bluuebunny/crossref_metadata_2025_split huggingface dataset:
The selective orexin-2 receptor antagonist seltorexant improves sleep: An exploratory double-blind, placebo controlled, crossover study in antidepressant-treated major depressive disorder patients with persistent insomnia
Authors: Brooks Sander , Jacobs Gabriël E , de Boer Peter , Kent Justine M , Van Nueten Luc , van Amerongen Guido , Zuiker Rob , Kezic Iva , Luthringer Remy , van der Ark Peter , van Gerven Joop MA , Drevets Wayne 
Published: January 2019

Background: Insomnia is common in patients with major depressive disorder. Although antidepressants improve mood, insomnia often persists as a result of physiological hyperarousal. The orexin-2 receptor is increasingly being recognized as a new target for the treatment of persistent insomnia in major depressive disorder . Aim: This exploratory study investigated the effects of seltorexant on objective sleep parameters and subjective depressive symptoms in antidepressant treated major depressive disorder patients with persistent insomnia. Methods: Twenty male and female patients received a single dose of 10, 20, 40 mg seltorexant and placebo with a washout period of seven days in a double-blind four-way crossover study. Effects on latency to persistent sleep, total sleep time and sleep efficiency were assessed with polysomnography. Subjective changes in mood were explored by the Quick Inventory of Depressive Symptomatology Self-Report. Safety was recorded and suicidal ideation and behavior were assessed with the Columbia Suicide Severity Rating Scale. Results: Latency to persistent sleep was significantly shorter for all doses of seltorexant compared to placebo. Placebo least square mean was 61.05 min with least square mean ratios treatment/placebo (80% confidence interval) of 0.32 (0.24–0.44), 0.15 (0.11–0.2) and 0.17 (0.12–0.23) 19.69, 9.2, 10.15 for 10, 20 and 40 mg seltorexant respectively, (all p<0.001). Total sleep time was significantly longer for all doses of seltorexant compared to placebo. Sleep efficiency was significantly improved. The Quick Inventory of Depressive Symptomatology Self-Report demonstrated a trend to mood-improvement for the 40 mg group. Conclusions: Seltorexant showed a statistically significant, dose-dependent decrease in latency to persistent sleep, and increase in total sleep time and sleep efficiency combined with a tendency toward subjectively improved mood.
Co-Administration of Drugs and Blood Products
Authors: Birch C. , Hogan C. , Mahoney G. 
Published: January 2019

The addition of a drug to a blood product intravenous line raises the question of physical and chemical compatibility of the drug with the blood and any preservatives or additives in the blood product. This clinical scenario is encountered frequently, however the practice has not been well studied. Protocols at most institutions prohibit the addition of drugs to blood products. We investigated the addition of analgesic drugs used for patient-controlled analgesia (morphine 1 mg/ml, pethidine 10 mg/ml and ketamine 1 mg/ml) to a standard red cell concentrate, resuspended red blood cells. The red cells were analysed by a Blood Transfusion Service Haematologist and subjected to standard quality control tests. The morphology of the red cells in resuspended red blood cell preparations was unchanged by the addition of these drugs at any stage during storage. The drug concentration in the resuspended red blood cell serum was measured at 0 and at 20 minutes and there was no decrease in concentration which showed that there was no loss of free drug in the resuspended red blood cell serum. This study demonstrates that the concern regarding injury to red cells in standard red cell concentrates by addition of these drugs is unjustified.
Cricoid Pressure: Beware the Patient with a Goitre
Authors: Fairweather N. L. 
Published: January 2019

A case of acute thyroid swelling is reported following intubation of a young woman with a pre-existing small goitre. The thyroid enlargement then distorted the airway, necessitating an emergency thyroidectomy. The application of cricoid pressure was believed to have caused the intrathyroidal bleeding and the complications of cricoid pressure are reviewed.
Efficacy of Low-dose Dexamethasone for Preventing Postoperative Nausea and Vomiting following Strabismus Repair in Children
Authors: Mathew P. J. , Madan R. , Subramaniam R. , Bhatia A. , Mala C. G. , Soodan A. , Kaul H. L. 
Published: January 2019

