bluuebunny/crossref_metadata_2025 huggingface dataset:
Applying the Cell-Based Coagulation Model in the Management of Critical Bleeding
Authors: Ho K. M. , Pavey W.
Published: January 2019

The cell-based coagulation model was proposed 15 years ago, yet has not been applied commonly in the management of critical bleeding. Nevertheless, this alternative model may better explain the physiological basis of current coagulation management during critical bleeding. In this article we describe the limitations of the traditional coagulation protein cascade and standard coagulation tests, and explain the potential advantages of applying the cell-based model in current coagulation management strategies. The cell-based coagulation model builds on the traditional coagulation model and explains many recent clinical observations and research findings related to critical bleeding unexplained by the traditional model, including the encouraging results of using empirical 1:1:1 fresh frozen plasma:platelets:red blood cells transfusion strategy, and the use of viscoelastic and platelet function tests in patients with critical bleeding. From a practical perspective, applying the cell-based coagulation model also explains why new direct oral anticoagulants are effective systemic anticoagulants even without affecting activated partial thromboplastin time or the International Normalized Ratio in a dose-related fashion. The cell-based coagulation model represents the most cohesive scientific framework on which we can understand and manage coagulation during critical bleeding.
A Pilot Study Using Preoperative Cerebral Tissue Oxygen Saturation to Stratify Cardiovascular Risk in Major Non-Cardiac Surgery
Authors: Wen S. Y. B. , Peng A. Z. Y. , Boyle S. , Cai S. , Pope L. , Tran M. T. , Short T. G. , Aneman A. , Jaeger M. , Chuan A.
Published: January 2019

This prospective pilot study evaluated whether low preoperative cerebral tissue oxygen saturation is associated with unfavourable outcomes after major elective non-cardiac surgery. Eighty-one patients over 60 years of age, American Society of Anesthesiologists physical status 3 or 4, were recruited. Resting cerebral tissue oxygen saturation was recorded on room air, and after oxygen supplementation, using cerebral oximetry. The primary outcome was 30-day major adverse event of combined mortality or severe morbidity, and the secondary outcome was 30-day new disability. Eleven patients (13.6%) suffered a major adverse event, and 28 patients (34.6%) experienced new disability. Room air cerebral tissue oxygen saturation was significantly different between patients who had a major adverse event, 67% (95% confidence interval [CI] 65–70) versus unaffected, 71% (95% CI 70–72; P=0.04). No statistical difference was found between patients for new disability (range 70%– 74%; P=0.73). Room air cerebral tissue oxygen saturation was significantly associated with major adverse events (odds ratio 1.36 (95% CI 1.03–1.79), P=0.03). Saturation levels ≤68% carried a positive likelihood ratio of 2.2 for death or severe morbidity, P=0.04. A definitive trial is required to confirm if cerebral oximetry can be used to stratify the cardiovascular risk of patients presenting for non-cardiac surgery.
Hospitals with Briefer than Average Lengths of Stays for Common Surgical Procedures Do Not Have Greater Odds of Either Re-Admission Or Use of Short-Term Care Facilities
Authors: Dexter F. , Epstein R. H. , Dexter E. U. , Lubarsky D. A. , Sun E. C.
Published: January 2019

We considered whether senior hospital managers and department chairs need to be concerned that small reductions in average hospital length of stay (LOS) may be associated with greater rates of re-admission, use of home health care, and/or transfers to short-term care facilities. The 2013 United States Nationwide Readmissions Database was used to study surgical Diagnosis Related Groups (DRG) with 1) national median LOS ≥3 days and 2) ≥10 hospitals in the database that each had ≥100 discharges for the DRG. Dependent variables were considered individually: 1) re-admission within 30 days of discharge, 2) discharge disposition to home health care, and/or 3) discharge disposition of transfer to short-term care facility (i.e., inpatient rehabilitation hospital or skilled nursing facility). While controlling for DRG, each one-day decrease in hospital median LOS was associated with an odds of re-admission nationwide of 0.95 (95% confidence interval [CI] 0.92–0.99; P=0.012), odds of disposition upon discharge being home care of 0.95 (95% CI 0.83–1.10; P=0.64), and odds of transfer to short-term care facility of 0.68 (95% CI 0.54–0.85; P=0.0008). Results were insensitive to the addition of patient-specific data. In the USA, patients at hospitals with briefer median LOS across multiple common surgical procedures did not have a greater risk for either hospital re-admission within 30 days of discharge or transfer to an inpatient rehabilitation hospital or a skilled nursing facility. The generalisable implication is that, across many surgical procedures, DRG-based financial incentives to shorten hospital stays seem not to influence post–acute care decisions.
Changes in Cerebral Oxygen Saturation and Haemoglobin Concentration during Paediatric Cardiac Surgery
Authors: Suemori T. , Horton S. B. , Bottrell S. , Skowno J. J. , Davidson A.
Published: January 2019

