bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Elimination of Pollution by a Non Inhalational Technique
Authors: Holmes C. McK. , Henderson R. S. 
Published: January 2019

A method is described whereby major surgery can be accomplished without inhalational anaesthetic agents, thus completely eliminating operating room pollution. The method is based on the balanced use of three intravenous agents — morphine, alcuronium and gamma-hydroxybutyrate (GHB). In the dose chosen for GHB, reliable unconsciousness can be produced for surgery of any length, and using physostigmine as an antidote, patients can be wakened within ten minutes. The advantages are convenience, simplicity of equipment, low cost, absence of pollution and good patient acceptance. The disadvantages are a certain incidence of hypertension and in this series, a small failure rate with the antidote.
Enflurane Nephrotoxicity and Pre-Existing Renal Dysfunction
Authors: Cousins Michael J. , Fulton Ann , Haynes W. David G. , Whitehead Richard 
Published: January 2019

This study provides the first morphological evidence of significant structural damage following high doses of enflurane alone and confirms previous findings of transient renal functional abnormalities following high dosage enflurane. The study also indicates that enflurane may have a greater potential for renal toxicity in the presence of renal impairment. Treatment of Fischer 344 rats with a nephrotoxic dose of gentamicin prior to six hours of enflurane (GE) anaesthesia at 1 MAC resulted in increased serum concentration of the enflurane metabolite inorganic fluoride (GE, 43.9 ± 1.5; E, 34.5 ± 1.8 μ mol/L), increased urine flow rate and a greater degree of structural damage in renal proximal convoluted tubule cells than was observed with either gentamicin (G) or enflurane (E) alone. Treatment with gentamicin prior to enflurane also resulted in reduced urinary osmolality compared to enflurane or gentamicin alone (GE, 742 ± 57; E, 1709 ± 66; G, 985 ± 32 m0sm/kg).
Local Cerebral Blood Flow and the Electrocorticogram during Sodium Nitroprusside Hypotension
Authors: Miller C. L. , Lampard D. G. , Griffiths R. I. , Brown W. A. 
Published: January 2019

Changes in local cerebral blood flow during sodium nitroprusside hypotension were measured using the hydrogen electrode technique. At mean arterial pressures from 90% to 50% of control values, local cerebral blood flow showed a significant decrease by 20%. When blood pressure was reduced below 50%, the local cerebral blood flow increased significantly and approached control levels. It is suggested that the flow increase may be due to local hypoxia. Associated with this increase were electrocorticogram changes indicative of hypoxia. The significant decrease in mean local cerebral blood flow and the large range of flows seen during mild hypotension indicate that autoregulation is impaired. During hypotension, intracranial pressure increased by, at most, 3 mm Hg. Cardiac output was usually unaffected and was never decreased by more than 20%.
Studies in Man with a Constant-Rate Infusion of Tubocurarine
Authors: Shanks C. A. , Ramzan M. I. , Triggs E. J. 
Published: January 2019

Tubocurarine (dTC) was administered to twenty patients by intravenous infusion at a predetermined constant rate, and the twitch responses recorded at stimulus intervals of 10 seconds (0.1 Hz). In half the group dTC plasma concentrations were measured both during and following the infusion. This provided data for derivation of the pharmacokinetic parameters, two plasma concentration-response curves and the dose-response curve. The mean effective dTC plasma concentration for 50% paralysis during the infusion (onset) was 0.93 fig/ml, but was lower post-infusion (offset) (0.54 μg/ml, p < 0.001). The steady state dTC plasma concentration which should produce 95% paralysis was predicted to lie between 0.95 and 1.67 μg/ml. In the range 20 to 80% paralysis the slopes of the two (log) concentration-response lines were similar, although steeper than the associated (log) dose-response regression line, the test for parallelism showed no statistical difference. Combination of the plasma concentration-response curve with pharmacokinetic models was used to predict the time course of paralysis in patients with normal and impaired renal function. Dose-response curves for the other 10 patients were also constructed to stimulus frequencies from 0.02 to 5 Hz. In the range 20 to 80% paralysis the regression lines appeared to be parallel. The results were pooled for all patients at a stimulation rate of 0.1 Hz, giving a mean effective dose of dTC at 95% paralysis of 0.53 mg/kg, and an ED50 of 0.22 mg/kg.
The Combination of General Anaesthesia and Epidural Block I: The Effects of Sequence of Induction on Haemodynamic Variables and Blood Gas Measurements in Healthy Patients
Authors: Germann P. A. S. , Roberts J. G. , Prys-Roberts C. 
Published: January 2019

