bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ‘'Wrong Drug” Problem in Anaesthesia: An Analysis of 2000 Incident Reports
Authors: Currie M. , Mackay P. , Morgan C. , Runciman W. B. , Russell W. J. , Sellen A. , Webb R. K. , Williamson J. A. 
Published: January 2019

Amongst the first 2000 incidents reported to the Australian Incident Monitoring Study, there were 144 incidents in which the “wrong drug” was nearly or actually administered to a patient. Thirty-three percent of the incidents involved ampoules and just over 40% syringes; in over half of the latter the syringes were of the same size, and also, in over half, they were correctly labelled. In 81% of the 144 incidents the “wrong drug” was actually given. This was more common with syringes (93%) than ampoules (58%). Thus the most common error was actually giving the wrong drug from a correctly labelled syringe. The most common drug involved was a muscle relaxant in both ampoule and syringe incidents. In 74% of all reports, there was the potential for serious harm to the patient; however no deaths were reported. Factors which contributed significantly to the incidents were similar appearance, inattention and haste. “Failure of communication” was a significant factor in syringe incidents when two or more staff were involved. The only significant factor which minimised the outcome was rechecking of the syringe or drug ampoule before giving the drug. Strategies suggested to address the “wrong drug” problem include education of staff about the nature of the problem and the mechanisms involved; colour coding of selected drug classes for both ampoules and syringes; the use of standardised drug storage, layout and selection protocols; having a drawing up and labelling convention; and the use of checking protocols.
Problems Related to the Endotracheal Tube: An Analysis of 2000 Incident Reports
Authors: Szekely S. M. , Webb R. K. , Williamson J. A. , Russell W. J. 
Published: January 2019

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to problems with the endotracheal tube; 189 (9%) were reported. The most common problem was endobronchial intubation which accounted for 42% of these 189 reports; endobronchial intubation was the most common cause of arterial desaturation in the 2000 incidents. Obstructions and oesophageal intubation each accounted for 18% of the 189 problems with tubes. The remainder was made up of disconnections and leaks (7% each), misplacements other than endobronchial or oesophageal (4%), inappropriate choice of tube (3%), cuff herniation (1%), failure to deflate the cuff and foreign body in the tube (0.5% each). The pulse oximeter and capnograph first detected 58% of these incidents; a further 25% were detected clinically. The pulse oximeter is the “front-line” monitor for endobronchial intubation, and the capnograph the “front-line” monitor for oesophageal intubation, disconnection and obstruction. Recommendations are made for how to prevent problems and how to determine the nature of those that do occur.
Air Embolism—An Analysis of 2000 Incident Reports
Authors: Williamson J. A. , Webb R. K. , Russell W. J. , Runciman W. B. 
Published: January 2019

There were 19 cases of air embolism (1%) among the first 2000 incidents reported to the Australian Incident Monitoring Study. No embolism-induced fatalities were reported. Serious acute systemic effects occurred in 14 incidents; one circulatory arrest required electrical counter-shock. The surgical field was the entry route for the air in 63% of the incidents; 47% of the cases occurred during head and neck surgery. Capnography was the most successful first detector (26%) and it confirmed the diagnosis in another 26%. Invasive blood pressure monitoring, the electrocardiograph and the pulse oximeter played a useful role in detecting and/or confirming air embolism. Doppler monitoring was not reported in this series. A successful first response for management included head-down posture, manual ventilation, 100% oxygen and control of the air entry site. Cerebral arterial gas embolism may induce vascular endothelial damage and possible delayed neurological sequelae; hyperbaric oxygen therapy should be considered.
Tidal Volume, Lung Hyperinflation and Arterial Oxygenation during General Anaesthesia
Authors: Tweed W. A. , Phua W. T. , Chong K. Y. , Lim E. , Lee T. L. 
Published: January 2019