Although near-infrared spectroscopy (NIRS) enables bedside assessment of cerebral oxygenation, it provides little information on the cause of deoxygenation. The authors aimed to investigate the changes in cerebral oxygenation and haemoglobin concentration and their associations during paediatric cardiac surgery in order to elucidate the physiology underlying cerebral deoxygenation. An observational retrospective study on 399 patients who underwent paediatric cardiac surgery was conducted. With use of NIRS, cerebral oxygen saturation as expressed by tissue oxygen index (TOI) before and after surgery, concentration changes in oxygenated haemoglobin (Δ[HbO2]) and deoxygenated haemoglobin (Δ[HHb]) after surgery were studied as were the associations between these values and clinical variables. TOI decreased after surgery (preoperative versus postoperative value, 66.0% [56.9, 71.3] versus 63.2% [54.3, 69.4], median [25th, 75th percentile], P <0.001) and the decrease was greater in higher category groups in the Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1). [HHb] increased from its baseline (+1.74 μmol/l [-1.57, +5.84], P <0.001) and the increase was greater in higher risk category groups. On the contrary, there was no evidence for a change in [HbO2] (+0.45 μmol/l [-4.76, +5.30], P=0.42). Cerebral oxygen saturation decreased after paediatric cardiac surgery and the decrease was greater in patients of higher risk groups. The increase in [HHb] was considered to play a predominant role in the cerebral deoxygenation noted, in particular in higher RACHS-1 category groups.
Validation of a Difficult Endotracheal Intubation Simulator Designed for Use in Anaesthesia Training
Authors: Brettig S. , Shurgott M. , Quinn S. J. , Owen H.
Published: January 2019

There is a need for a validated endotracheal intubation trainer that has variable difficulty settings for the training and assessment of medical practitioners. In this study three anatomical modifications were retrofitted to a commercial manikin and then validated. These modifications included restricted movements of the mandible as well as changes to the upper incisors. A total of 130 participants comprising specialists, trainees and medical students volunteered for this study. Validity was tested using randomised between-groups comparison of the time taken to intubate the manikin on all settings. Overall, and at each setting, there was a significant difference between the times to intubation among the three levels of experience (P <0.001). Novices were more than 12 times more likely to fail than experts (odds ratio [OR] 12.4, 95% confidence intervals [CI] 3.8, 41.8, P <0.001). The median time to intubation for all three groups changed significantly between settings 1 (easiest) and 4 (most difficult), novice 18 seconds (CI 8.9, 27.1, P <0.001), intermediate 15 seconds (CI 6.5, 23.5, P=0.001), and expert 9 seconds (CI 0.4, 17.6, P=0.04). The novice group was significantly different from the expert group at all attempts (P <0.002), and from the intermediates at all attempts apart from the third (P=0.055). The time for the novice and intermediate groups improved significantly by the fourth attempt, novice 15 seconds (CI 5.4, 24.6, P=0.002) and intermediate 10 seconds (CI 1.0, 19.0, P=0.03). Other aspects of validity were also satisfied during this study. A high degree of validity was established for these modifications, which can be retrofitted to an existing manikin and then used for teaching or assessment.
Cardiopulmonary Resuscitation—From the Patient'S Perspective
Authors: Wee S. , Chang Z. Y. , Lau Y. H. , Wong Y. K. Y. , Ong C. Y. M.
Published: January 2019

With increasing emphasis on patient autonomy, patients are encouraged to be more involved in end-of-life issues, including the use of extraordinary efforts to prolong their lives. Being able to make anticipatory decisions is seen to promote autonomy, empower patients and optimise patient care. To facilitate shared decision-making, patients need to have a clear and accurate understanding of cardiopulmonary resuscitation (CPR). This study aims to understand the knowledge and perspectives of the local community regarding resuscitation options and end-of-life decision-making and to explore ways to improve the quality of end-of-life discussions. An interviewer-administered survey was conducted with a prospectively recruited group of surgical patients admitted postoperatively to the day surgery ward of a single tertiary institution in Singapore from April to May 2015. The survey, modelled after two validated questionnaires, measured patients’ knowledge, attitudes and preferences regarding CPR in a series of 18 questions. Fifty-one out of 67 (76.1%) patients completed the survey. Results indicated that 80.4% (n=41) of participants correctly understood the purpose of CPR, but 64.7% (n=33) did not know of any possible complications of CPR. Less than half (n=21, 41.2%) of participants had thought about life support measures they wanted for themselves. Most of the participants agreed that they should personally be involved in making end-of-life decisions (n=44, 86.3%). Many patients had a poor knowledge of CPR and other resuscitation measures and the majority overestimated the success rate of CPR. However, a majority were receptive to improving their knowledge and keen to discuss end-of-life issues with physicians.
A Snapshot of the Oxygenation of Mechanically Ventilated Patients in One Australian Intensive Care Unit
Authors: Dennis D. , Torre L. , Baker S. , Hebden-Todd T.
Published: January 2019

