bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomised Controlled Trial Comparing Oral and Intravenous Paracetamol (Acetaminophen) Plasma Levels when given as Preoperative Analgesia
Authors: van der Westhuizen J. , Kuo P. Y. , Reed P. W. , Holder K. 
Published: January 2019

Gastric absorption of oral paracetamol (acetaminophen) may be unreliable perioperatively in the starved and stressed patient. We compared plasma concentrations of parenteral paracetamol given preoperatively and oral paracetamol when given as premedication. Patients scheduled for elective ear, nose and throat surgery or orthopaedic surgery were randomised to receive either oral or intravenous paracetamol as preoperative medication. The oral dose was given 30 minutes before induction of anaesthesia and the intravenous dose given pre-induction. All patients were given a standardised anaesthetic by the same specialist anaesthetist who took blood for paracetamol concentrations 30 minutes after the first dose and then at 30 minute intervals for 240 minutes. Therapeutic concentrations of paracetamol were reached in 96% of patients who had received the drug parenterally, and 67% of patients who had received it orally. Maximum median plasma concentrations were 19 mg.l-1 (interquartile range 15 to 23 mg.l-1) and 13 mg.l-1 (interquartile range 0 to 18 mg.l-1) for the intravenous and oral group respectively. The difference between intravenous and oral groups was less marked after 150 minutes but the intravenous preparation gave higher plasma concentrations throughout the study period. It can be concluded that paracetamol gives more reliable therapeutic plasma concentrations when given intravenously.
Intensity of Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis
Authors: Latour-Pérez J. , Palencia-Herrejón E. , Gómez-Tello V. , Baeza-Román A. , García-García M. á. , Sánchez-Artola B. 
Published: January 2019

The purpose of this study was to assess the efficacy of continuous renal replacement therapies in patients with severe sepsis or septic shock, with or without acute kidney injury. We performed a systematic search in Medline, Embase, Web of Knowledge, Cochrane Library and Clinicaltrials.gov and a hand search of the retrieved studies. We included both randomised controlled clinical trials and subgroups of randomised trials that assessed the effect of continuous renal replacement therapies (at traditional or high doses) and reported clinical outcomes in adult patients with severe sepsis or septic shock. The study selection and data extraction were performed by duplicate. Analysis of heterogeneity and meta-analysis was performed according to the Cochrane Collaboration guidelines for conducting systematic reviews of interventions. Twelve studies (1895 patients) met the inclusion criteria. Pooling of all studies resulted in a mortality risk ratio of 0.96 (95% confidence interval 0.83 to 1.12). The studies showed moderate statistical heterogeneity (I2 statistic 52%, P=0.02). The effect on mortality was not modified (interaction P values non significant) by the dose of continuous renal replacement therapies, the severity of illness or the risk of bias. The available evidence suggests that these therapies in patients with severe sepsis or septic shock are not associated with an improvement in other outcomes such as haemodynamics, pulmonary gas exchange, multiple organ dysfunction syndrome or length of stay. The best available evidence does not support the routine use of continuous renal replacement therapies (at traditional or high doses) in patients with severe sepsis or septic shock.
Effect of Daily Sedative Interruption on Sleep Stages of Mechanically Ventilated Patients Receiving Midazolam by Infusion
Authors: Oto J. , Yamamoto K. , Koike S. , Imanaka H. , Nishimura M. 
Published: January 2019