The haemodynamic effects of epidural block, administered before or after general anaesthesia, were investigated in twelve healthy women scheduled for elective gynaecological surgery. The effects of 10° head down tilt and administration of atropine 0.6 mg intravenously were also determined. Haemodynamic measurements included systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR), cardiac output (CO) and systemic vascular resistance (SVR). In those receiving general anaesthesia first (Group A) (thiopentone/suxamethonium/N2O/O2) significant changes occurred only at the time when epidural block and general anaesthesia were both present: SAP, DAP and MAP (-22%, p < 0.001) were reduced compared to awake control values, however changes in HR, CO and SVR were not significant. In those receiving epidural block first (Group B) (1.5% lignocaine, mean dose 270 mg), MAP was reduced by 20% (p < 0.01) from awake control values after epidural block and there was a further reduction to 35% below control (p < 0.001) when general anaesthesia was induced. These changes were accompanied by a significant reduction in SVR. Comparison of all variables between Group A and Group B showed no clinically significant differences, indicating that the order of performance of epidural block (before or after general anaesthesia) did not affect haemodynamic variables. Head down tilt resulted in no haemodynamic changes in the presence of general anaesthesia or epidural block alone and only minimal changes when the two were combined. In contrast, intravenous atropine (0.6 mg) resulted in a return of arterial pressures to essentially baseline values in both Group A and Group B (HR increased 84%, p < 0.001; MAP increased 37%, p < 0.001; CO increased 70%, p < 0.001).
Intensive Care Data — I: Computer Controlled Analysis
Authors: Austin K. L. , Phillips G. D. 
Published: January 2019

A flexible, simple computer-controlled system for analysis of administrative and clinical data in intensive care is described. The system uses an interactive data input programme to facilitate data entry, an editor to correct errors, and the Statistical Package for the Social Sciences (SPSS) for data selection, retrieval and analysis. The system has the following features: data input is simple; large amounts of data can be handled rapidly and accurately; old data is readily available for comparison with new data and can be included in the present analysis; available statistical packages remove the need for a programmer; complex analyses are possible. The system has been successfully used for two years to provide administrative and clinical data which is pertinent to patient care.
The Incidence and Aetiology of Phrenic Nerve Blockade Associated with Supraclavicular Brachial Plexus Block
Authors: Knoblanche G. E. 
Published: January 2019

A trial to ascertain the true incidence of inadvertent phrenic nerve block with brachial plexus block via the supraclavicular approach was carried out. Phrenic nerve block was monitored by x-ray screening of the diaphragm. There was an incidence of phrenic nerve block of 67% (10 cases of diaphragmatic paralysis in 15 brachial blocks). The possible causes of phrenic nerve block with brachial block are discussed. It is concluded that the phrenic nerve is blocked peripherally in front of the scalenus anterior.
Neurogenic Pulmonary Oedema in Man: Aetiology and Management with Vasodilators based on Haemodynamic Studies
Authors: Loughnan P. M. , Brown T. C. K. , Edis B. , Klug G. L. 
Published: January 2019

Acute pulmonary oedema is a rare complication of head injury. A case is reported in which the pulmonary oedema was treated initially by tracheal intubation, constant positive airway pressure, ventilation and isoprenaline. Subsequent treatment was by vasodilatation with sodium nitroprusside and phenoxybenzamine and the patient made a good recovery. The findings are discussed in relation to reported experimental work. The aetiology appears to be related to a massive sympathetic discharge leading to systemic vasoconstriction, shift of blood to the pulmonary circulation with left ventricular failure and pulmonary oedema.
Needle Tracheostomy: A Laboratory Study
Authors: Dobbinson T. L. , Whalen J. , Pelton D. A. , Nisbet H. I. A. , Volgyesi G. 
Published: January 2019