Hyperoxaemia in patients undergoing mechanical ventilation (MV) has been found to be an independent predictor of worse outcome and in-hospital mortality in some conditions. Data suggests that a fraction of inspired oxygen (FiO2) of 0.4 or lower may produce hyperoxaemia although it is commonly accepted without adjustment in ventilator settings. The primary aim of this study was to observe current practice at one Australian tertiary intensive care unit (ICU) with regard to prescription and titration of oxygen (O2) in patients undergoing MV, in particular whether they received higher FiO2 than required according to arterial blood gas (ABG) results, and whether there was FiO2 titration as a response to initial ABG results during the 12 hours following. A retrospective observational study of 151 ICU patients undergoing MV between November 2013 and February 2014 was conducted, with ABGs as the primary outcome measure. There were 250 ABG measures, with mean FiO2 0.38 (range 0.3–1.0) and mean PaO2 114 mmHg (standard deviation 36). Over all observations, 197 (79%) were of FiO2 ≤0.4, however no patients were ventilated on room air (FiO2 0.21) and 114 (46%) were in the hyperoxaemic range. Oxygen titration (up or down) occurred in 31% of patients. Morning ABGs were taken at a time suggested by ICU guidelines, and on review of these measures, the mean FiO2 was lower than that purported to create toxicity. Subsequently, almost one-third of the cohort had their FiO2 titrated, however there was a floor effect whereby 39%–43% of the cohort received an FiO2 of 0.3.
A Survey of Australian and New Zealand Anaesthetists’ Attitudes towards Resuscitation Orders in the Perioperative Setting
Authors: Keon-Cohen Z. , Myles P. S. , Story D. A.
Published: January 2019

Not for resuscitation (NFR) orders are often suspended during anaesthesia, as perioperative care is believed to inherently involve the need for resuscitation including ventilation support. Recent legislative changes in Australia, New Zealand and the UK have enacted the binding nature of advance care directives (ACDs) in healthcare. National guidelines regarding codes of practice and government strategic plans for implementing advance care planning have reinforced the role for advance care planning in modern healthcare. We surveyed a random selection of Australian and New Zealand consultant and trainee anaesthetists to assess their attitudes towards NFR orders and ACDs in the perioperative setting. We received 290 of 790 distributed surveys (37% response rate). The majority (75%) of respondents reported their knowledge as very low, low, or moderate; 37% never or rarely were treating a patient who had an ACD. Over 90% reported that patient's wishes and understanding of ACDs is important and 89% agreed or strongly agreed that advance care planning should be a routine part of hospital admission for high risk patients. Despite this, only 45% of the respondents would always follow an ACD. Although the majority of respondents to this survey support their use in the perioperative setting, clarification of the specific applicability of ACDs to anaesthesia and their binding nature is required.
Airway Heat and Humidity during Endotracheal Intubation: II. Partial Rebreathing via a Circle Absorber System
Authors: Shanks Colin , Sara Charles
Published: January 2019

The airway heat and humidity levels in the intubated patient during anaesthesia employing the circle absorber system with gas spill have been investigated. The relationship of these to homeostasis of the whole body and to the tracheobronchial mucosa is discussed.
The Interaction of Pentazocine and Pethidine in Anaesthetized Man
Authors: Torda T. A. , McCulloch C. H. , Kelly A. J.
Published: January 2019

Pethidine 3 mg/kg and pentazocine 0·5 mg/kg or 2 mg/kg were administered to subjects anaesthetized with thiopentone, nitrous oxide and oxygen. Cardiovascular and respiratory effects were studied. Pethidine 1 mg/kg and pentazocine 0·5 mg/kg were approximately equidepressant. Pethidine 1 mg/kg prevented the depressant effects of subsequently administered pentazocine. Pentazocine 2 mg/kg protected from the effects of pethidine, but pentazocine 0·5 mg gave only partial protection. Further work is necessary to delineate the interaction of pentazocine with the narcotic analgesics, particularly with reference to the analgesic effects.
Anaesthesia for Oesophagoscopy in a Child with Epidermolysis Bullosa—A Case Report
Authors: Fisk G. C. , Kern I. B.
Published: January 2019

A child aged 13 months suffering from epidermolysis bullosa developed an upper oesophageal stricture. This required oesophagoscopy and dilatation. Anaesthesia was induced using oxygen and halothane, blown initially over the face, and then into a modified head box. Tracheal intubation was carried out using a P.V.C. tube without the aid of muscle relaxants.
Surgical Respiratory Failure
Authors: Morton A. P.
Published: January 2019

Some factors considered important in the development of respiratory failure in the surgical patient are reviewed. Management, with the emphasis on prevention, is outlined.
The Physiological Basis of Geriatric General Anaesthesia
Authors: Evans T. I.
Published: January 2019

There is a decline in most physiological functions with age, independent of disease. The effect of geriatric physiology on anaesthetic drug administration is briefly reviewed.
Cardiac Output Measurements by Thermal Dilution in Anaesthesia and Intensive Care
Authors: Loughman James
Published: January 2019

Cardiac output measurements are rarely used in the evaluation of cardiovascular disorders encountered in anaesthesia and intensive care. The thermal dilution technique provides a practical method for its widespread introduction and only requires techniques already familiar to people working in this field. Adequate commercial equipment is now available in Australia, and a consideration of its use is presented. The principle of indicator dilution and its application is described. A comparison is made of dye and thermal dilution, and the relative advantages of two catheter systems for use in thermal dilution are discussed. The reported complications and those experienced by us are presented.
Awareness and Dreaming during Anaesthesia in a Paediatric Hospital
Authors: McKie B. D. , Thorp E. A.
Published: January 2019

Most studies of awareness and dreaming during general anaesthesia exclude children because of uncertainty of accurate communication, but the authors consider that, with care and patience, children over about 7 years of age can give sensible and useful information. A prospective study was carried out in which 202 patients aged between 7 and 14 years undergoing general anaesthesia for a wide range of surgical procedures were interviewed post-operatively, and a questionnaire was sent to the parents approximately one month after discharge from the hospital. Twenty-two patients (11 per cent) could recall what was either a dream or a factual event, and ten of these (5 per cent) were considered to be definite recall of factual events.
Symposium on Paediatric Anaesthesia and Intensive Care: Renal Physiology in Children
Authors: Roy L. P.
Published: January 2019

The human kidney may not reach functional maturity until the age of 18 months. In the preceding months there are limitations in response to such stresses as salt and water loading, acidosis and dehydration. It is seen that these limitations must not be taken out of context of the overall situation of health or disease and of actual solute load. Almost all drug dosages for children are calculated on the basis of body size, and it should be recalled that in the first months of life there exists relative renal insufficiency on the basis of body weight or surface area in comparison with older children and adults.

