bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association between Sedation Practices and Duration of Mechanical Ventilation in Intensive Care
Authors: Jarman A. M. , Duke G. J. , Reade M. C. , Casamento A. 
Published: January 2019

Choice of sedation agent may influence duration of mechanical ventilation in the intensive care unit (ICU). We conducted a retrospective observational analysis of 2102 consecutive mechanically ventilated ICU patients over an eight-year period at a Melbourne metropolitan hospital with a ten-bed general ICU to determine if propofol was associated with shorter duration of mechanical ventilation (MV) than midazolam. Data were extracted from the hospital administrative database, pharmacy supply order records and ICU database, to calculate rates of MV and tracheostomy, length-of-stay, propofol and midazolam infusion doses, illness severity and casemix and use of ‘sedation scores’ and ‘sedation break’ respectively. The primary end-points were duration of MV, tracheostomy rate and hospital outcome. Negative binomial regression and logistic regression were used to identify temporal trends. From 1 July 2002 to 30 June 2010 there were 5751 ICU admissions including 2102 (36.6%) with MV. Over this period there was a 70% decline in annual midazolam use and a greater than fivefold rise in propofol use. ‘Sedation scoring’ and ‘sedation break’ procedures were introduced from 2006. Over the eight-year observation period there were significant increases in the numbers of annual MV admissions and long-term (>96 hours) MV patients, but a decline in median duration of MV, tracheostomy rate, median ICU length-of-stay and median hospital length-of-stay. All temporal trends were significant ( P < 0.05). The temporal association with changes in sedation management practice, including primary sedative agent choice during MV, may explain these findings.
How do Anaesthetists in New Zealand Disseminate Critical Airway Information?
Authors: Baker P. A. , Moore C. L. , Hopley L. , Herzer K. R. , Mark L. J. 
Published: January 2019

The communication of information concerning patients with difficult airways is universally recognised as an important component in avoiding future airway management difficulties. A range of options is available to impart this information; little is known however, about the follow-up patterns of anaesthetists following the identification and management of a difficult airway. In this study, 158 anaesthetists were contacted and asked to comment on their follow-up patterns regarding a number of difficult airway scenarios. This was followed by a retrospective survey of 124 patients with known difficult airways. A wide discrepancy was found between stated follow-up preferences by anaesthetists and the actual use of options such as postoperative visits, notes in the clinical record, letters to the patient and family doctor, and entries in hospital, national and MedicAlert™ databases. Of the patients with an airway difficulty noted on their anaesthetic record, only 14% of them also had a pertinent comment on their clinical record; even fewer were referred to hospital warning systems (12%) or national (6%) and MedicAlert (7%) databases. Comments from our survey were critical of multiple difficult airway databases and alert systems, which are not linked and do not lead automatically to a single source of information. We suggest that a custom-designed MedicAlert New Zealand difficult airway/intubation registry could be established, with easy access for medical practitioners and patients. This registry could be accessed through the National Health Index database and linked to the MedicAlert international registry and their nine international affiliates.
Has the Middle-Level Anaesthesia Manpower Training Program of the West African College of Surgeons Fulfilled its Objectives?
Authors: Bode C. O. , Olatosi J. , Amposah G. , Desalu I. 
Published: January 2019

An audit of the West African College of Surgeons’ middle-level Diploma in Anaesthesia program was carried out to determine the current status of the diplomates. Using the West African College of Surgeons’ database, social media and personal communications, the current status of Diploma in Anaesthesia graduates spanning 20 years was determined. A total of 303 (97%) out of 311 of graduates were traced. Eighty percent were still practising anaesthesia, while 5% were now in other disciplines. Two hundred and four (67.3%) still resided in West Africa (183 in Nigeria, 50 in Ghana, one in Sierra Leone), while 69 (22.7%) were abroad: 35 (11.5%) in the United Kingdom, 21 (6.9%) in the United States of America and four (1.3%) in Canada. More Ghanaian than Nigerian graduates had emigrated (41 vs 14%, respectively). Only 9% of diplomates remained in rural communities (as originally envisaged), while 31% were now consultants (as fellows) and 30% were registrars in fellowship training. These findings indicate that most diplomates moved on to acquire further qualifications and a significant proportion migrated. The program did not appear to have achieved the objectives of meeting rural middle-level manpower needs in anaesthesia as envisaged. It has, however, boosted the recruitment drive for residency training in anaesthesia. Perhaps a less migrant cadre such as nurses may better serve this function if recruited into a suitably designed training program in countries desiring to use middle-level manpower in anaesthesia.
Acute Respiratory Distress Syndrome: Current Concepts and Future Directions
Authors: Fröhlich S. , Murphy N. , Ryan D. , Boylan J. F. 
Published: January 2019

