bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating the Net Effect of Unmeasured Ions in Human Extracellular Fluid using a new Mathematical Model. Part II: Practical Issues
Authors: Anstey C. M.
Published: January 2019

Building on the theoretical considerations developed in Part I of this two-part series, a population range was established for a new extracellular fluid acid-base parameter using Monte Carlo simulation. This new parameter, the unmeasured ion excess, had a normal range of ∓2.50 mEq/l which was slightly narrower than the normal range for the standard base excess at ∓3.20 mmol/l. In both cases, most of this variation occurred as a result of the estimation of the bicarbonate concentration. Finally, several short clinical vignettes were explored to highlight the differences between the unmeasured ion excess and the standard base excess.
Accuracy of Weight and Height Estimation in an Intensive Care Unit
Authors: Maskin L. P. , Attie S. , Setten M. , Rodriguez P. O. , Bonelli I. , Stryjewski M. E. , Valentini R.
Published: January 2019

We report the findings from a prospective study determining the magnitude of errors in the visual estimation of weight and height of critically ill patients. Forty-two consecutive patients were weighed by a physician with a calibrated stretcher scale and length measured with a steel measuring tape. The predicted body weight was calculated using the ARDSnet formulae. Attending physicians and nurses were asked to estimate patient's actual weight, predicted weight and height. The average percent errors in estimation of actual and predicted weight were 11.4 and 14.6%, respectively. Errors greater than 20% in patient's actual and predicted weight were observed in 15 and 24% of cases, respectively. The majority of height estimations (86%) had an error <10%. There were non-significant differences between the estimations made by intensive care unit physicians and nurses.

Our study shows that estimations of patient's weight made by intensive care unit staff are often inaccurate. In contrast, estimations of height made by intensive care unit staff are usually adequate. Estimated body weight of critically ill patients has implications for drug and respiratory therapy and should be used with caution.
A Comparison of Low dose Hyperbaric Levobupivacaine and Hypobaric Levobupivacaine in Unilateral Spinal Anaesthesia
Authors: Kaya M. , Öztürk İ. , Tuncel G. , Şenel G. Özalp , Eskiçirak H. , Kadioĝullari N.
Published: January 2019

The aim of this study was to compare the clinical effects and characteristics of hyperbaric and hypobaric levobupivacaine for unilateral spinal anaesthesia. Sixty patients were randomly allocated into two groups to receive either 7.5 mg (1.5 ml) hyperbaric levobupivacaine 0.5% or 7.5 mg (4 ml) hypobaric levobupivacaine 0.1875% for elective arthroscopic surgery of the knee under spinal anaesthesia. The level and duration of sensory block, intensity and duration of motor block were recorded.

Unilateral sensory block was observed in 27 patients (90%) in the hyperbaric group and 24 patients (80%) in the hypobaric group in the lateral position. After 15 minutes, patients were turned to supine to redistribute the spinal block toward the non-operative side, but spinal anaesthesia was still unilateral in 18 patients (60%) in the hyperbaric group and 10 patients (33%) in the hypobaric group (P=0.038). Time to readiness for home discharge and complete recovery of sensory block were similar in both groups. In the hyperbaric group, the motor block scores were higher on the operative side during first 10 minutes than they were in the hypobaric group (P <0.002). Motor block regression was faster in the hyperbaric group (P=0.01). Hyperbaric and hypobaric levobupivacaine both provided satisfactory unilateral spinal anaesthesia with good haemodynamic stability for arthroscopic surgery, but with more frequent unilateral spinal anaesthesia in the hyperbaric group.
Vocal Cords-Carina Distance in Anaesthetised Caucasian Adults and its Clinical Implications for Tracheal Intubation
Authors: Pang G. , Edwards M. J. , Greenland K. B.
Published: January 2019

Previous work has assessed vocal cords-carina distance in Chinese patients and compared it to commonly used tracheal tubes. In addition, an attempt was made to identify surface anatomy measurements with short tracheas. We have examined the length of tracheas in Caucasian patients and compared it with currently used tracheal tubes. We have investigated a wider range of surface anatomy measurements in an attempt to correlate measurements with vocal cords-carina distance and identifying patients who may be at risk of endobronchial intubation. In this study, the vocal cords-carina distance was measured in 150 anaesthetised Caucasian patients with a fibreoptic bronchoscope. We also attempted to correlate height and various surface anatomy measurements on the patients’ chest, neck and limb regions to predict those patients at risk of endobronchial intubation. The mean vocal cords-carina distance was 12.7 cm (standard deviation 1.6 cm). The best predictors in our study of vocal cords-carina distance less than 11.3 cm were a height of ≤182 cm, an ulnar length of ≤31.2 cm or a thyroid to xiphisternum distance of ≤31.8 cm. This correlation is poor however, and prediction of vocal cords-carina distance remains difficult clinically. It was therefore concluded that surface anatomy measurements are a poor predictor of vocal cords-carina distance.
Influence of Leg Position on the Depth and Sonographic Appearance of the Sciatic Nerve in Volunteers
Authors: Quah V. Y. , Hocking G. , Froehlich K.
Published: January 2019

