bluuebunny/crossref_metadata_2025_split huggingface dataset:
Response of a Coastal Plume Formed by Tidally Modulated Estuarine Outflow to Light Upwelling-Favorable Wind
Authors: Yankovsky Alexander E. , Voulgaris George 
Published: January 2019

AbstractThis study presents observations of a buoyant plume off Winyah Bay, South Carolina, which was formed under conditions of high freshwater discharge and upwelling-favorable wind forcing. Analysis of observations demonstrates that the response of the anticyclonic bulge formed by tidally modulated estuarine outflow to the light upwelling-favorable wind is more complex than the previously studied far-field response. The latter can be described by a slab-like model with mixing concentrating at the offshore edge of a buoyant layer. The observed plume depth increased from ~3 m near the mouth to 6 m at the offshore edge, with plume depth changing in a steplike fashion rather than continuously. CTD profiles near these steps revealed overturning indicative of vigorous mixing. Estimates of the gradient Richardson number confirmed the likelihood of mixing/entrainment not only at the offshore edge of the plume but also in the proximity of the observed steps. We hypothesize that these steps represent tidal fronts that undergo geostrophic adjustment and are advected offshore by the superimposed Ekman drift. Scaling analysis suggests that mixing and entrainment at the observed interior fronts can be enhanced by superposition of geostrophic and wind-induced shear.
WMO Interlaboratory Comparison in Europe with Loops Linkage and Data Processing
Authors: Bojkovski Jovan , Drnovšek Janko , Groselj Drago , Knez Joško , Begeš Gaber 
Published: January 2019

Abstract
This article describes the interlaboratory comparison (ILC) of meteorological and hydrological calibration laboratories in the field of temperature (−30° to 40°C), humidity (10%–95% RH at room temperature), and pressure (800–1100 hPa). The ILC was organized by the World Meteorological Organization (WMO) Regional Instrument Centre (RIC) at the Slovenian Environment Agency and University of Ljubljana, Faculty of Electrical Engineering, Laboratory of Metrology and Quality as an accredited interlaboratory comparison (proficiency testing) provider according to the ISO/IEC 17043:2010 standard. The ILC was organized in the target area of WMO Regional Association VI (Europe). The protocol and procedure for ILC were developed within European Metrology Research Project (EMRP) MetoMet2. The participants used their standardized procedures for calibration. Because of the large number of participating laboratories (18) from 17 countries, the ILC was organized in two loops, which were linked via four linking laboratories and evaluated using the En number. The equipment used in both loops exhibited stability and uncertainty, which enabled evaluation of the laboratories’ capabilities. The article presents the data processing, the linkage procedure, and the main results for all three categories (temperature, humidity, and pressure). It was observed that some of the laboratories had unusually low uncertainties. From the metrological point of view, the authors present some comments and suggestions to the laboratories, the results of which differ from the reference ones. The conclusions can help also other meteorological laboratories and organizations that did not participate in the ILC with their everyday work.
Paraesthesiae during Needle-through-Needle Combined Spinal Epidural versus Single-shot Spinal for Elective Caesarean Section
Authors: McAndrew C. R. , Harms P. 
Published: January 2019

The aim of this study was to compare the incidence of paraesthesiae during spinal needle insertion in a needle-through-needle combined spinal-epidural (CSE) versus a single-shot spinal (SSS) technique. Eighty-nine women presenting for elective caesarean section at a tertiary referral obstetric unit were randomized to receive either needle-through-needle CSE or SSS. Equipment used was a 16 gauge/26 gauge combined spinal-epidural kit and a 26 gauge pencil-point spinal needle with introducer (both Sims Portex, Australia) The presence and distribution of paraesthesiae was recorded by an observer at spinal needle insertion and again on day one postoperatively. There were three failures to perform the intended block. One patient was lost to follow-up at postoperative day one. Seventeen of forty-six (37%) women in the needle-through-needle CSE group and four of forty-three (9%) in the SSS group had paraesthesiae upon spinal needle insertion (P<0.05, Chi-squared test). No patient had persistent neurological symptoms at postoperative day one. We postulate that the higher incidence of paraesthesiae with needle-through-needle CSE may be related to deeper penetration of the subarachnoid space with this technique.
Correlation and Linear Regression between Blood Pressure Decreases after a Test Dose Injection of Propofol and that following Anaesthesia Induction
Authors: Sato J. , Saito S. , Jonokoshi H. , Nishikawa K. , Goto F. 
Published: January 2019

