bluuebunny/crossref_metadata_2025_split huggingface dataset:
Point-of-Care Assessment of Antiplatelet Agents in the Perioperative Period: A Review
Authors: Gibbs N. M. 
Published: January 2019

The aim of this paper was to review the strengths and limitations of current ‘point-of-care’ techniques for the detection of antiplatelet drug effects. The review was based on a Medline search for articles with key words related to “platelet function tests”, “point-of-care”, and “anaesthesia”, published in English between January 1996 and September 2008. It was found that global assessments of ‘haemostasis’, such as the standard thrombelastograph®, Sonoclot®, Clot Signature Analyser® and Hemodyne™, are not specific for platelet function and are essentially insensitive to cyclooxygenase inhibitors (aspirin, non-steroidal anti-inflammatory drugs) and P2Y12 antagonists (ticlopidine, clopidogrel). Global assessments of ‘platelet function’, such as the PFA-100® and PlateletWorks®, are more specific for platelet function, but also have limited sensitivity for cyclooxygenase inhibitors and P2Y12 antagonists. The newer devices developed specifically for the assessment of antiplatelet drugs, such as Platelet Mapping, the Impact™ Cone and Platelet Analyser and the VerifyNow®, are more promising, but are not as sensitive as laboratory platelet aggregometry. All three categories of devices detect GpIIb/IIIa antagonists (abciximab, tirofiban, eptfibatide) activity, but not all provide quantitative assessments for monitoring therapy. The limitations appeared to be related to the complexity of platelet function, the multiple pathways of platelet activation, the wide interpatient variability in platelet responses and the interdependence between platelets and other aspects of coagulation. The strengths and limitations of point-of-care devices should be appreciated before they are used to assist clinical decision-making in the perioperative period.
An Intraoperative Pre-incision Single Dose of Intravenous Ketamine does not have an Effect on Postoperative Analgesic Requirements under Clinical Conditions
Authors: Dullenkopf A. , Müller R. , Dillmann F. , Wiedemeier P. , Hegi T. R. , Gautschi S. 
Published: January 2019

Evidence about the effectiveness of the N-methyl-D-aspartate antagonist ketamine to reduce postoperative acute and long-lasting pain is inconclusive. The aim of this study was to investigate effects of adding an intraoperative, pre-incision single intravenous dose of ketamine to a routine anaesthesia regimen on postoperative analgesic requirements, side-effects and persisting pain up to three months. After obtaining Ethical Committee approval and written informed patient consent, 120 patients were included in this prospective, randomised, double-blinded, placebo-controlled study. Patients were randomised into three groups, receiving 0.15 mg/kg ketamine intravenously, 0.5 mg/kg ketamine intravenously or normal saline in groups low-dose ketamine, moderate-dose ketamine and placebo, respectively. Anaesthesia maintenance, intraoperative pain management and postoperative pain therapy were standardised. The primary study endpoint was consumption of morphine during the first 24 hours after surgery. Three months after surgery, pain scores were assessed. Data were compared by t-test and Kruskall-Wallis test with alpha = 0.05. There was no difference between the groups in the assessed variables. These findings indicate that with the anaesthesia regimen described, and in the doses used, a single intravenous dose of ketamine does not reduce postoperative analgesic requirement or postoperative pain at three months.
Audit of Performance of Size 1.5 ProSeal Laryngeal Mask Airways in Infants Less than Six Months Undergoing Inguinal Herniotomy
Authors: White M. C. , Kelly F. , Bayley G. , Sale S. , Cook T. , Stoddart P. A. 
Published: January 2019