We investigated the effect of leg position on the depth of the sciatic nerve and quality of ultrasound images taken at the proximal and mid-thigh level. Twenty-one volunteers with average body mass index were recruited to represent the younger population receiving sciatic nerve blocks for sports injury surgery. The volunteers were placed in the lateral position, with the hip flexed and with the hip in a neutral (extended) position. A single operator imaged the uppermost leg and the best images of the sciatic nerve at the proximal and mid-thigh level were saved. Sciatic nerve depth was measured at each level. Eleven clinicians experienced in ultrasound-guided regional anaesthesia assessed the paired images. In the proximal thigh, the sciatic nerve depth was greater with the hip flexed compared to the neutral position (median 30 vs 23 mm, P=0.0002). There was no consistent difference in the mid-thigh. More clinicians favoured the proximal sciatic image with the leg in the neutral position. Although statistically significant, the depth difference is probably not a major clinical consideration in most patients with an average body mass index. We suggest clinicians place the leg in the most ergonomically favourable position when performing sciatic nerve blocks in the proximal thigh in these patients.
A Comparison of Electronic and Handwritten Anaesthetic Records for Completeness of Information
Authors: Wrightson W. A. G.
Published: January 2019

Complete documentation in anaesthetic records is important for patient management, research and quality assurance and has medicolegal implications. This study compares the completeness of information contained in electronic versus handwritten intraoperative anaesthetic records.

A sample of 70 handwritten records was randomly selected from anaesthesia performed in the month prior to implementation of the Integrated Injectable Drug Administration and Automated Anaesthesia Record System and compared to a similar sample of electronic records generated eight months later. A comprehensive scoring system, based on the Australian and New Zealand College of Anaesthetists’ guideline PS6, was used to compare the completeness of information throughout the entire intraoperative record.

There was no significant difference in the total score for completeness between electronic (78%) and handwritten (83%) records (P=0.16). Handwritten records were more complete with respect to weight (P <0.0001), American Society of Anesthesiologists’ physical status score (P <0.0001), the size and type of artificial airway used (P=0.003) and a record of the surgeons involved (P=0.0004). Electronic records were more complete with respect to a record of drug administration including intravenous drugs (P <0.0001), vapour (P=0.0001) and nitrous oxide/oxygen (P <0.0001), a record of end-tidal carbon dioxide monitoring (P=0.006) and the level of trainee supervision (P=0.0002).

There was no overall difference in the completeness of electronic versus handwritten records. Several differences did exist however, highlighting both clinically important advantages and deficiencies in the electronic system. Records from both systems sometimes lacked important information.
The Interpretation of Perioperative Lactate Abnormalities in Patients Undergoing Cardiac Surgery
Authors: O'Connor E. , Fraser J. F.
Published: January 2019

Hyperlactataemia and lactic acidosis are commonly encountered during and after cardiac surgery. Perioperative lactate production increases in the myocardium, skeletal muscle, lungs and in the splanchnic circulation during cardiopulmonary bypass. Hyperlactataemia has a bimodal distribution in the perioperative period. An early increase in lactate levels, arising intraoperatively or soon after intensive care unit admission, is a familiar and concerning finding for most clinicians. It is highly suggestive of tissue ischaemia and is associated with a prolonged intensive care unit stay, a prolonged requirement for respiratory and cardiovascular support and increased postoperative mortality. Its presence should prompt a thorough search for potential causes of tissue hypoxia. In contrast, late-onset hyperlactataemia, a less well recognised complication, occurs 4 to 24 hours after completion of surgery and is typically associated with preserved cardiac output and oxygen delivery. Risk factors for late-onset hyperlactataemia include hyperglycaemia, long cardiopulmonary bypass time and elevated endogenous catecholamines. Although patients with this complication may have a longer duration of ventilation and intensive care unit length of stay than those with normolactataemia, an association with increased mortality has not been demonstrated. The discovery of late-onset hyperlactataemia should not delay the postoperative progress of an otherwise stable patient following cardiac surgery.
Accuracy of Recorded Body Temperature of Critically Ill Patients Related to Measurement Site: A Prospective Observational Study
Authors: Nonose Y. , Sato Y. , Kabayama H. , Arisawa A. , Onodera M. , Imanaka H. , Nishimura M.
Published: January 2019

Accurate measurement of body temperature is an important indicator of the status of critically ill patients and is therefore essential. While axillary temperature is not considered accurate, it is still the conventional method of measurement in Asian intensive care units. There is uncertainty about the accuracy of thermometers for the critically ill. We compared the accuracy and precision of bladder, axillary and tympanic temperature measurements in critically ill patients.

A total of 73 critically ill patients admitted to the intensive care unit of a teaching hospital were prospectively enrolled. Every four hours, we measured body temperature at three sites (bladder, axillary and tympanic). If the patient had received an indwelling pulmonary artery catheter, blood temperature was also recorded and this was compared with bladder, axillary and tympanic temperature readings. For all patients, axillary and tympanic temperature readings were compared with bladder temperature readings. Accuracy and precision were analysed using Bland-Altman analysis.

When blood temperature data was available, the mean difference between blood and bladder temperature readings was small (0.02±0.21°C). Compared with bladder temperature, mean difference for axillary temperature was −0.33±0.55°C and for tympanic temperature it was −0.51±1.02°C.

