bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Carbon Monoxide Poisoning
Authors: Unsworth Ian P.
Published: January 2019

Acute carbon monoxide poisoning most commonly follows inhalation of coal gas but may also occur from internal combustion engines fumes and in burns victims. The condition must be treated with urgency. This paper describes the pathology of formation and dissociation of carboxyhaemoglobin and discusses the management including normobaric and hyperbaric oxygen. It is recommended that hyperbaric oxygenation be used where possible in acute carbon monoxide poisoning.
A Review of Acute Salicylate Poisoning
Authors: McCleave D. J. , Havill J.
Published: January 2019

A five-year review of patients admitted to the Royal Adelaide Hospital with Salicylate overdose is presented. Despite a significant increase in the total patients admitted, those with Salicylate overdose show a steady decrease in number. There appears to be a linear relationship between dosage consumed and blood level two hours after ingestion. In addition signs and symptoms relate to blood Salicylate level. The effects of Salicylates on physiological systems is discussed. The current principles of treatment for Salicylate overdose are presented.
Acute Cyanide Poisoning
Authors: Naughton Michael
Published: January 2019

Cyanide poisoning results in cytotoxic hypoxia due to the inactivation of mitochondrial cytochrome oxidase. The pathophysiology of this intoxication is discussed and antidotal therapies are examined and contrasted.

Two case reports of patients with acute poisoning are presented. The importance of general supportive measures, the administration of 100 per cent oxygen and reversal of metabolic acidosis are stressed.
Lithium Toxicity and Refractory Cardiac Arrhythmia Treated with Intravenous Magnesium
Authors: Worthley L. I. G.
Published: January 2019

A case of refractory cardiac arrhythmia induced by lithium and controlled by intravenous magnesium sulphate is described

The mechanism of action of the magnesium in controlling the arrhythmia is discussed.
Organophosphate Insecticide Poisoning and its Management
Authors: Ganendran A.
Published: January 2019

The organophosphate insecticides have become widely used in agriculture and in home gardening. There has been an increase in accidental and intentional poisoning.

Almost all these compounds are potent cholinesterase inhibitors, and signs of poisoning are attributable to the accumulation of acetylcholine.

The local absorption of these compounds from the conjunctiva, upper respiratory tract and skin following exposure to the aerosol or dust used in agricultural work, produces mild symptoms and is rarely of consequence except in accidents due to careless handling. The severe type of poisoning is caused usually by ingestion of the compound(s), and accumulation of large amounts of acetylcholine is fatal if not antagonized rapidly by atropine in large and continuous doses, together with respiratory support.

Pyridine-2-Aldoxime Methiodide (P-2-AM) has been reported to be successful in treating Parathion poisoning. There is experimental evidence that it is not of similar value in some other organophosphorus insecticide poisoning.
Evaluation of Infant Ventilators
Authors: Abrahams N. , Fisk G. C. , Vonwiller J. B. , Grant G. C.
Published: January 2019

A method of evaluating the performance of paediatric ventilators under simulated clinical conditions is described, together with the results of this evaluation of the prototypes of two ventilators designed specifically for use with infants and small children.
Presidential Address: Latent and Overt Shock
Authors: Maplestone Patrick A.
Published: January 2019

Reference is made to the impact of unfamiliar political philosophies and new social attitudes on an unprepared medical profession, and it is suggested that the latter should prepare for even more profound changes in the future.
Heat Balance during Surgery Involving Body Cavities
Authors: Shanks C. A.
Published: January 2019

Three groups of adult patients were anaesthetized for elective intra-abdominal surgery. In one group, patients were ventilated with dry anaesthetic gases, and these patients all lost heat In the second group humidification was used to annul respiratory heat exchange, and these patients lost heat initially but tended to regain heat during anaesthesia. The third group, in addition to humidification, had surface insulation and all these patients gained heat. It is suggested that conservative methods which negate heat loss are able to prevent hypothermia by the retention of metabolically produced heat.
Selective Bronchial Blocking in Children
Authors: Cay D. L. , Csenderits L. E. , Lines Verlie , Lomaz G. , Overton J. H.
Published: January 2019

The use of the Fogarty arterial embolectomy catheter as an endobronchial blocker in infants and children has previously been reported. The farther development of this technique is outlined and its use in two patients is described.
A Technique of Nasotracheal Intubation in Patients with Recent Facio-Maxillary Injury
Authors: Why Kwong Sze
Published: January 2019

A technique of nasotracheal intubation in patients with recent facial injury is described. Oral intubation is performed initially to ensure the safety of the patient during the procedure of nasal intubation.
Anaesthetic Considerations in Chronic Renal Failure
Authors: Morgan M. , Lumley Jean
Published: January 2019

This paper discusses the anaesthetic problems presented by patients in chronic renal failure. The anaesthetic agents and techniques used in 181 patients who underwent 941 operations (including 218 renal transplants) are described.
The Final F.F.A.R.A.C.S. Examination
Authors: Fisk G. C. , Dunstan M. R. , Currie T. T. , Dwyer B. E. , Newman H. C.
Published: January 2019