Daily sedative interruption (DSI) may reduce excessive sedation and shorten the duration of mechanical ventilation. It is not clear, however, how DSI affects sleep characteristics. For patients receiving mechanical ventilation, we compared the effect on sleep quality of DSI and continuous sedation (CS). Twenty-two mechanically ventilated patients who were receiving midazolam by infusion were randomly assigned to two groups, DSI (n=11) or CS (n=11). In the DSI group, sedatives were interrupted until the patients awoke and expressed discomfort, after which midazolam or opioids were administered intermittently as needed during the daytime (0600 to 2100 hours); during the night (2100 to 0600) midazolam was administered intravenously to maintain Ramsay sedation scale 4 to 5. In the CS group, the sedatives were titrated to obtain Ramsay sedation scale 4 to 5 throughout the day. The polysomnography of each patient was recorded continuously over a 24 hour period. Sleep stages were analysed using Rechtschaffen and Kales criteria. In the DSI group, the amount of stage 3 and 4 non-rapid eye movement sleep (slow wave sleep) was longer (6 vs 0 minutes, P=0.04) and rapid eye movement sleep was longer than in CS (54 vs 0 minutes, P=0.02). In the CS group, total sleep time during night-time was longer (8.7 vs 7.3 hours, P=0.047) and frequency of arousal was lower (2.2 vs 4.4 event/hour, P=0.03) than those in the DSI group. All mechanically ventilated patients demonstrated abnormal sleep architecture, but, compared with CS, DSI increased the amount of slow wave sleep and rapid eye movement sleep.
Mini-Ventilation for Improved Oxygenation during Lung Resection Surgery
Authors: Shechtman M. Y. , Ziser A. , Barak M. , Ben-Nun A. 
Published: January 2019

Lung separation is frequently used during lung resection to facilitate surgery and hypoxaemia may occur because of increasing pulmonary shunt. In this study, we tested a method of mini-ventilation to the non-dependent lung and compared it to continuous positive airway pressure (CPAP) to improve oxygenation during lung resection. Thirty-eight adult patients participated in this randomised, single-blinded crossover study. Following lung separation, mini-ventilation and CPAP of 5 cmH2O were alternately applied every 15 minutes to the non-dependent lung. Mini-ventilation was performed by a portable time-cycled ventilator with a respiratory rate of 8 breaths/minute and a tidal volume of 0.1 to 0.15 l. Arterial blood gases, peak inspiratory pressure, the dynamic compliance in the dependent lung and the surgeon's evaluation of the surgical field exposure were recorded. The arterial oxygen partial pressure was significantly higher during mini-ventilation compared to CPAP (379 vs 228 mmHg). No difference was noted in the dependent lung peak inspiratory pressure or in the dynamic compliance. The surgical conditions were similar with both methods in 53% of the patients, while the surgeon preferred CPAP in 44% and mini-ventilation in 3%. In conclusion, mini-ventilation is a simple method which improves oxygenation during lung resection. However, due to interference with surgical field exposure, it should be reserved for cases in which CPAP does not relieve hypoxaemia.
Clinical Prediction of Weaning and Extubation in Australian and New Zealand Intensive Care Units
Authors: Rose L. , Presneill J. J. 
Published: January 2019

Our objective was to describe, in Australian and New Zealand adult intensive care units, the relative frequency in which various clinical criteria were used to predict weaning and extubation, and the weaning methods employed. Participant intensivists at 55 intensive care units completed a self-administered questionnaire, using visual analogue scales (0=not at all predictive, 10=perfectly predictive, not used=null score) to record the perceived utility of 30 potential predictors. Survey response rate was 71% (164/230). Those variables thought most predictive of weaning readiness were respiratory rate (median score 8.0, interquartile range 7.0 to 8.6) effective cough (7.3, 5.9 to 8.2) and pressure support setting (7.2, 6.0 to 8.0). The most highly rated predictors of extubation success were effective cough (8.0, 7.0 to 9.0), respiratory rate (8.0, 7.0 to 8.5) and Glasgow Coma Score (7.9, 6.1 to 8.3). Variables perceived least predictive of weaning and extubation success were P0.1, Acute Physiological and Chronic Health Evaluation score II, mean arterial pressure, electrolytes and maximum inspiratory pressure (individual median scores <5). Most popular clinical criteria were those perceived to have high predictive accuracy, both for weaning (respiratory rate 96%, pressure support setting 94% and Glasgow coma score 91%) and extubation readiness (respiratory rate 98%, effective cough 94% and Glasgow Coma Score 92%). Weaning mostly employed pressure support ventilation (55%), with less use of synchronised intermittent mandatory ventilation (32%) and spontaneous breathing trials (13%). Classic ventilatory performance predictors including respiratory rate and effective cough were reported to be of greater clinical utility than other more recently proposed measures.
The History of Premedication
Authors: Ball C. , Westhorpe R. N. 
Published: January 2019