For critically ill patients, recorded axillary temperature was closer to bladder temperature than tympanic temperature.
Contribution of Morphine and Morphine-6-Glucuronide to Respiratory Depression in a Child
Authors: Hannam J. A. , Anderson B. J.
Published: January 2019

A morphine plasma concentration/respiratory rate relationship has been described for both adults and children although that of its metabolite, morphine-6-glucuronide, remains uncertain. We describe this relationship in a child with end-stage renal failure who received repeat morphine administration over two days. An EMAX model for additive morphine and morphine-6-glucuronide respiratory effects described respiratory rate better than models describing either alone. Failure to clear morphine-6-glucuronide renally led to respiratory depression episodes occurring later than those predicted by modelling morphine levels only. These findings support the use of alternative analgesics (e.g. fentanyl) that are cleared by non-renal pathways and have no active metabolites in patients with end-stage renal disease.
The Tyranny of Distance: Telemedicine for the Critically Ill in Rural Australia
Authors: Boots R. J. , Singh S. J. , Lipman J.
Published: January 2019

A case of severe sepsis with multi-organ failure needing complex support was deemed too ill for transfer to a major centre. Telemedicine allowed direct patient review, collaborative advice and collegial support with maintained healthcare standards while avoiding long distance transfer from his home and family.
A Pilot Study of Cerebral and Haemodynamic Physiological Changes during Sedation with Dexmedetomidine or Propofol in Patients with Acute Brain Injury
Authors: James M. L. , Olson D. M. , Graffagnino C.
Published: January 2019

Sedation for the mechanically-ventilated, brain-injured patient remains challenging. The purpose of this pilot study was to compare the cerebral physiologic effects of sedation with propofol versus dexmedetomidine in mechanically-ventilated, brain-injured patients. Using a randomised, crossover, unblinded clinical trial, we enrolled patients with severe brain injury (Glasgow Coma Score ≤8) from traumatic injury, subarachnoid haemorrhage or intracerebral haemorrhage undergoing multimodal monitoring (intracranial pressure, brain temperature, oximetry and microdialysis). Patients received an infusion of either propofol or dexmedetomidine for six hours and then a crossover for the subsequent six hours after sufficient washout/in. Clinical and physiological measurements were recorded hourly. In eight patients, (four traumatic injury, three subarachnoid haemorrhage and one intracerebral haemorrhage), the mean dose of propofol used was 25.5 μg/kg/minute while the mean dose of dexmedetomidine was 0.54 μg/kg/hour. All subjects were effectively sedated to a goal of Richmond Agitation Sedation Scale −2 and Bispectral Index of 50-70 throughout the study period. We did not observe any statistically significant differences between the groups in systemic or cerebral physiologic metrics. Though differences were noted in cerebral metabolic substrates (lactate/pyruvate ratio), none were statistically significant. In our pilot cohort, dexmedetomidine and propofol appear equally effective in sedating severely brain-injured patients and neither is associated with adverse physiological effects as measured by multimodal monitoring. Larger long-term studies are required to determine whether clinically favourable benefits demonstrated in the medical critical care setting also apply to this patient population.
Audit of Co-Management and Critical Care Outreach for High Risk Postoperative Patients (The POST Audit)
Authors: Story D. A. , Shelton A. , Jones D. , Heland M. , Bellomo R.
Published: January 2019

Co-management and critical care outreach for high risk surgical patients have been proposed to decrease postoperative complications and mortality. We proposed that a clinical project with postoperative co-management and critical care outreach, the Post Operative Surveillance Team: (POST), would be associated with decreased hospital length of stay. We conducted a retrospective before (control group) and after (POST group) audit of this hospital program. POST was staffed for four months in 2010 by two intensive care nurses and two senior registrars who conducted daily ward rounds for the first five postoperative days on high risk patients undergoing inpatient general or urological surgery. The primary endpoint was length of hospital stay and secondary endpoints were Medical Emergency Team (MET) calls, cardiac arrests and in-hospital mortality. There were 194 patients in the POST group and 1,185 in the control group. The length of stay in the POST group, median nine days (Inter-quartile range [IQR]: 5 to 17 days), was longer than the control group, median seven days (IQR: 4 to 13 days): difference two days longer (95.0% confidence interval [95.0% CI]: 1 to 3 days longer, P <0.001). There were no important differences in the proportion of patients having MET calls (16.0% POST versus. 13% control ( P=0.25)) or mortality (2.1% POST versus 2.8% Control ( P=0.82)). Our audit found that the POST service was not associated with reduced length of stay. Models of co-management, different to POST, or with different performance metrics, could be tested.
Missed Carotid Artery Cannulation: A Line Crossed and Lessons Learnt
Authors: Ho L. , Spanger M. , Hayward P. , Mcnicol L. , Weinberg L.
Published: January 2019

We report a case of an infusion of intra-aortic propofol after the missed inadvertent placement of a centra venous catheter into the right common carotid artery. Radiological imaging revealed bilateral ischaemic infarct in the posterior fossa and right cerebral artery territories consistent with an embolic source. The potential cause of the neurological injuries sustained in this case are explored. Discussion focuses on the sequelae, managemen and prevention of an iatrogenic carotid artery injury from a central venous catheter insertion. Finally, we propose an algorithm for management of iatrogenic carotid artery cannulation.
Cognitive Function, Quality of Life and Mental Health in Survivors of Out-of-Hospital Cardiac Arrest: A Review
Authors: Green C. R. , Botha J. A. , Tiruvoipati R.
Published: January 2019