The development of the Final Examination for Fellowship of the Faculty of Anaesthetists of the Royal Australasian College of Surgeons is described from its inception in 1956 to the present. A statistical analysis was made of the examinations in 1969 and 1970. The correlations between marks for essay questions, within the multiple choice examination and between clinical examinations were low, suggesting that the reliability of these tests was unsatisfactory. At this same time, applied anatomy was added to the subjects in this examination. The examination was restructured with more emphasis on the oral and multiple choice examination and the marking system was revised. Continuing analysis has shown higher correlations between and within most parts of the examination. The correlations for the essay marks have remained lower, but essays have been retained in an attempt to assess and encourage the skills involved. Feedback of teaching and learning information obtained from analysis of the examination is provided to Regional Education Officers and Supervisors of Training.
Chest Physiotherapy during Mechanical Ventilation
Authors: Brock-Utne J. G. , Winning T. J. , Botha E. , Goodwin N. M.
Published: January 2019

The effects of three different physiotherapy techniques on arterial oxygen tensions and A-aO2 gradients were evaluated in 17 patients subjected to mechanical ventilation. No significant changes were detected and the clinical significance of these findings, which contrast with those of other investigators, is discussed.
A Simple Clinical Method of Quantitating the Effects of Chest Physiotherapy in Mechanically Ventilated Patients
Authors: Winning T. J. , Brock–Utne J. G. , Goodwin N. M.
Published: January 2019

A simple clinical method, allowing quantitive assessment of the effects of chest physiotherapy on patients subjected to I.P.P.V., is presented. The method involves measuring of the “alveolar “pressure using the end-expiratory retard mechanism available on the Bennet MA 1 (volume cycled) ventilator.

Using this simple technique three different methods of physiotherapy were shown to significantly lower alveolar pressure, indicating an increase in pulmonary compliance. The inhalation of acetyl cysteine however, appeared to render treatment less effective in this regard.
Post Operative Pulmonary Dysfunction: An Historical Review
Authors: Morton Anthony
Published: January 2019

The development of current understanding of post operative pulmonary dysfunction is outlined and discussed.
Difficulties with Positioning Robertshaw Double Lumen Tubes
Authors: Black A. M. S. , Harrison G. A.
Published: January 2019

Difficulties in positioning Robertshaw tubes have been reviewed in a retrospective and a prospective series. Pre-operative chest X-rays did not help in predicting difficulties. The performance of the Robertshaw tube was carefully recorded for each malposition in the prospective series, and the relationship of the malplaced tube to the tracheobronchial tree was reconstructed. This exercise allowed a more precise definition of the dangers of malpositions and formulation of procedure to minimize their incidence.
The Peri-Operative Measurement of Cardiac Output in Infancy by the Thermodilution Technique
Authors: Lawrie G. M. , Stacey R. B. , Wright J. S.
Published: January 2019

Cardiac output has been measured in infants by thermodilution during and after surgery. A method employing commercially available equipment has been developed. An animal model has been devised whereby right heart outputs of 210 ml to 2240 ml, measured by thermodilution, could be compared with left heart outputs measured by an aortic by-pass. The results of this study suggest that thermodilution is a simple, accurate method for measurement of cardiac output in infancy.
Cardiac Pacemaker Induced Ventricular Fibrillation during Surgical Diathermy
Authors: Orland H. J. , Jones D.
Published: January 2019

Two demand pacemakers were observed to repeatedly fibrillate the heart during clinical surgery employing diathermy. Marked hypotension associated with a rapid, irregular ventricular action was observed in another patient who had a fixed rate pacemaker implanted. Pacemakers were tested with function generators over a range of frequencies and some increased their rate to between 200–600 impulses/min. Animal experiments confirmed that, contrary to manufacturers advice, surgical diathermy produces myocardial fibrillation in the presence of some pacemakers. Mechanisms of these effects and their clinical significance are discussed.
Enflurane (Ethrane)—A Preliminary Study in Children
Authors: Alexander K. D. , Cole W. H. J. , Havill J. H. , Brown T. C. K.
Published: January 2019

A clinical trial of enflurane with paediatric patients is reported and confirms that it is a satisfactory inhalational anaesthetic agent without serious adverse effects.
A Practical Apparatus for Measuring Average Exposure of Operating Theatre Personnel to Halothane
Authors: Dupressoir C. A. J.
Published: January 2019

A procedure for the measurement of halothane in the breathing zone of operating theatre personnel is described. This is achieved by sampling air through a U-tube containing silica gel. Concentrations found in operating theatres ranged from less than 0·1 to 8 ppm. The method can be used to evaluate exposure over a full working day.
Computer Controlled Muscle Relaxation: A Comparison of Four Muscle Relaxants in the Sheep
Authors: Cass N. M. , Lampard D. G. , Brown W. A. , Coles J. R.
Published: January 2019

Computer control of anaesthesia has been extended to include muscle relaxant drugs. Injection of d-tubocurarine, gallamine, alcuronium or pancuronium was controlled by computer to reduce the integrated electromyogram to a preset level (40 per cent of control) for one hour. A programmed level of muscle paralysis is therefore possible for use in physiological and pharmacological experiments, and in clinical practice where precise control of the degree of paralysis together with minimal dosage is advantageous.
Severe Histamine Mediated Reactions to Althesin
Authors: Fisher Malcolm McD.
Published: January 2019

Two severe histamine mediated reactions to Althesin are described. Althesin is significantly more likely to cause such reactions than barbiturate induction agents and should be used with caution, especially in repeated anaesthesia.
The Effect of Halothane-Nitrous Oxide Anaesthesia and Spontaneous Ventilation on Arterial Blood Oxygenation and Physiological Deadspace
Authors: Morgan M. , Norman J.
Published: January 2019