Precise physiologic data are necessary for completely successful management of the critically ill patient. It is seen from this review that not only are there gaps in our knowledge of developmental renal physiology, but also the process of development has introduced another variable into the evaluation of the individual patient.
Equipment for Inhalation Anaesthesia for Children
Authors: Fisk G. C.
Published: January 2019

The modified T-piece is the most commonly used system for inhalation anaesthesia for children in Australia. Its advantages are that it is light-weight and convenient, having low dead-space and resistance. Artificial humidification of gases is recommended to prevent drying of the trachea and to reduce heat loss in anaesthetized infants.

The advantages of standard tapers in 15 mm and 22 mm sizes are discussed. These are interchangeable with other resuscitation and anaesthetic equipment. The Rendell-Baker Soucek face-masks used with a divided mask mount have smaller dead-space than cushioned face-masks. Endotracheal tubes made from PVC are preferred for children, provided they meet implantation test standards. Standard gas machines and ventilators may be used for small children, although specially designed ventilators are available.
Bronchoscopy for Removal of Foreign Bodies in Children
Authors: Brown T. C. K.
Published: January 2019

The removal of foreign bodies is one of the main indications for bronchoscopy in children. One hundred and eight foreign bodies were found at bronchoscopy in 123 children during the five years 1967–1971 at the Royal Children's Hospital. The majority were under three years of age, and the commonest foreign bodies were peanuts. The clinical features and diagnoses are discussed.

Various anaesthetic techniques available for bronchoscopy in children are reviewed with emphasis on inhalation agents, the use of gammahydroxybutyrate, and considerations in the use of the Venturi bronchoscopic attachment in children.
Aspects of Management of the Burned Child
Authors: Overton J. H. , Kilham H. A.
Published: January 2019

This paper presents some principles and practical aspects of the management of children with burn injuries.

Special problems of respiratory tract damage and later problems in fluid and electrolyte therapy are discussed.

Various difficulties for the anaesthetist are outlined and the authors’ methods in preoperative, intraoperative and postoperative management are detailed.
Congenital Hypertrophic Pyloric Stenosis the Anaesthetist's View
Authors: Steven I. M. , Allen T. H. , Sweeney D. B.
Published: January 2019

This paper briefly reviews 48 consecutive patients with congenital pyloric stenosis. Suggested management of these patients in the preoperative and postoperative period together with intraoperative management of anaesthesia is outlined.

The importance of proper preoperative assessment and treatment of dehydration, metabolic alkalosis and electrolyte disturbances is emphasized.
Caudal Anaesthesia in Infants and Children
Authors: Lourey C. J. , McDonald I. H.
Published: January 2019

The combination of caudal analgesia and light general anaesthesia has been used in 290 lower abdominal and urogenital operations. The advantages of this type of anaesthesia in the paediatric age group is discussed. The technique used by the authors at the Royal Children's Hospital, Melbourne, is described and the complications reviewed in the literature are outlined.
Malignant Subcutaneous Emphysema—A Case Report and Discussion
Authors: Williams J. G.
Published: January 2019

A case is described of gross subcutaneous emphysema progressing to acute respiratory obstruction. The case is assessed with reference to a short review of the literature and a plea is made for awareness of serious complications of an apparently benign condition.
Accidental Hypothermia: Report of a Case following Alcohol and Barbiturate Overdose
Authors: Day E. A. , Morgan E. B.
Published: January 2019

A case of accidental hypothermia due to overdose of alcohol and barbiturates combined with exposure to cold is described and management is discussed.
Towards a Better Classification of Lung Ventilators
Authors: Baker A. B. , Murray-Wilson A.
Published: January 2019

Previous classifications of lung ventilators are discussed with their attendant disadvantages. The need for a new classification is indicated, and a new classification proposed. This classification is based on flow control and force characteristics, together with the peak pressure achieved by the ventilator. Examples are used to illustrate the new classification.
A Complication of Alpha Methyldopa Therapy
Authors: Gillies Janice D.
Published: January 2019

A case is presented as a complication of long-term alpha methyldopa (“Aldomet”) therapy. The complication was the development of an antibody resulting in a positive direct Coombs reaction and consequent difficulty in cross-matching blood.
The pH and Hydrogen Ion Content of Stored A.C.D. Blood
Authors: Gaudry P. L. , Duffy C. , Joseph D.
Published: January 2019