Many anaesthetists have found the size 1.5 classic Laryngeal Mask Airway unsuitable for use in children under 10 kg, whereas recent studies evaluating the ProSeal Laryngeal Mask Airway (PLMA) show high success rates, even during laparoscopic surgery. Our routine practice has been to use tracheal intubation for inguinal herniotomy in children weighing less than 10 kg. Following the introduction of the PLMA to our hospital, we decided to audit our use of the PLMA 1.5 in this group of patients. We included 20 consecutive infants, aged less than six months and weighing 5 to 10 kg. We recorded patient, anaesthetic and insertion details, device performance data and complications. No aspect of anaesthetic practice was changed by involvement in this audit. The PLMA was inserted successfully at the first attempt in 85% (17/20) of infants. Overall successful insertion occurred in 90% (18/20) and satisfactory airway maintenance was provided for the duration of anaesthesia in 90% (18/20). The mean leak pressure was 24 cmH20) (range 15 to 30 cmH20). We found the 1.5 PLMA provided a satisfactory airway in 90% of infants. This report adds to the evidence that the PLMA 1.5 can provide a satisfactory alternative to intubation in selected infants.
The Rise of Simulation in Technical Skills Teaching and the Implications for Training Novices in Anaesthesia
Authors: Castanelli D. J. 
Published: January 2019

Changes in work practices have led to a decline in the opportunities for anaesthetic trainees to learn technical procedures in supervised practice. Efforts to mitigate medical error and other changes have coincided with the development of alternative training methods so that it is increasingly difficult to justify the traditional model of teaching technical procedures. The range of simulators available for training in technical procedures in anaesthesia continues to expand. While simulation has been widely adopted in anaesthesia for crisis management training, there is little documented evidence of its use for technical skills training. The theoretical basis for the use of simulation to aid the acquisition of psychomotor skills and the development of expertise is now well established. In addition, practical frameworks that allow this theory to be applied in a systematic fashion have been developed and successfully used in other specialties. Using the available simulation equipment and educational tools, trainees can be prepared to begin supervised practice having demonstrated adequate procedural knowledge and expertise in simulation. With the use of simulated patients there is also the opportunity to integrate non-technical skills as well where appropriate. This review summarises the justification for the use of simulation in technical skills training in anaesthesia and the educational theory that supports its use, and outlines one of the available frameworks that can be used to aid its application.
Continuous Intra-articular Infusion of Ropivacaine after Unilateral Total Knee Arthroplasty
Authors: Reeves M. , Skinner M. W. 
Published: January 2019

Intra-articular infusion of local anaesthetic after joint arthroplasty is attractive in that it is simple and will not cause motor block. However, the efficacy of the technique has yet to be established. We enrolled 66 patients scheduled for unilateral total knee arthroplasty under general anaesthesia and single-shot femoral and sciatic nerve blocks. All patients had an intra-articular Painbuster® device sited at the end of the procedure. Patients were then randomised to control or one of two treatment arms – low-dose and high-dose ropivacaine. In the control group the balloon was filled with saline, in the low-dose group with 0.2% ropivacaine and in the high-dose group 0.375% ropivacaine. The catheters were infused continuously for 48 hours and then removed. Patients were followed up daily for three days to determine pain scores, opioid consumption and subjective assessment of the analgesic efficacy of the catheter. Data were analysed for 30 controls and 31 in the treatment arms. Both groups were similar. There were no significant differences between the control and treatment groups at all time points after adjustment for age. Patients in the high-dose group had higher pain scores and higher opioid consumption than the control groups from 24 to 48 hours. There were two cases of infection, both in the treatment groups. No positive benefit of intra-articular infusion of local anaesthetic after total knee arthroplasty could be identified. On the contrary there may be negative effects in terms of expense, pain and possibly infection risks.
Derivation and Prospective Testing of a Two-step Sevoflurane-O2-N2O Low Fresh Gas Flow Sequence
Authors: Van Zundert T. , Brebels A. , Hendrickx J. , Carette R. , De Cooman S. , Gatt S. , De Wolf A. 
Published: January 2019