There is growing interest in the long-term outcomes of patients surviving out-of-hospital cardiac arrest (OHCA). This paper aims to summarise the available literature on the long-term cognitive, health-related quality of life (QoL) and mental health outcomes of survivors of OHCA. Between 30 and 50% of survivors of OHCA experience cognitive deficits for up to several years post-discharge. Deficits of attention, declarative memory, executive function, visuospatial abilities and verbal fluency are commonly reported. Survivors of OHCA appear to report high rates of mental illness, with up to 61% experiencing anxiety, 45% experiencing depression and 27% experiencing post-traumatic stress. Fatigue appears to be a commonly reported long-term outcome for survivors of OHCA. Investigations of long-term QoL for these patients have produced mixed findings. Carers of survivors of OHCA report high rates of depression, anxiety and post-traumatic stress, with insufficient social and financial support. The heterogeneous range of instruments used to assess cognitive function and QoL prevent any clear conclusions being drawn from the available literature. The potential biases inherent in this patient population and the interaction between QoL, cognitive performance and mental health warrant further investigation, as does the role of post-discharge support services in improving long-term patient outcomes.
Wrong Gas Connections
Authors: Hood John W.
Published: January 2019

Gas-driven ventilators are being increasingly used in anaesthesia. Industrial type fittings are commonly used at various points in the gas lines that drive these ventilators. These fittings do not have the Pin Index or the Diameter Index. They allow the possibility of the oxygen hose connected to a Boyle apparatus accidentally supplying a gas other than oxygen.

These potentially dangerous fittings are discussed, methods of modifying them suggested, and a new alternative adaptor described.
A Chair of Anaesthesia
Authors: Pollard Brian J.
Published: January 2019

Some of the requirements of comfortable seating are discussed. A chair for use by anaesthetists in the operating room is described which fulfils most of the criteria of good seating.
Prolonged Apnoea Due to Suxamethonium in Chinese
Authors: Chan C. S. , Robinson J. D. , Lam K. T.
Published: January 2019

A Chinese patient was hypersensitive to a therapeutic dose of suxamethonium because of a genetically determined quantitative and qualitative abnormality of plasma pseudocholinesterase.
The Fat Embolism Syndrome Treated with Oxygen, Diuretics, Sodium Restriction and Spontaneous Ventilation
Authors: Worthley L. I. G. , Fisher M. McD.
Published: January 2019

The fat embolism syndrome is a self limiting disease with its mortality related to the degree of respiratory failure. Treatment therefore is directed at maintaining satisfactory pulmonary gas exchange throughout the course of the disease.

In 28 consecutive patients diagnosed with fat embolism syndrome and severe respiratory failure, therapy consisted of oxygen, diuretics, sodium restriction and a trial of spontaneous ventilation. There was no mortality.
Femoral Nerve Block — the Anatomical Basis for a Single Injection Technique
Authors: Khoo S. T. , Brown T. C. K.
Published: January 2019

A technique for blocking the femoral nerve using a single needle placement is described. It depends on an appreciation of the anatomy and the need to feel loss of resistance twice as two fascial layers are penetrated during insertion of the needle just lateral to the femoral artery. A single injection of bupivacaine 0.35-0.5 per cent of at least 0.3 ml/kg will produce a satisfactory block.
The Introduction of Local Anaesthesia in Australia, January 19, 1885
Authors: Wilson Gwenifer C. M.
Published: January 2019

Medical journals in Australia between 1856 and 1884 were wont to publish many references to forms of local anaesthesia, probably because this form of pain relief was of assistance to lone practitioners in isolated country towns. Some of these methods are described, as is the first use of cocaine by A. S. Gray and J. T. Rudall on January 19, 1885. As in journals elsewhere there followed a spate of articles reporting various aspects of cocaine and its usage, including an abortive attempt to find an alternative agent.
Perioperative Management of Neonatal Aortic Isthmic Coarctation
Authors: Jones R. D. M. , Duncan A. E. , Mee R. B. B.
Published: January 2019

Aortic isthmic coarctation is a common cardiovascular cause of neonatal mortality. This study reviews retrospectively sixty-one consecutive neonates operated on for this condition at the Royal Children's Hospital, Melbourne, in the years 1978-1983 inclusive. In this series, the overall mortality has fallen from 50% and 67% in 1978 and 1979 respectively, to 11% in 1983. In the last three years of this review, there have been no early hospital deaths and the late deaths relate to associated congenital anomalies.

The decrease in mortality is ascribed to methods of perioperative support, non-invasive cardiac investigation, and surgical repair with subclavian aortoplasty. Prior to surgery, all infants are paralysed, mechanically ventilated and infused with prostaglandin E1 to reopen the ductus arteriosus, and dopamine to support the failing myocardium. The physical status of all infants improved with these maneouvres. This paper reviews the pathophysiology of neonatal aortic coarctation, the current modes of management, results and complications.
New Generation Ventilators
Authors: Bersten A. D. , Skowronski G. A. , Oh T. E.
Published: January 2019

Desirable features of new generation intensive care ventilators include the ability to ventilate a wide range of patient sizes, an uncomplicated control panel, an appropriate but not excessive variety of ventilatory patterns, adequate patient monitoring and alarm functions, and simplicity of cleaning and routine maintenance. Examples of currently available ventilators include the Servo 900-C, CPU-1, Engstrom Erica, Bear 5, Drager EV-A and Hamilton Veolar.