The metabolic and respiratory components of the hydrogen ion content of A.C.D. blood was directly measured by in vitro titration at controlled partial pressures of carbon dioxide. Blood stored for periods of up to 20 days had a mean pH of 6·53. The mean metabolic hydrogen ion excess was 37 mEq/litre and the mean respiratory hydrogen ion excess (carbonic acid) was 98 mEq/litre. The pH and hydrogen ion excess were not significantly related to duration of storage. Both metabolic and respiratory acidosis may occur in recipients of these hydrogen ion loads. In addition, sodium citrate in A.C.D. solution is metabolized in vivo to sodium bicarbonate. Clinically, a variable state of acid-base imbalance may result from the transfusion of A.C.D. blood until homeostasis is restored by renal and respiratory excretion of the acid and base loads.
Measurement of the Cardiac Pre-Ejection Period as a Guide to the Therapy of Sympathetic Overactivity in Tetanus
Authors: Alfred E. E. , James O. F.
Published: January 2019

The measurement of the squared reciprocal of the cardiac pre-ejection period (= 1/PEP2 index) was used to assess cardiac performance in severe tetanus with sympathetic overactivity.

The measurement of the index and its clinical application in two patients is outlined and it is concluded that the index provided a valuable guide to therapy.

Because the measurement of 1/PEP2 is relatively non-invasive and simple it is suggested it may have a place in the management of other critically ill patients.
Tissue Reaction to Cuffed Tube Materials
Authors: Lam W. K. P. , Goss A. N. , McCleave D. J.
Published: January 2019

The tissue reactions to materials of the cuff of recently developed high volume, low pressure tracheostomy tubes were assessed by intra-abdominal and intra-nasal implantation in rats. Intra-abdominal implantation over a maximum of three months showed that the polyurethane and silicone was walled off by fibrous tissue and foreign body giant cells. The degree of giant cell reaction was similar to that seen about silk sutures. There was no evidence of hepatic or renal toxicity. Polyurethane foam also caused some inflammation and ulceration of nasal mucosa when it was implanted for six days. The degree of ulceration and inflammation was greater than that seen about an inert implant (cotton wool). Further, there was progression rather than reversal of these mucosal changes when the foam was removed. These findings are discussed and it is concluded that the demonstrated reactions of the tissues to the cuff material is acceptable when related to the clinical usage of these cuffed tubes.
Use of Ketamine Hydrochloride in the Treatment of Convulsions
Authors: Fisher M. McD.
Published: January 2019

Two children with convulsions refractory to conventional anticonvulsant therapy had their convulsions rapidly terminated on a number of occasions by intramuscular ketamine. The paradoxical ability of ketamine to cause and to terminate convulsions is discussed and some of the published findings are presented. It is suggested that ketamine is worthy of use in the treatment of convulsions.
Venomous Australian Creatures: The Action of their Toxins and the Care of the Envenomated Patient
Authors: Sutherland Struan K.
Published: January 2019

Potentially fatal bites and stings by Australian terrestrial and marine animals are relatively common, but with correct management of victims, death should be an infrequent occurrence. The known pharmacopathological actions of some of these venoms are enumerated and specific antidotes are described. In cases of certain venoms against which no “specific” treatment has yet been developed, an approach to management based upon clinical and experimental evidence is presented.
Self Poisoning with Dieldrin: A Case Report and Pharmacokinetic Discussion
Authors: Black A. M. S.
Published: January 2019

A 21-year-old man ingested 120 mg/Kg of technical dieldrin (hexachloro-epoxy-octahydrodimethano-naphthalene), and survived after mannitol catharsis and three days of vigorous anticonvulsive treatment (which included muscle paralysis), β sympathetic blockade and conventional supportive treatment. His progress has been followed for two months with EEG recording and measurements of serum and adipose tissue dieldrin levels. These data suggest that he may have absorbed only a fraction of the ingested dose.
Malignant Hyperthermia Caused by Salicylate Overdose Associated with Phenelzine Therapy—A Case Report
Authors: Havill J. H.
Published: January 2019

A patient was admitted following a self-administered salicylate overdose. She rapidly deteriorated and died in spite of resuscitative measures. Features of her death included hyperthermia convulsions, hypoxia, acidaemia, extreme muscular rigidity, a high serum creatine phosphokinase, hypocalcaemia, hyperphosphataemia, raised potassium, and increasingly abnormal coagulation parameters. The patient had been receiving phenelzine 45 mg daily but none was detected on analysis of gastric aspirate. Her serum salicylate level was extremely high (120 mg/100 ml).

Malignant hyperthermia, its association with monoamine oxidase inhibitors, and its possible relationship in this case to salicylate overdosage with acidaemia are discussed.
A Comparison of Two Heated Water-Bath Humidifiers
Authors: Shanks C. A. , Gibbs J. M.
Published: January 2019

The performance of two heated water-bath humidifiers was examined in terms of airway temperatures and humidities. These were the simple heated tank [Marshall and Spalding, 1953) and the Fisher and Paykel No. 328 (Spence and Melville, 1972), both of which had the potential to deliver gases at temperatures above 40°C, and with a moisture content in excess of 50 mg/litre. The major advantage of the No. 328 was its heating wire in the delivery tube. This lessened or prevented condensation within the tube, and allowed the water bath to be maintained at lower temperatures.

