bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Computer-integrated Patient-controlled Epidural Analgesia and Patient-controlled Epidural Analgesia with a Basal Infusion for Labour and Delivery
Authors: Sng B. L. , Sia A. T. H. , Lim Y. , Woo D. , Ocampo C. 
Published: January 2019

Computer-integrated patient-controlled epidural analgesia (CIPCEA) is a novel epidural drug delivery system. It automatically adjusts the background infusion based on the individual parturient's need for analgesia as labour progresses. In this randomised controlled trial, we compared the local anaesthetic consumption by parturients using either CIPCEA or patient-controlled epidural analgesia with a moderate basal infusion (PCEABI) of 5 ml/hour. We recruited 60 parturients after receiving ethics committee approval. Group CIPCEA (n=30) received a similar patient-controlled epidural analgesia regimen but the computer integration titrated the background infusion to 5, 10 or 15 ml/hour if the patient required respectively one, two or three demand boluses in the previous hour. The background infusion was decreased by 5 ml/hour if there was no demand in the previous hour. Group PCEABI received patient-controlled epidural analgesia with a basal infusion of 5 ml/hour. The sample size was calculated to show equivalence in local anaesthetic use. The time-weighted consumption of local anaesthetic was similar in both groups (mean difference 0.3 mg/hour, 95% confidence interval: −1.8, 1.3, P=0.755). The CIPCEA group had higher maternal satisfaction scores: mean (SD) 94.8 (6.32) vs. 85.5 (9.41), P=0.0001. The CIPCEA group had a higher infusion rate during the second stage of labour (mean (SD) 7.0 (4.1) ml/hour vs. 4.5 (1.5) ml/hour, P= 0.008), but did not have a longer duration of this stage. There were no differences between the groups in obstetric or foetal outcomes or side-effect profiles. The CIPCEA system has similar time-weighted, hourly consumption of local anaesthetic to PCEABI and may increase patient satisfaction.
Mechanism of Cardiac Preconditioning with Volatile Anaesthetics
Authors: Hu Z.-Y. , Liu J. 
Published: January 2019

In recent years, there has been increased interest in the mechanisms involved in anaesthetic-induced cardioprotection. It is not thoroughly understood how volatile anaesthetics protect the myocardium from ischaemia or reperfusion injury, but the overall mechanism is likely to be multifactorial. This review examines the recent experimental and clinical research underlying the cellular and molecular mechanisms involved in anaesthetic-induced preconditioning. A variety of intracellular signalling pathways have been implicated in the protective phenomenon. Ischaemic preconditioning and anaesthetic-induced preconditioning share similar molecular mechanisms, including activation of guanine nucleotide-binding proteins, triggering of second messenger pathways, activation of multiple kinases, mediation of nitric oxide formation and reactive oxygen species release, maintenance of intracellular and/or mitochondrial Ca2+ homeostasis and moderation of the opening of adenosine-triphosphate-sensitive potassium channels. A more thorough understanding of the multiple signalling steps and the ultimate cytoprotective mechanisms underlying anaesthetic-induced preconditioning may lead to improvements in the management of ischaemia and/or reperfusion injury.
A Prospective Comparison between Written Examination and Either Simulation-Based or Oral Viva Examination of Intensive Care Trainees’ Procedural Skills
Authors: Nunnink L. , Venkatesh B. , Krishnan A. , Vidhani K. , Udy A. 
Published: January 2019