Arterial blood, inspired and expired gas samples were taken from seven patients anaesthetized with halothane (1–2 per cent) and nitrous oxide in oxygen and who breathed spontaneously. Over a two hour period, the average arterial oxygen tension was 75 mm Hg and carbon dioxide tension 49 mm Hg. No significant deterioration of either blood gas value occurred during the two hours. The dead-space/tidal volume ratio and alveolar-arterial oxygen tension difference did not alter significantly during the period of the study.
Six Unusual Cases of Drug Overdose
Authors: James Owen , Gibbons Jennifer
Published: January 2019

Six patients out of a total of 1,137 adults treated for drug overdose died during the period May, 1968 to June, 1973. Their case histories are summarized, and the conclusion drawn that, whilst death from drug overdose is unusual, increased vigilance particularly for the unsuspected secondary diagnosis or complication, is needed if there is to be any further reduction in the already small mortality rate.
Intradermal Testing after Severe Histamine Reactions to Intravenous Drugs Used in Anaesthesia
Authors: Fisher M. McD.
Published: January 2019

In a series of patients who suffered severe histamine mediated reactions to induction agents and muscle relaxants, intradermal testing enabled the drug involved to be distinguished. The correct use of intradermal testing to give reliable results is discussed and a protocol described. Prausnitz Kustner testing was of little help in confirming the results.

A number of patients tested showed high levels of immunoglobulin G (IgG) and it is believed that IgG mediated anaphylaxis may be the mechanism responsible for reactions that have been previously described as anaphylactoid or direct chemical histamine release.
The Management of the Retained Tracheostomy Tube
Authors: Bush Gordon H.
Published: January 2019

A tracheostomy tube that has to be retained despite attempts to remove it, must be defined as a retained tube. The previous literature is reviewed. The consequences of establishing a tracheostomy are described and, based on these considerations, recommendations are made for a regime to allow decannulation to be performed.
The Cardiovascular Effects of Pancuronium in the Dog during Pentobarbitone Anaesthesia
Authors: Gibbs J. M. , Tait A. R. , Sykes M. K.
Published: January 2019

The effect of pancuronium on the cardiovascular system of the dog was studied in 12 greyhounds who were anaesthetized with pentobarbitone 30–40 mg/kg body weight. During the study, the animals were artificially ventilated to give an end-tidal carbon dioxide in the range 4·0–4·5 per cent. Duplicate cardiac output measurements were made before and ten minutes after the intravenous administration of pancuronium (0·18 mg/kg). There was a slight (but statistically insignificant) fall in cardiac output. Heart rate, aortic and pulmonary arterial pressures remained substantially unaltered. It is suggested that pancuronium should be used in the dog when muscle relaxation is required during pentobarbitone anaesthesia. In this way cardiovascular changes related to the drugs themselves will be minimized.
Use of Physostigmine in Tricyclic Antidepressant Poisoning
Authors: Chin L. S. , Havill J. H. , Rothwell R. P. G. , Bishop B. G.
Published: January 2019

The use of physostigmine in the treatment of tricyclic antidepressant overdose is discussed. The importance of continuous observation is emphasized and the method of preparation of physostigmine is outlined.
A Haemodynamic Study of Patients Anaesthetized with Enflurane and Halothane
Authors: Ascorve A. , Criado A. , Peral P. , Avello F. , Conejero P.
Published: January 2019

The cardiovascular effects of equipotent concentrations of enflurane and halothane were studied and compared in two groups of patients. The agents were shown to have similar effects.
Metabolism of Enflurane in Man following a Second Exposure
Authors: Norgate C. E. , Sharp J. H. , Cousins M. J.
Published: January 2019

A second administration of one half MAC enflurane for two hours one week following a previous identical exposure caused no increase in urinary inorganic Fluoride excretion (UFV).

At this dosage of 1 MAC hour, which is equivalent to use as a supplement, UFV did not exceed 800 μM/day in any subject (Nephrotoxic threshold=2500 μM/day. Thus, when sub-anaesthetic doses of enflurane are administered at this time interval there appears to be no increased risk of nephrotoxicity.

This study also provides strong support for the concept that drug metabolism is very reproducible within individuals but there is considerable variation between individuals. Since the subjects in this study were all of similar age, and drug free, the results are in keeping with recent twin studies which indicate that individual differences in drug metabolism are largely determined on a genetic basis.
The Hypotensive Effect of Fresh Lypholised Plasma
Authors: Kaye S. E.
Published: January 2019

The hypotensive effect of fresh, lypholised plasma, both during, and after cardiopulmonary bypass is demonstrated. It is postulated that the mediator is bradykinin, or one of it precursors.
Formal Presentation at a Scientific Meeting
Authors: Burnett William
Published: January 2019

The giving of a ten minute scientific communication is an art form peculiar to researchers who frequently fail to research the technology required for the performance. Careful selection of the scientific material to be included, the audio-visual aids to support it, and adequate rehearsal before presentation to a critical audience are vital to the success of the presentation.
Intravenous Flunitrazepam as an Anaesthetic Induction Agent
Authors: Chiu H. H. , Ang P. P. L. , Lean T. H.
Published: January 2019