Simple vaporiser setting (FD) and fresh gas flow (FGF) sequences make the practice of low-flow anaesthesia not only possible but also easy to achieve. We sought to derive a sevoflurane FD sequence that maintains the end-expired sevoflurane concentration (FAsevo) at 1.3% using the fewest possible number of FD adjustments with a previously described O2-N2O FGF sequence that allows early FGF reduction to 0.7 l.min−1. In 18 ASA physical status I to II patients, FD was determined to maintain FAsevo at 1.3% with 2 l.min−1 O2 and 4 l.min−1 N2O FGF for three minutes, and with 0.3 and 0.4 l.min−1 thereafter. Using the same FGF sequence, the FD schedule that approached the 1.3% FAsevo pattern with the fewest possible adjustments was prospectively tested in another 18 patients. The following FD sequence approximated the FD course well: 2% from zero to three minutes, 2.6% from three to 15 minutes and 2.0% after 15 minutes. When prospectively tested, median (25th; 75th percentile) performance error was 0.8 (-2.9; 5.9)%, absolute performance error 6.7 (3.3; 10.6)%, divergence 18.2 (-5.6; 27.4)%.h−1 and wobble 4.4 (1.7; 8.1)%. In one patient, FGF had to be temporarily increased for four minutes. One O2/N2O rotameter FGF setting change from 6 to 0.7 l.min−1 at three minutes and two sevoflurane FD changes at three and 15 minutes maintained predictable anaesthetic gas concentrations during the first 45 minutes in all but one patient in our study.
Comparison of Forehead Max-Fast Pulse Oximetry Sensor with Finger Sensor at High Positive End-expiratory Pressure in Adult Patients with Acute Respiratory Distress Syndrome
Authors: Hodgson C. L. , Tuxen D. V. , Holland A. E. , Keating J. L. 
Published: January 2019

In the critical care setting it may be difficult to determine an accurate reading of oxygen saturation from digital sensors as a result of poor peripheral perfusion. Limited evidence suggests that forehead sensors may be more accurate in these patients. We prospectively compared the accuracy of a forehead reflectance sensor (Max-Fast) with a conventional digital sensor in patients with acute respiratory distress syndrome during a high positive end-expiratory pressure (PEEP) recruitment manoeuvre (stepwise recruitment manoeuvre). Sixteen patients with early acute respiratory distress syndrome were enrolled to evaluate the blood oxygen saturation during a stepwise recruitment manoeuvre. PEEP was increased from baseline (range 10 to 18) to 40 cmH2O, then decreased to an optimal level determined by individual titration. Forehead and digital oxygen saturation and arterial blood gases were measured simultaneously before, during and after the stepwise recruitment manoeuvre at five time points. Seventy-three samples were included for analysis from 16 patients. The SaO2 values ranged from 73 to 99.6%. The forehead sensor provided measurements that deviated more from arterial measures than the finger sensor (mean absolute deviations 3.4%, 1.1% respectively, P=0.02). The greater variability in forehead measures taken at maximum PEEP was reflected in the unusually large precision estimates of 4.24% associated with these measures. No absolute differences from arterial measures taken at any other time points were significantly different. The finger sensor is as accurate as the forehead sensor in detecting changes in arterial oxygen saturation in adults with acute respiratory distress syndrome and it may be better at levels of high PEEP, such as during recruitment manoeuvres.
The Efficacy of Landiolol for Suppressing the Hyperdynamic Response following Laryngoscopy and Tracheal Intubation: A Systematic Review
Authors: Inoue S. , Tanaka Y. , Kawaguchi M. , Furuya H. 
Published: January 2019

Landiolol is a recently developed, selective short-acting β1-antagonist. The aim of the study was to evaluate the efficacy of landiolol for suppressing haemodynamic changes induced by laryngoscopy and tracheal intubation (LTI) in Japanese patients. A comprehensive search was undertaken to identify all randomised comparisons of landiolol with placebo that examined effects on haemodynamic responses following LTI. MEDLINE, Cochrane CENTRAL, EMBASE and the Japanese Central Review of Medicine were searched from their date of inception to February 2009. Trials were included in the review if heart rate, systolic blood pressure or mean blood pressure was recorded at three different stages: pre-induction, just before intubation and in the post-intubation period. Weighted mean differences and 95% confidence intervals (CI) were calculated for changes in haemodynamic variables between treatment and placebo groups. Seven randomised controlled trials involving 325 patients were included in the study. Of these, five trials that used the same continuous infusion regimen for landiolol (0.125 mg/kg/minute for one minute followed by 0.04 mg/kg/minute) showed efficacy in attenuation of heart rate and blood pressure following LTI (heart rate weighted mean difference: −21.18 bpm, 95% CI −18.59 to −14.20; systolic blood pressure weighted mean difference: −23.03 mmHg, 95% CI −43.59 to −2.47; mean blood pressure weighted mean difference: −16.26 mmHg, 95% CI −23.96 to −8.55). The other two studies used bolus administration of landiolol (0.1 to 0.3 mg/kg), but it was difficult to evaluate the efficacy because of the limited amount of data. Landiolol administration at 0.125 mg/kg/minute for one minute followed by 0.04 mg/kg/minute effectively suppresses the increases in heart rate and blood pressure following LTI. For a bolus regimen of landiolol, further studies are required to determine the efficacy and the optimal dose and timing for suppression of haemodynamic responses following LTI.
Gilles vs Pugh and the lost letter
Authors: Paull J.D. 
Published: January 2019

