bluuebunny/crossref_metadata_2025_split huggingface dataset:
Calcium, Phosphorus and Magnesium Turnover
Authors: Thomas D. W. 
Published: January 2019

The body content of calcium, phosphorus and magnesium is important, not only from the structural or supporting aspect, but also from the aspect of cellular function. Membrane integrity, nervous tissue conduction, neuromuscular excitability, muscle contraction, hormone secretion, intermediary metabolism and synthesis, to mention but a few activities, are all influenced by these elements. The normal body content and turnover of calcium, phosphorus and magnesium are outlined, together with a brief description of their physiological roles, emphasizing intracellular functions rather than their predominance within the skeleton. Regulatory mechanisms, particularly for calcium, involving vitamin D and its metabolites, parathormone, and possibly calcitonin, are discussed within the context of maintaining normal body content and turnover. Homeostatic mechanisms maintaining plasma concentrations in health and disease, as far as they have been identified, are also outlined. Lastly, disorders of calcium, phosphorus and magnesium turnover are considered from the aspect of altered plasma concentrations of these substances. Throughout emphasis is given to common problems and their practical management. Metabolic bone disease and uncommon disorders of bone and bone mineral are not discussed specifically.
Intradermal Testing in the Diagnosis of Acute Anaphylaxis during Anaesthesia — Results of Five Years Experience
Authors: Fisher M. McD. 
Published: January 2019

Intradermal testing has been used in the diagnosis of acute anaphylactic reactions during anaesthesia in 51 patients. Positive results occurred in 32 patients and confirmation was possible in 26. Only in one case did a combination of history and intradermal testing not give a diagnosis. Nine of the negative results were confirmed. Intradermal testing is of no value in the diagnosis of reactions to local anaesthetics or colloids but has great value in determining the cause of reactions due to induction agents or muscle relaxants if performed under controlled conditions. It is safe, and requires no expertise in performance or interpretation.
Clinical Presentation of Haemolytic Transfusion Reactions
Authors: Webster B. H. 
Published: January 2019

Haemolytic transfusion reactions can be defined as the occurrence after transfusion of measurably increased destruction of red cells, of donor or recipient, by alloantibodies. They may be acute (occurring within 24 hours of transfusion) or delayed (when signs of red cell destruction do not occur until 4 to 10 days after transfusion). The severest signs and symptoms of acute reactions follow intravascular red cell lysis and progress to anaemia, fever, haemoglobinuria and jaundice. The subjective responses of pain, restlessness, nausea, skin flushing, dyspnoea and shock are mediated by cleavage products of complement (C3a, C5a) activated by red cell antigen-antibody reaction. The bleeding and renal failure complications that follow are multi-factoral in aetiology but also stem from the activation of intravascular clotting and from the vasomotor disturbances following histamine and kinin release.
Post Carotid Endarterectomy Hypertension
Authors: Davies M. J. , Cronin K. D. 
Published: January 2019

Blood pressure changes following carotid endarterectomy were studied in 39 patients undergoing 42 carotid endarterectomies, in order to establish the incidence of hypertension and to study the use of hydrallazine for its treatment. Hypertension occurred in 28 cases (66%) and was treated with intravenous hydrallazine in a dose of 20 ±8 mg; this resulted in a systolic blood pressure fall of 46 ±22 mmHg, diastolic blood pressure fall of 24 ± 12 mmHg, mean blood pressure fall of 31 ± 15 mmHg, and a pulse rate increase of 7 ±9 beats per minute. Hydrallazine is a safe, effective drug for the treatment of intraoperative hypertension.
The pH and Titratable Acidity of Stored CPD Blood
Authors: Gaudry P. L. , Duffy C. , Joseph D. 
Published: January 2019

Blood stored in citrate-phosphate-dextrose (CPD) solution for periods up to 20 days had a mean pH 6.71. The mean metabolic hydrogen ion excess was 32 mmol/litre and the mean respiratory hydrogen ion excess was 80 mmol/litre. These results for CPD blood are compared with those obtained on acid-citrate-dextrose blood. A prediction is made that clinically, only small variations in metabolic and respiratory acid-base balance would be produced directly due to the acid and base loads in transfused blood.
Etomidate: A foreshortened clinical trial
Authors: Yelavich P. M. , Holmes C. McK. 
Published: January 2019