Propofol reduces systemic vascular resistance and suppresses cardiac function when injected rapidly. In this study we investigated whether blood pressure decrease after a minimal dose (test-dose) injection of propofol correlates with that after an induction-dose injection. Patients were randomly divided into two groups; anaesthesia was induced in group A (n=60) using 1.5 mg/kg propofol and in group B (n=61) using 2.0 mg/kg. Blood pressure reduction after a minimal dose injection (0.4 mg/kg) was examined non-invasively prior to anaesthetic induction. Bispectral Index monitoring was measured and sedation level scored to evaluate anaesthetic depth. After the minimal dose injection, 18 of 121 patients showed behaviour suggesting minor disinhibition, five patients were sedated and seven were drowsy. Oxygen saturation was not significantly changed after test-dose injection. Reduction in systolic blood pressure (mean±SD) was 17±11 mmHg after the minimal dose injection, 42±20 mmHg after a 1.5 mg/kg induction dose injection, and 42±22 mmHg after a 2.0 mg/kg induction-dose injection. In both groups, blood pressure after induction was significantly lower than the control value (P<0.05). In both groups, a positive correlation was observed between blood pressure reduction after the minimal dose injection and that after the induction-dose injection [P<0.01, R value for systolic blood pressure correlation in group A 0.712 (P<0.01) and in group B 0.758 (P<0.01)]. We concluded there was a positive correlation between blood pressure reduction after a minimal (test-dose) injection and that after an induction-dose injection.
Serum Procalcitonin and C-reactive Protein as Markers of Sepsis and Outcome in Patients with Neurotrauma and Subarachnoid Haemorrhage
Authors: O'Connor E. , Venkatesh B. , Mashongonyika C. , Lipman J. , Hall J. , Thomas P. 
Published: January 2019

This prospective study evaluated serum procalcitonin (PCT) and C-reactive protein (CRP) as markers for systemic inflammatory response syndrome (SIRS)/sepsis and mortality in patients with traumatic brain injury and subarachnoid haemorrhage. Sixty-two patients were followed for 7 days. Serum PCT and CRP were measured on days 0, 1, 4, 5, 6 and 7. Seventy-seven per cent of patients with traumatic brain injury and 83% with subarachnoid haemorrhage developed SIRS or sepsis (P=0.75). Baseline PCT and CRP were elevated in 35% and 55% of patients respectively (P=0.03). There was a statistically non-significant step-wise increase in serum PCT levels from no SIRS (0.4±0.6 ng/ml) to SIRS (3.05±9.3 ng/ml) to sepsis (5.5±12.5 ng/ml). A similar trend was noted in baseline PCT in patients with mild (0.06±0.9 ng/ml), moderate (0.8±0.7 ng/ml) and severe head injury (1.2±1.9 ng/ml). Such a gradation was not observed with serum CRP. There was a non-significant trend towards baseline PCT being a better marker of hospital mortality compared with baseline CRP (ROC-AUC 0.56 vs 0.31 respectively). This is the first prospective study to document the high incidence of SIRS in neurosurgical patients. In our study, serum PCT appeared to correlate with severity of traumatic brain injury and mortality. However, it could not reliably distinguish between SIRS and sepsis in this cohort. This is in part because baseline PCT elevation seemed to correlate with severity of injury. Only a small proportion of patients developed sepsis, thus necessitating a larger sample size to demonstrate the diagnostic usefulness of serum PCT as a marker of sepsis. Further clinical trials with larger sample sizes are required to confirm any potential role of PCT as a sepsis and outcome indicator in patients with head injuries or subarachnoid haemorrhage.
Early and Late Reversal of Rocuronium with Pyridostigmine during Sevoflurane Anaesthesia in Children
Authors: Oh A. Y. , Kim S. D. , Kim C. S. 
Published: January 2019

This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch®, rocuronium (0.6 mg/kg) were then administered. Maximal block occurred 1.1±0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T25) was 40.1±8.8 min and the recovery index (time between T25 and T75) 19.9±9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.
The Effect of Increasing Operating Room Capacity on Day-of-surgery Cancellation
Authors: Yoon S.-Z. , Lee S. I. , Lee H. W. , Lim H. J. , Yoon S. M. , Chang S. H. 
Published: January 2019