In June 1842 the wife of Lewis W. Gilles, a banker in Launceston, wrote to Mrs Pugh, inviting her and her husband, Mr William Russ Pugh, to an entertainment and ball. The Pughs neither responded to the invitation, nor attended the ball. Mrs Gilles mentioned the discourtesy of their non-attendance to a friend, who the following morning brought the complaint to the attention of Dr Pugh. Pugh immediately wrote a brief note explaining that neither he nor his wife had received the invitation. Further correspondence between Gilles and Pugh ensued, becoming more and more bitter until Pugh publicly insulted Gilles. The Launceston Club, of which both men were members, ultimately became a casualty of the dispute and was dissolved. A Supreme Court defamation and libel case followed with Gilles as plaintiff and Pugh as defendant. Gilles won the case but received only token damages. And the missing letter? Too late, Mrs Pugh's maid found it tucked between the pages of a periodical on the dresser.
Rapid Reversal of Coagulopathy in Warfarin-Related Intracranial Haemorrhages with Prothrombin Complex Concentrates
Authors: Chong C. T. , Lew T. W. K. , Kuperan P. , Tan J. J. E. , Tan H. L. , Kwek T. K. 
Published: January 2019

We report our initial experience using Profilnine SD, a 3-Factor prothrombin complex concentrate (PCC) in combination with fresh frozen plasma and vitamin K in seven patients admitted to our neurointensive care unit with oral anticoagulation therapy-related intracranial haemorrhage over a six-month period, to achieve rapid normalisation of the international normalised ratio (INR) and allow surgical evacuation when indicated. Four patients presented with subdural haematomas while three had intracerebral haematomas. Six of seven patients had admission INR in the appropriate therapeutic range for oral anticoagulation therapy. The median dose of PCC administered was 28.5 IU/kg body weight (interquartile range 21.3 to 38.5 IU/kg). All four patients with subdural haematoma underwent surgical evacuation once INR was less than 1.5. Median time from computed tomography diagnosis to surgery was 275 minutes (range 102 to 420 minutes). The median time to INR normalisation post-PCC administration was shorter, at 85 minutes (range 50 to 420 minutes) for the four patients who survived, versus 10 hours (range 9 to 44 hours) in the three patients who died. Two of the three patients who died had haematoma increase, worsening midline shift and subfalcine herniation, leading to withdrawal of therapy. Prothrombin complex concentrates should be considered for use in the urgent reversal of INR in oral anticoagulation therapy-related intracranial haemorrhage, potentially halting haematoma expansion and expediting urgent neurosurgical intervention, although data from randomised controlled trials is still lacking. The literature supporting the use of PCC is reviewed and a protocolised emergent treatment algorithm is proposed, which may help achieve earlier consistent normalisation of the INR.
The Development and Implementation of an Obstetric Cell Salvage Service
Authors: McDonnell N. J. , Kennedy D. , Long L. J. , Gallagher-Swann M. C. , Paech M. J. 
Published: January 2019