Acute respiratory distress syndrome is one of the leading causes of death in critically ill patients. Recent advances in supportive care have led to a moderate improvement in mortality. In particular, a much lower mortality rate than expected was evident in the severest category of patients (requiring extracorporeal membrane oxygenation) in Australia during the recent H1N1 pandemic. Though improvements in supportive care may have provided some benefit, there remains an absence of effective biological agents that are necessary to achieve further incremental reduction in mortality. This article will review the evidence available for current treatment strategies and discuss future research directions that may eventually improve outcomes in this important global disease.
Does Left Ventricular Tissue Doppler Peak Systolic Velocity (Sm) Reflect Cardiac Output in the Critically Ill?
Authors: Golowenko A. R. , Nalos M. , Huang S. J. 
Published: January 2019

Cardiac output (CO) is dependent on a number of factors, in particular, the systolic function of the heart. Tissue Doppler (TD) is a modality in echocardiography that measures myocardial velocity and is related to contractility. TD can therefore be used to measure the systolic function of the heart. This study sought to establish whether the systolic component of TD can be used to estimate CO in critically ill patients. Retrospective data was obtained from a total of 80 patients: 29 patients with a normal echocardiogram, and 51 intensive care unit patients; 28 septic and 23 with heart failure. The mean TD peak systolic velocity (Sm) was significantly lower in the heart failure patients ( P <0.05) compared to both normal and septic group. The mean CO was significantly higher in septic patients when compared to heart failure patients. A mild to moderate positive correlation was found between Sm and CO in the heart failure group and with all patients combined (r2=0.19, P <0.001). Subsequent analysis of Sm versus stroke volume again showed a mild positive correlation in the heart failure group and combined results (r2=0.18, P <0.001). Sm was weakly correlated to heart rate only in the normal group but not in the combined cohort. Our data confirms a weak to moderate correlation between Sm and CO, probably resulting from a positive correlation of Sm and stroke volume. This correlation is not strong enough to support the use of an individual's Sm to estimate CO in intensive care patients.
Current Oxygenation Practice in Ventilated Patients—An Observational Cohort Study
Authors: Panwar R. , Capellier G. , Schmutz N. , Davies A. , Cooper D. J. , Bailey M. , Baguley D. , Pilcher D. V. , Bellomo R. 
Published: January 2019

Oxygen therapy is a mainstay of critical care medicine, yet its optimal therapeutic use has not been systematically evaluated. A detailed understanding of current practice in oxygen therapy in intensive care is required to enable future interventional studies. We aimed to describe current oxygenation practice in patients requiring >48 hours of mechanical ventilation (MV) at an academic tertiary referral centre. We collected longitudinal arterial blood gas and hourly oxygenation data from intensive care unit charts in a consecutive cohort of 40 trauma, 41 medical and 20 surgical patients for their first seven MV days, analysed data for 14,063 MV hours, and derived time-weighted averages (TWA) of variables for each 24-hour interval on MV for all patients. The TWA-FiO2 was 0.42 (95% CI 0.41 to 0.44) and TWA-SpO2 was 97.1% (95% CI 96.8 to 97.4) for the first seven MV days. TWA-PaO2 was >80 mmHg on 80% of MV days. TWA-FiO2 of ≥0.35 was used to achieve TWA-SpO2 >95% on 61% of MV days. Of 58 MV days with TWA-FiO2 ≥0.60, TWA-SpO2 ≥96% occurred on 28 (48%) days. Mean SpO2 and PaO2 in patients with severe acute lung injury (ATI) scores were higher than recommended targets. Wide variability in the mean SpO2 and PaO2 was observed in patients with comparable ATI scores. Inspired oxygen therapy in these MV patients was ‘liberal’, with PaO2 and SpO2 values generally above 80 mmHg and 96% respectively. An interventional study comparing current practice to more conservative targets (PaO2≍60 to 65 mmHg and/or SpO2≍90 to 92%) appears possible.
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.
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.
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.
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.
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.
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.
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 Value of Anaesthesia Training in the First Two Postgraduate Years
Authors: Roberts M. T. S. , Baker A. B. 
Published: January 2019