Percutaneous needle tracheostomy and transtracheal ventilation continues to be advocated for the management of upper airway obstruction. Recent studies recommend the use of artificial ventilation. However, as apparatus for this is not always available and because there remains some doubt regarding conditions for successful use of needle tracheostomy during spontaneous respiration, we undertook such a study in dogs. Pressure-flow characteristics of short hollow needles 18–10 SWG were first determined. The smallest of these (14 SWG Bardic Intracath) that would deliver flow sufficient (by calculation) to meet the respiratory requirement of 10–13 kg laboratory dogs was selected for further study. Respiration was possible by spontaneous or artificial methods in the presence of complete tracheal occlusion. Little or no deterioration was noted in an hour of such breathing. Artificial ventilation by machine and by hand could considerably lower PaCO2. We conclude that the technique is possible provided appropriate needles are selected and care is given to their method of use.
Hazards of Anaesthetic Scavenging: Case Reports and Brief Review
Authors: O'Connor D. E. , Daniels B. W. , Pfitzner J. 
Published: January 2019

Two cases are presented of misadventure occurring in association with the use of anaesthetic scavenging equipment. The first case demonstrates how easily the scavenging line linking the venting port of a mechanical ventilator to the scavenging interface can become accidentally obstructed. The second case suggests that the proper use of scavenging equipment will effectively eliminate any possibility of recognising by smell an accidental overdose of volatile anaesthetic agent. Previous reports of scavenging hazards are briefly reviewed. It is concluded from this review that scavenging suction should be‘low-vacuum’, that a relief valve must be included in the scavenging pathway proximal to any site of potential obstruction, and that the appearance and function of a scavenging interface must be simple and immediately obvious.
4-Aminopyridine — A Review
Authors: Soni N. , Kam P. 
Published: January 2019

4-aminopyridine is the first of the aminopyridines to be used in clinical practice. It blocks potassium channels and thereby increases acetylcholine, and possibly noradrenaline, release at nerve terminals. In man the drug has a significant action at the neuromuscular junction, but has little effect on the autonomic nervous system or muscle (smooth, skeletal, or cardiac) although such actions have been demonstrated in animals. It may be clinically useful in the reversal of nondepolariser blockade and a role in antibiotic associated block has been proposed. It may be used effectively as an analeptic agent. It appears to be a useful therapeutic agent in myasthenia gravis and Eaton Lambert syndrome, although of limited use in botulism. Its effects on the central nervous system are considerable. These account for the major side effects of the drug which include tremor, excitability and convulsions.
Bronchial Adenoma Mimicking Complications of Endotracheal Intubation
Authors: Him David Yeo Keat 
Published: January 2019

A 39-year-old Chinese lady was admitted to hospital for an emergency caesarian section under general anaesthesia. After intubation it was discovered that there was diminished air entry to the left side. The cause could not be elicited during anaesthesia and a postoperative chest radiograph revealed no abnormality. Subsequent tomography revealed a mass in the lumen of the left main bronchus. Biopsy of the lesion revealed an adenoid cystic carcinoma (bronchial adenoma — cylindroma type). By causing airway obstruction with gas trapping this rare neoplasm may present as the cause of a problem mimicking more common complications of endotracheal intubation.
One Year's Evaluation of a System of On-line Computerisation of Anaesthetic Records Using a Computer Bureau
Authors: Roessler P. , Lambert T. F. 
Published: January 2019

A system for the on-line computerisation of anaesthetic records using a computer bureau is described. The requirements of the system are a keyboard and video display unit appropriately linked to the bureau's computer. The system was cheap and easy to install. It required no programming expertise from department members. Disadvantages included the need to change between two screens for data entry, a delay of over 8 months before satisfactory reports materialised for individuals or the department, congestion at peak times for data entry, excessive time spent on data entry, reluctance of the bureau to alter the format of the screens once they had been generated. The cost of the system is felt to be justified by the information provided for both accreditation requirements and for department management.
Platelet Counts in Stored Donor Blood
Authors: Russell W. J. , Tunbridge L. J. 
Published: January 2019