The incorporation of microcomputer control into some of these ventilators has resulted in improved flexibility and a limited number of automatic responses to detected patient changes. However, the function of components provided to allow spontaneous ventilation, such as demand valves, requires considerable improvement.

Current trends in ventilator design include further refinement of computer control and the provision of graphic displays showing the results of continuous sophisticated analysis of respiratory function. The extent to which these developments will prove clinically useful will require careful evaluation.
Narcotic Pharmacokinetics and Dynamics: The Basis of Infusion Applications
Authors: Stanski D. R.
Published: January 2019

Morphine, pethidine and fentanyl have similar pharmacokinetic profiles with moderately long elimination half-lives (3 to 4 hours), large steady-state volumes of distribution (2 to 4 l/kg), and high hepatic clearances (10 to 20 ml/kg/min). Alfentanil has a shorter terminal elimination half-life (1 1/2 hours) because of a decreased steady-state volume of distribution (0.5 to 1 l/kg). Physicochemical properties and blood: brain tissue solubility can explain the clinical differences in the rate of onset and dissipation of narcotic effect for these four narcotics. Morphine's low lipid solubility and limited rate of blood: brain barrier penetration results in the slow onset and dissipation of narcotic effect relative to pethidine or fentanyl. Alfentanil's lower blood: brain solubility results in the very rapid onset of narcotic effect when compared to fentanyl. All of the narcotics have a very steep blood concentration: narcotic effect curves. Thus, small changes of narcotic blood concentrations can have profound changes of narcotic effect. Finally, different degrees of perioperative stimuli result in different narcotic blood concentration requirements. Thus, narcotic infusion rates need be varied during surgical procedures to adjust for the varying opiate requirement.
In-Hospital Cardiopulmonary Resuscitation: Prospective Survey of Management and Outcome
Authors: Woog R. H. , Torzillo P. J.
Published: January 2019

A sixteen-month prospective survey of in-hospital cardiac arrests indicated that of 168 patients who received cardiopulmonary resuscitation, 27(16%) survived to leave hospital. Ninety-three per cent of these patients were ambulant and 81 % were able to care for themselves.

Poorest outcome was associated with initial rhythm of asystole, prolonged resuscitation and arrest in the Intensive Care Units.

When compared with recent and past literature, these figures suggest that the incidence of successful outcome for cardiopulmonary resuscitation in hospitals has not changed significantly over the past twenty years.
Core-Peripheral Temperature Gradient Does Not Predict Cardiac Output or Systemic Vascular Resistance in Children
Authors: Butt W. , Shann F.
Published: January 2019

We prospectively measured toe temperature, rectal temperature, systemic arterial pressure and cardiac output on two occasions one hour apart in 136 children who had had phenoxybenzamine after cardiac surgery while on cardiopulmonary bypass. Repeated measures analysis showed that there was no significant correlation between the change in temperature gradient over one hour in each patient and the change in cardiac index (r = 0.03, P > 0.1) or systemic vascular resistance (r = 0.007, P > 0.1). Although the peripheral temperature (toe temperature), and the core-peripheral temperature difference are simple, safe and inexpensive to measure in the population studied, they did not provide any guide to either cardiac output or systemic vascular resistance.
Haemodynamic Effects of Ketanserin following Coronary Artery Bypass Grafting
Authors: Lee E. J. E. , Lee T. L. , Woo M. , Boey W. K. , Kumar A. , Lee C. N.
Published: January 2019

The haemodynamic effects of ketanserin were studied consecutively in seventeen patients in the intensive care unit following coronary artery bypass grafting. Hypertensive patients (Group 1, systolic blood pressure (SBP) ≥ 150 mmHg following discontinuation of nitroprusside, n = 10) received intravenous ketanserin 10 mg and infusion of 0.1 mg.kg−1.hr−1 with additional boluses as required to maintain SBP ≤ 130 mmHg for one hour. Non-hypertensive patients (Group 2, SBP < 150 mmHg, n = 7) received a 5 mg bolus and the same infusion. Ketanserin significantly decreased arterial blood pressure (P < 0.001) in all patients in Group 1. Heart rate was decreased but not significantly. Cardiac index, systemic and pulmonary vascular resistance and pulmonary shunt fraction were not significantly altered from pre-ketanserin values when blood pressure was controlled with nitroprusside. Normotensive patients in Group 2 did not show any undesirable hypotension or significant haemodynamic changes. Mean nitroprusside dose requirements following ketanserin therapy were significantly reduced by 91.6% in Group 1 and 78.4% in Group 2 (P < 0.05). Ketanserin is effective in treating hypertension following coronary artery bypass grafting with an advantage of lack of reflex tachycardia.
Does Propofol Have an Anti-Emetic Effect? A Prospective Study of the Anti-Emetic Effect of Propofol following Laparoscopy
Authors: Campbell N. N. , Thomas A. D.
Published: January 2019