“- An anaesthetic is a frightening adventure into the unknown over which a patient can exert no control, and few can meet this type of ordeal with equanimity”1. British Medical Journal, 1964. Prior to the discovery of anaesthesia, medication before surgery was the only way of diminishing the patient's suffering. In 1682, George Wedel, Professor of Medicine at Jena, suggested that opium could be given to a patient prior to an amputation so that he “… bears the burning and cutting of the limb with a readier spirit”2. Alcohol was often recommended for the same reason3. In 1805, Seishu Hanaoka, a Japanese surgeon, administered a potent oral mixture of alkaloids, largely from the Datura stramonium plant, to a woman for a mastectomy4. He called this mixture Tsusensan, successfully using it on many patients: it produced hours of complete unconsciousness – long before Morton demonstrated the effect of ether.
Evaluation of the Mediseus® Epidural Simulator
Authors: Lee R. A. , van Zundert T. C. R. V. , van Koesveld J. J. M. , van Zundert A. A. J. , Stolker R.-J. , Wieringa P. A. , Gatt S. P. 
Published: January 2019

The demand for increased patient safety has led to greater use of simulation training of health professionals performing medical procedures. The study aim was to evaluate the usefulness of the Mediseus® Epidural Simulator in teaching basic epidural needle-handling skills. Three groups of 15 anaesthetists (Novice=zero to two year anaesthesia trainees; Intermediate=three- to five-year anaesthesia trainees; Expert=consultants and regional-specialist anaesthetists) from three different medical centres participated. Each participant performed 20 simulated epidural needle insertions and was scored on several parameters (e.g. time, success of the insertion, bone collisions). Following familiarisation with the simulator and the needle insertions, participants answered seven questions on the applicability of the simulator to the teaching of basic epidural needle-handling skills. There was a clear learning effect with regard to the simulation procedure time, this decreasing throughout the experiment (P=0.037). There was no significant influence of either group or experience with the simulator in the study on the number or type of errors made. The quality of the simulation was scored 2.3 out of 5.0 (for bone simulation) and 4.7 (for loss-of-resistance simulation). All groups considered that the simulator was best suited for training prospective anaesthetists. Each group rated the usefulness of the simulator for training novices at greater than 3.0 out of 5.0. The Mediseus® Epidural Simulator seems to be an appropriate training device for an introduction to epidural needle insertion. For medical professionals with procedural knowledge, the simulation is not realistic enough and the simulator did not distinguish between the groups based on the errors made.
Reliability of the Direct Observation of Procedural Skills assessment tool for ultrasound-guided regional anaesthesia
Authors: Chuan A. , Thillainathan S. , Graham P. L. , Jolly B. , Wong D. M. , Smith N. , Barrington M. J. 
Published: January 2019

Summary The Direct Observation of Procedural Skills (DOPS) form is used as a workplace-based assessment tool in the current Australian and New Zealand College of Anaesthetists curriculum. The objective of this study was to evaluate the reliability of DOPS when used to score trainees performing ultrasound-guided regional anaesthesia. Reliability of an assessment tool is defined as the reproducibility of scores given by different assessors viewing the same trainee. Forty-nine anaesthetists were recruited to score two scripted videos of trainees performing a popliteal sciatic nerve block and an axillary brachial plexus block. Reliability, as measured by intraclass correlation coefficients, was −0.01 to 0.43 for the individual items in DOPS, and 0.15 for the ‘Overall Performance for this Procedure’ item. Assessors demonstrated consistency of scoring within DOPS, with significant correlation of sum of individual item scores with the ‘Overall Performance for this Procedure’ item (r=0.78 to 0.80, P <0.001), and with “yes” versus “no” responses to the ‘Was the procedure completed satisfactorily?’ item (W=24, P=0.0004, Video 1, and W=65, P=0.003, Video 2). While DOPS demonstrated a good degree of internal consistency in this setting, inter-rater reliability did not reach levels generally recommended for formative assessment tools. Feasibility of the form could be improved by removing the ‘Was the procedure completed satisfactorily?’ item without loss of information.
The Anaesthetic Assessment, Management and Risk Factors of Bariatric Surgical Patients requiring Postoperative Intensive Care Support: A State-Wide, Five-Year Cohort Study
Authors: Morgan D. J. R. , Ho K. M. 
Published: January 2019