Several studies have been conducted to evaluate the utilisation of the operating room, a fixed resource, in terms of conditions that prevent day-of-surgery cancellation due to deficient operative capacity. In this study, we surveyed the causes and overall rates of elective surgery cancellation and then compared the number of cancellations that occurred before and after the installation of additional operating rooms. We surveyed all patients undergoing elective surgery for 100 days prior to and after the installation of additional operating rooms. The causes for cancellations were divided into six categories: departmental issues, abnormal laboratory results, patient denial, inadequate preparation, over-booking and other issues. The departmental causes were further divided into four categories: ward overflow, scheduling date errors, unavailable surgeons and other issues. The number of overall cancelled cases and scheduled cases increased following the increase in operating room capacity, although this increase was not statistically significant. However, the cancellation ratio rose significantly after the operating room capacity was increased. The primary reasons for cancellation prior to the increase in operating room capacity were departmental issues, over-booking and abnormal laboratory data, in that order. After the operating room capacity was increased, the primary reasons for cancellation were departmental issues, abnormal laboratory data and over-booking, in that order. Taken together, the results of this study indicate that increased operating room capacity can prevent cancellation due to over-booking. However, the numbers of cancellations due to ward overflow exceeded the numbers of cancellations that occurred as a result of over-booking. In conclusion, increasing the operating room capacity is not an appropriate option for preventing the cancellation of operations.
Effects of Fluid Preload (Crystalloid or Colloid) Compared with Crystalloid Co-Load Plus Ephedrine Infusion on Hypotension and Neonatal Outcome during Spinal Anaesthesia for Caesarean Delivery
Authors: Gunusen I. , Karaman S. , Ertugrul V. , Firat V. 
Published: January 2019

Preload with crystalloid or colloid solution is widely recommended for the prevention of maternal hypotension during spinal anaesthesia. A combination of simultaneous rapid crystalloid infusion with vasopressor has also been suggested. This study tested the hypothesis that ephedrine infusion with crystalloid loading at spinal anaesthesia would reduce hypotension and alter neonatal outcome compared with fluid preloading. One hundred and twenty women undergoing elective caesarean delivery were randomly allocated to one of three groups to receive rapid infusion of lactated Ringer's solution (20 ml.kg-1, n=40) or 4% succinylated gelatin solution (500 ml, n=40) before spinal anaesthesia or an ephedrine infusion (1.25 mg.minute-1) plus lactated Ringer's solution (1000 ml, n=40) after spinal anaesthesia. The incidence of hypotension (moderate and severe) and the ephedrine dose used to treat hypotension were compared. Neonatal outcome was assessed using Apgar scores and umblical venous and arterial blood gas analysis. The frequency of moderate or severe hypotension was lower in the ephedrine group than in the crystalloid or colloid preload group (10% vs 51% and 38%; 5% vs 21% and 23% respectively, P <0.05). The incidence of nausea was significantly different between the crystalloid preload and ephedrine group. Umbilical blood gas analysis and Apgar scores were similar in all groups. A combination of an ephedrine infusion at 1.25 mg.minute-1 with a crystalloid co-load was more effective than fluid preloading with crystalloid or colloid in the prevention of moderate and severe hypotension.
Effect of Intravenous Ondansetron on Sensory and Motor Block after Spinal Anaesthesia with Hyperbaric Bupivacaine
Authors: Samra T. , Bala I. , Chopra K. , Podder S. 
Published: January 2019

Ondansetron is a potent antiemetic and a competitive antagonist at serotonin receptors, which are also involved in modulation of pain. This study was designed to assess the effect of systemic ondansetron on sensory and motor block after subarachnoid anaesthesia with hyperbaric bupivacaine. Sixty patients undergoing transurethral resection of bladder tumours were randomly assigned to one of two groups. Group 1 received 2 ml (4 mg) of ondansetron whereas patients in group 2 received 2 ml of normal saline 15 minutes prior to administration of subarachnoid block with 2.5 ml of hyperbaric bupivacaine 0.5%. Time to attain peak sensory block (P=0.27), time to two segment regression (P=0.19) and time to regression to the S2 dermatome (P=0.84) did not significantly differ between the two groups. No differences in regression of sensory block were noted at any time. The mean duration of motor block also did not differ (P=0.44), with similar regression of block at all time intervals except at 90 minutes. We concluded that intravenous ondansetron does not affect the intensity or duration of sensory and motor block after spinal anaesthesia with hyperbaric bupivacaine.
The Relationship between Patient Data and Pooled Clinical Management Decisions
Authors: Ludbrook G. L. , O'Loughlin E. J. , Grant C. , Corcoran T. B. 
Published: January 2019

A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management. In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. In the current study, the relationship between patient data and these decisions was examined using binomial logistic regression analysis. Backward stepwise regression was used to identify independent predictors of each decision (at P <0.15), which were then incorporated into a predictive model. The number of factors related to each decision varied: blood picture (four factors), biochemistry (six factors), coagulation studies (three factors), electrocardiography (eight factors), chest X-ray (seven factors), preoperative outpatient assessment (17 factors), intensive care unit requirement (eight factors) and aspiration prophylaxis (one factor). The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics with the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient data may have utility supporting clinicians’ preoperative decisions.
Pseudomonas Infection and the Anaesthetist
Authors: Cumpston P. , Narasimhan S. 
Published: January 2019