Platelets were counted in eight units each of one- and three-day-old blood. Counts were done both before and after the blood had passed through a standard 170 micron filter. In the one-day-old blood, platelet counts were within the normal range. The mean count was 237,000 platelets/microlitre. Platelet counts on three-day-old blood were lower, but generally still within the normal range. The mean count was 183,000/microlitre. Only a few platelets were retained by the filter in the transfusion set; about 90% of platelets passed the filter in both the one- and three-day-old blood. It appears that whole blood, anticoagulated with citrate/phosphate/dextrose (CPD), and stored under Australian blood bank conditions retains platelets in sufficient numbers for at least the first three days to be clinically significant. However, it remains to be determined whether satisfactory platelet activity can be expected during this time.
The Effects of Suxamethonium and D-Tubocurarine on the Pressor and Plasma Catecholamine Responses to Tracheal Intubation
Authors: Cummings M. F. , Russell W. J. , Frewin D. B. , Jonsson J. R. 
Published: January 2019

Changes in mean arterial pressure (MAP) and plasma catecholamine concentrations in response to endotracheal intubation were examined in 8 patients who had received d-tubocurarine and 10 who had received suxamethonium. MAP fell after induction of anaesthesia and administration of the relaxant by a mean of 11 mmHg in those who had received suxamethonium and 19 mmHg in those who had received d-tubocurarine (p <0.05 for each). MAP rose sharply when the trachea was intubated, by a mean of 29 mmHg for the suxamethonium group, and 35 mmHg for the curare group (p <0.001 for each). A significant rise in plasma noradrenaline was also noted after intubation in each group, 51% (p <0.01) for the suxamethonium group and 28% (p <0.05) for the d-tubocurarine. The results suggest that the fall in MAP after administration of d-tubocurarine does not attenuate the pressor response associated with intubation.
A Comparison of Methods of Cardiac Output Measurement
Authors: Woog R. H. , McWilliam D. B. 
Published: January 2019

Cardiac output measurements determined by dye dilution, iced-injectate thermodilution and room temperature thermodilution were compared in man in order to assess the random error of each method and to examine the systematic error of both thermodilution methods in comparison with dye dilution. Results showed that random error was greatest with room temperature thermodilution and least using iced thermodilution. Iced thermodilution correlated well with dye dilution, tending to overestimate cardiac output only at low flows. Room temperature thermodilution, however, overestimated cardiac output by up to 25% in the clinically important range and more so at low cardiac output.
Medical Diseases in Surgical Patients in Hong Kong
Authors: Yeung M. L. 
Published: January 2019

The incidence of medical diseases in surgical patients was assessed using data gathered from 5944 consecutive anaesthetics. Medical disease which might affect anaesthetic management was present in 23.2% of patients. The commonest diseases were hypertension, anaemia, chronic obstructive airway disease, diabetes mellitus, and pulmonary tuberculosis. No significant difference was detected in sex incidence for ischaemic heart disease and cerebrovascular disease. There was a disproportionate preponderance of males with respiratory diseases. It is suggested that anaesthetics should be administered only by qualified anaesthetists, that the establishment of anaesthetic outpatient clinics is desirable, and that internal medicine should be included in anaesthetic training.
Fasting and Non-fasting Serum Amino Acid Values in three Home Parenteral Nutrition Patients: A Comparison between Synthamin 17R and Vamin N 7%R
Authors: Worthley L. I. G. , Philcox J. C. , Hartley T. F. 
Published: January 2019

Serum amino acid concentrations were measured during the fasting and non-fasting stages of nutrition in three home parenteral nutrition patients who received their nitrogen requirement as Synthamin 17R for 12 months then Vamin N 7%R for 12 months. When the patients received Synthamin 17R, the fasting serum amino acid values revealed consistently elevated levels of glycine, phenylalanine, methionine and alanine and low levels of leucine, iso-leucine, valine, lysine, histidine, cystine and serine. When the patients received Vamin N 7%R, the fasting serum amino acid levels showed consistently elevated levels of proline, phenylalanine, glutamate, alanine, cystine and valine and low levels of arginine. Many of the serum amino acid abnormalities observed reflected the differences in the amino acid profiles of Vamin N 7%R and Synthamin 17R when compared with a normal diet.
A Technique for the Insertion of an Implantable Portal System for the Long-Term Epidural Administration of Opioids in the Treatment of Cancer Pain
Authors: Cherry David A. , Gourlay Geoffrey K. , Cousins Michael J. , Gannon Bren J. 
Published: January 2019