Summary Bariatric surgery is a rapidly growing and dynamic discipline necessitating a specialised anaesthetic approach coordinating high-risk patients with appropriate postoperative intensive care (ICU) support. The relationship between the anaesthetic and ICU utilisation after bariatric surgery is poorly understood. All adult bariatric surgery patients admitted to any ICU over a five-year period between 2007 and 2011 in Western Australia were identified from hospital admission records and cross-referenced against the Western Australian Department of Health Data Linkage Unit database. During the study period 12,062 patients underwent bariatric surgery with 581 (4.8%) patients admitted to ICU immediately following surgery. The mean preoperative ASA score was 3.3 (standard deviation 1.1) with 76.9% of patients assessed by their anaesthetist for the first time on the day of surgery. Blood pathology (75%) and ECG (46.3%) were the most common preoperative investigations. Intraoperatively, 2.1% of patients had a grade 4 intubation with only 3.4% of patients requiring video-assisted intubation. Despite being deemed at high risk, 23.6% of patients were managed with 20 Gauge or smaller intravenous access. Anaesthetic complications were extremely uncommon (0.5% of all bariatric cases) but accounted for 9.7% of all postoperative ICU admissions. Smoking history, but not body mass index ( P=0.46), was the only significant prognostic factor for respiratory or airway-related anaesthetic complications ( P=0.012). In summary, the anaesthesia management of bariatric surgery varied widely in Western Australia, with smoking as the only significant preoperative risk factor for respiratory or airway-related anaesthesia complications.
Validation of Air as an Equilibration Medium in Gastric Tonometry: An in Vitro Evaluation of Two Techniques for Measuring Air Pco2
Authors: Venkatesh B. , Morgan J. , Jones R. D. M. , Clague A. 
Published: January 2019

This laboratory-based bench study was undertaken to evaluate the accuracy and equilibration characteristics of air and saline respectively as CO2 equilibrating media in the silicone balloon of a gastric tonometer and to compare two methods of measuring air Pco2. Two gastric tonometers were suspended in a bath containing 0.9% saline maintained at 37°C. Certified calibration gases at three different CO2 concentrations were bubbled into the bath. When the bath Pco2 measurement was stable the tonometers were primed with 5 ml of air and 2.5 ml normal saline respectively and allowed to equilibrate for 30 and 90 minutes. Following equilibration, samples were aspirated and analysed in duplicate in a blood gas analyser. Bias and precision were calculated from the measured and expected Pco2 values. A consistent negative bias (21–23%) was seen with air at all three CO2 concentrations at 30 and 90 minutes with a coefficient of variation between 2.7 and 3.3%. Imprecise data were obtained with saline at different levels of CO2. A similar experimental set-up was used to compare air Pco2 measurement by a blood gas analyser and an infra-red analyser (Tonocap). Similar bias was obtained with the blood gas analyser with respect to air Pco2 measurement as in experiment 1. The infra-red analyser measurement was highly precise with negligible bias. Air appears to be a better CO2 equilibration medium during bench testing of tonometry producing a systematic negative offset and requiring a uniform correction factor of 1.25. This correction factor is independent of equilibration time and equilibrating CO2 concentration. The use of the infra-red analyser eliminates any bias in the measurement of air Pco2 and obviates the need for a correction factor.
Subcutaneous Tunnelling of Epidural Catheters for Postoperative Analgesia to Prevent Accidental Dislodgement: A Randomized Controlled Trial
Authors: Burstal R. , Wegener F. , Hayes C. , Lantry G. 
Published: January 2019

The use of subcutaneous tunnelling to prevent movement of epidural catheters was examined in a prospective controlled trial. There were 113 patients in the standard group and 100 in the tunnelled group. The groups were similar with respect to age, sex and weight. There were 176 thoracic catheters, and 37 lumbar catheters. Mean duration of catheterization in the tunnelled group was 3.5±1.3 days and in the standard group, 3.1±1.5 days. In total, 60 catheters moved significantly from their initial position: 17 (28%) moved inwards and 43 (72%) moved outwards. 159 catheters were still functioning at the time of their removal, 76 standard and 83 tunnelled. This represents 67 and 83% of the two groups respectively. Subcutaneous tunnelling was shown to prevent clinically significant inwards (P=0.043) and outwards (P=0.0005) movement of epidural catheters and is more likely to result in a functional epidural blockade at the time of catheter removal (P=0.0084).
Postoperative Nausea and Vomiting: Development of a Management Protocol
Authors: Paech M. J. , Pavy T. J. G. , Kristensen J. H. , Wojnar-Horton R. E. 
Published: January 2019