Impaired pulmonary oxygen (O2) exchange is common during general anaesthesia but there is no clinical unanimity as to methods of prevention or treatment. We studied 14 patients at risk for pulmonary dysfunction because of increased age, obesity, cigarette smoking, or chronic lung disease. Pulmonary O2 exchange was measured during four conditions of ventilation: awake spontaneous, conventional tidal volume (CVT, 7 ml.kg-1) or high tidal volume (HVT, 12 ml.kg-1) controlled ventilation, and five min after manual hyperinflation (H1) of the lungs. The F1O2 was controlled at 0.5, and FETCO2 was kept constant by adding dead space during HVT. Eight patients were ventilated with N2O/O2 and six with air/O2. Arterial blood gases were used to calculate the (A-a)DO2. In seven patients (A-a)DO2 worsened after induction of anaesthesia, while in seven there was no change or an improvement. Manual HI significantly reduced (A-a)DO2, but changing tidal volume (VT) had no effect. Using a multivariate model to predict O2 exchange, obesity and type of surgery were significantly associated with worsening, while level of VT and inspiratory gas (N2O or N2) were not significant predictors. Thus patient and surgical factors were more important determinants of pulmonary gas exchange during anaesthesia than were tidal volume or inspiratory gas. Manual HI is a simple and effective manoeuvre to improve gas exchange.
The Training/Examination Programme in Intensive Care, Australian and New Zealand College of Anaesthetists: 2. Examination
Authors: Harrison G. A. , Clarke G. M. 
Published: January 2019

The structure of the Final Examination in Intensive Care for the award of Diploma of Fellow of the Australian and New Zealand College of Anaesthetists is based on a model explicated in the College's Objectives of Training in Intensive Care. There are five sections in the examination: short answer questions, essay questions, investigations, orals and a clinical. The first examination was held in October 1979. Up to and including the examination of October 1992, 94 of the 136 attempts by 107 candidates had been successful. Eighty-three per cent of the candidates passed at the first attempt. The failure rate has been highest in the clinical section. The examination is regarded as a hard examination but one which is helpful in training and subsequent practice.
Training, Skills and Approach to Potentially Difficult Anaesthesia in General Practitioner Anaesthetists
Authors: Watts R. W. , Bassham M. 
Published: January 2019

Seventy-six of the 92 practising South Australian rural general practitioner anaesthetists responded to a questionnaire on anaesthetic training, skills and approach to potentially difficult anaesthesia. The mean training period in anaesthesia was 7.5 months, 24% at registrar level. Eight per cent had no training, and 40% had 3 months or less. Thirty-three per cent trained exclusively overseas and 13% hold a Diploma in Anaesthesia. A total of 11,400 anaesthetics were performed by 76 general practitioners in 1992 at an average of 152 (range 2 to 1500). The mean visual analog “comfort score” in performing anaesthesia was 6.6 and correlated best with the number of procedures per year (r = 0.32, P = 0.03). Forty-six per cent of general practitioners provided anaesthesia for the 0 to 12 month age group, and only 35% had regional skills to use in obstetric anaesthesia. Patients classified as ASA grade 3 to 5, disease states such as unstable angina, severe asthma, and risk factors such as skeletal myopathy, were avoided by most general practitioners. The failed intubation rate was 50/10,000. The conclusion is that South Australian general practitioner anaesthetists exhibit a generally safe approach to selection of patients for anaesthesia, although in some instances the approach to potentially difficult anaesthesia should be more conservative.
Changes in Oxygen Saturation in the 72 Hours after Hip Surgery: The Effect of Oxygen Therapy
Authors: Fugere F. , Owen H. , Ilsley A. H. , Plummer J. L. , Hawkins D. J. 
Published: January 2019