In order to investigate the putative anti-emetic effect of propofol, 53 patients undergoing gynaecological laparoscopy were given a standard anaesthetic including induction with thiopentone. At the end of surgery, the patients received either a sub-anaesthetic does of propofol or an equivalent volume of normal saline. There was no difference in the incidence of nausea and vomiting between the propofol and control group. It is concluded that low-dose propofol does not have an anti-emetic effect.
The Functional Deadspace of Needle-free Injection Ports
Authors: Smart N. G.
Published: January 2019

This study examined six needle-free injection ports comprising three taps (Sorenson Intralock®, Top type L, Viggo Connecta®), a one-way valve (Braun RV 1000) and two cannulae with integral injection ports (Vasofix, Venflon® 2) with regard to deadspace, protection against blood spillage, and potential difficulties in use.

A conventional bung (Baxter), requiring needle use for drug administration, was included for comparison.

Where necessary, ports were combined with cannulae in order to simulate clinical practice and allow fair comparison with the Vasofix and Venflon cannulae. Total deadspace was then calculated by filling with normal saline and measuring weight increase. Deadspace (0.10 to 0.43 ml) varied with injection port type and cannula size. Such volumes can contain significant amounts of drug and may be hazardous if not flushed after injection. Only the Vasofix and Venflon Cannulae and the Braun RV1000 protected adequately against blood spillage. Costs varied widely (A$0.19 to A$2.20 excluding cannula). The Vasofix and Venflon 2 cannulae were found to be nearest the ideal.
Diclofenac in Combination with Opiate Infusion after Joint Replacement Surgery
Authors: Anderson S. K. , Shaikh B. A. Al
Published: January 2019

The effect of intramuscular diclofenac or placebo on analgesia obtained and on opiate and antiemetic requirements was observed in a randomised double-blind study of sixty patients receiving continuous intravenous papaveretum.

Those patients receiving diclofenac required less papaveretum (P = 0.001) than those receiving placebo. They also had lower visual analogue pain scores (VAS) at four hours (P < 0.05) and decreased requirement for antiemetics (P < 0.02). No gastrointestinal complications were observed in either group and blood loss did not differ significantly between the two.
Interpleural Bupivacaine Infusion Compared with Intravenous Pethidine Infusion after Cholecystectomy
Authors: Kastrissios H. , Mogg G. A. G. , Triggs E. J. , Higbie J. W.
Published: January 2019

Twenty-six cholecystectomy patients received either an interpleural infusion of bupivacaine (Group B, n = 12) or an intravenous infusion of pethidine (Group P, n = 14) for management of postoperative pain over a three-day period. Patients in Group P experienced a significantly (P < 0.05) greater incidence of total side-effects (146) than patients in Group B (66). Pain scores (VAS) and responses to a pain questionnaire were similar for both groups; however, within Group B improvement in mean VAS scores at rest with time were more sustained. Similar reductions in FEV, and FVC from preoperative values occurred for both groups, while for Group P there were significant (P < 0.05) changes in arterial blood gases (increase in Pco2, decrease in Po2) over two days postoperatively. Patients in Group P recorded longer times to passing flatus and unaided mobilisation (P < 0.05), and required a significantly greater number of additional medications (anti-emetics and analgesics) over the postoperative period (41 vs 29, P < 0.05).
Shoulder Manipulation to Facilitate Central Vein Catheterization from the External Jugular Vein
Authors: Sparks C. J. , McSKimming I. , George L.
Published: January 2019

Manipulation of the shoulder to facilitate passage of J-wires past the clavicle during external jugular vein catheterization was tested prospectively in 111 adult patients undergoing cardiac surgery. On 10 of 25 occasions when the wire would not pass into the thorax, manipulation of the shoulder then allowed the wire to pass.
Is Fentanyl Effective for Postoperative Analgesia in Day-Surgery?
Authors: Cade L. , Ross A. W.
Published: January 2019

Fentanyl is commonly used as an adjunct to general anaesthesia for day-surgery procedures. We have prospectively studied the effect of this practice on postoperative analgesia in 304 day-surgery patients, 164 undergoing termination of pregnancy and 140 having various other minor gynaecological procedures. Approximately half the patients received fentanyl, the mean dose being 50 mcg. Fentanyl given during anaesthesia had no effect during recovery on analgesic requirements or on nausea or vomiting in either pregnant or non-pregnant patients.
Comparison of Epidural and Intravenous Opioid Analgesia after Elective Caesarean Section
Authors: Cade L. , Ashley J. , Ross A. W.
Published: January 2019

Patient acceptance is a particularly relevant method of assessing currently employed epidural and intravenous techniques of opioid analgesia after elective caesarean section. We have prospectively studied 71 such patients, randomised postoperatively to receive epidural morphine, intravenous morphine or intravenous pethidine. When compared with either intravenous opioid, epidural morphine provided twofold better average or excellent analgesia with 30% less drowsiness but with about 50% more pruritus. In spite of this troublesome complication, more patients (83% vs 74%) preferred epidural to intravenous opioid analgesia.
A Double-Blind Randomised Trial Comparing Postoperative Analgesia after Perioperative Loading doses of Methadone or Morphine
Authors: Chui P. T. , Gin T.
Published: January 2019

