers of surgical patients is required. Continuous infusion of fentanyl 100 μg h−1 IV begun two hours before surgery and supplemented by a single bolus dose of fentanyl 100 μg IV provided an effective background of analgesia.
Continuous Infusions of Muscle Relaxants — Why and How
Authors: Beemer G. H.
Published: January 2019

The degree of neuromuscular blockade that occurs in an individual patient following the administration of competitive neuromuscular blocking agents cannot be accurately predicted because of the large individual variation in the pharmacokinetics and pharmacodynamics of these agents. Without monitoring of the neuromuscular blockade, this unpredictability predisposes to the occurrence of residual curarisation with its potentially lethal consequences. Variable rate continuous infusion of a short-acting competitive neuromuscular blocking agent with monitoring of the neuromuscular blockade is a flexible and accurate method for maintaining a precise degree of neuromuscular blockade during prolonged surgical procedures which ensures reliable reversability of the residual neuromuscular blockade. A system for the continuous infusion of atracurium with manual monitoring of the neuromuscular blockade is described, together with the results of a study demonstrating its efficacy.
The Effects of Formulation and Addition of Adrenaline to Cocaine for Haemostasis in Intranasal Surgery
Authors: Lips F. J. , O'Reilly J. , Close D. , Beaumont G. D. , Clapham M.
Published: January 2019

Twenty patients presenting for submucous resection of the nasal septum under general anaesthesia were randomly allocated to four groups to receive either 1.0 ml 25% cocaine HCl in paraffin paste, 1.0 ml 25% cocaine HCl combined with 0.1% adrenaline in paraffin paste, 4.0 ml aqueous 4% cocaine HCl combined with 0.05% adrenaline or 4.0 ml aqueous 4% cocaine HCl on ribbon gauze applied to the nasal mucosa. Mean intraoperative blood loss was significantly decreased when the 25% cocaine 0.1% adrenaline combination in paraffin paste was used (11 (SD 8) ml, 60 (SD 30) ml, P<0.05, for adrenaline and plain paste respectively). Combination of adrenaline with cocaine in the aqueous formulation was not associated with a significant decrease in blood loss compared with aqueous cocaine alone (75 (SD 51), 96 (SD 66) ml respectively). Cocaine adrenaline paste and plain cocaine paste were associated with higher mean maximum cocaine blood concentrations (1.6 (SD 1.4), 2.0 (SD 1.5) μg/ml respectively) when compared with aqueous cocaine adrenaline and aqueous cocaine alone (0.03 (SD 0.003), 0.5 (SD 0.3) μg/ml respectively). Heart rate and blood pressure changes were similar in all four groups and cardiovascular toxicity was not observed.

One ml of topical intranasal 25 % cocaine HCl with 0.1 % adrenaline in paraffin paste provided the best haemostasis for nasal septal surgery.
Oral Premedication in Children
Authors: Van Der Walt J. H. , Nicholls B. , Bentley M. , Tomkins D. P.
Published: January 2019

Preoperative and postoperative sedation, postoperative analgesia and vomiting were assessed following four different oral premedications in 143 children aged 1–10 years, weighing 10–30 kg, and undergoing elective adenotonsillectomy or inguinal surgery. Diazepam, diazepam combined with droperidol, trimeprazine and trimeprazine combined with droperidol were compared in a double-blind trial in conjunction with a standardised inhalational anaesthetic technique employing an intraoperative narcotic. Trimeprazine produced significantly more preoperative sedation (P<0.001) and was associated with enhanced postoperative analgesia (P<0.01). The incidence of postoperative vomiting was significantly less in the group receiving trimeprazine (P<0.001). The addition of droperidol to diazepam and trimeprazine only marginally improved the performance of those drugs but significantly prolonged postoperative recovery times. This was more marked when droperidol was combined with trimeprazine.
For Calculating Osmolality, the Simplest Formula is the Best
Authors: Worthley L. I. G. , Guerin M. , Pain R. W.
Published: January 2019