The effects of the fluorinated benzodiazepine compound flunitrazepam were studied in eighty patients. The drug was administered intravenously in a standard dose of 2 mg, 3 mg, or 4 mg to supplement lumbar epidural analgesia. Induction was smooth and pleasant. The sleep onset time was dose related and exceeded one minute in the majority of patients. Sleep was invariably produced in patients receiving 4 mg but at lower dosage some patients failed to become unconscious. Pain in the arm during injection was a common feature. The respiratory rate was slightly increased, but in two patients apnoea occurred at induction. The cardiovascular system was minimally depressed with a small decrease in systolic blood pressure and pulse rate. Recovery from sleep was slow but sequelae were minimal. The sedative and amnesic properties contributed significantly to the high rate of patient acceptance.
Measurement Errors in Pneumotachography Due to Pressure Transducer Design
Authors: Churches A. E. , Loughman J. , Fisk G. C. , Abrahams N. , Vonwiller J. B.
Published: January 2019

When pneumotachography is used during intermittent positive pressure ventilation (IPPV), the design of some differential pressure transducers can cause measurement errors. These errors may be avoided by using differential pressure transducers which have small, equal chambers free from temperature sensitive electrical elements. Few of the transducers which are sensitive enough for clinical use fulfil these requirements.
Airway Pressure Changes Observable with Constant-Flow Inflation and an End-Inspiratory Pause
Authors: Shanks C. A. , Campbell D. I. , Telford H. J.
Published: January 2019

Constant-flow inflation and a prolonged end-inspiratory pause were studied, observing the airway pressures in model lungs. The technique demonstrated the changes associated with compliance, resistance and gas redistribution under varying conditions. The studies suggest that when intratracheal pressures indicate a large element of gas redistribution, constant flow inflation and end-inspiratory pause produce pendelluft, and other pressure patterns are preferable for I.P.P.V.
Case Report: Anaesthesia in Familial Hypokalaemic Periodic Paralysis
Authors: Bashford A. C.
Published: January 2019

A case of familial hypokalaemic periodic paralysis is described together with the management of anaesthesia for caesarian section. There was no adverse reaction to muscle relaxant drugs.
Case Report: Complication of a Polyvinyl Chloride Endotracheal Tube
Authors: Wong R. M.
Published: January 2019

A case report illustrates obstruction of a Polyvinyl Chloride endotracheal tube due to occlusion of the lumen by high cuff pressure. Recommendations are made for the prevention of this hazard.
Extracorporeal Membrane Oxygenation in the Treatment of Respiratory Failure—A Review
Authors: Newland Peter E.
Published: January 2019

Extracorporeal membrane oxygenation (ECMO) can be used for the treatment of acute respiratory failure. Based on recent experience in establishing such a method of treatment, this paper reviews those aspects of ECMO that need careful consideration before it can be undertaken. Methods of patient selection for ECMO and the physiological changes associated with it are also discussed.
Some Adverse Physiological Effects of Hypocarbia and Methods of Maintaining Normocarbia during Controlled Ventilation—A Review
Authors: Pollard Brian , Gibb David B.
Published: January 2019

Some of the adverse physiological effects of hypocarbia are described and the methods available to maintain the PaCO2 within or near the normal range during controlled ventilation are reviewed.
Methods of Conserving Carbon Dioxide in Artificially Ventilated Patients a Clinical Investigation
Authors: Gibb David B. , Prior Geoffrey , Pollard Brian
Published: January 2019

A technique is described for maintaining the PaCO2 within, or close to, the normal range in patients hyperventilated using the Mapleson D Circuit or the Circle system with the soda-lime excluded. Control is achieved by limiting the fresh gas inflow to 4·5 litres/minute.
Technical Considerations in the Use of the Membrane Oxygenator (Lande'-Edwards) for Open Heart Surgery
Authors: Stagey R. B. , Wright J. S. , Fisk G. C.
Published: January 2019

Experience has shown that successful cardio-pulmonary bypass depends upon an efficient oxygenator which causes minimum blood damage. Experience with 1,600 Lande'-Edwards membrane oxygenators in more than 1,000 patients has led to the development of a simple and safe routine for their use in open heart surgery. The circuitry, method of preparation for perfusion, and management of perfusion are described in detail.
Post Operative Pulmonary Compliance
Authors: Morton A. , Hansen P. , Baker A. B.
Published: January 2019

Lung compliance was studied pre-operatively and post-operatively in a group of patients having abdominal surgery. Lung compliance was shown to be markedly reduced postoperatively especially in the patients with chronic bronchitis.
Radiological Lung Volume in Surgical Patients
Authors: Morton A. , Mahoney P. , Lindley T.
Published: January 2019

Radiological total lung capacity (T.L.C.) was measured preoperatively and postoperatively in a group of patients. A decrease in T.L.C. postoperatively in patients who smoke was demonstrated. The use of radiological T.L.C. in the study of postoperative respiratory dysfunction is suggested.
Complication of Laparoscopy under General Anaesthesia
Authors: Chiu H. H. , Ng K. H.
Published: January 2019

Two cases are presented in which injury to the stomach occurred in association with laparoscopy under general anaesthesia. The common aetiological factor was gastric inflation resulting from I.P.P.V. via mask. Precautionary measures in the anaesthetic induction technique are described.
Anaphylaxis to Alcuronium
Authors: Fisher Malcolm McD. , Hallowes Richard C. , Wilson Ross M.
Published: January 2019

Five cases of severe anaphylactic reactions to alcuronium are described. Investigation suggested that these are probably true anaphylaxis to the drug. The cases illustrate the value of intradermal testing in detecting the drug involved and the necessity of using colloidal solutions and adrenaline in the management of hypotension due to anaphylaxis.
Clinical Evaluation of Etomidate as an Induction Agent
Authors: Chiu H. H. , Van W. K.
Published: January 2019

A comparative study between Etomidate and Thiopentone was carried out on 100 healthy female patients scheduled for post-partum abdominal sterilization under epidural analgesia.