Independent heat controls for the water bath and the delivery tubing allow precision of humidities in the gases provided for inspiration through an artificial airway. When condensation is prevented, the temperature of the saturated gases leaving the humidifier limits the absolute humidity supplied. Monitoring and adjustment of airway temperature of the patient then allows selection of temperature and relative humidity in the inspired gas.
The Biomedical Engineer and the Doctor
Authors: Cass Noel
Published: January 2019

The appearance of engineers with special training in biology has occurred only in the past fifteen years, and the spectacular contributions they can make to patient care have been confined mainly to the years since solid-state electronic circuitry became available. It is timely to review the relationships between them and the clinicians, and to indicate the growing interdependence they have on each other.

The three points at which their interests converge most noticeably are: 1. in the collection, storage and display of data, 2. in the maintenance of electrical safety and the proper functioning of apparatus, and 3. in the design of electro-medical equipment.
The Biomedical Engineer in the Hospital
Authors: Johnston Glen S.
Published: January 2019

The role of the hospital biomedical engineer is described with reference to design and development of equipment and its maintenance, provision of a technical advisory service, and teaching.
End-Tidal Carbon Dioxide Levels in the Early Detection of Air Embolism
Authors: Pattison W. J.
Published: January 2019

Two cases of air embolism in patients anaesthetized in the sitting position are described. The emboli, though producing no signs and therefore probably small, were readily detected by the fall in the end tidal CO2 fraction. Techniques for the detection of air emboli are briefly reviewed.
Cholinesterase Reactivation: In Vitro Studies
Authors: Ganendran A. , Balabaskaran S.
Published: January 2019

In vitro studies confirm the clinical impression that P–2–AM does not reverse the cholinesterase inhibition caused by organophosphorus insecticides.
Choice of Anaesthetic Technique for Microsurgery of the Larynx
Authors: Cole W. H. J.
Published: January 2019

The methods available for anaesthesia for microsurgery of the larynx are briefly outlined. The relative merits of different techniques and the indications for selection of a particular method are outlined.
Elective Postoperative I.P.P.V. for Extensive Head and Neck Skin Grafting
Authors: Delilkan A. E. , Sivaloganathan V.
Published: January 2019

Patients with extensive skin-grafting of the head and neck are managed for the first 24–48 hours postoperatively in the Intensive Care Unit with muscle paralysis, controlled ventilation, timed parenteral analgesia and sedation. The aims are to provide full immobilization of the graft and to allow pressure dressings without embarrassment to the airway. The regime is suggested as an added indication for intensive care therapy.
Insertion of Central Venous Catheters through Arm Veins
Authors: Lumley Jean , Russell W. J.
Published: January 2019

The position of the tip of a central venous catheter inserted through an arm vein is not influenced by the arm or by the vein chosen. There may be some advantage in inserting the catheter with the arm at the patient's side, although there seems to be no benefit from turning the patient's head towards the side of insertion. Because the most common malposition from an apparently uneventful insertion is due to the catheter tip entering the internal jugular vein, neck compression has been established as a useful test. If the catheter tip is well into the internal jugular vein, compression on that side of the neck should cause a rise in the recorded pressure of 10 or more cm H2O. This rise should not occur on compression of the other side of the neck.

We wish to emphasize that it is important to confirm radiographically the position of the catheter tip.
Severe Drug Overdose: Results of Treatment
Authors: Morgan E. B.
Published: January 2019

The incidence and management of severe drug overdose patients over a five-year period is presented, together with results and complications. Emphasis is placed on the importance of conservative measures with minimal need for more aggressive methods of treatment.
Althesin in Shared Airway Anaesthesia
Authors: Delilkan A. E. , Yan Gracie Ong Siok
Published: January 2019

The anaesthetic management for surgical procedures involving the larynx and/or trachea and the problem of the shared airway are outlined. The use of intravenous Althesin on 31 patients (43 administrations) is described.

It is suggested that Althesin has a place in the management of these patients.
Severe Histamine Mediated Reactions to Intravenous Drugs Used in Anaesthesia
Authors: Fisher M. McD.
Published: January 2019

Severe histamine mediated reactions to intravenous drugs used in anaesthesia may occur as a result of anaphylactic and anaphylactoid reactions. The incidence is rare, but appears to be increasing. The difficulties in diagnosing such reactions and in determining the drug responsible and how these difficulties have led to confusion in the literature are discussed.

Six cases of severe histamine mediated reactions are presented and detailed analyses of the drugs in these and other reported reactions is made showing varied clinical patterns with different drugs. The prevention, treatment, and follow-up of severe histamine mediated reactions are considered.
Pre-operative Neutralization of Gastric Acidity
Authors: Hutchinson B. R. , Newson A. J.
Published: January 2019

The incidence of Mendelson's syndrome in the four major Auckland hospitals is reviewed. The frequency of this condition was reduced following the pre-operative administration of magnesium trisilicate mixture in two hospitals. A trial was conducted in a third hospital and this showed that a 52 per cent incidence of highly acid gastric juice (pH less than 2 · 5) in patients prepared for elective surgery was reduced by administration of magnesium trisilicate mixture at the time of premedication. When the magnesium trisilicate mixture was given within the 30 minutes prior to induction of anaesthesia, the number of patients with highly acid gastric content fell to one per cent.
New Zealand's First General Anaesthetic
Authors: Newson A. J.
Published: January 2019