Plasma osmolalities were measured in 100 normal, 100 general hospital and 100 intensive care patients, and compared with the osmolalities calculated from the plasma concentrations of sodium, potassium, glucose and urea, using five different published formulae. The mean osmolar gaps in the 100 consecutive intensive care patients and the 100 general hospital patients were not significantly different from the mean osmolar gap in the 100 normal individuals. The formula which gave the least difference between the measured and calculated osmolality was 2 × Na + urea + glucose, where the concentrations of sodium, urea and glucose were measured in mmol/l.
An Intensive Care Trolley — An Economical and Versatile Alternative to the Mobile Intensive Care Unit
Authors: Dawson A. D. G. , Babington P. C. B.
Published: January 2019

The concept of a mobile intensive care unit is not new. However, most of those described require modification of the ambulance which is to carry the equipment. We describe a lightweight, self-contained intensive care trolley which will fit into any of the front-line ambulances at present in service in our district.
A Comparison of Rectal Indomethacin with Placebo for Pain Relief following Spinal Surgery
Authors: McGlew I. C. , Angliss D. B. , Gee G. J. , Rutherford A. , Wood A. T. A.
Published: January 2019

Rectal indomethacin was compared with placebo in a randomised, double-blind study of 100 patients undergoing spinal surgery, in which postoperative pain scores, pethidine, diazepam and metoclopramide consumption, bleeding time, blood loss and oral fluid and food tolerance were measured. Side-effects of indomethacin and pethidine were compared in the two groups.

In the indomethacin group, pain scores were significantly less for all measurements made during the first three postoperative days, pethidine and diazepam consumption were significantly less on all three days, bleeding time was significantly increased, although still within the clinically normal range, intraoperative and postoperative blood losses were not significantly affected, coagulation was not significantly impaired as assessed clinically, patients tolerated oral feeding significantly earlier, there was no significant increase in the incidence of gastro-intestinal side-effects except for diarrhoea, and there was no significant reduction in the incidence of side-effects associated with the use of pethidine.
A Comparison of Postoperative Analgesia Provided by Wound Infiltration or Caudal Analgesia
Authors: Schindler M. , Swann M. , Crawford M.
Published: January 2019

A prospective randomised study was performed to compare postoperative analgesia produced by caudal block with that of local wound infiltration in 54 children following unilateral inguinal herniotomy. There was no statistically significant difference in the analgesia produced by these two methods. The requirement for additional postoperative analgesia and the incidence of side-effects was similar in the two groups.
The Anaesthetic Record: A Confidential Survey on Data Omission or Modification
Authors: Galletly D. C. , Rowe W. L. , Henderson R. S.
Published: January 2019

A confidential survey was conducted among medical practitioners in New Zealand with a stated interest in anaesthesia to ascertain the proportion of those currently engaged in anaesthetic practice (thought to be approximately 325), who knowingly omit or alter undesirable physiological parameters from the anaesthetic record. Two hundred and forty-five replies were received from currently active anaesthetists. The reported frequency of occasional data omission or falsification was 55%. Those anaesthetists who intentionally manipulated data were more likely to be dissatisfied with their current anaesthetic record form, to view the record as an intraoperative distraction and less likely to perceive the record as being important for the use of future anaesthetists. There was no correlation between data manipulation and concerns over the medicolegal uses of the record.
Studies on Australian Snake Venoms, Part II: The Haematological Effects of Brown Snake (Pseudonaja) Species in the Dog
Authors: Tibballs J. , Sutherland S. K. , Kerr S.
Published: January 2019

The haematological effects of Brown Snake (Pseudonaja) species (textilis, affinis, nuchalis) were studied in anaesthetised, mechanically ventilated dogs. Marked thrombocytopenia, depletion of serum fibrinogen and prolonged prothrombin and activated partial thromboplastin time, were recorded at 5 to 10 and 30 to 40 minutes after intravenous envenomation. Fibrin degradation products were not elevated. Because these haematological effects occurred simultaneously with cardiovascular depression (previously reported), we postulate that hypotension sometimes observed in human envenomation may be due to intravascular coagulation with myocardial ischaemia.
The Influence of Rectal Cisapride on Morphine-induced Gastric Stasis
Authors: Kluger M. T. , Plummer J. L. , Owen H.
Published: January 2019