Our results show Etomidate to be a safe and effective induction agent, comparable to Thiopentone in having a rapid onset of action and rapid recovery time. The pulse rates and blood pressures remained relatively stable during the use of Etomidate. However, there was a high incidence of transient respiratory upsets while causing less respiratory depression than Thiopentone. The objectionable features of Etomidate are high incidence of pain on injection and involuntary muscular activity, which account for the low anaesthetist acceptance rate.
An Air-Machine for Infants and Children
Authors: Coglan Charles J.
Published: January 2019

Modifications to the Jobson Air-machine are described which permit its use in infants and children under three years of age.
Device for Humidification and Controlled Oxygenation during Spontaneous Breathing
Authors: Talsma P. , Optroodt N. , Havill J. H.
Published: January 2019

A system for humidification with adjustable flows and oxygen concentrations for use in spontaneously breathing patients is described.
Gas Identity Hazards and Major Contamination of the Medical Gas System of a New Hospital
Authors: Tingay M. G. , Ilsley A. H. , Willis R. J. , Thompson M. J. , Chalmers A. H. , Cousins M. J.
Published: January 2019

During commissioning of the medical gas system of a new hospital, fourteen connection defects were found; six of these were potentially lethal cross-connections. A major contaminant was also detected throughout the medical gas system.

The methods of testing a new medical gas system described in this report highlight the need for up-grading of existing standards.
Altered Drug Metabolism in Anaesthetists Exposed to Volatile Anaesthetic Agents
Authors: Harman A. W. , Russell W. J. , Frewin D. B. , Priestly B. G.
Published: January 2019

Antipyrine kinetics were measured on saliva in eight anaesthetists during a period when they were giving general anaesthetics and a period when they were working exclusively in intensive care. During the anaesthesia period there was a reduction in antipyrine half-life and the clearance of antipyrine increased. Analysis of the data in groups failed to detect these changes because of the wide variation in metabolism between subjects. Exposure to anaesthetic agents under non-scavenging operating theatre conditions appears to enhance hepatic metabolism.
Intravenous Ketamine Anaesthesia for Major Abdominal Surgery — An Assessment of a Technique and the Influence of Ataractic Drugs on the Psychomimetic Effects of Ketamine
Authors: Houlton P. J. C. , Downing J. W. , Brock-Utne J. G.
Published: January 2019

Eighty-two patients presenting for major abdominal surgery were divided into five groups, and received intravenous ketamine, muscle relaxation and controlled ventilation with oxygen-enriched air. For maintenance of anaesthesia patients were given a single intravenous dose of either droperidol 5 mg, diazepam 5 mg, promethazine 25 mg, flunitrazepam 0.5 mg or lorazepam 2 mg, followed by incremental doses of ketamine.

Flunitrazepam and lorazepam were the adjuvants associated with the lowest incidence of dreaming and emergence phenomena; post anaesthetic sequelae occurred most frequently with both ketamine/diazepam and ketamine/droperidol anaesthesia. However, the differences between the five groups failed to reach statistical significance.
The Peripheral Pulse Monitor — A Review of Electrical Plethysmography
Authors: Sara C. A. , Shanks C. A.
Published: January 2019

The electrical plethysmogram, as a monitor of cardiovascular function, is reviewed; and its use as peripheral pulse monitor during clinical anaesthesia is evaluated.
Local Anaesthetic Plasma Levels in Children
Authors: Eyres R. L. , Kidd J. , Oppenheim R. , Brown T. C. K.
Published: January 2019

Blood levels of lignocaine and bupivacaine were measured in children following caudal, subcutaneous and tracheal administration. The highest peak levels were in children under 3 years following tracheal spray but all blood levels were below accepted toxic adult levels for anaesthetised patients. No toxic manifestations were seen.
Continuous Lumbar Plexus Block—Analgesia for Femoral Neck Fractures
Authors: Brands Emile , Callanan V. I.
Published: January 2019

In a series of 21 patients with fractures of the neck of the femur, continuous lumbar plexus block provided effective pain relief in 17 cases. The technique for continuous lumbar plexus block is described. The technique has advantages over conventional methods of analgesia.
A New Polyvinyl Chloride Coil with Improved Performance for Blood Warming
Authors: Russell W. J.
Published: January 2019

A new polyvinyl chloride (PVC) coil has been tested. The thinner walls give a better heat transfer so that an output temperature of 32.7°C occurs at 150 ml/min under test. This is higher than any PVC coil previously tested.

Suggestions are made about methods of further improving the performance.
An Epidural Anaesthetic with Unusual Complications
Authors: Maycock Elizabeth
Published: January 2019

Respiratory paralysis and prolonged duration of anaesthesia followed lumbar epidural block with bupivacaine. Subdural, extra arachnoid block is postulated.
The Surgical Diathermy: Principles of Operation and Safe Use
Authors: Watson A. B. , Loughman J.
Published: January 2019

An understanding of the principles of operation and hazards of the surgical diathermy is necessary for the safety of the anaesthetized patient. The surgical diathermy performs its function by the application of high density radio frequency current which can be used to cut or coagulate tissue. Its improper use can result in electrical burns and even electrocution. The principles underlying its safe use are outlined, and detailed recommendations are made to ensure the patient's safety.
Mechanism of the Hypertensive Effect of Droperidol in Pheochromocytoma
Authors: Oh T. E. , Turner C. W. , Ilett K. F. , Waterson J. G. , Paterson J. W.
Published: January 2019

Droperidol is used in the anaesthetic management of pheochromocytoma because of its sedative, antidysrhythmic and alpha-adrenoreceptor blocking properties. However, droperidol when used in pheochromocytoma, has been reported to produce a paradoxical hypertensive response.