Cultures of specimens taken from anaesthetic equipment after routine cleaning and chemical decontamination revealed contamination with Pseudomonas Aeruginosa. Attention is drawn to the widely practised but unsatisfactory methods of decontaminating equipment. Consideration of the subject of decontamination of anaesthetic equipment led to the re-evaluation of our current practice, with surprising results. At the end of our brief look, we had changed our methods of decontamination dramatically and heightened awareness of a large section of theatre staff with regard to aseptic technique. We had also found a possible method of eliminating Pseudomonas Aeruginosa from the sinks in the operating theatre. Recommendations as to future practice are included.
Antimicrobial Activity of Bupivacaine and Pethidine
Authors: Grimmond T. R. , Brownridge P. 
Published: January 2019

The antimicrobial activity of bupivacaine and pethidine in concentrations commonly used in epidural practice was studied by an agar dilution method against ten common micro-organisms. Both drugs showed increasing microbe inhibition with increasing drug concentrations. Bupivacaine at common epidural concentrations inhibited eight of the ten organisms and pethidine inhibited six. These findings confirm previous reports of microbe inhibition by bupivacaine, and in addition demonstrate a similar but slightly lesser activity by pethidine. Although antimicrobial activity of epidural drugs can be regarded as a desirable property, clinical implications of such findings remain unclear.
Delayed Onset of Alcuronium Effect in Children with Cyanotic Congenital Heart Disease
Authors: Keneally J. P. , Goonetilleke P. H. , Ramzan I. M. 
Published: January 2019

The effect of alcuronium dichloride (0.3 mg/kg) was studied in seven normal children (Group A), nine with acyanotic congenital heart disease (Group B) and eight with cyanotic disease (Group C). The onset of action was recorded using an integrated electromyograph and blood samples taken for later estimation of plasma concentrations of the drug. The mean time (SD) taken to 75% suppression of twitch height was 1.3(0.8), 1.7(1.0) and 3.8(2.8) minutes, respectively, in each of the three groups. This was significantly slower in Group C compared with both other groups (P<0.05). While six of the Group A patients and seven from Group B reached 95 % paralysis within ten minutes, only two of the cyanosed children achieved this level of relaxation. However, if times to 95% relaxation were extrapolated, there was no significant difference between the groups at 4.5(3.9), 5.8(5.7) and 10.9(6.5) minutes respectively. There was a weak but statistically significant relationship between haematocrit and time to 75% blockade. Maximum twitch depression was similar in all three groups with plasma concentrations at this time being 1.6(0.7), 1.8(0.5) and 2.3(1.4) μg/ml respectively. Again, there was no statistically significant difference between these values. These results confirm that the clinical onset of relaxation is delayed in children with cyanotic congenital heart disease, possibly because of delayed distribution of alcuronium.
Adverse Incident Reporting in Intensive Care
Authors: Hart G. K. , Baldwin I. , Gutteridge G. , Ford J. 
Published: January 2019

This prospective, observational, anonymous incident reporting study aimed to identify and correct factors leading to reduced patient safety in intensive care. An incident was any event which caused or had the potential to cause harm to the patient, but included problems in policy or procedure. Reports were discussed at monthly meetings. Of 390 incidents, 106 occasioned “actual” harm and 284 “potential” harm. There was one death, 86 severe complications and 88 complications of minor severity. Most were transient but the effects of 24 lasted up to a week. Most incidents affected cardiovascular and respiratory systems. Incident categories involved drugs, equipment, management or procedures. Incident causes were knowledge-based, rule-based, technical, slip/lapse, no error or unclassifiable. The study has identified some human and equipment performance problems in our intensive care unit. Correction of these should lead to a reduction in the future incidence of those events and hence an increased level of patient safety.
Midazolam-Flumazenil Topical Anaesthesia for Microlaryngoscopy with Jet Ventilation
Authors: Rushatamukayanunt W. , Tritrakarn T. 
Published: January 2019

A comparison between midazolam and midazolam-flumazenil for total intravenous anaesthesia in combination with topical anaesthesia and muscle relaxants was performed in a double-blind, parallel study in 40 patients scheduled for microlaryngoscopy with or without bronchoscopic procedures using jet ventilation with oxygen. A single intravenous injection of midazolam 0.3 mg/kg, lignocaine spray and muscle relaxants provided adequate anaesthesia and good operative conditions throughout the procedures, which took 20 to 30 minutes. Patients who had placebo at the end of the procedures had a longer recovery and a high incidence of airway obstruction (20%). Administration of flumazenil provided prompt awakening in 19 of 20 patients (95%) within five minutes, resulting in rapid and favourable recovery without resedation or other side-effects, while only three of 20 (15%) patients in the placebo-treated group had improved consciousness within five minutes. The simplicity and reliability of the midazolam-flumazenil technique is attractive. We consider it worthy of further investigation for wider application in clinical practice.