We compared results of written assessment of intensive care trainees’ procedural skills with results obtained from one of two live assessment formats for the purposes of assessing the concurrent validity of the different test methods. Forty-five Australasian senior trainees in intensive care medicine completed a written test relating to a procedural skill, as well as either a simulation format or oral viva assessment on the same procedural skill. We analysed correlation between written exam results and results obtained from simulation format or oral viva assessment. For those who completed the simulation format examination, we also maintained a narrative of actions and identified critical errors. There was limited correlation between written exam results and live (simulation or viva) procedure station results (r=0.31). Correlation with written exam results was very low for simulation format assessments (r=0.08) but moderate for oral viva format assessment (r=0.58). Participants who passed a written exam based on management of a blocked tracheostomy scenario performed a number of dangerous errors when managing a simulated patient in that scenario. The lack of correlation between exam formats supports multi-modal assessment, as currently it is not known which format best represents workplace performance. Correlation between written and oral viva results may indicate redundancy between those test formats, whereas limited correlation between simulation and written exams may support the use of both formats as part of an integrated assessment strategy. We hypothesise that identification of critical candidate errors in a simulation format exam that were not exposed in a written exam may indicate better predictive validity for simulation format examination of procedural skills.
The Effect of Remote Ischaemic Preconditioning on Myocardial Injury in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery
Authors: Hong D. M. , Min J. J. , Kim J. H. , Sohn I. S. , Lim T. W. , Lim Y. J. , Bahk J.-H. , Jeon Y. 
Published: January 2019

In several recent clinical trials on cardiac surgery patients, remote ischaemic preconditioning (RIPC) showed a powerful myocardial protective effect. However, the effect of RIPC has not been studied in patients undergoing off-pump coronary artery bypass graft surgery. We evaluated whether RIPC could induce myocardial protection in off-pump coronary artery bypass graft surgery patients. Patients undergoing elective off-pump coronary artery bypass graft surgery were randomly allocated to the RIPC (n=65) or control group (n=65). After induction of anaesthesia, RIPC was induced by four cycles of five-minute ischaemia and reperfusion on the upper limb using a pneumatic cuff. Anaesthesia was maintained with sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after surgery. There were no statistical differences in troponin I levels between RIPC and control groups (P=0.172). Although RIPC reduced the total amount of troponin I (area under the curve of troponin increase) by 26%, it did not reach statistical significance (RIPC group 53.2∓72.9 hours.ng/ml vs control group 67.4∓97.7 hours.ng/ml, P=0.281). In this study, RIPC by upper limb ischaemia reduced the postoperative myocardial enzyme elevation in offpump coronary artery bypass graft surgery patients, but this did not reach statistical significance. Further study with a larger number of patients may be needed to fully evaluate the clinical effect of RIPC in off-pump coronary artery bypass graft surgery patients.
Repeated Intrathecal Administration of Ropivacaine Causes Neurotoxicity in Rats
Authors: Sun Z. H. , Xu X. P. , Song Z. B. , Zhang Z. , Wang N. , Guo Q. L. 
Published: January 2019

Previous studies have shown that ropivacaine is the least neurotoxic local anaesthetic. Most of the data derive from short-term ropivacaine injection into the subarachnoid space. Intrathecal administration for a prolonged period, and the histological changes and behavioural effects of repeated intrathecal administration, have not previously been investigated. We studied the possible neurotoxicity of intrathecal injection of ropivacaine in a rat model. Rats received 0.12 ml/kg body weight of ropivacaine at concentrations of 0.5 or 1%, or normal saline only, via an implanted intrathecal catheter at 90-minute intervals for 12 hours. On days 1, 3, 5, 7, 14 and 28, the spinal cord was examined by light and electron microscopy at the L3 level. We assessed sensory thresholds to noxious stimulation, behavioural change and protein kinase B immunoreactivity for possible neuronal injury within the spinal cord. Ropivacaine 1% induced thermal hyperalgesia and mechanical allodynia, neuronal injury characterised by tissue oedema, proliferation of glial cells, neuronal morphology changes and degeneration and protein kinase B expression. There were no significant differences in motor function as a result of different concentrations of ropivacaine. Repeated intrathecal injection of ropivacaine 1% can induce neurotoxicity in rats. Our data suggests that expression of protein kinase B might be involved in this neurotoxicity.
Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing Airway Pressure Release Ventilation
Authors: Suehiro K. , Rinka H. , Ishikawa J. , Fuke A. , Arimoto H. , Miyaichi T. 
Published: January 2019