We studied the efficacy of a range of doses of dexamethasone for prevention of postoperative nausea and vomiting following strabismus repair in children in a hospital-based, prospective, double-blinded, randomized, placebo-controlled trial. Two hundred and ten children were randomized to receive either dexamethasone in one of four dosages: 50 μg/kg (Group 1), 100 μg/kg (Group 2), 200 μg/kg (Group 3) and 250 μg/kg (Group 4) or normal saline (Group 5) prior to corrective surgery for strabismus. Anaesthesia was standardized and included nitrous oxide, pethidine, intubation and the use of muscle relaxant and reversal with neostigmine. Postoperative nausea and vomiting were evaluated in epochs of 0-2 hours, 2-6 hours and 6-24 hours after surgery. Parent satisfaction was assessed 24 hours after surgery and the operated eye was examined for wound infection and delayed healing one week later. Dexamethasone was effective in preventing nausea and vomiting after strabismus repair: 57.1% children in Group 1, 42.9% in Group 2, 52.4% in Group 3, and 59.5% in Group 4 were free from postoperative nausea and vomiting compared with 7.1% in placebo group. The lowest dose of 50 μg/kg was as efficacious as the higher dosages of dexamethasone during the 24 hours studied. Of the children who developed postoperative nausea and vomiting, those who received dexamethasone had significantly fewer episodes than those in the placebo group. We conclude that dexamethasone 50 μg/kg is effective for the prevention of postoperative nausea and vomiting following strabismus repair in children.
Malignant Hyperthermia and Day Stay Surgery
Authors: Pollock N. , Langton E. , Mcdonnell N. , Tiemessen J. , Stowell K. 
Published: January 2019

Patients who are malignant hyperthermia susceptible are often admitted overnight for observation, even after minor surgery. They may be declined care in a stand-alone day stay unit. This prospective audit set out to investigate whether patients susceptible to malignant hyperthermia can be safely treated as day stay patients. The audit was conducted for four years from late 2000. All patients who were known to be susceptible to malignant hyperthermia, and their untested relatives, who received day stay anaesthesia were included in the audit. Malignant hyperthermia status, age, duration of anaesthesia, anaesthetic technique, type of procedure, intraoperative and postanaesthesia care unit observations and complications were recorded. All patients received a trigger-free anaesthetic technique. Detailed postanaesthesia care unit monitoring was undertaken and patients were observed for two and a half hours postoperatively. Seventy-two patients were included in the audit. General anaesthesia was administered to 85% and regional to 15%. Only minor complications arose in the postoperative period, and none suggested a malignant hyperthermia reaction. Postanaesthesia care unit nursing staff contacted 49 (68%) of the patients the following day, and there was no evidence of malignant hyperthermia reactions. This audit suggests that malignant hyperthermia susceptible patients can be safely managed as day stay patients in appropriate facilities, with appropriate postoperative care.
Anaesthesia for Emergency Caesarean Section, 2000-2004, at the Royal Women's Hospital, Melbourne
Authors: Popham P. , Buettner A. , Mendola M. 
Published: January 2019

The provision of anaesthesia for emergency caesarean section is a major part of the workload of obstetric anaesthetists and the urgency often dictates the mode of anaesthesia that can be provided. We have audited the provision of anaesthesia for ‘immediate’ caesarean sections over a four-year period following the introduction of a ‘Code Green’ system to coordinate a rapid response to an obstetric decision to proceed with an ‘immediate’ caesarean section. The records of all patients for whom a Code Green was called between July 2000 and June 2004 were studied. The reasons for the call, interval timings (for example decision-to-delivery interval) and type of anaesthesia used were collected. There were 444 Code Green procedures, of which 47 were excluded due to incomplete data. The most common indication was ‘fetal distress’ and the three most common types of anaesthesia used were general (n=206), Epidural top-up (n=106) and spinal (n = 65). Mean decision-to-delivery intervals (±SD) for all caesarean sections were 17 (±6) minutes with general anaesthesia, 19 (±9) minutes with epidural and 26 (±9) minutes with spinal anaesthesia. Forty-five percent of calls were made between the hours of 0700 and 1700 h. General anaesthesia was most used between the hours of 0700 and 1700 h. A swift response to the call for an immediate caesarean section can be achieved when suitable facilities and procedures are in place. Administering an epidural bolus into an already established epidural catheter that is working effectively can allow a decision-to-delivery interval almost as short as general anaesthesia.
Comparison of the Laryngeal Mask (LMA™) and Laryngeal Tube (LT®) with the Perilaryngeal Airway (CobraPLA®) in Brief Paediatric Surgical Procedures
Authors: Kaya G. , Koyuncu O. , Turan N. , Turan A. 
Published: January 2019