The administration of New Zealand's first general anaesthetic took place at the Colonial Gaol, Wellington, on the morning of Monday, September 27th, 1847. The agent used was sulphuric ether which was administered by Mr. Marriot, the manufacturer of the Herapath-type inhaler used on this occasion. The operation, a dental extraction, was performed by the Colonial Surgeon, Dr. J. P. Fitzgerald.
Anaesthesia for Electroconvulsive Therapy
Authors: McCleave D. J. , Blakemore W. B.
Published: January 2019

The results of a prospective study of 3,500 Anaesthetics for electroconvulsive therapy is presented. Minimal differences were observed between thiopentone and methohexitone. Propanidid and Diazepam were found to be unsuitable induction agents. Other findings included minimal serum potassium elevation and a low incidence of post treatment muscle pains. The place of the single-handed operator and the place of unmodified electroconvulsive therapy is questioned as being unacceptable practice.
Thiopentone Anaphylaxis—Case Report
Authors: Brown T. P.
Published: January 2019

A case history is presented of a man who developed angioedema of his head and neck during anaesthesia for his 11th cystoscopy within four years. Thiopentone was always used to induce his general anaesthesia. An intradermal skin test with 1: 100 dilution of 2·5 per cent thiopentone was positive and subsequent anaesthesia without thiopentone was straightforward.
Accurate Volume Ventilation of Neonates with Maintenance of Humidification
Authors: Campbell D. I. , Shank C. A. , Flachs J. , Austin P.
Published: January 2019

A method is presented for producing adequate humidification and accurate volume ventilation of neonates. This was effected by pressurizing the humidifier and fresh gas flow up to the T-piece. By using a ventilator which acted as a timed occluder of the T-piece, the system functioned as an accurate flow generator. Its precision of ventilation was confirmed with a neonatal test lung.
The Geoffrey Kaye Museum Collection of Portable Ether Inhalers
Authors: Penn H. P.
Published: January 2019

A collection of twenty nine portable, “hold in hand” ether inhalers is housed in the Geoffrey Kaye Museum. These inhalers are briefly described together with some historical notes.
Reactions to Rapid Infusion of Stable Plasma Protein Solution during Large Volume Plasma Exchange
Authors: Isbister J. P. , Biggs J. C.
Published: January 2019

Five per cent heat treated stable plasma protein solution (SPPS) has been rapidly infused into 25 patients, as fluid replacement during large volume plasmapheresis. Reactions were produced in 20 patients. Subjective symptoms of flushing, nasal stuffiness, fullness and throbbing in the head, colicky abdominal pain, metallic taste or apprehension were observed in 16 patients, and 11 patients became hypotensive with an average systolic pressure of 70 mm Hg. These observations support earlier reports of hypotension due to rapid SPPS infusion, and document the occurrence of subjective symptoms which may be the harbingers of a hypotensive reaction. In view of the known presence of a bradykinin-like substance in some heat treated plasma protein solutions, hypotension during SPPS infusion should be interpreted with caution in the light of these findings.
Maternal Complications of Obstetric Epidural Analgesia
Authors: Holdcroft Anita , Morgan M.
Published: January 2019

The maternal complications associated with 1,000 consecutive obstetric epidurals are described. Although the analgesia provided was very satisfactory, complications were common. A dural puncture rate of 1·7 per cent resulted’ in 13 patients suffering from “spinal headache”. Blood vessel puncture occurred in 45 patients, while the presence of unblocked segments and unilateral block was troublesome. There were no serious sequelae, but it is suggested that the provision of an epidural service for women in labour requires the immediate availability of an experienced anaesthetist to attend the labour ward.
Pulmonary Water Content in Critical Illness
Authors: Morton A. , Mahoney P. , Wilkie W. , McCosker J. , Hansen P. , Bowen J. , Baker A. B.
Published: January 2019

Pulmonary extravascular water content was measured using a double indicator technique and results compared with chest radiography. It is concluded that careful chest radiography is an effective and simple technique for assessing the pulmonary extravascular water content.
Effect of Diazepam on Neuromuscular Transmission and its Interaction with Non-Depolarizing Muscle Relaxants
Authors: Jain P. D. , Pandey K. , De Manika
Published: January 2019

Neuromuscular blocking actions of diazepam and its interaction with some myoneural blocking agents were studied in dogs and in humans undergoing surgery under general anaesthesia. Diazepam alone had no effect on the response of tibialis anterior muscle to indirect stimulation in dogs. Again, diazepam in a bolus dose of 5 mg did not influence a pre-existing partial block by d-tubocurarine, gallamine or pancuronium. But a significant increase in both the degree and duration of block was observed when diazepam and d-tubocurarine were given simultaneously, suggesting an agonist action in diazepam. On the contrary, simultaneous use of diazepam and gallamine caused a significantly less intense block of tibialis muscle twitch tension as compared to gallamine alone, suggesting an antagonistic action. The degree and duration of block by d-tubocurarine were not affected significantly by simultaneous administration of diazepam in human beings. It is, therefore, concluded that diazepam in clinical doses can be safely used with d-tubocurarine in humans.
Constant Negative Pressure: An Adjunct in the Treatment of Gastroschisis
Authors: Roberts M. T. S. , Wiseman N. E.
Published: January 2019

Three cases of gastroschisis are described, managed surgically in the neonatal period by staged reduction employing a dacron reinforced silastic sac. All three cases were treated during the postoperative period with the application of constant negative pressure around the thorax and abdomen. Reduction of the eviscerated mass appeared to be accelerated and all three cases survived.