A clinical evaluation of etomidate for outpatient cystoscopy was embarked upon. Unpremedicated patients were given fentanyl 1 $mUg/kg followed by etomidate 0.3 mg/kg. Anaesthesia was maintained with intermittent etomidate in 2–4 mg doses. Patients were interviewed personally later the same day, and by questionnaire three to four weeks later. The trial was discontinued after 20 cases because of an unacceptable incidence of side effects. Venous pain occurred in 68% of patients and 50% had redness, pain or swelling related to the injection site, in some cases lasting up to three weeks after anaesthesia. Skeletal movements occurred in 50% of patients; 30% experienced respiratory upset, one sufficiently severe to necessitate abandoning the technique. Nausea and vomiting occurred in 40% and 25% had disturbing emergence psychoses.
Autotransfusion: An Impossible Dream?
Authors: Isbister James P. 
Published: January 2019

Despite the many critics of autologous blood transfusion, there is virtually no literature to support such an attitude in relation to any form of premeditated autologous blood transfusion. It is only in relation to intraoperative blood scavenging that there have been complications. In contrast, there is considerable literature supporting the theoretical and practical advantages of autologous transfusion and haemodilution and a wealth of evidence pointing to the immediate and delayed complications of homologous transfusions. In this paper autologous blood transfusion is reviewed with particular emphasis on the factors responsible for its failure to achieve a widely accepted place in clinical medicine despite its theoretical, practical and economic advantages.
Spinal Anaesthesia Revisited: An Evaluation of Subarachnoid Block in Obstetrics
Authors: Brownridge P. 
Published: January 2019

A series of 442 women receiving subarachnoid block for various obstetrical procedures is described. These included caesarean section, instrumental delivery, manual removal of placenta, insertion of cervical suture and miscellaneous procedures. General anaesthesia was required in ten patients because subarachnoid block proved to be unsatisfactory. There were no serious complications. The overall headache rate, ascertained by daily direct questioning during hospital admission, was 26.2%. Clinical features of dural puncture headache (DPH) were present in 8.6% and equivocally so in a further 3.4%. A significantly higher incidence of DPH was recorded among patients receiving a cervical suture. Among the thirty-eight patients who developed DPH, a 25 or 26 SWG spinal needle had invariably been used and in most instances the procedure was described as being uneventful. There were no consistent technical features among the patients who developed DPH, although operator experience may have been a factor. DPH was graded as ‘severe’ in ten patients (2.3%) and an epidural blood patch was rapidly curative in each of these cases. One patient required a repeat patch. Subarachnoid block proved to be a satisfactory technique for the procedures outlined in the survey. It proved to be particularly valuable when anaesthesia was required urgently in the delivery suite and may even be regarded as the anaesthetic of choice in these circumstances.
Anaesthesia for Closed Embolisation of Cerebral Arteriovenous Malformations
Authors: O'Mahony B. J. , Bolsin S. N. C. 
Published: January 2019

Cerebral arteriovenous malformation embolisation is a therapeutic, neuroradiological procedure involving injection of bucrylate glue into the nidus of the A V malformation to obliterate the abnormal vascular network. These procedures may involve significant risks, are often long and thereby necessitate the need for some form of sedation and for adequate monitoring of the cerebral, cardiovascular and respiratory systems. The anaesthetic management of a series of twenty patients undergoing embolisation of a cerebral arteriovenous malformation is outlined, seven general and nineteen neurolept anaesthetics being administered. Neurolept anaesthesia is the preferred technique as neurological assessment during the procedure is possible and complications may be diagnosed immediately. Systemic arterial hypotension may facilitate the embolisation process and various agents, including glyceryl trinitrate and sodium nitroprusside, have been employed for this purpose.
Dopamine and Renal Salvage in the Critically Ill Patient
Authors: Duke G. J. , Bersten A. D. 
Published: January 2019