We investigated the effectiveness of stroke volume variation (SVV) shown by the Vigileo-FloTrac™ system (Edwards Lifesciences, Irvine, CA) to predict fluid responsiveness in patients undergoing airway pressure release ventilation (APRV). All 80 patients mechanically ventilated in the intensive care unit of our hospital from April to November 2010 were included in this study. After starting APRV, Ringer's lactate solution was administered for 30 minutes. Haemodynamic variables including heart rate, mean arterial pressure, cardiac index (CI), stroke volume index (SVI) and SVV were measured before and after volume loading. SVV before volume loading was significantly correlated with absolute change in SVV (ΔSVV) and percentage change in stroke volume index (ΔSVI) after volume loading (ΔSVV: P 2=0.534; ΔSVI: P &0.05, r2=0.217). Of the 80 patients, 38 (47.5%) were responders to intravascular volume expansion (increase in CI ≥15%) and 42 (52.5%) were non-responders (increase in CI P <0.05). The optimal threshold value of SVV to discriminate between responders and nonresponders was 14% (sensitivity: 78.9%; specificity: 64.3%). We found that SVV was able to predict fluid responsiveness in patients undergoing APRV with acceptable levels of sensitivity and specificity.
Performance of Apache III over Time in Australia and New Zealand: A Retrospective Cohort Study
Authors: Paul E. , Bailey M. , Van Lint A. , Pilcher D. V. 
Published: January 2019

The Acute Physiology and Chronic Health Evaluation (APACHE) III-j model has been used for benchmarking intensive care unit (ICU) outcomes in Australia and New Zealand for over a decade. This study assessed performance of the APACHE III-j model in adult patients admitted to Australasian ICUs during a ten-year period. Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. Performance of APACHE III-j at different time points and within different age strata was evaluated by dividing the whole cohort into five ‘two-year’ groups. Calibration and discrimination were assessed by the Brier score, Hosmer-Lemeshow C and H statistics, Standardised Mortality Ratio (SMR), Cox calibration regression, calibration curves and area under the receiver operating characteristic curve (AUROC). Model performance within diagnostic categories was evaluated. Between 1 January 2000 and 31 December 2009, 558,585 ICU admissions which met inclusion criteria were included in the analysis. The mean (standard deviation) age was 60.8 (18.4) years and 58.3% were male. Overall observed mortality was 12.6%. The mean (standard deviation) APACHE III-j predicted mortality was 14.5% (21.8). Although discrimination (as measured by AUROC) was preserved over time, all other markers of model performance showed deterioration. There was a significant decrease in SMR in eight of ten most common diagnoses examined. This study demonstrates that performance of APACHE III-j model has deteriorated in Australasian hospitals and there is now a clear need for an updated modelling approach to improve mortality prediction, performance monitoring and quality of research undertaken in Australian and New Zealand ICUs.
Simulation Training for Rare Medications in the Intensive Care Unit—A Study with Bivalirudin
Authors: Edrich T. , Frendl G. 
Published: January 2019

The purpose of this study was to assess whether simulation training can improve the clinician's ability to predict the effect of bivalirudin infusion. Six clinicians with experience using bivalirudin and six without experience (Groups Exp and NoExp) entered predictions for partial thromboplastin time while viewing a running display of clinical data obtained retrospectively from intensive care unit patients who had received bivalirudin infusion after cardiac surgery. All clinicians entered guesses for the same sequence of 30 patients. Average guessing-errors were analysed using analysis of variance and linear regression. All physicians evaluated 30 patients (813 partial thromboplastin time guesses overall) in less than two hours. Average errors in Groups Exp and NoExp decreased from 9.4 and 11.7 seconds in the first tercile, to 8.2 and 8.4 seconds in the last tercile of patients, respectively. The guessing-errors of Group NoExp were significantly higher than Group Exp in the first and second terciles, with no significant difference in the third tercile. Linear regression indicated a significantly steeper learning curve in Group NoExp than Exp. Brief simulation training using retrospective patient data improved the ability of inexperienced clinicians to predict the effect of bivalirudin as compared to experienced clinicians.
Anaesthesia and Serum Creatine Phosphokinase Levels in Patients with Duchenne's Pseudohypertrophic Muscular Dystrophy
Authors: Richards W. C. 
Published: January 2019

