bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oseltamivir Pharmacokinetics in Critically Ill Adults Receiving Extracorporeal Membrane Oxygenation Support
Authors: Mulla H. , Peek G. J. , Harvey C. , Westrope C. , Kidy Z. , Ramaiah R. 
Published: January 2019

Extracorporeal membrane oxygenation (ECMO) is known to affect pharmacokinetics and hence optimum dosing. The aim of this open label, prospective study was to investigate the pharmacokinetics of oseltamivir (prodrug) and oseltamivir carboxylate (active metabolite) during ECMO. Fourteen adult patients with suspected or confirmed H1N1 influenza were enrolled in the study. Oseltamivir 75 mg was enterally administered twice daily and blood samples for pharmacokinetic assessment were taken on day 1 and 5. A multi-compartmental model to describe the pharmacokinetics of oseltamivir and oseltamivir carboxylate was developed using a nonlinear mixed effects modelling approach. The median (range) clearance of oseltamivir carboxylate was 15.8 (4.8–36.6) 1/hour, lower than the reported mean value of 21.5 1/hour in healthy adults. The median (range) steady state volume of distribution of oseltamivir carboxylate was 179 (61–436) litres, much greater than healthy adults but similar to previous reports in critically ill patients. Substantial ‘between subject’ variability in systemic exposure to oseltamivir carboxylate was revealed; median (range) area under the curve and Cmax were 4346 (644–13660) ng/hour/ml and 509 (54–1277) ng/ml, respectively. Both area under the curve and Cmax were significantly correlated with serum creatinine (r2=0.37, P=0.02 and r2=0.29, P=0.02, respectively). Systemic exposure to oseltamivir carboxylate following the administration of enteral oseltamivir 75 mg twice daily in adult ECMO patients is comparable to those in ambulatory patients and far in excess of concentrations required to maximally inhibit neuraminidase activity of the H1N1 virus. Dosage adjustment for ECMO, per se, appears not to be necessary; however, doses should be reduced in patients with renal dysfunction.
Bench Performance of Ventilators during Simulated Paediatric Ventilation
Authors: Park M. A. J. , Freebairn R. C. , Gomersall C. D. 
Published: January 2019

This study compares the accuracy and capabilities of various ventilators using a paediatric acute respiratory distress syndrome lung model. Various compliance settings and respiratory rate settings were used. The study was done in three parts: tidal volume and FiO2 accuracy; pressure control accuracy and positive end-expiratory pressure (PEEP) accuracy. The parameters set on the ventilator were compared with either or both of the measured parameters by the test lung and the ventilator. The results revealed that none of the ventilators could consistently deliver tidal volumes within 1 ml/kg of the set tidal volume, and the discrepancy between the delivered volume and the volume measured by the ventilator varied greatly. The target tidal volume was 8 ml/kg, but delivered tidal volumes ranged from 3.6–11.4 ml/kg and the volumes measured by the ventilator ranged from 4.1–20.6 ml/kg. All the ventilators maintained pressure within 20% of the set pressure, except one ventilator which delivered pressures of up to 27% higher than the set pressure. Two ventilators maintained PEEP within 10% of the prescribed PEEP. The majority of the readings were also within 10%. However, three ventilators delivered, at times, PEEPs over 20% higher. In conclusion, as lung compliance decreases, especially in paediatric patients, some ventilators perform better than others. This study highlights situations where ventilators may not be able to deliver, nor adequately measure, set tidal volumes, pressure, PEEP or FiO2.
Epidural versus Continuous Transversus Abdominis Plane Catheter Technique for Postoperative Analgesia after Abdominal Surgery
Authors: Kadam V. Rao , Van Wijk R. M. , Moran J. L. , Miller D. 
Published: January 2019

Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery, but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia. We designed a randomised controlled trial comparing these techniques for major abdominal surgery. Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2% and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375% bilaterally and an infusion of 0.2% ropivacaine 8 ml/hour bilaterally, for three days. Both groups received paracetamol and patient controlled analgesia with fentanyl for three days. Primary outcomes were numerical rating scores for pain (rest and dynamic over 72 hours) and total fentanyl use; complications and satisfaction scores were also noted. The study was terminated early after 42 patients had been randomised (epidural n=19; transversus abdominis plane block n=22; one excluded). No differences were found in regards to point pain scores or scores over time, either immediately postoperatively or in surgical wards; total fentanyl requirement and Likert satisfaction scores were also similar in both groups. In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction after abdominal surgery. To confirm this finding, randomised trials with larger numbers of participants are needed.
A Preliminary Evaluation of Plasma B-Type Natriuretic Peptide as a Screening Test for Left Ventricular Diastolic Dysfunction in Non-Cardiac Intensive Care
Authors: Sturgess D. J. , Parmar D. , Dulhunty J. M. , Hegde R. , Jarrett P. , Udy A. 
Published: January 2019

Left ventricular filling and thus diastolic function are frequently monitored and managed in critical care. However, scant data exist regarding possible screening tests for diastolic dysfunction in the intensive care unit (ICU). The present study aimed to evaluate plasma b-type natriuretic peptide (BNP) as a marker of diastolic dysfunction in a single-centre cohort of ‘non-cardiac’ ICU patients. The ICU is non-cardiac in that it provides mixed medical/surgical services with the exception of cardiology, cardiac surgery and solid organ transplantation. Clinical data were recorded over the first 24 hours of ICU stay for 32 consecutive patients. Transthoracic echocardiogram and blood collection for BNP assay were then performed. Diastolic dysfunction was demonstrated in 34% (n=11). Mean ± standard deviation BNP values were higher with diastolic dysfunction (238±195 vs 72±78 pg/ml; P=0.003). A BNP threshold of >43 pg/ml yielded a sensitivity of 80% and a specificity of 59%; area under the receiver operating characteristic curve was 0.82. BNP correlated independently with E/e’ (R = 0.425; P=0.015) (E/e’: peak early transmitral velocity [E]/early diastolic mitral annular velocity [e']) but not left ventricular ejection fraction ( P=0.8), illness severity (Acute Physiological and Chronic Health Evaluation II; P=0.3) or fluid balance ( P=0.4). Diastolic dysfunction was common in this cohort of non-cardiac ICU patients and was independently associated with a significantly higher BNP. The potential application as a screening test for diastolic dysfunction is likely to require a threshold lower than previously proposed for heart failure.
The Axillary Approach to Brachial Plexus Anaesthesia
Authors: Hopcroft S. C. 
Published: January 2019

A method of brachial plexus block using the axillary approach is described. The method differs from previously described techniques and allows anaesthesia to be obtained using between 7 and 20 ml of local anaesthetic solution. The results of 100 consecutive cases are reported.
Coeliac Plexus Block
Authors: Black Andrew , Dwyer Brian 
Published: January 2019

Coeliac plexus blocks have had a reasonable success rate (approximately 70 per cent) in the relief of the pain of carcinoma of the pancreas or upper abdominal malignancy and were helpful for pancreatitis and in some cases of inoperable arterial insufficiency. Diagnostic coeliac plexus blocks sometimes provided useful information about some types of pain. There were no dangerous complications in this series so that this seems a reasonable form of therapy for patients for whom there is often little else to offer.
Electronic Digital Computer Control of Ventilation and Anaesthesia
Authors: Lampard D. G. , Coles J. R. , Brown W. A. 
Published: January 2019

The use of a small digital computer to control a number of interactive physiological variables is demonstrated. It is shown that by monitoring the values of end tidal per cent CO2, inspired O2 percentage and mean arterial blood pressure, a computer-controlled system can regulate the ventilation and anaesthesia of an animal within fine tolerances. Similarly it is shown that by controlling the infusion of muscle relaxant, the integrated electromyogram of a muscle can be maintained at any desired level. The computer control system automatically allows for random disturbances in system parameters in maintaining set levels of the controlled variables. The system responds rapidly to changes in the desired level of variables, and prescribed time courses of variables can be followed.
Case Report: Diuretics and Non-respiratory Alkalosis
Authors: Poole John L. 
Published: January 2019