Dopamine is a catecholamine used widely in critically ill patients and those undergoing major surgery, often as a ‘renal protective’ agent. Direct renal vasodilatation with ‘low-dose’ dopamine is the widely accepted basis for its use – hence the term ‘renal dose’ dopamine. However, recent evidence has revealed that the renal effects of this agent are far more complex. Moreover, some of these effects may be undesirable in the ‘at-risk’ kidney. The increased renal blood flow (RBF) of dopamine may be largely attributable to its inotropic (myocardial) action, even with low doses (i.e. < 5 μg/kg/min). Similar increases in RBF can also be demonstrated with other (non-dopaminergic) inotropes. The early evidence for direct renal vasodilatation in response to dopamine has been brought into question by more recent research. The diuresis and natriuresis commonly seen following dopamine administration is now known to be due to a direct renal tubular (or ‘diuretic’) action. Furthermore, increasing knowledge regarding the pathophysiology of acute (ischaemic) renal failure, including RBF and the concept of ‘oxygen supply and demand’ in relation to tubular function, suggests that dopamine may mask important signs of renal ischaemia. Whether or not dopamine is truly beneficial to renal function currently remains unanswered. As it stands however, there is sufficient evidence to question its routine use in the setting of renal dysfunction in the critically ill patient.
Obstetric Epidural Services in Rural South Australia
Authors: Watts R. W. 
Published: January 2019

A survey of sixty South Australian country hospitals found that 35 units had more than 25 deliveries per year (total deliveries 4,247, which is 21.5% of total live births in South Australia during 1989). Twenty-five of these units had an epidural service (71%) and the overall epidural rate was 16.7%, 9.5% provided by general practitioner anaesthetists and 7.2% by specialists. General practitioner anaesthetists were involved more in the medium-sized units (50–200 deliveries per year), whereas specialists provided more services in the larger regional units and the small units as visitors. The epidural rate varied between 6–20% depending on the size of the unit. Most country regions in South Australia have reasonable access to an epidural service. The more geographically isolated areas are being serviced by general practitioner anaesthetists.
Transfusion Transmitted Infection: Viral and Exotic Diseases
Authors: Wylie B. R. 
Published: January 2019

Viral and other exotic diseases may be transmitted by blood transfusion. These infections include human immunodeficiency virus (HIV), hepatitis viruses (A, B, C, D and E), syphilis, malaria, retrovirus HTLV-1, and cytomegalovirus. Other more exotic diseases which may be transmitted by transfusion of blood or blood components include Chagas’ disease (Trypanosomiasis cruzi), Lyme disease (Borrelia burgdorferi), and Jakob-Creutzfeldt disease. Screening procedures currently used in Australian blood banks minimise transfusion-transmitted infection. The risk of acquiring any infection in this manner may be less than 0.1%.
Vecuronium-Thiopentone Induction for Emergency Caesarean Section under General Anaesthesia
Authors: Teviotdale B. M. 
Published: January 2019

Induction of general anaesthesia for emergency caesarean section has always been hazardous. Acid aspiration syndrome1 and adverse reactions to suxamethonium1- are well recognised problems, in spite of which “crash” induction using thiopentone and suxamethonium remains a common induction technique.4 Recent case reports-1 suggest that the use of medium duration nondepolarising relaxants in place of suxamethonium achieves satisfactory intubating conditions in the emergency caesarean section patient. This study was undertaken to investigate the following aspects of rapid-sequence vecuronium-thiopentone induction for emergency caesarean section. 1. To establish whether 8 mg of vecuronium provides effective intubating conditions. 2. To establish whether placental transfer of vecuronium used in the above dosage has any clinically detectable effect upon the newborn. 3. To establish the limit of lead time by which vecuronium may precede thiopentone to minimise the dangerous period between loss of consciousness and intubation. 4. To detect instances of acid regurgitation or aspiration. 5. To confirm that relaxant reversal is clinically effective at the completion of surgery. In this series of thirty cases, vecuronium 8 mg preceding thiopentone 250 mg and atropine 0.6 mg by 20 seconds provided effective induction and easy intubating conditions without clinical effects on the newborn, maternal acid aspiration, or clinical signs of persistent paralysis after reversal.
Which Monitor? An Analysis of 2000 Incident Reports
Authors: Webb R. K. , Van Der Walt J. H. , Runciman W. B. , Williamson J. A. , Cockings J. , Russell W. J. , Helps S. 
Published: January 2019