The effect of a new formulation of the gastric prokinetic agent cisapride on opioid-induced gastric stasis was investigated. Forty patients were randomly allocated to one of four therapies administered as premedication; group A, placebo suppositories only; group B, placebo suppositories and intramuscular morphine 10 mg; group C, rectal cisapride 30 mg and intramuscular morphine 10 mg and group D, rectal cisapride 60 mg and intramuscular morphine 10 mg. Gastric emptying was assessed from the small bowel absorption of paracetamol following oral absorption. The kinetics of the suppository formulation were determined from venous blood samples. Rectal cisapride in the two doses used did not prevent opioid-induced gastric stasis. This may reflect an inability of this formulation to produce adequate plasma concentrations.
A Comparison of Oral Midazolam Solution with Temazepam as a Day Case Premedicant
Authors: Turner G. A. , Paech M.
Published: January 2019

Seventy-five women undergoing elective day case gynaecological surgery were randomised into one of three groups to receive an oral formulation of midazolam IV solution 10 mg, temazepam 20 mg or placebo for premedication. The two treatment groups showed a significant reduction in anxiety score compared with placebo (P < 0.002 and P < 0.04 for placebo compared with temazepam and midazolam respectively). Similarly the treatment groups showed a significantly greater sedation score compared with placebo. Recovery as assessed by letter deletion and memory tests was no worse for the treatment groups than for placebo. Patient acceptance of the two treatment groups was significantly greater than that of placebo. There was no significant difference between treatment groups with respect to anxiolysis, sedation or recovery. As a day case premedicant, midazolam IV solution 10 mg orally was found to be as effective as temazepam 20 mg and superior to placebo, in terms of anxiolysis and sedation, but did not offer any clinical advantage over temazepam in this setting.
N-Trifluoroacetyl-Ethanolamine: A Proposed Urinary Metabolite of Halothane: Validation and Measurement in Children
Authors: Wark H. , Earl J. , Chau D. , Overton J.
Published: January 2019

It has been postulated that trifluoroacetyl chloride, a halothane metabolite, can bind covalently with the phosphatidylethanolamine component of the hepatic cell membrane and cause cell necrosis. Breakdown of the necrotic hepatocyte would release N-trifluoroacetyl-ethanolamine (TFAE) into the serum with subsequent urinary excretion. An original High Performance Liquid Chromatography (HPLC) method for the measurement of TFAE is described. In six children 1 % halothane was administered for one hour and the halothane uptake measured. Urinary excretion of TFAE was measured for up to eight days and found to be 0.09 ± 0.07% or less of the absorbed halothane. In children TFAE is not a major urinary metabolite of halothane.
The King Edward Memorial Hospital 1000 Mother Survey of Methods of Pain Relief in Labour
Authors: Paech M. J.
Published: January 2019

A survey of one thousand women having a vaginal delivery in an obstetric teaching hospital was conducted in order to ascertain maternal opinions of various methods of pain relief in labour. Women were questioned on the day following delivery as to their pain experience, the degree of analgesia obtained, their satisfaction with and criticisms of the analgesic method or methods used, and their overall satisfaction with their childbirth experience.

More pain than expected was reported significantly more often by primiparous women (P < 0.001) and those having induced or augmented labour (P < 0.04). Epidural analgesia was significantly more effective and resulted in greater satisfaction than other methods alone, or when used in combination (P < 0.0001). ‘Inadequate analgesia’ was also reported less frequently by women using non-pharmacological methods alone (P < 0.0001).

Dissatisfaction with their experience was reported by 5% of women and was most frequently related to inadequate pain relief. Although uncommonly cited as a reason, instrumental delivery was statistically associated with dissatisfaction (P < 0.003).