A patient with chronic respiratory failure and cor pulmonale was admitted to hospital with an exacerbation of cardiac failure. In attempting to control cardiac failure, intensive diuretic therapy resulted in the development of dehydration, alkalosis, grand mal convulsions and signs of a left hemiparesis. Correction of the electrolyte and acid-base abnormalities resulted in complete neurological recovery. Mechanisms of production by diuretics and the treatment of non-respiratory alkalosis is discussed.
Paediatric Endotracheal Suction
Authors: Poole John L. , Abrahams N. , Fisk G. C. 
Published: January 2019

Catheters for paediatric endotracheal suction were studied using an artificial lung with compliances in the range encountered in paediatric practice. With various combinations of “lung” compliance, size of endotracheal tube, endotracheal connector and catheter,” tracheal” pressure and air flow between endotracheal tube and catheter were measured. Recommendations for combinations of endotracheal tube, connector and catheter size are made. The maximum negative pressure applied to the catheter should be limited.
Initial Clinical Experiences with Althesin (CT 1341) in Malaysian Patients
Authors: Delilkan A. E. 
Published: January 2019

The history of steroidal intravenous anaesthesia is traced. Althesin was used as an induction agent in 60 elective minor gynaecological procedures requiring general anaesthesia, followed by nitrous oxide/oxygen maintenance anaesthesia. Clinical assessment showed predominantly a transient hypotension (10–20 mm Hg fall in systolic blood pressure), a rise in pulse and respiratory rates. Recovery was smooth, rapid and pleasant. As an induction agent Althesin (CT 1341) has effects similar to the well-known and established side-effects of the ultra-short-acting barbiturates. The obvious advantage would be for patients in whom barbiturates are contraindicated. The clear-headed, pleasant recovery should enhance its value for outpatient minor procedures requiring general anaesthesia.
Acute Cyanide Poisoning
Authors: Naughton Michael 
Published: January 2019

Cyanide poisoning results in cytotoxic hypoxia due to the inactivation of mitochondrial cytochrome oxidase. The pathophysiology of this intoxication is discussed and antidotal therapies are examined and contrasted. Two case reports of patients with acute poisoning are presented. The importance of general supportive measures, the administration of 100 per cent oxygen and reversal of metabolic acidosis are stressed.
Lithium Toxicity and Refractory Cardiac Arrhythmia Treated with Intravenous Magnesium
Authors: Worthley L. I. G. 
Published: January 2019

A case of refractory cardiac arrhythmia induced by lithium and controlled by intravenous magnesium sulphate is described The mechanism of action of the magnesium in controlling the arrhythmia is discussed.
Organophosphate Insecticide Poisoning and its Management
Authors: Ganendran A. 
Published: January 2019

The organophosphate insecticides have become widely used in agriculture and in home gardening. There has been an increase in accidental and intentional poisoning. Almost all these compounds are potent cholinesterase inhibitors, and signs of poisoning are attributable to the accumulation of acetylcholine. The local absorption of these compounds from the conjunctiva, upper respiratory tract and skin following exposure to the aerosol or dust used in agricultural work, produces mild symptoms and is rarely of consequence except in accidents due to careless handling. The severe type of poisoning is caused usually by ingestion of the compound(s), and accumulation of large amounts of acetylcholine is fatal if not antagonized rapidly by atropine in large and continuous doses, together with respiratory support. Pyridine-2-Aldoxime Methiodide (P-2-AM) has been reported to be successful in treating Parathion poisoning. There is experimental evidence that it is not of similar value in some other organophosphorus insecticide poisoning.
A Simple Clinical Method of Quantitating the Effects of Chest Physiotherapy in Mechanically Ventilated Patients
Authors: Winning T. J. , Brock–Utne J. G. , Goodwin N. M. 
Published: January 2019

A simple clinical method, allowing quantitive assessment of the effects of chest physiotherapy on patients subjected to I.P.P.V., is presented. The method involves measuring of the “alveolar “pressure using the end-expiratory retard mechanism available on the Bennet MA 1 (volume cycled) ventilator. Using this simple technique three different methods of physiotherapy were shown to significantly lower alveolar pressure, indicating an increase in pulmonary compliance. The inhalation of acetyl cysteine however, appeared to render treatment less effective in this regard.
Intradermal Testing after Severe Histamine Reactions to Intravenous Drugs Used in Anaesthesia
Authors: Fisher M. McD. 
Published: January 2019