In vitro experiments with perfused rabbit ear arteries using a histochemical fluorescence technique, showed droperidol to be an inhibitor of noradrenaline uptake into sympathetic nerve endings, and this uptake inhibition was dose related. The uptake inhibition effect did not, however, produce pressor changes in experiments simulating pheochromocytoma in cats. The hypertensive response to droperidol may be due to blockade of presynaptic alpha-adrenoreceptors and this possible mechanism of action is discussed.
Topical Cocaine/Adrenaline Combination in Intransal Surgery — is it Necessary?
Authors: Delilkan A. E. , Gnanapragasam A.
Published: January 2019

Topic adrenaline with cocaine has been used commonly for intranasal vasoconstriction to facilitate surgery and to control haemorrhage. Pharmacologically the drug combination is known to be a potentially dangerous interaction. This investigation studied whether either drug could be used separately rather than in combination, to achieve the same purposes. One hundred cases were randomized into four groups using 1:1000 Adrenaline, 5% Cocaine, 10% Cocaine and 5% Cocaine/1:1000 Adrenaline as the topical vasoconstriction regimes. The results showed that the vasoconstrictor effect was not significantly different within the four groups; topical 1:1000 Adrenaline resulted in more haemorrhage compared to the other three regimes; comparing the other three regimes the blood loss was not significantly different.

The conclusion is that the Adrenaline/Cocaine mixture has no advantage and its potentially dangerous interaction makes it unnecessary and unjustified. Topical 5% Cocaine is recommended because it achieves the aims with the least side-effects.
Haematological and Biochemical Abnormalities Associated with Intralipid Hyperalimentation
Authors: Gibson Joyce C. , Simons Leon A. , Raik Eva , Barton Lee
Published: January 2019

Haematological and biochemical parameters were monitored in six patients during Intralipid hyperalimentation. A mild anaemia was consistently observed, accompanied by morphological changes in red cells, granulocytes, and platelets. All patients demonstrated an abnormally high percentage of plasma cholesterol in the unesterified form and altered plasma cholesterol esterification, but red cells were not uniformly enriched in cholesterol. These findings stress the need for careful monitoring during Intralipid therapy.
Teaching Neonatal Resuscitation: A Programmed Approach
Authors: Crankshaw D. P.
Published: January 2019

A method of teaching neonatal resuscitation based on a logic flow-chart is described
Snake Bite in Australia — the Problems Involved and a Protocol for Hospital Management
Authors: Sullivan Mark J.
Published: January 2019

Despite a great deal of original research into Australian snakes and their complex venoms, there is still confusion about the correct first-aid and hospital management of the bitten patient. This review illustrates the difficulties in diagnosis and treatment and presents a well tried protocol for the successful management of snake bite.
Outpatient Anaesthesia for Dilatation and Curettage
Authors: Baker A. B. , Baker J. E.
Published: January 2019

An anaesthetic technique (caudal blockade with chloroprocaine and intravenous propanidid) for patients having dilatation and curettage of the uterus as outpatients is presented, and a prospective series of patients reviewed. Results show a high level of patient satisfaction with the technique and a low incidence of side effects.
Department Staffing in Anaesthesia
Authors: Baker A. B.
Published: January 2019

A survey about staffing of departments of anaesthesia in teaching hospitals, and about the duties of their anaesthetists, showed similar results to a preliminary survey (Baker 1978) which suggested that two-thirds of Australasian departments were understaffed by senior specialists. The survey also showed a high ratio of one, of trainees to senior specialists, which will soon over supply specialists in practice if allowed to continue.
Tubocurarine and Pancuronium: A Pharmacokinetic View
Authors: Shanks C. A. , Somogyi A. A. , Ramzan M. I. , Triggs E. J.
Published: January 2019

This review is an attempt to bring together the pharmacokinetic data on d-tubocurarine and pancuronium with clinical observations on relaxant dosage and effect. The modelling techniques used here represent an oversimplification of the relationships between relaxant plasma concentration and response as they do not predict either the time of onset of paralysis or its peak intensity. However, they do enable calculation of a bolus dose of relaxant required to achieve a particular intensity of paralysis for the average patient once pseudo-distribution equilibrium has been achieved. This has been further extended to predict the cumulation of the relaxants with subsequent dosage in average patients.

Suggested regimens incorporating bolus and infusion doses of the relaxants to achieve continuous neuromuscular blockade have been calculated also.