The role of monitors in patients undergoing general anaesthesia was studied by analysing the first 2000 incidents reported to the Australian Incident Monitoring Study; 1256 (63%) were considered applicable to this study. In 52% of these a monitor detected the incident first; oximetry (27%) and capnography (24%) detected over half of the monitor detected incidents, the electrocardiograph 19%, blood pressure monitors 12%, a low pressure (circuit) alarm 8%, and the oxygen analyser 4%. Of the other monitors used, 5 first detected 1–2% of incidents, and the remaining 8 less than 0.5% each. The oximeter would have detected over 40% of the monitor detected incidents had its more informative modulated pulse tone always been relied upon instead of the “bleep” of the ECG. A theoretical analysis was then carried out to determine which of an array of 17 monitors would reliably have detected each incident had each monitor been used on its own and had the incident been allowed to evolve. To facilitate “scoring” of monitors, the incidents were categorized empirically into 60 clinical situations; 40% of applicable incidents were accounted for by only 5 clinical situations, 60% by 10 and nearly 80% by 20. 98% were accounted for by the 60 situations. A pulse oximeter, used on its own, would theoretically have detected 82% of applicable incidents (nearly 60% before any potential for organ damage). These figures for capnography are 55% and 43 % and for oximetry and capnography combined are 88% and 65%, respectively. With the addition of blood pressure monitoring these become 93% and 65%, and of an oxygen analyser, 95 and 67%. Other monitors, including the ECG, each increase the yield by by less than 0.5%. The international monitoring recommendations and those of the Australian and New Zealand College of Anaesthetists are thoroughly vindicated by the patterns revealed in this study. The priority sequence of monitor acquisition for those with limited resources should be stethoscope, sphygmomanometer, oxygen analyser if nitrous oxide is to be used, pulse oximeter, capnograph, high pressure alarm, and, if patients are to be mechanically ventilated, a low pressure alarm (or spirometer with alarm); an ECG, a defibrillator, a spirometer and a thermometer should be available.
The Pulse Oximeter: Applications and Limitations—An Analysis of 2000 Incident Reports
Authors: Runciman W. B. , Webb R. K. , Barker L. , Currie M. 
Published: January 2019

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the pulse oximeter. Of these 184 (9%) were first detected by a pulse oximeter and there were a further 177 (9%) in which desaturation was recorded. Of the 1256 incidents which occurred in association with general anaesthesia 48% were “human detected” and 52% “monitor detected”. The pulse oximeter was ranked first and detected 27% of these monitor detected incidents; this figure would have been over 40% if an oximeter had always been used and its more informative modulated pulse tone relied upon instead of that of the “bleep” of the ECG. The pulse oximeter is the “front-line” monitor for endobronchial intubation, the fourth most common incident in association with general anaesthesia (it detected 87% of the 76 cases in which it was in use). It also played an invaluable role as a “back-up” monitor in 40 life-threatening situations in which “front-line” monitors (e.g. oxygen analyser, low pressure alarm, capnograph) were either not in use, were being used incorrectly or failed. Other situations detected, in order of frequency of detection, were: circuit disconnection, circuit leak, desaturation (severe shunt), oesophageal intubation, aspiration and/or regurgitation, pulmonary oedema, endotracheal tube obstruction, severe hypotension, failure of oxygen delivery, hypoxic gas mixture, hypoventilation, anaphylaxis, air embolism, bronchospasm, malignant hyperthermia, and tension pneumothorax. There were 15 reports of “failure”; four because the model in use had no modulated tone or alarm, four in which performance was in fact adequate, three were probe problems, two involved “over-reading”, one “under-reading” and in one new device the alarm failed. In the theoretical analysis of the 1256 general anaesthesia incidents it was concluded that pulse oximetry, used on its own, would have detected 82% of these incidents, had they been allowed to evolve (nearly 60% before any potential for organ damage). It is highly recommended that a suitable pulse oximeter be used on all patients from the time of arrival in the induction room until return of protective reflexes and demonstration of adequate saturation when breathing room air.
Blood Pressure Monitoring—Applications and Limitations: An Analysis of 2000 Incident Reports
Authors: Cockings J. G. L. , Webb R. K. , Klepper I. D. , Currie M. , Morgan C. 
Published: January 2019