The incidence of dissatisfaction did not significantly differ with respect to the analgesic method or methods used.
Does Regional Block Improve Outcome after Surgery?
Authors: Rigg J. R. A.
Published: January 2019

Seventy-five years have elapsed since the first claim that the use of local anaesthetics improved surgical outcome. Despite extensive research, the literature provides contradictory views of the role of regional block in improving outcome.

This paper attempts to reconcile these contradictions by examining biological hypotheses underlying the research question and reviewing relevant epidemiological clinical research methodology. The paper concludes with recommendations to prospective investigators for strategies in design, planning and execution of randomised trials to assess the efficacy of regional block in determining outcome after surgery.
Measuring the Efficiency of an Artificial Lung: 1. Carbon Dioxide Transfer
Authors: Pybus D. A. , Lyon M. , Hamilton J. , Henderson M.
Published: January 2019

The performance of a hollow fibre artificial lung (‘Capiox E’) was analysed by measurement of the ‘parallel deadspace’ of the device under varying conditions in 21 patients. The efficiency with which carbon dioxide was exchanged was determined by the time available for equilibration between the blood and gas phases. When this equilibration coefficient was less than 12 seconds per litre of blood flow per litre of gas flow, there was a marked reduction in the efficiency of gas exchange. Under certain conditions, the ‘counter-current’ design of the device apparently permitted the clearance of carbon dioxide at a partial pressure greater than that which was found in the mixed venous blood. This anomalous behaviour may represent in vivo confirmation of the Haldane effect.
Performance of BOC Ohmeda Tec 3 and Tec 4 Vaporisers following Tipping
Authors: Scott D.M.
Published: January 2019

The introduction of systems to facilitate the changing of vaporisers on the back bar of the anaesthetic machine has increased the risk of a vaporiser being tipped or inverted prior to attachment. The performance of three Ohmeda Tec 3 and three Ohmeda Tec 4 vaporisers following tipping to 30°, 90° and inversion to 180° was measured using a calibrated Datex Capnomac AGM-103 analyser. Both types of vaporiser when switched off tolerated tipping and inversion without alteration of the anaesthetic concentration subsequently delivered. The same was true for the Tec 3 after tipping to 30° and 90° with the dial set at zero or above. However, after inversion of the Tec 3 vaporiser with the dial at zero or higher, the anaesthetic concentration delivered was much greater than shown on the dial, initially exceeding 12% for all agents. Should a Tec 3 vaporiser be inverted with the dial at any setting other than OFF, it is necessary to adequately flush it with fresh gas and check its output prior to use.
Variation in the Blood Concentration/Analgesic Response Relationship during Patient-Controlled Analgesia with Alfentanil
Authors: Owen H. , Currie J. C. , Plummer J. L.
Published: January 2019

The effect of supplementing postoperative patient-controlled analgesia (PCA) with a mandatory fixed-rate infusion was studied using alfentanil. Patients were assigned by lottery to receive alfentanil PCA with a bolus of 200 or 300 mcg or alfentanil PCA with a bolus of 100 or 200 mcg plus an infusion of 900 mcg/hr, such that ten patients received each treatment. Seven patients receiving PCA only, compared to two in the groups receiving infusion, were withdrawn due to inadequate pain relief (0.1 > P > 0.05). One patient receiving PCA only was withdrawn because of a low respiratory rate, whereas three patients receiving PCA plus infusion developed respiratory depression. Patients prescribed PCA plus infusion received significantly more alfentanil but did not describe less pain than patients prescribed PCA only. The blood alfentanil concentration immediately prior to demands was significantly higher in the PCA plus infusion groups. These results suggest that during PCA therapy the drug prescription influences the blood concentration associated with satisfactory analgesia.
CPAP, Effective Respiratory Support in Patients with AIDS-related Pneumocystis Carinii Pneumonia
Authors: Prevedoros H. P. , Lee R. P. , Marriot D.
Published: January 2019

Human Immunodeficiency Virus (HIV) related Pneumocystis carinii pneumonia (PCP) associated with severe respiratory failure is an increasingly common problem in major centres and is associated with a high mortality in previous and recent studies. Early in the epidemic, alternatives to invasive intensive care treatment were utilized in our institution and found to be successful. When respiratory failure developed, mask CPAP was used instead of intubation and ventilation.