The aim of this study was to investigate changes in oxygen saturation (SpO2) occurring during the three days following hip surgery in patients in this hospital and to determine to what extent SpO2 might be improved by oxygen therapy for 24 or 72 hours. Eighty-three patients (aged 43-96 years) scheduled for elective total hip replacement or emergency surgery for hip fractures were studied. Forty-four patients had 24 hour postoperative oxygen prescribed by their anaesthetist or surgeon; we randomized these to either continue oxygen for a total of three days (Group 1) or to discontinue oxygen after Day 1 (Group 2). Patients not prescribed oxygen by the surgeon or anaesthetist (n = 39) were randomly assigned either to receive oxygen for three days (Group 3) or not to receive oxygen (Group 4). Oxygen was administered through nasal cannulae at a flow of 2 l.min−1. SpO2 was measured every 10 seconds for three days and stored on computer disc. Percentage of time spent with SpO2 below 90% was used as an idex of desaturation. Patients receiving oxygen had significantly improved SpO2. In patients not receiving oxygen, desaturation was most severe on Days 1 and 2, improving somewhat on Day 3. On Day 2 desaturation was similar in Groups 2 and 4. When oxygen was not being administered males were significantly more desaturated than females. Our investigations indicate that following hip surgery poor saturation continues for at least two days and can be improved by oxygen therapy.
A Survey of Families of Brain Dead Patients: Their Experiences, Attitudes to Organ Donation and Transplantation
Authors: Pearson I. Y. , Bazeley P. , Spencer-Plane T. , Chapman J. R. , Robertson P. 
Published: January 2019

A questionnaire survey of 69 families of brain dead patients is reported. The study population included those who had been asked about organ donation as well as those who had not, those who had agreed to organ donation and those who had declined. Their experiences and their perceptions of treatment and explanations of underlying disease, brain death and organ donation were examined. Their own knowledge of and attitudes towards organ donation as well as the prior knowledge and wishes of their deceased relative were also explored. Statistical analysis did not show any differences between the three groups of families with regard to their experiences, their perceptions of the treatment they received, or in the resolution of their grief. Family members who had agreed to organ donation were significantly more likely to donate their own organs and to be more resolved in their grief. There was a strong correspondence between the attitudes of respondents and their agreement or otherwise to donate their relatives’ organs. One quarter, however, made the opposite choice for their relative, where their relative's wishes were known. There was a highly significant relationship between those who had previously discussed organ donation to have expected to be asked or to raise the subject themselves. Hospital treatment in general did not appear to have any effect on the decision to donate. Involvement in organ donation was felt by most of the donor families to have been helpful to the grieving process.
An Enclosed Efferent Afferent Reservoir System: The Maxima
Authors: Miller D. M. 
Published: January 2019

A single, lightweight, valveless, non-absorber breathing system, which functions with near maximal efficiency (hence the name Maxima) in spontaneous and controlled ventilation is described. It may be classified as an enclosed efferent afferent reservoir (EEAR) breathing system and is characterised by the selective elimination of alveolar gas in all modes of ventilation. A functional description explains how this is achieved in the system in spontaneous and controlled ventilation. The potential for error which arises in combination systems for different switch positions with different modes of ventilation is avoided, as it is a single universal system. With no moving parts, mechanical reliability is guaranteed. The apparatus deadspace is negligible making the system usable even in neonates. Finally, the characteristics of the theoretical ideal non-absorber circuit are discussed as this illustrates the objective of the circuit design and important physical principles surrounding its function.
EMLA Cream Prior to Insertion of Elective Epidurals
Authors: Elson J. A. , Paech M. J. 
Published: January 2019

A randomized double-blind study was conducted in 83 women scheduled for elective caesarean section to determine the efficacy of EMLA and lignocaine infiltration for epidural insertion. The patients were randomly allocated to one of three groups: Group A (EM/LIG) received EMLA and intradermal and subdermal 1% lignocaine infiltration, Group B (EM/SAL) EMLA and saline while Group C (PL/LIG) received placebo cream and 1% lignocaine. Assessments using a 100 mm pain score were performed on skin infiltration and after subsequent insertion of a 16 gauge Tuohy needle into the supraspinous ligament. Skin changes under the applied cream and nursing rating of patients’ response were also noted. Statistical analyses were performed using Kruskal-Wallis and Fisher's Exact Tests. Groups were comparable for age, weight, parity and EMLA application time (interquartile range 105-150 minutes) There were significantly higher pain scores for skin infiltration in Group C (PL/LIG) (P<0.01) and for epidural needle insertion in Group B (EM/SAL) (P<0.05). We concluded that in this patient population, the application of EMLA cream for at least 90 minutes plus 1% lignocaine infiltration optimized patient comfort for epidural insertion.
Single-Dose Prophylaxis for Postoperative Nausea and Vomiting after Major Abdominal Surgery: Ondansetron versus Droperidol
Authors: Paech M. J. , Pavy T. J. G. , Evans S. F. 
Published: January 2019