Cell salvage in obstetric haemorrhage is now endorsed by a number of organisations. Most of the literature has focused on isolated case series and safety. We describe how cell salvage, including a quality assurance process conducted prior to clinical implementation, was introduced to our stand-alone obstetric hospital which had no previous experience of this technique. An implementation committee was established and 25 quality assurance and familiarisation cases were initially conducted. As part of this process the alpha fetoprotein, haematocrit, free plasma haemoglobin, potassium and Kleihauer tests were performed when enough blood was available for processing. Our guidelines for clinical use included women at greatly increased risk of obstetric haemorrhage and women at increased risk of haemorrhage who refused traditional transfusion. After the successful completion of this process, cell salvage was signed off for clinical use in March 2007 and was used on 51 occasions between March 2007 and July 2009. Twenty-one patients had salvaged blood re-transfused and for seven patients this was their only red blood cell replacement. The median blood loss in patients re-transfused was 3000 ml (range <500 to 8500 ml), with the median volume re-transfused 359 ml (range 60 to 1300 ml). There was one episode of unexplained hypotension associated with administration of salvaged blood. We have successfully introduced obstetric cell salvage into clinical practice. A quality assurance process prior to implementation was beneficial for the staff involved. Despite targeting a high-risk obstetric population, our re-transfusion rates are approximately 40%. No serious adverse events have been recorded. We recommend that in units that already provide intraoperative cell salvage in a non-obstetric setting, extending the service into obstetric situations should be considered. Units that routinely care for high-risk obstetric patients should also consider the introduction of such a service. Post transfusion Kleihauer testing should be performed as soon as possible in Rhesus-negative mothers who deliver a Rhesus-positive foetus, so that appropriate anti-D prophylaxis can be administered.
Cardiovascular Collapse following Povidone-Iodine Wash
Authors: Ramaswamykanive H. , Nanavati Z. , Mackie J. , Linderman R. , Lavee O. 
Published: January 2019

We present a case study of a severe episode of iodine toxicity following povidone-iodine wash with clinical manifestations of cardiovascular collapse, metabolic acidosis, renal failure and seizures. Povidone-iodine has been used as a medical antiseptic and disinfectant since 1952. Iodine toxicity secondary to povidone-iodine use is rare. Iodine toxicity is difficult to diagnose and the diagnosis is made by a high index of suspicion. Toxicity due to iodine correlates with serum and urine iodine levels. Treatment of iodine toxicity is supportive. A review of literature relating to the components of povidone-iodine, iodine metabolism, its manifestations and management of iodine toxicity secondary to povidone-iodine is also presented. An Ovid-Medline search from 1950 to 2009 revealed 1236 articles on the clinical manifestations of povidone-iodine usage but no article on iodine toxicity relating to povidone-iodine based on the following search criteria: povidone-iodine and/or iodine toxicity secondary to povidone-iodine (limited to English language, review articles, full text and human patients).
A Prospective Randomised Comparison of the LMA ProSeal™ versus Endotracheal tube on the Severity of Postoperative Pain following Gynaecological Laparoscopy
Authors: Griffiths J. D. , Nguyen M. , Lau H. , Grant S. , Williams D. L. 
Published: January 2019

Pain and postoperative nausea and vomiting (PONV) are common problems after gynaecologic laparoscopy. Two recent studies have shown that morphine requirements and PONV are lower when a LMA ProSeal™ is used, rather than an endotracheal tube (ETT), for female patients undergoing breast and gynaecological surgery. We conducted a patient and observer-blinded randomised controlled trial, recruiting non-obese women without gastro-oesophageal reflux undergoing laparoscopic gynaecological surgery. Patients received a standardised relaxant general anaesthetic and then were randomised to receive either an LMA ProSeal or an endotracheal tube. Patients were assessed at two and 24 hours post-anaesthesia. The primary outcome was postoperative pain score and secondary endpoints included morphine consumption, postoperative emesis and adverse upper airway symptoms. We recruited 116 patients to the study, 57 patients in the ETT group and 59 patients in the LMA ProSeal group. The patients were similar in demographic and surgical characteristics. At two hours, the ETT group was similar to the LMA ProSeal group in regards to pain scores (verbal rating scale 3.0 vs 3.5, P=0.86), morphine consumption (7.2 vs 7.4 mg, P=0.56) and PONV (47.4 vs 47.5%, P=0.99). After 24 hours, pain scores and PONV rates were also similar. No significant difference in rates of sore throat or dysphagia was observed between the ETT and LMA ProSeal groups. No significant complications were attributable to either airway device. The LMA ProSeal did not decrease pain or PONV in patients undergoing gynaecological laparoscopy when compared to endotracheal intubation.