A retrospective review of 175 cases of HIV infected patients with confirmed first presentation PCP was undertaken. Treatment with our protocol resulted in an overall hospital mortality of 9%. Those patients who did not require supplemental oxygen or respiratory support had no in-hospital mortality. The group who required supplemental oxygen had a mortality of 10%. If respiratory failure supervened (severe respiratory distress, Pao2 < 50 mmHg, SaO2 < 90% on mask oxygen), CPAP was introduced. The mortality in this group was 22%. Only two patients were admitted to the intensive care unit for respiratory support after failure of CPAP. Both patients were intubated and received intermittent positive pressure ventilation (IPPV). Both patients died.
A Comparison of Five Devices for the Bedside Monitoring of Heparin Therapy
Authors: O'Neill A. I. , McAllister C. , Corke C. F. , Parkin J. D.
Published: January 2019

Five instruments were tested for their capacity to monitor heparin therapy on whole blood at the bedside. The instruments were 512 Coagulation Monitor (Ciba-Corning), Thrombotrack (Nycomed), Automated Coagulation Timer (Hemotec), Hemochron-ACT and Hemochron-APTT (International Technidyne Corporation).

Fifty subjects with various levels of heparinisation were tested on each instrument and were also assayed for antithrombin III, fibrinogen, haematocrit, platelet count and plasma heparin level.

The results were compared with a reference APTT performed on the Automated Coagulation Laboratory 300R (Instrumentation Laboratories). The Hemochron-ACT correlated least well. The Hemotec and Thrombotrack were unsuitable in a clinical setting because of pipetting requirements, although the Thrombotrack did correlate well with the reference parameters. The 512 Coagulation Monitor was the simplest to use, but its maximum response corresponded to the midpoint of the reference APTT therapeutic range. The Hemochron-APTT was simple to use, had an adequate response range and correlated well with reference parameters.
Oral Midazolam is an Effective Premedication for Children Having Day-Stay Anaesthesia
Authors: Parnis S. J. , Foate J. A. , van der Walt J. H. , Short T. , Crowe C. E.
Published: January 2019

The effect of oral premedication was studied in a double-blind, randomised trial of 200 children undergoing day-stay anaesthesia. Midazolam 0.25 mg/kg, midazolam 0.5 mg/kg, diazepam 0.5 mg/kg or a placebo was given orally one hour prior to anaesthesia. Patient state was assessed at nine stages, from administration of the premedication up to and including induction of anaesthesia, using a four-point behavioural scale. Patient state was also assessed postoperatively in the recovery area and the day-stay ward. There was no difference between the four groups until induction of anaesthesia. At this stage 82% of children were either asleep or awake and calm. Patients who received midazolam 0.5 mg/kg were more likely to be asleep or awake and calm at induction rather than other groups (P= 0.05). Children receiving midazolam 0.5 mg/kg or diazepam 0.5 mg/kg slept longest in the post anaesthetic recovery room (P < 0.005), and spent most time there (P <. 005). There was no difference between groups in the length of time spent in the day-stay ward or in the number of overnight admissions.

The study shows that a high proportion of unsedated children are calm at induction of anaesthesia and that oral midazolam is an effective premedication in children for day-stay anaesthesia.
Patient-Controlled Epidural Analgesia in Labour — is a Continuous Infusion of Benefit?
Authors: Paech M. J.
Published: January 2019

A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia — bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. Up to three additional staff-administered supplements of 0.5% bupivacaine 4 ml (20 mg) were allowed.

There was no significant difference between groups with respect to pain relief, supplementary boluses required, satisfaction, side-effects or details of patient-controlled epidural analgesia, with the exception of greater fentanyl usage in the bolus plus infusion group (P < 0.003).

Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.
The Cardiovascular and Haematological Effects of Purified Prothrombin Activator from the Common Brown Snake (Pseudonaja textilis) and their Antagonism with Heparin
Authors: Tibballs J. , Sutherland S. K. , Rivera R. A. , Masci P. P.
Published: January 2019

The cardiovascular and haematological effects of purified prothrombin activator derived from the venom of the Australian Common Brown Snake (Pseudonaja textilis) were studied in anaesthetised, mechanically ventilated dogs. Severe depression of systemic blood pressure and cardiac output and a rise in central venous pressure were observed. Thrombocytopenia, prolongation of both prothrombin time and activated partial thromboplastin time and a reduction in serum fibrinogen were also observed. All of these observed effects were prevented by the prior administration of heparin — a naturally occurring anticoagulant. We conclude that the prothrombin activator in Pseudonaja textilis venom may cause cardiovascular depression due to myocardial dysfunction secondary to disseminated intravascular coagulation.
The Efficacy of Heparin in the Treatment of Common Brown Snake (Pseudonaja textilis) Envenomation
Authors: Tibballs J. , Sutherland S. K.
Published: January 2019

The efficacy of heparin therapy after subcutaneous injection of Common Brown Snake (Pseudonaja textilis) venom was studied in anaesthetised, mechanically ventilated dogs. Intravenous heparin (100 U/kg), administered fifteen minutes after envenomation, neither prevented nor hastened the recovery from cardiovascular depression and coagulopathy observed after venom administration. Heparin therapy is not recommended for the treatment of established human envenomation.
Management of Theophylline Overdose Patients in the Intensive Care Unit
Authors: Henderson A. , Wright D. M. , Pond S. M.
Published: January 2019

In a retrospective survey of all adults admitted to the Intensive Care Unit with acute theophylline poisoning over the last five years, we identified 38 patients (6.8% of all admissions for poisoning), two of whom died. Thirty-five (92%) had taken a sustained-release preparation. Eight patients had grand mal seizures and six developed arrhythmias (ventricular fibrillation, 3; atrial fibrillation, 2; supraventricular tachycardia, 1). Severe vomiting was present in 34 (89%) and proved to be a serious obstacle to the administration of enteral charcoal. The vomiting was controlled by intravenous metoclopramide in seventeen patients (50%), but the remaining seventeen required mechanical ventilation with sedation and muscle relaxation for the effective delivery of nasogastric charcoal. Importantly, in nine (24%), the serum theophylline concentration continued to rise despite enteral charcoal. Charcoal haemoperfusion was used in seven (18%). We present an algorithm for the management of severe, acute theophylline poisoning.
Anaesthesia and the ‘Inert’ Gases with Special Reference to Xenon
Authors: Kennedy R. R. , Stokes J. W. , Downing P.
Published: January 2019

Xenon has many of the properties of the ideal anaesthetic agent and has been proposed as a suitable replacement for nitrous oxide in routine clinical anaesthesia. Xenon, krypton and argon are chemically inert under most circumstances, yet all have anaesthetic properties. Xenon is of particular interest because it is the only ‘inert’ gas which is an anaesthetic under normobaric conditions. Because of this property, xenon has an important place in the history of the development of theories of anaesthetic action and of concepts such as MAC. Cost is likely to be a major impediment to the regular use of xenon.
Anaesthesia and Breast-feeding – the Effect on Mother and Infant
Authors: Bond G. M. , Holloway A. M.
Published: January 2019

In this paper, we summarise the physiology of lactation and discuss the pathophysiology brought about by fasting, stress and anaesthetic drugs. Drug secretion into breast milk and subsequent absorption by the infant is considered. Maternal hydration must be well maintained with intravenous fluids, allowing an added 500 to 1000 ml for daily fluid loss in lactation.

Maternal premedication, general anaesthesia and routine postoperative analgesics are also discussed as to the effects on the breast-fed infant.