Of the first 2000 incidents reported to the Australian Incident Monitoring Study, 1256 occurred in relation to general anaesthesia and 81 of the latter were first detected by blood pressure (BP) monitoring. A further 25 incidents not associated with general anaesthesia were first detected by blood pressure monitoring, giving a total of 106. In the monitor detection of incidents in relation to general anaesthesia, BP monitoring ranked fourth after oximetry, capnography and low pressure alarms. On the other hand, 38 incidents in which the problem was primarily one of significant change in BP were first detected by means other than the BP monitor (20 clinically, 12 by pulse oximetry and 6 by ECG). Early detection rates of hypotension were 60% for invasive methods, 40% for automated non-invasive (NIBP) devices and 30% for manual sphygmomanometry. There were 21 reports of BP monitor “failure”; the 11 of these which occurred with NIBPs involved unexplained false “low” or “high” readings and failure to detect profound hypotension, and led to considerable morbidity and at least one death. The 10 cases of invasive monitoring failure were predominantly due to mains power loss, hardware breakage or operator error. In a theoretical analysis of the 1256 GA incidents, it was considered that on its own, BP monitoring would have detected 919 (73%), but in the vast majority, by the time this detection has occurred, potential organ damage could not be excluded. It is recommended that BP be measured at regular intervals dictated by clinical requirements (usually at least every five minutes). BP monitoring should be supplemented by other modalities in accordance with the College of Anaesthetists guidelines and when immediate and reliable detection of change in BP is critical, invasive monitoring should be used.
The Oxygen Analyser: Applications and Limitations – An Analysis of 2000 Incident Reports
Authors: Barker L. , Webb R. K. , Runciman W. B. , Van Der Walt J. H. 
Published: January 2019

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the oxygen analyser; 27 (1%) were first detected by the oxygen analyser. All of these were amongst the 1256 incidents which occurred in association with general anaesthesia, of which 48% were “human detected” and 52% “monitor detected”. The oxygen analyser was ranked 7th and detected 4% of these monitor detected incidents. This figure would have been much higher had the oxygen analyser been correctly used on more occasions. The oxygen analyser detected 10 ventilator-driving-gas leaks into the circuit, 6 hypoxic mixtures due to rotameter settings, 3 inappropriate nitrous oxide concentrations, 2 disconnections and 1 leak at the common gas outlet, and 2 partial and 1 total failure of ventilation. In a theoretical analysis of these 1256 incidents it was considered that the oxygen analyser, used on its own, would have detected 114 (9%), had they been allowed to evolve (3% before any potential for organ damage). In 4 incidents an oxygen analyser gave faulty readings, in 3 caused a leak and in one a total circuit obstruction; 5 incidents were not detected because the alarm had been disabled. Despite the advent of piped gas supplies, failure of gas delivery or delivery of a “wrong” gas mixture still occurs surprisingly frequently in current anaesthetic practice; hypoxic mixtures were supplied on 16 occasions, other “wrong” mixtures on 23 and the oxygen supply failed on 7 occasions. Failure to use and improper use of the oxygen analyser is also surprisingly common; this is mainly due to a rule-based error encouraged by the poor design of the high alarm. It is highly recommended that a suitable, correctly sited, calibrated, tested oxygen analyser be used from before pre-oxygenation until the patient is no longer breathing gas from the anaesthetic machine or circuit.
Problems before Induction of Anaesthesia: An Analysis of 2000 Incident Reports
Authors: Ludbrook G. L. , Webb R. K. , Fox M. A. , Singleton R. J. 
Published: January 2019

The first 2000 incidents reported to the Australian Incident Monitoring study (AIMS) were examined to identify those incidents which occurred preoperatively (defined as occurring prior to the commencement of general or regional anaesthesia). The 35 incidents, representing 1.7% of the total, which occurred in this time period were analysed with a view to identifying areas in which current practice could be improved. Almost all incidents led to significant delays in operating lists, and 9 resulted in cancellation of surgery. A number of areas of concern specific to the preoperative period were identified. Inadequate coordination between surgical and anaesthetic staff in patient preparation was a frequent cause of preoperative incidents. Improvement in this area may reduce surgical delays and patient morbidity. Problems with premedication drugs resulted in 8 of the 35 incidents, and care must be taken in the prescription and administration of these drugs to minimise adverse effects on patients. Only 2 cases of incorrect patient identification were reported. However, in view of its disastrous consequences, vigilance in patient identification by all members of the operating team, including the anaesthetist, is essential.