The new antiemetic ondansetron is effective for the prophylaxis and treatment of postoperative nausea and vomiting (PONV), but has been subject to limited comparative evaluation in surgical inpatients. Two hundred and seventy women having abdominal gynaecological surgery were investigated for 24 hours postoperatively in a randomized, double-blind, placebo-controlled study of intraoperative intravenous ondansetron 8 mg (n=83), droperidol 2.5 mg (n = 89) or saline placebo (n=87). Patients receiving either ondansetron or droperidol remained likely to vomit, although the incidence was significantly reduced compared with placebo (72% and 83% versus 91%, P<0.01). Both drugs also resulted in significantly fewer vomiting episodes (P<0.001), lower nausea scores (P<0.05) and a lower incidence of patients requiring treatment for PONV (P<0.01). Compared with droperidol, the risk of vomiting after ondansetron was less (odds ratio 0.5, CI 0.3–1.0). Ondansetron resulted in fewer vomiting episodes (P<0.05) and a higher percentage of patients free of nausea after six hours postoperatively (P<0.05). In patients with a past history of PONV, both drugs had a similar short-lived antiemetic effect, reducing the incidence of vomiting and the need for treatment while in the recovery room, but not thereafter. Droperidol was associated with significantly less headache (P<0.05), but higher early sedation scores (P<0.05). Although, compared to placebo, both droperidol and ondansetron administered intraoperatively reduced vomiting after major abdominal gynaecological surgery, the incidence during the first 24 postoperative hours was very high in all groups. Ondansetron reduced the risk of experiencing nausea after six hours postoperatively and the risk of vomiting, with respect to the total number of episodes, in the first 24 hours. It was no better than droperidol, however, in reducing the incidence of vomiting or the need for antiemetic treatment during the first postoperative day, whether or not patients had a past history of PONV.
Rectal Indomethacin Potentiates Spinal Morphine Analgesia after Caesarean Delivery
Authors: Pavy T. J. G. , Gambling D. R. , Merrick P. M. , Douglas M. J. 
Published: January 2019

This double-blind, randomized study was designed to evaluate the use of indomethacin (Indocid®, MSD) following caesarean delivery performed under spinal anaesthesia. Thirty ASA I-II women presenting for elective caesarean were recruited. Spinal anaesthesia was performed in a standard manner using hyperbaric bupivacaine, fentanyl and morphine. At the completion of surgery, subjects were administered two rectal suppositories, followed by 12-hourly suppositories for six doses (three days). The study group received 100 mg indomethacin suppositories and controls were given placebo (Anusol®). Data collected included Visual Analog Scale (VAS) pain scores at rest and with movement, VAS scores for nausea and itch, and analgesic use. Demographic data were similar in the two groups. Median time to first analgesia (TTFA) was nine hours in the control group v. 39.5 hours in the indomethacin group (P<0.003). Additional analgesic requests throughout the postoperative period were less in women who received indomethacin: 4 v 11 (P<0.001). Women who received indomethacin had significantly less pain on the first postoperative day, especially on movement: mean VAS 1.4 v. 5.1 (P<0.00001). There were no reported adverse neonatal or maternal effects from the use of indomethacin. Rectal indomethacin use following caesarean delivery leads to significantly improved pain relief compared with placebo. The combination of spinal morphine and rectal indomethacin leads to high-quality postoperative analgesia.
Comparison of Total Intravenous, Balanced Inhalational and Combined Intravenous-Inhalational Anaesthesia for Tympanoplasty, Septorhinoplasty and Adenotonsillectomy
Authors: Van Den Berg A. A. , Savva D. , Honjol N. M. , Prabhu N. V. Rama 
Published: January 2019