Drug side-effects may be avoided by timing breast feeding just before the next due dose. Sedatives with long half-lives should not be used. Endocrine and metabolic responses to anaesthesia and surgery are less with regional anaesthesia than with general, hence regional anaesthesia is preferred where it is a reasonable alternative technique.
Vasopressor Therapy in Cardiac Resuscitation
Authors: McLean A. S.
Published: January 2019

The standard 0.5 to 1.0 mg dose of adrenaline used in cardiac resuscitation may be inadequate on the basis of theoretical and experimental evidence. Well designed clinical trials are indicated to test the hypothesis that higher doses of adrenaline could be more effective in specific subgroups of people experiencing cardiac arrest. The success in resuscitation is related to the aortic diastolic pressure and the effectiveness of adrenaline relates to its peripheral vasopressor effect. Other catecholamines such as noradrenaline may be more efficacious, as could be non-adrenergic vasopressors. Clinical studies are required, however, to evaluate these potential alternatives.
Mortality Prediction in Infants with Congenital Diaphragmatic Hernia: Potential Criteria for ECMO
Authors: Butt W. , Taylor B. , Shann F.
Published: January 2019

Over the last ten years the survival of infants born with congenital diaphragmatic hernia who reach the Intensive Care Unit of the Royal Children's Hospital, Melbourne has been constant at 56±6%. Experimental therapies such as extracorporeal membrane oxygenation, high-frequency oscillation and lung transplantation are now being considered as therapeutic options, and as such the ability to predict survival or death of these infants is increasingly important. The records of all infants with congenital diaphragmatic hernia admitted to the Intensive Care Unit between 1 January 1980 and 30 April 1989 were reviewed; blood gas, ventilatory details, and outcome information was obtained. Receiver operating curve analysis was used to determine the best predictor of death. An oxygenation index (MAP X Fio2/Pao2) > 0.3 or ventilation index (PIP X RR X CO2/1000) > 70 predicted a 94% mortality with a specificity of 96% and a sensitivity of 82%.
High-Volume Spinal Anaesthesia. A Dose-Response Study of Bupivacaine 0.125%
Authors: Tay D. H. B. , Tay S. M. , Thomas E.
Published: January 2019

The clinical effects of high-volume spinal anaesthesia with bupivacaine 0.125% were studied in 30 patients presenting for postpartum sterilisation. Group A, B and C patients received 6, 8 and 10 ml of bupivacaine 0.125% respectively. Onset, duration and regression of sensory block and motor blockade, haemodynamic parameters and postoperative complications were studied. A sensory level of T10 was reliably obtained in Group B and C but not in Group A. Similarly motor blockade was unreliable in Group A compared with Group B (P < 0.05) and Group C (P < 0.05). Two segment regression times were similar in all three groups. L1 regression times were 4 7.9, 94.3 and 99.0 minutes in Groups A, B and C respectively. The corresponding times for complete recovery of motor power were 120, 212.3 and 182.7 minutes respectively (P < 0.01 when Group A compared to B and C). A significant incidence of high spinal anaesthesia occurred when 10 ml bupivacaine 0.125% was administered (P < 0.05 when compared with Group A). No patient experienced respiratory discomfort in spite of sensory levels of up to T1. Hypotension responded readily to intravenous fluids and small doses of ephedrine (three patients). Only one patient (Group A) developed a postdural puncture headache. In this study, high-volume spinal anaesthesia with bupivacaine 0.125% was found to be satisfactory for postpartum tubal ligation. The optimal volume of bupivacaine 0.125% was 8 ml.
The Effect of Epidural Blockade on Postoperative Hypercoagulability following Abdominal Aortic Bypass Surgery
Authors: Gibbs N. M. , Crawford G. P. M. , Michalopoulos N.
Published: January 2019