Forty-three patients with Duchenne's pseudohypertrophic muscular dystrophy receiving a total of 61 general anaesthetics were reviewed to assess the effect of the anaesthetic with particular regard to rise in temperature and its relationship, if any, to serum creatine phosphokinase (C.P.K.) levels. All popular forms of anaesthetic were administered to these patients, who had a wide range of C.P.K. levels. No patient developed hyperpyrexia or had a cardiac arrest. The features of Duchenne's dystrophy are described, the complications reviewed in the literature are outlined, and some recommendations about the anaesthetic management are made.
Irreversible Curarization
Authors: Baraka Anis 
Published: January 2019

The reversal effect of neostigmine following different doses of tubocurarine was investigated in 20 anesthetized adults. After five minutes, neostigmine could rapidly and effectively reverse a blocking dose of tubocurarine. Doubling the dose of tubocurarine necessitated a much higher concentration of neostigmine to achieve reversal, while a triple dose could be reversed only after enough time had elapsed to allow for lowering its concentration. It is concluded that the degree of reversal by neostigmine is related inversely to the concentration of tubocurarine at the time of reversal. An overdose of tubocurarine predisposes to the so called “neostigmine-resistant curarization”.
Ed50 Values for Thiopentone, Methohexital Propanidid and Alfathesin: A Clinical Experiment
Authors: Crankshaw D. P. , Allt-Graham J. 
Published: January 2019

A cumulative dose response curve for loss of consciousness was obtained using 48 unselected premedicated patients presenting for elective surgery. Dosage was administered on the basis of lean tissue mass (LTM) using a simple nomogram. The end point for loss of consciousness was the failure of the patient to grasp a light object. Using probit analysis an ED50 for thiopentone in premedicated patients was found to be 2.63 mg/kg LTM. The sequential up-and-down technique was then used to determine ED50 values for thiopentone (2.70 mg/kg LTM), methohexitone (1.1 mg/kg LTM), propanidid (3.66 mg/kg LTM) and Alfathesin (0.014 ml/kg LTM). The experimental methods and, in particular, the administration of doses to patients on the basis of LTM, would appear to be responsible for a high level of predictability of response in an apparently heterogeneous patient population. The ED50 values compared favourably with clinically recommended doses for induction of anaesthesia, except the ED50 for Alfathesin which was approximately one quarter of that recommended. An appendix provides some of the mathematical background of the up-and-down sequential technique together with a table of maximum likelihood solutions for different sequences and an example of the calculation of an ED50 and its confidence limits
A Comparison between Ketamine and Diazepam as Induction Agents for Pericardiectomy
Authors: Kingston H. G. G. , Bretherton K. W. , Holloway A. M. , Downing and J. W. 
Published: January 2019

Ketamine 1 · 0 mg/kg and diazepam 0 · 3 mg/kg was used to induce anaesthesia in patients requiring pericardiectomy. A significant rise in blood pressure in patients receiving ketamine was noted. In contrast, a fall in blood pressure was seen when diazepam was administered. Changes in cardiac output, cardiac index, central venous pressure and systemic vascular resistance are discussed. Ketamine appears to be a more satisfactory agent for induction of anaesthesia in patients for pericardiectomy, whereas diazepam should be used with caution.
Technical Aspects of Bronchopulmonary Lavage for Alveolar Proteinosis: Two Case Reports
Authors: Harrison G. A. , Kelly A. J. 
Published: January 2019

Under general anaesthesia, therapeutic bronchopulmonary lavage was performed in two patients suffering from alveolar proteinosis. In one patient, difficulties were experienced during attempted lavage of the right lung. Fluid trapping occurred when saline was infused down the tracheal (right) lumen of a Carlen's double lumen endobronchial tube and also when a left Robertshaw tube was similarly used. Spillover of saline into the left lung occurred when a right Robertshaw was used. Efficient lavage of the right lung could only be performed after insertion of a White endobronchial tube. In the second patient, both lungs were washed without problem using a left Robertshaw tube after difficulty had been experienced with a Carlen‘s tube. In both cases venous admixture was least when the lavaged lung was filled with saline. Hypoxaemia increased as the lung was drained. Details of technique are discussed as are problems with double lumen endobronchial tubes used during the procedure.
The Management of Headache following Accidental Dural Puncture in Obstetric Patients
Authors: Brownridge Peter 
Published: January 2019