The possible benefits of constant negative pressure around the thorax and abdomen in the treatment of gastroschisis are discussed.
Cerebral Arteriovenous Oxygen Difference: A Bedside Test for Cerebral Death
Authors: Torda T. A.
Published: January 2019

A bedside test is described which compares the patients cerebral arterio-venous oxygen difference with a predicted norm at various levels of arterial CO2 tension. In patients in coma dépassé this difference is reduced and is unresponsive to variations in arterial carbon dioxide tension. The test also confirms lack of respiratory efforts in the presence of adequate carbon dioxide tension.
Case Report: Pheochromocytoma. Aspects of Management
Authors: Maddern P. J. , Davis N. J. , McGlew I. , Oh T.
Published: January 2019

The management of a patient with Pheochromocytoma is reported. Consideration of pre-operative preparation, hazards of beta-blocking agents in the absence of alpha blockade, potential hazards of butyrophenones, control of arterial blood pressure with sodium nitroprusside and the usefulness of continuous pulmonary artery wedge pressure monitoring are discussed.
A Disconnection Alarm for the Bennett BA–4 Ventilator
Authors: Overton J. H. , Miceli R. M.
Published: January 2019

A simple warning device is described to attach to a Bennett BA–4 Ventilator. It has proved reliable in practice when the ventilator is operated on pressure limit.
Preoperative Haemoglobin Levels
Authors: Rawstron R. E.
Published: January 2019

It is a common practice in many anaesthetic centres throughout the world to require a minimum preoperative haemoglobin level of 10g/100 ml of blood or more, but very few references are quoted by writers on this subject. A search of relevant medical literature has been made in an attempt to establish the origin and significance of the preoperative haemoglobin requirements recommended.
Use of an Automated Register in the Administration of an Operating Theatre Suite
Authors: Mather B. Sherwood
Published: January 2019

Slight modification of established recording practices is frequently all that is necessary to enable a computer to be used as a powerful and flexible administrative tool. The organization of an automated data processing system in a hospital operating theatre suite is outlined and discussed.
Clinical Evaluation of Etidocaine in Continuous Caudal Analgesia for Pelvic Floor Repair and Post-Operative Pain Relief
Authors: Seow L. T. , Chiu H. H. , Tye C. Y.
Published: January 2019

A randomized double-blind trial compared 1·0% etidocaine and 1·5% lignocaine (both with 1/200,000 adrenaline), for caudal anaesthesia for pelvic floor repair. Etidocaine was highly effective for the surgical procedure, with rapid onset of action, adequate muscle relaxation and longer duration of action. Its use for post-operative analgesia may be hindered by the concomitant immobilization of the legs. The problem of tachyphylaxis with etidocaine needs further investigation.
Bronchospasm Associated with Enflurane Exposure—Three Case Reports
Authors: Lowry C. J. , Fielden B. P.
Published: January 2019

Three cases of severe bronchospasm occurring in known asthmatics following the administration of enflurance are described. Other commonly known causes of bronchospasm did not seem to be operative. Moderately high concentrations of halothane in the respired gases protected against the bronchospasm whereas a moderately high blood concentration did not. Although the authors have administered enflurane to other known asthmatics without producing bronchospasm, they feel it should be used with caution in such patients.
Intercostal Block for Post Operative Pain Relief
Authors: Cronin K. D. , Davies M. J.
Published: January 2019

Intercostal nerve blocks with 0·5 per cent bupivicaine were used for post operative pain relief in 100 patients having upper abdominal operations. The blocks were very effective in 86 patients and had an average duration of 11 hours. Two asymptomatic pneumothoraces occurred.
Aims and Objectives for Postgraduate Learning in Anaesthesia
Authors: Fisk G. C. , Harrison G. A.
Published: January 2019

This paper describes the statement of aims and objectives of postgraduate training for the Faculty of Anaesthetists of the Royal Australasian College of Surgeons. The objectives of the authors are that after study of this paper, the readers will:

( a) Understand the importance of both “stated “and “informal “objectives in teaching and learning.

( b) Understand the important terms used in the Faculty of Anaesthetists’ Document on Objectives.

( c) Know the strategies used in writing the Faculty's Document on Objectives.
The Role of Formal Courses in the Vocational Training of Anaesthetists
Authors: Harrison G. A.
Published: January 2019

Some of the factors which influence the conduct and the effectiveness of formal courses are discussed. It is considered that the needs and the aims of the trainees and teachers are especially relevant, but sometimes a difference in priorities exists. It is suggested that there should be careful definition of the needs to be satisfied by the formal course and that the educational body conducting the course and the geographical location of the course should be based on those needs. The role of the course supervisor in the organizer-teacher-trainee communication system is especially important.
Organizing an Educational Exercise
Authors: Paull John D.
Published: January 2019

The satisfactory organization of an educational exercise is dependent on the organizer having a precise understanding of the needs of his students, their present level of knowledge and understanding, the motives which govern their will to learn, and on the organizer's ability to draw together people with intellectual resources capable of satisfying those needs of the students. Both students and tutors must be placed in an environment which encourages communication and interaction and adequate physical resources for teaching must be provided.