The effect of epidural blockade on postoperative hypercoagulability was assessed in patients undergoing elective abdominal aortic bypass surgery. Twenty patients were randomised to receive general anaesthesia alone, or general anaesthesia plus thoracic epidural blockade with 0.5% bupivacaine. It was found that the addition of epidural blockade did not alter the postoperative increase in plasma fibrinogen, factor VIII coagulant, or α1-antitrypsin. Similarly, epidural blockade did not affect the postoperative decrease in antithrombin III. The results suggest that epidural blockade with local anaesthetic agents does not prevent the postoperative hypercoagulability response following abdominal aortic bypass surgery.
Anaesthetic Experience with Cryotherapy for Treatment of Hepatic Malignancy
Authors: Goodie D. B. , Horton M. D. A. , Morris R. W. , Nagy L. S. , Morris D. L.
Published: January 2019

Hepatic cryotherapy is a relatively new technique, currently employed in the treatment of unresectable liver malignancy, which involves direct freezing of tumour deposits with liquid nitrogen. In a review of 26 patients undergoing this procedure, the anaesthetic considerations are defined. The total operation time ranged from 133 to 410 minutes. In spite of preventative measures, varying degrees of hypothermia occurred (range 33.7° C to 36.5° C), but no sequelae were encountered. Mean blood loss was 926 ml, and eleven patients required blood transfusion of between one and five units. There was a marked drop in platelet count associated with cryotherapy (mean fall of 123,000/mm3 by the second postoperative day). Following the procedure, fever and basal pulmonary atelectasis were common, while hypoglycaemia and renal impairment occurred on single occasions. Six patients underwent postoperative mechanical ventilation. Despite this, the mean hospital stay was under seven days.
“Whoosh” Test as a Teaching Aid in Caudal Block
Authors: Chan S. Y. , Tay H. B. D. , Thomas E.
Published: January 2019

Fifty-three patients presenting for minor gynaecological procedures received caudal blocks performed by residents. These residents used the standard technique which relied on the “give” felt as a needle penetrates the sacrococcygeal membrane and the loss of resistance to air when the needle is correctly placed. The “whoosh” test was noted by the supervising anaesthetist who did not reveal his findings to the residents. A positive test consisted of a characteristic “whoosh” sound on auscultation of the thoracolumbar region when 2 to 3 ml of air was injected into the caudal extradural space. The predictive value of a positive test was found to be 78%, 80.7% and 97.7% (P<0.01) for a positive “give”, loss of resistance and “whoosh” test respectively. Negative tests had no predictive value for “give” and loss of resistance whilst the predictive value of an absent “whoosh” was 100% (P<0.05). Thus we conclude that the “whoosh” test is an excellent aid in the teaching of caudal anaesthesia.
A Comparison of Caudal Epidural Bupivacaine with Adrenaline and Bupivacaine with Adrenaline and Pethidine for Operative and Postoperative Analgesia in Infants and Children
Authors: Kumar T. P. Santhosh , Jacob R.
Published: January 2019

This study compares the effectiveness of two drug combinations–010-(010a) bupivacaine with adrenaline and (b) bupivacaine with adrenaline and pethidine — on operative and postoperative pain relief when administered by the caudal route in infants and children.

A randomised controlled trial was conducted on fifty children below the age of twelve years: 25 children were randomly allocated to each group. Both groups had a significant period of analgesia in the postoperative period. None of the children in either group required parenteral analgesia. Though the group with pethidine had a longer duration of analgesia and sedation, the very high incidence of vomiting and delay in urination observed in this group would preclude the use of pethidine routinely. No respiratory depression was seen in either group.
Use of a New Syringe Pump (Springfusor®) for Muscle Relaxant Infusion
Authors: Eagle C. C. P. , Capes D. F.
Published: January 2019

A new spring-driven syringe pump (Springfusor 10®, Go Medical Industries, Subiaco, W.A.) was evaluated for infusion of muscle relaxants in 50 surgical cases. After an initial bolus dose, atracurium was given at a rate of 25 to 37.5 mg/hour and vecuronium at a rate of 4 to 6 mg/hour. The mean infusion rate was found to be 4% above the nominal rate of 5 ml/hour and the accuracy in all cases was within ± 20%. The Springfusor was found to be rugged, cheap and easy to use. It lacks dose flexibility but is suitable for continuous background infusion of muscle relaxants during surgery.