The feasibility of using a subcutaneously implanted portal system attached to a conventional 16-gauge epidural catheter has been evaluated in 50 patients with severe pain associated with cancer. This technique allowed for the percutaneous epidural administration of morphine at 8-12-hourly intervals for pain control. The mean duration of implantation was 12 weeks and the longest period a portal remained in situ was 36 weeks. Five portals had to be removed for various reasons. The injection system has blocked on eight occasions due to catheter blockage (six times) and portal blockage (two occasions). These patients have continued to obtain excellent analgesia when either catheter or portal were replaced. In a cadaver, 300 injections were simulated using either 22-gauge Huber point needles or disposable needles (25 gauge) and the injectate examined by both light and scanning electron microscopy. Both needle types resulted in particulate contamination which was greater with the recommended Huber point needles.
Platelet Function in Platelet Concentrates and in Whole Blood
Authors: Rodgers S. E. , Lloyd J. V. , Russell W. J. 
Published: January 2019

Platelet function was studied in CPD whole blood stored at 4°C for one and three days and in platelet concentrates stored at room temperature for the same periods of time. Comparisons were made of platelet shape, nucleotide content, β-thromboglobulin (βTG) liberated during storage, and platelet aggregation in response to ADP, collagen, sodium arachidonate and ristocetin. It was found that in whole blood the shape of the platelets was less discoid than in platelet concentrates. However, platelet aggregation in response to ADP, collagen, and sodium arachidonate was preserved better in whole blood than in platelet concentrates. Platelet nucleotides were the same in whole blood as in platelet concentrates, but the plasma levels of βTG were less in whole blood. The results show that as judged by aggregation, βTG release and nucleotide content, platelets from whole blood were at least as functional as those from platelet concentrates. However, platelets from whole blood had lost their discoid shape, which suggests that they would have a short survival in the circulation.
Paediatric Retrievals in South Australia
Authors: Sweeney D. B. , Turtle M. J. 
Published: January 2019

Since the early 1970s there has been a co-ordinated retrieval service in South Australia for adult, paediatric and neonatal patients. The paediatric service has been mounted from the Adelaide Children's Hospital and to the end of 1983 numbers 379 patients, including 90 patients in 1983. This is now providing a considerable workload on the Anaesthetic and Intensive Care Departments. The records have been entered into a file program in a microcomputer and analysed. The results of this analysis are presented and discussed.
The Influence of Age on Lignocaine Pharmacokinetics in Young Puppies
Authors: Hastings C. L. , Brown T. C. K. , Eyres R. L. , Oppenheim R. C. 
Published: January 2019

Eight mongrel puppies were studied at intervals of a few weeks. Lignocaine 4mg/kg was infused over 60 seconds. Frequent samples were taken over 30 minutes for plasma lignocaine assay. Initially the concentrations were significantly higher in the oldest group (178–191 days) but after 10 minutes the youngest group (3–16 days) had significantly higher levels than the other groups. Pharmacokinetic data derived included the rate constants k21, k12 (drug movement between two compartments), k10 (elimination from the central compartment), and the volume of distribution (Vβ). The elimination rate constant k10 was significantly lower in Group 1 (3–16 days) than all other groups and Group 2 (37–57 days) was lower than Group 4 (178–191 days). The calculated β half-life was significantly longer in the youngest group than the others. There was no significant difference in the volume of distribution between these age groups — up to 6 months.
Relationship between Methaemoglobin Production and Methylene Blue Plasma Concentrations under General Anaesthesia
Authors: Lamont A. S. M. , Roberts M. S. , Holdsworth D. G. , Atherton A. , Shepherd J. J. 
Published: January 2019

Recently, a family tree with a predisposition for the gene of multiple endocrine neoplasia Type 1 has been identified in Tasmania. As the surgical identification and localisation of parathyroid adenomas is facilitated by the administration of methylene blue, an opportunity has presented to measure the plasma concentration of methylene blue and methaemoglobin production. The study was undertaken to establish whether significant methaemoglobin concentrations were generated during the infusion and whether these concentrations could be related to the corresponding methylene blue concentrations. Mean peak methylene blue concentrations of 3.72 μgl−1, mean percentage methaemoglobin of 10.0 and a Pa.O2 within acceptable clinical ranges were found. No apparent relationship between methylene blue concentration and methaemoglobin production was found.