This double-blind randomised study compared postoperative analgesia after a loading regimen of methadone or morphine in thirty women undergoing abdominal hysterectomy. Methadone or morphine, 0.25 mg.kg−1, was given intravenously at induction of anaesthesia with further increments in the recovery room for analgesia if required. The mean (SD) total doses of methadone and morphine required were 0.43 (0.13) mg.kg−1 and 0.45 (0.15) mg.kg−1 respectively. Patients in the methadone group had lower pain scores in the subsequent 48 hours (P < 0.001) and required less supplementary intramuscular opioids (P < 0.001). Ten patients in the methadone group did not request any further opioid analgesics while all patients in the morphine group made at least two requests for opioids. The overall postoperative course was remembered as less painful by patients in the methadone group (P < 0.001). There was no significant respiratory depression or excessive sedation in either group.
Chromobacterium Violaceum Septicaemia: The Intensive Care Management of Two Cases
Authors: Martin J. , Brimacombe J.
Published: January 2019

The first human infection with Chromobacterium violaceum was recorded in 1927,1 but since men mere have been about 33 cases reported worldwide, including two from Australia.2,3 Chr. violaceum occurs in the tropics and subtropics and is generally considered to be nonpathogenic, but infection can occur in patients who are immunosuppressed4 and it has a high mortality rate.3 This paper presents the intensive care management of two cases of Chr. violaceum infection occurring in Far North Queensland. The patients’ predisposition appears to have been malnourishment and alcohol abuse. The increased use of immunosuppressive drugs and the appearance of diseases such as acquired immune deficiency syndrome (AIDS) make it possible that we will see more of this condition in Australian intensive care units.
Estimation of Cardiac Output by Noninvasive Echocardiographic Techniques in the Critically Ill Subject
Authors: McLean A. S. , Needham A. , Stewart D. , Parkin R.
Published: January 2019

We evaluated the accuracy of cardiac output estimations by three transthoracic echocardiographic techniques in critically ill subjects. This study was a prospective comparison study carried out in a general intensive care unit of a teaching hospital. The subjects had a broad range of diagnoses including pulmonary embolus, cardiogenic shock, septic shock, Legionnaire's disease and perioperative myocardial infarction. All patients requiring pulmonary artery catheterization underwent echocardiographic cardiac assessment with comparison of findings to those obtained by thermodilution techniques. Nineteen studies on eighteen patients were performed, with cardiac output calculated by the two-chamber Simpson's, four-chamber Simpson's, and left ventricular outflow tract (LVOT) Doppler methods. Acceptable data was obtained in those patients without mitral regurgitation. There was good correlation between the thermodilution technique and Simpson's two-chamber method (r=0.91), but less so with the Simpson's four-chamber method (r=0.77). All studies were included in the LVOT Doppler method with a good correlation (r=0.94). A plot of differences between methods using the Bland and Altman statistical method indicated that only the LVOT Doppler method demonstrated acceptable agreement with a mean of 0.2 litres/minute, standard deviation of 0.82 litres/minute and 95% limits of agreement of –1.5 to +1.9 litres/minute.

We concluded that the LVOT Doppler method was the only one which demonstrated acceptable agreement between the thermodilution method and echocardiographic techniques in all critically ill patients studied.
History: An Early Anaesthetic in Papua New Guinea
Authors: Phillips G. D.
Published: January 2019

A search for information about early anaesthetics administered in Papua New Guinea has revealed that an ether or chloroform anaesthetic was given, probably for a retained placenta, at Port Hunter on December 9, 1880. The anaesthetist or anaesthetic assistant was the Reverend George Brown, a Wesleyan Methodist missionary.
Propofol-Thiopentone Admixture—Hypnotic Dose, Pain on Injection and Effect on Blood Pressure
Authors: Jones D. , Prankerd R. , Lang C. , Chilvers M. , Bignell S. , Short T.
Published: January 2019

This study examined some pharmacodynamic characteristics of two admixtures of propofol and thiopentone. Ninety unpremedicated ASA 1 or 2 patients were group-randomized to receive, in a double-blinded manner, one of the following mixtures for induction of anaesthesia: Group P50: propofol 1% 10ml/thiopentone 2.5% 10 ml; Group P75: propofol 1% 15 ml/thiopentone 2.5% 5 ml; Group P100: propofol 1% 20 ml/lignocaine 1% 4 ml. An additional 30 randomized but unblinded patients from the same patient cohort received thiopentone 2.5% to provide predictive dose data for groups P50 and P75. Haemodynamic data were collected pre- and post-induction.

The required induction dose of both mixtures of propofol and thiopentone found an additive rather than a synergistic interaction with no significant difference between predicted and observed dose. Thiopentone resulted in significantly more rapid induction of anaesthesia than propofol/lignocaine or propofol/thiopentone. The addition of thiopentone to propofol was found to be as efficacious as the mixing of lignocaine with propofol in reducing pain on injection. The fall in systolic blood pressure was significantly less in group P50 compared with groups P75 or P100.