Postoperative nausea and vomiting (PONV) is still an important and common problem. Despite the introduction of new antiemetic drugs, the management of PONV remains difficult. In this article we describe the development and evaluation of a management protocol for PONV, which consists of a treatment algorithm accompanied by a nursing education program. Implementation of this management protocol has been well-accepted by staff, appears to have reduced delay in patient treatment and improved patient care, and has significantly reduced staff workload. It is planned to use continuous quality improvement techniques to further refine the algorithm and continue assessment of its efficacy and of patient satisfaction.
Anaesthesia for Tracheoplasty: Case Report and Review of Anaesthesia Techniques
Authors: Tan S. S.-W. , Tan G. M. 
Published: January 2019

Congenital tracheal stenosis is an uncommon cause of stridor and can be associated with other anomalies. It may present anytime during childhood depending on the severity of the lesion. The anaesthetist may be involved in all stages of management of this problem; from diagnostic investigations to surgical correction. Various methods of tracheoplasty have been described, some requiring cardiopulmonary bypass support and others may be carried out with conventional ventilatory techniques.
The Effect of Manual Lung Hyperinflation and Postural Drainage on Pulmonary Complications in Mechanically Ventilated Trauma Patients
Authors: Ntoumenopoulos G. , Gild A. , Cooper D. J. 
Published: January 2019

This study questioned whether manual lung hyperinflation (MHI) and postural drainage reduced the incidence of nosocomial pneumonia or improved other outcome variables in mechanically ventilated trauma patients. Patients were withdrawn from the study if they developed nosocomial pneumonia according to a predetermined definition or on the clinical suspicion of nosocomial pneumonia by the attending intensivist. Of the 46 patients who fulfilled all the inclusion criteria and were enrolled into the study, 22 patients were randomized to group A (physiotherapy) and 24 patients to group B (control group). Twice as many patients were withdrawn in group B (8/24) compared with group A (4/22), although the differences were not statistically significant, [X2(1, 1) = 1.36, P = 0.24]. The length of time receiving mechanical ventilation and in the ICU was similar between the two groups and there were no differences in pulmonary dysfunction (“worst” daily PaO2/FiO2 ratio) between the two groups. There were no ICU deaths in either group. Physiotherapy as used in this study was not associated with a reduced incidence of nosocomial pneumonia based on standard clinical criteria. Nevertheless the trend to more frequent nosocomial pneumonia in the control patients suggests that a larger study in more severely injured patients with stricter clinical criteria for the definition of nosocomial pneumonia is indicated.
Community Pharmacists’ Perceptions of Care Following the Implementation of a Transitions-of-Care Program
Authors: Graham Jove , Tusing Lorraine D. , Gregor Christina M. , Wright Eric A. 
Published: January 2019

Background: Pharmacist-led collaborative interventions can support improved medication use and adherence during transitions of care (TOC). Community pharmacists are not always actively connected with other health-care team professionals, however, and their confidence in having necessary information may vary. Objective: To assess community pharmacists’ perceptions of information, care provided, and communication, before and after a postdischarge intervention designed to increase communication between inpatient and community pharmacists. Methods: A survey assessing 4 domains related to pharmacists’ perceptions of information and care of hospital discharge patients was developed and distributed to 106 community pharmacists before and after a TOC interventional study. Results: Based on 151 responses (77 baseline, 74 followup) from 84 participants, community pharmacists have high confidence in their ability to counsel and feel that they are an important part of the healthcare team. They are less confident that they have adequate information about patients and report gaps in having adequate support and resources to provide care. When a TOC intervention was implemented, there was significant improvement in community pharmacists’ feeling of having adequate information about the patients. Conclusion: Not having adequate information regarding patients discharged from the hospital is an area of concern for community pharmacists and a modifiable opportunity to improve TOCs.