Two hundred and thirty-five consecutive Saudi patients aged between two and fifty-three years undergoing elective tympanoplasty (n = 32), septorhinoplasty (n = 68) or adenotonsillectomy (n=135) were studied. They were randomized to receive either a total intravenous anaesthetic (10 ears, 23 noses, 44 throats) consisting of propofol for induction of anaesthesia followed by a propofol infusion, a combined intravenous-inhalational anaesthetic (11 ears, 22 noses, 46 throats) consisting of the above with isoflurane in oxygen-enriched air, or a balanced inhalational anaesthetic (11 ears, 23 noses, 45 throats) consisting of thiopentone for induction of anaesthesia and oxygen in nitrous oxide with isoflurane for maintenance. During tympanoplasty, all three anaesthetic techniques produced stable heart rates and arterial pressures. During septorhinoplasty, blood pressure rose in patients who received total intravenous anaesthesia, while combined and balanced techniques produced haemodynamic stability. During adenotonsillectomy, total intravenous anaesthesia produced a rise in both heart rate and blood pressure, the combined technique produced a rise in heart rate alone while balanced anaesthesia produced haemodynamic stability. Postoperatively, vomiting, pain scores and analgesic requirements were similar following all three types of anaesthetic within each surgical site subgroup. Our findings support the choice of balanced inhalational anaesthesia for all three types of ENT surgery and, where cost and facilities permit, total intravenous anaesthesia for tympanoplasty and combined intravenous-inhalational anaesthesia for septorhinoplasty.
Prospective Clinical Evaluation of Two Combined Spinal-Epidural Kits
Authors: Paech M. J. , Evans S. F. 
Published: January 2019

One hundred combined spinal-epidural kits (Portex, n = 51, Mallinckrodt, n=49) were evaluated clinically by twelve anaesthetists with respect to performance of the loss-of-resistance syringe, epidural needle and spinal needle, and success in establishing single-segment combined spinal-epidural anaesthesia for caesarean section. Similar components included a plastic loss-of-resistance device, a Tuohy epidural needle, 26 or 27 gauge pencil-point spinal needle and closed end, three-lateral-eye epidural catheter. The Mallinckrodt kit incorporated a “back-eye” design for exit of the spinal needle from the epidural needle. The epidural and subarachnoid spaces were satisfactorily identified on 98 occasions. Most anaesthetists preferred the Mallinckrodt kit packaging and the Portex loss-of-resistance syringe, although the latter may have been biased by familiarity with this device. The Portex spinal needle was more likely to be felt penetrating the dura (P=0.02) and aspiration of cerebrospinal fluid was more frequently described as easy (P=0.01). The most common criticisms of both kits were difficulty controlling the spinal needle position after entry into the subarachnoid space and subjectively, a high degree of resistance to injection through the spinal needle.
Aspects of Theophylline Clearance in Children
Authors: Anderson B. J. , Holford N. H. G. , Woollard G. A. 
Published: January 2019

Michaelis-Menten pharmacokinetic parameters for theophylline were estimated in a three-month infant following an accidental overdose of intravenous aminophylline. Fitting of time-concentration data was performed using nonlinear regression with MKMODEL. A mixed order elimination model was superior to a first order model. Parameter estimates were standardized to a 70 kg human using an allometric power model. Parameter estimates (SE) were: maximum rate of metabolism (Vmax) 71(42) mg.h–1, Michaelis-Menten constant (Km) 32.3 (33.5) mg.l–1, volume of distribution (Vd) 46.9 (2.6) l. This Michaelis-Menten constant is lower than that reported for adults and consequently non-linear elimination will occur at lower plasma concentrations in infants than in adults. Theophylline clearance has traditionally been reported as directly proportional to body weight. This per kilogram model gives an erroneous impression that clearance is greatest in early childhood and then decreases with age until adult rates are reached in late adolescence. Age-related clearance values reported in the literature were reviewed using an allometric 3/4 power model. This size model demonstrates that clearance increases in infancy and reaches adult rates in the first one to two years of life.