Averaged pharmacokinetic parameters derived from patients with renal or hepatic dysfunction have been used to predict the likely duration and intensities of paralysis for the relaxants.
Reversal of Non-Depolarizing Block by Neostigmine
Authors: Cass N. M. , Brown W. A. , No K. C. , Lampard D. G.
Published: January 2019

Paralysis was maintained in the sheep for 30 or 90 minutes by computer-controlled injection of gallamine, pancuronium, alcuronium or d-tubocurarine, using the integrated electromyogram as a measure of neuromuscular transmission. Neostigmine was given and the recovery time measured. In all trials the recovery rise time was no longer than two minutes, but varied between one and two minutes.
An Analysis of the Performance of a Variable Venturi-type Oxygen Mask
Authors: Woolner D. F. , Larkin J.
Published: January 2019

The theoretical performance of the Hudson Multivent mask is considered. A method is described of determining the flow-weighted mean inspired oxygen concentration produced by the mask. Using this method, it was found that the inspired oxygen concentration was predictable only at the 24% setting using the recommended flow rates, but that increasing the supplied-oxygen flow rates above the recommended levels resulted in the return of predictable function. At settings above 30% predictable function was found to be unlikely, whatever the supplied oxygen flow rate. Recommendations are made regarding the use of this device.
Assessment of Waste Anaesthetic Gas Scavenging Systems under Simulated Conditions of Operation
Authors: Ilsley A. H. , Crea J. , Cousins M. J.
Published: January 2019

A critical assessment of available waste anaesthetic gas scavenging devices was made by simulating the worst theatre conditions as well as ideal conditions. Only one of the scavenging devices tested proved to be unacceptable. However, the critical nature of suction flow rates was revealed and the ineffectiveness of air conditioning in the absence of adequate scavenging was highlighted.
Difficult Tracheal Intubation
Authors: Payne K. A.
Published: January 2019

Three cases of difficult tracheal intubation are presented. An approach to the management of difficult tracheal intubation is discussed.
Caesarean Section and Placental Transfer of Alcuronium
Authors: Ho P. C. , Stephens I. D. , Triggs E. J.
Published: January 2019

The placental transfer of alcuronium was studied in twelve patients undergoing elective or emergency caesarean section. Umbilical cord vein and maternal plasma was analysed for alcuronium at dose-delivery time intervals ranging from 5 to 10.5 minutes. The mean umbilical vein concentration of the relaxant was 0.41 ± 0.18 (SD) μg/ml, and the mean foetal/maternal concentration ratio was 0.26 ± 0.11. A positive correlation between foetal and maternal concentrations of alcuronium was demonstrated. Although alcuronium appears to cross the placenta rapidly and in reasonably high concentration, no apparent adverse effects on the neonates was evident as judged by measurement of Apgar scores.
Aural Thermometry during Profound Hypothermia
Authors: Davis F. M. , Barnes P. K. , Bailey J. S.
Published: January 2019

External auditory canal temperature changes during profound hypothermia were studied experimentally in ten dogs and clinically in 20 patients undergoing open-heart surgery. The results were compared with nasopharyngeal and lower oesophageal temperatures. Tympanic membrane temperature provided a better approximation to brain temperatures measured in four dogs to below 20°C than did either of the other two methods. In patients, auditory canal temperature showed less variability with respect to oesophageal temperature and fell at a faster rate than did nasopharyngeal temperature. It did not appear to be subject to positional or other artefacts but four patients showed evidence of auditory canal trauma. The precise relationship between auditory canal or tympanic membrane temperature and brain temperature during profound hypothermia is not established. Routine otoscopic examination should accompany the use of an ear probe.
Thermodilution Cardiac Output — A Systematic Error
Authors: Runciman W. B. , Ilsley A. H. , Roberts J. G.
Published: January 2019

The purpose of this study was to examine the mechanism and magnitude of a systematic error in thermodilution cardiac output measurement. One hundred and seventy-one thermodilution cardiac output measurements in dogs using a Swan-Ganz catheter were compared with simultaneously made dye dilution measurements under different conditions over a wide range of cardiac outputs.

A systematic error with the thermodilution technique was confirmed and was almost identical to that observed in the literature. It is proposed that its mechanism is loss of thermal indicator between the injectate orifice and detection. Application of a further correction factor for thermal indicator loss is suggested.
Sparks, Low Voltage Sources and Flammable Anaesthetics
Authors: Russell W. J. , Booker N. A. , Tait R. W. F.
Published: January 2019

Battery operated laryngoscopes have two types of switching, one of which could cause an external spark. Laryngoscopes normally supply 2.8 volts and 0.67 amps, which theoretically gives ample energy for ignition of a cyclopropane/oxygen mixture. Attempts were unsuccessful to ignite a stoichiometric mixture of 17% cyclopropane in oxygen by breaking resistive circuits having up to 5.8 volts and 9.2 amps. It appears extremely unlikely that the common battery-powered laryngoscope can ignite a flammable mixture by sparking when being switched off.
Difficult Removal of External Jugular Vein Catheters
Authors: McKenzie B. J. , Latto I. P.
Published: January 2019

Two cases of difficult removal of external jugular vein catheters and their probable cause are discussed.
Disposable Condenser Humidifiers in Intensive Care
Authors: Oh T. E. , Thompson W. R. , Hayward D. R.
Published: January 2019

Two disposable condenser humidifiers were evaluated in nine ventilated intensive care patients. The Portex “Humid Vent” delivered end-inspired absolute humidities of 22-26,3 g/m3 at end-inspired temperatures of 27-28.3 °C. Corresponding humidities and temperatures with the Servo “Humidifier 150” were higher and were constant, at 27.7-29 g/m3 and 29.3-29.7°C respectively. These disposable devices can be used for humidification in intensive care, but only for patients breathing room air, or on a short term basis.
Pathophysiology and Management of Raised Intracranial Pressure
Authors: Jones R. F. C. , Dorsch N. W. C. , Silverberg G. D. , Torda T. A.
Published: January 2019