In a series of patients who suffered severe histamine mediated reactions to induction agents and muscle relaxants, intradermal testing enabled the drug involved to be distinguished. The correct use of intradermal testing to give reliable results is discussed and a protocol described. Prausnitz Kustner testing was of little help in confirming the results. A number of patients tested showed high levels of immunoglobulin G (IgG) and it is believed that IgG mediated anaphylaxis may be the mechanism responsible for reactions that have been previously described as anaphylactoid or direct chemical histamine release.
Metabolism of Enflurane in Man following a Second Exposure
Authors: Norgate C. E. , Sharp J. H. , Cousins M. J. 
Published: January 2019

A second administration of one half MAC enflurane for two hours one week following a previous identical exposure caused no increase in urinary inorganic Fluoride excretion (UFV). At this dosage of 1 MAC hour, which is equivalent to use as a supplement, UFV did not exceed 800 μM/day in any subject (Nephrotoxic threshold=2500 μM/day. Thus, when sub-anaesthetic doses of enflurane are administered at this time interval there appears to be no increased risk of nephrotoxicity. This study also provides strong support for the concept that drug metabolism is very reproducible within individuals but there is considerable variation between individuals. Since the subjects in this study were all of similar age, and drug free, the results are in keeping with recent twin studies which indicate that individual differences in drug metabolism are largely determined on a genetic basis.
Clinical Evaluation of Etomidate as an Induction Agent
Authors: Chiu H. H. , Van W. K. 
Published: January 2019

A comparative study between Etomidate and Thiopentone was carried out on 100 healthy female patients scheduled for post-partum abdominal sterilization under epidural analgesia. Our results show Etomidate to be a safe and effective induction agent, comparable to Thiopentone in having a rapid onset of action and rapid recovery time. The pulse rates and blood pressures remained relatively stable during the use of Etomidate. However, there was a high incidence of transient respiratory upsets while causing less respiratory depression than Thiopentone. The objectionable features of Etomidate are high incidence of pain on injection and involuntary muscular activity, which account for the low anaesthetist acceptance rate.
Gas Identity Hazards and Major Contamination of the Medical Gas System of a New Hospital
Authors: Tingay M. G. , Ilsley A. H. , Willis R. J. , Thompson M. J. , Chalmers A. H. , Cousins M. J. 
Published: January 2019

During commissioning of the medical gas system of a new hospital, fourteen connection defects were found; six of these were potentially lethal cross-connections. A major contaminant was also detected throughout the medical gas system. The methods of testing a new medical gas system described in this report highlight the need for up-grading of existing standards.
Intravenous Ketamine Anaesthesia for Major Abdominal Surgery — An Assessment of a Technique and the Influence of Ataractic Drugs on the Psychomimetic Effects of Ketamine
Authors: Houlton P. J. C. , Downing J. W. , Brock-Utne J. G. 
Published: January 2019

Eighty-two patients presenting for major abdominal surgery were divided into five groups, and received intravenous ketamine, muscle relaxation and controlled ventilation with oxygen-enriched air. For maintenance of anaesthesia patients were given a single intravenous dose of either droperidol 5 mg, diazepam 5 mg, promethazine 25 mg, flunitrazepam 0.5 mg or lorazepam 2 mg, followed by incremental doses of ketamine. Flunitrazepam and lorazepam were the adjuvants associated with the lowest incidence of dreaming and emergence phenomena; post anaesthetic sequelae occurred most frequently with both ketamine/diazepam and ketamine/droperidol anaesthesia. However, the differences between the five groups failed to reach statistical significance.
A New Polyvinyl Chloride Coil with Improved Performance for Blood Warming
Authors: Russell W. J. 
Published: January 2019