The value of an anaesthetic attachment during the first two postgraduate years is considered under three major headings, the value to the recent graduate, the value to the specialty, and the value to the community. The anaesthetic attachment offers all recent graduates an opportunity to perfect practical skills which should from part of the armamentarium of all doctors, and for some there is the option to aquire the ability to administer a safe anaesthetic. Exposure to the specialty at this time is important for recruitment to the specialist ranks.
Epidural Block for Abdominal Surgery: Aspects of Clinical Pharmacology of Etidocaine
Authors: Cousins M. J. , Augustus J. A. , Gleason M. , Morgan D. J. , Thomas J. 
Published: January 2019

A randomized, prospective, controlled study has compared 1% etidocaine (E) in nineteen patients and 0.5% bupivacaine (B) in 22 patients when used with 1/200,000 adrenaline for epidural blockade. There were unexpected similarities in onset profiles for the two agents, however etidocaine produced a superior intensity of sensory and motor blockade without increased toxicity. Onset times for sympathetic blockade (E = 6.9 ± 1.2, B = 6.8 ±1.2 minutes) were similar for both agents as were times to maximum change in blood pressure (E = 19.4 ± 9.7, B = 18.9 ± 3.7 minutes). Initial onset time for sensory loss to pin prick (partial sensory block) was surprisingly similar for the two drugs (E = 5.6 ± 0.6, B = 6.4 ± 0.7 minutes). However, onset of loss of touch sensation (complete sensory block) was much more rapid for etidocaine (E = 17.7 ± 1.7 minutes, B = 36.8 ± 3.5 minutes). Readiness for surgery, as assessed by spread of complete sensory block into four segments above and below the injection site, was rapid for etidocaine (23.1 ± 2.3 minutes) but this degree of blockade was only achieved in two patients following bupivacaine. Complete blockade on both sides of the body was achieved for two segments on either side of the infection site in 100% of patients following etidocaine, compared to only 30–50% following bupivacaine. A similar example of superior neural penetration was seen in onset of blockade of the large S1 root (E = 8.3 ± 1.4, B = 16.2 ± 4.6 minutes) Complete spread of motor blockade was much more rapid for etidocaine (14.7 ± 2.8, B = 28.9 ± 2.8 minutes). Degree of motor blockade was also significantly greater for etidocaine from ten minutes post blockade onwards (P < 0.001). Peak plasma concentrations were in keeping with ctox/cmax ratios of 1.9 for bupivacaine and 2.7 for etidocaine. Etidocaine was shown to be extensively and rapidly metabolized and to have a high degree of plasma protein binding.
The Effect of Speed of Injection on the Potency of Anaesthetic Induction Agents
Authors: Aveling W. , Bradshaw A. D. , Crankshaw D. P. 
Published: January 2019

The effect of speed of injection on the hypnotic actions of thiopentone, methohexitone, propanidid and Alfathesin was studied in elective surgical patients. The sequential up-and-down technique was used to determine ED50 values. A significant reduction in ED50 was observed for doses injected over five seconds when compared with doses injected over fifteen seconds for thiopentone (64%, P=.001) and methohexitone (83%, P=.05). In the case of Alfathesin, relatively wide confidence limits were observed at all injection speeds and reduction in ED50 at fifteen seconds (63%, P=.01) was noted when compared with the ED50 at five seconds. No significant differences were noted with any of the drugs studied, for variations in infusion time between fifteen, thirty and sixty seconds. It was concluded that only at very rapid infusion rates does the speed of injection influence the potency of the commonly used induction agents.