The mechanism of cerebral homeostasis is reviewed, paying particular attention to the way blood-brain barrier, cerebrospinal fluid and cerebral blood flow contribute to the maintenance of normal intracranial pressure. The pathophysiology of raised intracranial pressure is outlined delineating the different types of cerebral oedema. Guidelines for the management of patients with raised intracranial pressure are presented as well as the techniques of intracranial pressure monitoring.
Factors Affecting an Anaesthetist's Work: Some Findings on Vigilance and Performance
Authors: Paget N. S. , Lambert T. F. , Sridhar K.
Published: January 2019

This paper reviews factors which may influence the vigilance tasks of an anaesthetist during an anaesthetic. Vigilance tasks are found to be unlike any other automatic, repetitive or monotonous tasks. While many factors affect vigilance and may result in performance decrements during psychological testing, little of this work has been done on anaesthetists. We suggest, however, that there are many parallels between findings related to vigilance in general and the type of work done by anaesthetists. Implications of major factors are discussed, and recommendations for further study are proposed.
Option Term in Anaesthetics for Medical Students
Authors: Bookallil M. J. , Joseph D.
Published: January 2019

The Option Term in Anaesthetics in The University of Sydney is reported on. It is now undertaken by 18% of medical students and is proving a valuable part of the undergraduate course.
Fresh Blood by Direct Transfusion for Haemostatic Failure in Massive Haemorrhage
Authors: Loong E. D. , Law P. R. , Healey J. N.
Published: January 2019

Direct donor-to-patient transfusion has been employed in the management of bleeding disorders which complicated massive blood loss and transfusion. The procedure is practical and offers certain advantages over other methods of fresh blood transfusion.
Toxic Shock Syndrome — Some New Features
Authors: Oh T. E. , Quinlan M. F. , Thompson W. R. , Haywood E. F. , Lloyd B. L. , Bower G. , Hookway G.
Published: January 2019

A thirty-year-old female presented with a high fever, conjunctivitis, confusion, vomiting, watery diarrhoea, diffuse erythroderma, shock and oliguric renal failure. Staphylococcus aureus phage 29/52 (Group 1) was isolated from a high vaginal swab. In addition to all the previously reported features which defined toxic shock syndrome, there were pustular skin vesicles, altered red cell morphology, and severe myocardial involvement. Treatment with fluid replacement, cloxacillin, haemodialysis, positive inotropic agents, and supportive measures resulted in a full recovery.
Subtotal Spinal Anaesthesia as a Complication of Intrathoracic Intercostal Nerve Blocks
Authors: Chester S. C. , Gutteridge G. A.
Published: January 2019

A patient developed subtotal spinal anaesthesia following intercostal nerve block performed by the surgeon during thoracotomy. Direct intraneural injection of bupivacaine appeared to be the most likely mechanism for this complication.
Pulmonary Artery Catheterisation. An Assessment of Risks and Benefits in 220 Surgical Patients
Authors: Davies Michael J. , Cronin Keith D. , Domaingue Charles M.
Published: January 2019

The benefits and risks of pulmonary artery catheterisation were assessed in 220 patients having cardiac or vascular surgery. Prior to induction of anaesthesia 20% of patients had pulmonary artery wedge pressure measurements which indicated the need for blood volume support, vasodilator therapy or modification of the anaesthetic induction technique. Of those patients for cardiac surgery, 38% had important changes before cardiopulmonary bypass requiring blood volume support or vasodilator therapy. These changes were not reflected by similar changes in the central venous pressure. The risks of the technique were minimal. Minor complications occurred in 25% of patients (transient arrhythmias) and more serious complications occurred in 3.6% of patients. There was no mortality or long-term sequelae. We conclude that the benefits of pulmonary artery catheterisation outweigh its risks in patients having major cardiac and vascular surgery.
The Patient's View of Anaesthesia in an Australian Teaching Hospital
Authors: Burrow Bruce J.
Published: January 2019

One hundred and thirty-nine patients undergoing routine surgical procedures over a five-day period at Royal Brisbane Hospital were interviewed after operation. 66.2% of patients were aware that an anaesthetist needed a medical qualification. 76% expected their anaesthetic to be without complications. 80% were seen pre-operatively by an anaesthetist. 8% volunteered complaints about some aspect of the anaesthetic. On closer questioning, 80% mentioned specific complaints.
Midazolam as an Intravenous Induction Agent for General Anaesthesia: A Clinical Trial
Authors: Baber Rod , Hobbes Alick , Munro Ian A. , Purcell Greg , Binstead Rod
Published: January 2019

The peripheral and central nervous, cardiovascular and respiratory effects of midazolam 0.15 mg/kg, administered intravenously, were studied in 57 patients. Midazolam induced anaesthesia satisfactorily in 78% of the patients, the remainder required either further doses of midazolam, or alternative induction agents.

There was no pain on injection. No evidence of thrombophlebitis was apparent up to 72 hours after injection.

Mean systolic arterial pressure decreased from 128 mm Hg to 114 mm Hg and mean diastolic pressure decreased from 75 mm Hg to 67 mm Hg (P < 0.005) four minutes after injection. Mean heart rate increased from 81 beats/min to 88 beats/min (P < 0.005) one minute after injection. Apnoea occurred in 14 patients, with a mean onset time of 82 sec and a mean duration of 30 sec. Patients showed a decrease in mean respiratory rate from 13.7 breaths/min to 12.8 breaths/min two minutes after injection of midazolam.

A larger dose than used in this study would be necessary for satisfactory use of midazolam as an induction agent for general anaesthesia.