A new polyvinyl chloride (PVC) coil has been tested. The thinner walls give a better heat transfer so that an output temperature of 32.7°C occurs at 150 ml/min under test. This is higher than any PVC coil previously tested. Suggestions are made about methods of further improving the performance.
Mechanism of the Hypertensive Effect of Droperidol in Pheochromocytoma
Authors: Oh T. E. , Turner C. W. , Ilett K. F. , Waterson J. G. , Paterson J. W. 
Published: January 2019

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

Topic adrenaline with cocaine has been used commonly for intranasal vasoconstriction to facilitate surgery and to control haemorrhage. Pharmacologically the drug combination is known to be a potentially dangerous interaction. This investigation studied whether either drug could be used separately rather than in combination, to achieve the same purposes. One hundred cases were randomized into four groups using 1:1000 Adrenaline, 5% Cocaine, 10% Cocaine and 5% Cocaine/1:1000 Adrenaline as the topical vasoconstriction regimes. The results showed that the vasoconstrictor effect was not significantly different within the four groups; topical 1:1000 Adrenaline resulted in more haemorrhage compared to the other three regimes; comparing the other three regimes the blood loss was not significantly different. The conclusion is that the Adrenaline/Cocaine mixture has no advantage and its potentially dangerous interaction makes it unnecessary and unjustified. Topical 5% Cocaine is recommended because it achieves the aims with the least side-effects.
Tubocurarine and Pancuronium: A Pharmacokinetic View
Authors: Shanks C. A. , Somogyi A. A. , Ramzan M. I. , Triggs E. J. 
Published: January 2019

This review is an attempt to bring together the pharmacokinetic data on d-tubocurarine and pancuronium with clinical observations on relaxant dosage and effect. The modelling techniques used here represent an oversimplification of the relationships between relaxant plasma concentration and response as they do not predict either the time of onset of paralysis or its peak intensity. However, they do enable calculation of a bolus dose of relaxant required to achieve a particular intensity of paralysis for the average patient once pseudo-distribution equilibrium has been achieved. This has been further extended to predict the cumulation of the relaxants with subsequent dosage in average patients. Suggested regimens incorporating bolus and infusion doses of the relaxants to achieve continuous neuromuscular blockade have been calculated also. Averaged pharmacokinetic parameters derived from patients with renal or hepatic dysfunction have been used to predict the likely duration and intensities of paralysis for the relaxants.
Thermodilution Cardiac Output — A Systematic Error
Authors: Runciman W. B. , Ilsley A. H. , Roberts J. G. 
Published: January 2019

The purpose of this study was to examine the mechanism and magnitude of a systematic error in thermodilution cardiac output measurement. One hundred and seventy-one thermodilution cardiac output measurements in dogs using a Swan-Ganz catheter were compared with simultaneously made dye dilution measurements under different conditions over a wide range of cardiac outputs. A systematic error with the thermodilution technique was confirmed and was almost identical to that observed in the literature. It is proposed that its mechanism is loss of thermal indicator between the injectate orifice and detection. Application of a further correction factor for thermal indicator loss is suggested.
Midazolam as an Intravenous Induction Agent for General Anaesthesia: A Clinical Trial
Authors: Baber Rod , Hobbes Alick , Munro Ian A. , Purcell Greg , Binstead Rod 
Published: January 2019

The peripheral and central nervous, cardiovascular and respiratory effects of midazolam 0.15 mg/kg, administered intravenously, were studied in 57 patients. Midazolam induced anaesthesia satisfactorily in 78% of the patients, the remainder required either further doses of midazolam, or alternative induction agents. There was no pain on injection. No evidence of thrombophlebitis was apparent up to 72 hours after injection. Mean systolic arterial pressure decreased from 128 mm Hg to 114 mm Hg and mean diastolic pressure decreased from 75 mm Hg to 67 mm Hg (P < 0.005) four minutes after injection. Mean heart rate increased from 81 beats/min to 88 beats/min (P < 0.005) one minute after injection. Apnoea occurred in 14 patients, with a mean onset time of 82 sec and a mean duration of 30 sec. Patients showed a decrease in mean respiratory rate from 13.7 breaths/min to 12.8 breaths/min two minutes after injection of midazolam. A larger dose than used in this study would be necessary for satisfactory use of midazolam as an induction agent for general anaesthesia.