Admixture of thiopentone with propofol results in an additive hypnotic effect, a reduction in pain of injection (comparable with addition of lignocaine) and a reduced hypotensive response compared to propofol injection alone during induction.
The Antiemetic and Dysphoric Effects of Droperidol in the Day Surgery Patient
Authors: Lim B. S. L. , Pavy T. J. G. , Lumsden G.
Published: January 2019

The incidence of side-effects of two doses of droperidol used as a prophylactic antiemetic were compared (10 vs 20 μg/kg). Two hundred and twenty-eight women for day case laparoscopy were recruited. Pain and nausea scores were collected in the recovery area and in the Day Surgery Unit prior to discharge. A telephone follow-up questionnaire was administered. Incidences of anxiety, restlessness and dysphoric reactions were similar in both groups (29.2% vs 29.0%). The incidence of postoperative vomiting varied from 4.4 to 7.7%. There were no significant differences between the two groups when nausea scores, incidences of vomiting and pain after discharge were compared. An unexpected finding was the significantly higher incidence of pain in the 10 μg/kg group. We conclude that there is no advantage in lowering the dose of droperidol below 20 fig/kg in this group of patients.
Patient Referral and Transportation to a Regional Tertiary ICU: Patient Demographics, Severity of Illness and Outcome Comparison with Non-Transported Patients
Authors: Flabouris A.
Published: January 2019

A descriptive analysis and comparison of critically ill transported patients with non-transported patients will assist in selecting the appropriate referral and transportation process and subsequent incorporation into the critical care services of receiving hospitals. A retrospective review of transported and non-transported patients admitted to the same Intensive Care Unit was conducted. Patient demographics, disease categories, source of admission to ICU, APACHE II scores, predicted and actual hospital mortality, hospital and ICU length of stay were examined. Of all ICU admissions, 16% were transported. Transported patients had a different case mix, significantly higher severity of illness measures, mortality and length of ICU stay. Observed mortality of transported patients with sepsis, gastrointestinal disease or bleeding, intracranial haemorrhage and post respiratory arrest was less than predicted whilst those with neurological disease, post cardiac arrest and overdose had a higher than predicted mortality.
A Survey of Australasian Obstetric Anaesthesia Audit
Authors: Smith S. J. , Cyna A. M. , Simmons S. W.
Published: January 2019

In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinical audit best practice, we carried out a postal survey of 69 Australasian anaesthetic departments covering an obstetric service. We asked about data being collected, specifically concerning the high risk obstetric patient, epidural analgesia and postoperative anaesthetic review. Examples of any data collection forms were requested. Of the 66 responses, 35 departments (53%) were not collecting any audit data. Twenty-six of the 31 departments (84%) performing obstetric anaesthesia audit responded to our follow-up telephone survey. Eighteen departments believed that there had been an improvement in patient care as a result of their audit and 13 felt that the benefits outweighed the costs involved. However, only six departments (9%) had performed an audit cycle. The importance of feedback to patients or hospital staff and the incidence of post dural puncture headache (PDPH) were cited by some as priorities for obstetric anaesthesia audit. There was however no consistency as to what data should be collected. Many responses suggested a perceived need to collect clinical data without knowing what to do with it. Our survey has highlighted confusion between three distinct objectives; a dataset for obstetric anaesthesia record keeping, data required for continuing patient management in hospital and, a specific minimal dataset for clinical audit purposes. We conclude that current Australasian obstetric anaesthesia audit strategies are inadequate to develop a minimal dataset for cost-effective clinical audit.
The Effect of Single Dose Intravenous Dexamethasone in Tonsillectomy in Children
Authors: Vosdoganis F. , Baines D. B.
Published: January 2019

A prospective, randomized, double-blinded, placebo-controlled clinical trial was conducted in 41 patients evaluating the effect of a single preoperative dose of intravenous dexamethasone on postoperative vomiting and pain in children undergoing elective tonsillectomy. Dexamethasone was found to significantly reduce the incidence of vomiting in the first 24 hours postoperatively (P=0.02), the time to first intake of solids (P=0.001), the need to administer a rescue antiemetic (P=0.005) and intravenous fluid therapy requirements (P=0.006) in the postoperative period. No significant difference was found between the dexamethasone and placebo groups in the time to first intake of fluids, pain scores or analgesic requirement postoperatively. These results indicate that dexamethasone substantially reduces morbidity after tonsillectomy in children.
Bacterial Contamination of Propofol in the Operating Theatre
Authors: Soong W. A. L.
Published: January 2019

There have been several reports of propofol becoming extrinsically contaminated with bacteria. These reports have usually related to infusions or delays in administration after the ampoule has been opened. This observational study was performed to examine bacterial contamination of propofol during usual practice in the operating theatres of a single large hospital group.

One hundred samples of propofol were collected and cultured. Samples were taken immediately after administration in cases where the delay between opening the ampoule and administration was at least 15 minutes. The samples were classified according to whether the propofol was kept in the ampoule or a syringe after opening the ampoule and whether the intended use was for a single patient or multiple patients. The time between opening the ampoule and administration was recorded.

There were three positive bacterial cultures. These samples all came from ampoules used for more than one patient, without the later dose (doses) being drawn into a syringe at the time the ampoule was opened. This common clinical practice, especially in paediatric anaesthesia, does not comply with the manufacturer's recommendations. The clinical significance of the bacterial contamination detected is not clear. It is recommended that propofol should be handled in an aseptic fashion and measures taken to minimize the risk of bacterial contamination.