The progress and management of fifty-eight obstetric patients who received an accidental dural puncture is described. Headache attributable to dural puncture occurred in 85% of patients managed conservatively. Epidural infusion or repeat epidural bolus injections of saline after delivery reduced the incidence to 65%. A therapeutic autologous blood patch using 8-10 ml of blood was performed in 28 patients at least 24 hours after the accidental puncture. Dramatic and permanent relief occurred in 75% following this procedure. A repeat blood patch was effective in four patients, and ineffective in the remaining two. Mild and temporary back stiffness and one case of moderately severe radicular pain for three days were the only complications noted after the procedure. The pathophysiology and treatment of dural puncture headache is reviewed. Reduction of pressure differential across the dural puncture site is most useful in the first 24-48 hours. Persistent and severe headache occurring after this should be treated with blood patch.
Reduction of Heat Loss during Transurethral Resection of the Prostate
Authors: Dyer P. M. , Heathcote P. S. 
Published: January 2019

A prospective trial was performed on 100 patients to determine whether using a reflective blanket (Space Blanket) and heated glycine 1.5% bladder irrigation solution would decrease the fall in body temperature associated with transurethral resection of the prostate under spinal anaesthesia. Patients who received a combination of reflective blanket and heated glycine 1.5% solution had their fall in body temperature significantly reduced when compared with those patients managed without a reflective blanket and/or heated 1.5% glycine. There was a marked decrease in the number of patients shivering and no increase in blood loss was seen when heated bladder irrigation solution was used.
Alfentanil for Short Duration Laparoscopic Procedures
Authors: Lee K. S. , Purcell G. J. , Rae B. R. , White B. 
Published: January 2019

Alfentanil in low dosage (8 μg kg−1) as an analgesic agent for short duration surgery was evaluated. Forty-one women undergoing laparoscopy received double-blind either alfentanil 8 μg kg−1 or normal saline at induction, and all received thiopentone, alcuronium, enflurane, nitrous oxide and oxygen. The fall in mean arterial pressure (MAP) with induction was similar between groups. The MAP following intubation with alfentanil was unchanged, while with normal saline a mean rise of 23 (SD 15.2) mmHg occurred (P<0.001). The pulse rate following intubation showed a smaller rise (P<0.001) with alfentanil of 26 (SD 14.6) beats min−1, than the normal saline group of 46 (SD 13.3) beats min−1. Alfentanil was found to be a safe and effective analgesic agent in short duration surgery, by reducing sympathetic responses to intubation without cardiovascular depression or compromise of postoperative recovery.
Epidural Analgesia in Labour: Constant Infusion plus Patient-Controlled Boluses
Authors: Paech M. J. 
Published: January 2019

A randomised, single-blind study to investigate patient-controlled epidural analgesia during labour was conducted using a solution of low-dose bupivacaine-fentanyl. Two groups (n = 25 in each) received a constant infusion supplemented by patient demand boluses, and midwife-administered boluses if required, the size of the infusion and patient increments varying between groups. The quality of analgesia, as assessed by pain scores and patient ratings, was high and participant acceptability very high in both groups. Fourteen per cent of participants were withdrawn due to cephalad extension of block to T5 or supplementary bolus requirements outside the study protocol. Epidural side-effects were not troublesome and drug dose utilisation was low. Significantly greater pain relief (P < 0.04) three hours after commencing patient-controlled epidural analgesia and a trend to fewer women requiring more than two supplementary midwife-administered boluses (P = 0.11) was seen in the group receiving a higher infusion rate. This group used significantly more bupivacaine (P < 0.04) and fentanyl (P < 0.001), but this did not appear to be clinically important with respect to degree of motor block or side-effects. Patient-controlled epidural analgesia appears to be an effective and well accepted method of obstetric analgesia and warrants further investigation.