We compared the laryngeal mask airway (LMA™) and the laryngeal tube (LT®) with the perilaryngeal airway (CobraPLA®, PLA) in anaesthetised, paralysed children having brief surgical procedures. After obtaining informed consent, 90 paediatric ASA Status 1 and 2 patients awaiting short surgical procedures were randomised to have their airways managed with an LMA, LT or PLA. Anaesthesia was induced with sevoflurane (2.5 to 4%) and muscle paralysis with mivacurium (0.2 mg/kg intravenously). The number of insertion attempts, time taken to insert the device, haemodynamic responses to insertion (mean arterial blood pressure, heart rate, pulse oximetry and end-tidal CO 2 ), clinical performance and occurrence of postoperative sore throat were recorded. When the airway device was removed, it was examined for visible blood. Patients and parents were asked about the occurrence of sore throat, dysphonia and dysphagia 24 hours postoperatively. Heart rate, mean arterial blood pressure, pulse oximetry and end tidal CO 2 did not differ among the groups. Insertion times for the devices were similar (LMA: 19 ± 11 seconds, LT: 21 ± 12 seconds, PLA: 18 ± 12 seconds), as were the rates of successful insertion at first attempt (LMA 66.7%; LT 70.0%; PLA 73.3%). The number and type of airway interventions to achieve an effective airway were comparable. When the airways were removed, positive blood traces were noted on 20% of the LMAs, 20% of the PLAs and 10% of the LTs. Haemodynamic, ventilation and oxygenation variables throughout the surgery were similar with LMA, LT and PLA and there were no significant differences in insertion time or signs or symptoms of mucosal trauma when these devices were used in paralysed children.
Dose Requirements for Propofol Anaesthesia for Dental Treatment for Autistic Patients Compared with Intellectually Impaired Patients
Authors: Asahi Y. , Kubota K. , Omichi S. 
Published: January 2019

We had clinical grounds to suspect that patients with autism had greater propofol requirements during dental procedures than patients with intellectual impairment without autism. This hypothesis was tested by an audit of a standard anaesthetic technique. The audit was approved by our Hospital Ethics Committee. We compared the propofol requirements and effect using a standardised protocol during dental treatment in 56 autistic patients (age range three to 35 years) and 56 intellectually impaired patients (age range four to 42 years). Patients in each disability group were divided into three subgroups by age: six years or younger, seven to 19 years and 20 years or older. Combative patients received oral midazolam premedication, other patients received a single intravenous bolus of midazolam at induction. Otherwise, standardised propofol boluses and infusion were the only anaesthetic agents used. The propofol infusion rates of the intellectually impaired group showed significant decline with age (propofol rate of requirement mg.kg−1.h−1 mean [SD]): <six years 13.6 (3.6), seven to 19 years 9.5 (3.0) (P=0.008 cf <six years group), >19years group 8.5 (2.4) (P=0.001 cf <six years group). The propofol requirement was greater in the autism group than in the intellectual disability group, and the proportion of the cases where bolus propofol administration was needed after induction was significantly higher in the autistic patient group than in the intellectually impaired patients (P <0.002). This suggests that autistic patients have greater propofol requirements for anaesthesia during ordinary dental treatment compared with intellectually impaired patients.
Magnetic Resonance Scanning of the Upper Airway following Difficult Intubation Reveals an Unexpected Lingual Tonsil
Authors: Greenland K. B. , Cumpston P. H. V , Huang J. 
Published: January 2019

We present a case of a 40-year-old woman requiring elective surgery who had an unexpected Grade 4 Cormack and Lehane laryngoscopy view. Both curved and straight laryngoscope blades in the sniffing and hyperextended head and neck positions were used. Endotracheal intubation was accomplished with some difficulty using a No. 3 Macintosh blade and Frova intubating catheter in the sniffing position. The cause of the difficult laryngoscopy was a lingual tonsil as shown in postoperative magnetic resonance scans. We feel that a comprehensive postoperative evaluation should be conducted after every difficult laryngoscopy (Cormack and Lehane Grade 3b and 4). The use of magnetic resonance imaging may provide important objective information for both the anaesthetist and the patient, allowing a better understanding of causes and possible solutions for future airway management.
Ultrasound-guided Transversus Abdominis Plane Block for Neonatal Abdominal Surgery
Authors: Fredrickson M.J. , Seal P. 
Published: January 2019

This paper describes four neonates having abdominal procedures with intraoperative and early postoperative analgesia provided by a transversus abdominis plane regional block. Analgesia for neonatal upper and midabdominal surgery usually involves regional anaesthesia and/or systemic opioid. All these analgesia techniques have problems specific to the neonatal period. Neonates are sensitive to the respiratory depressant effects of systemic opioid, while the low threshold for local anaesthetic toxicity limits regional anaesthesia/analgesia, which in neonatal upper abdominal surgery is often limited to local anaesthetic infiltration. The transversus abdominis plane block has been shown to provide effective analgesia following a variety of abdominal surgeries in both adults and children. We report four neonates who underwent minor or major abdominal surgery under general anaesthesia supplemented by ultrasound-guided transversus abdominis plane block. Perioperative opioids were administered to one neonate who required postoperative ventilation. Ultrasound-guided transversus abdominis plane bock is a technically feasible alternative to local anaesthetic wound infiltration in the neonate and warrants further evaluation.
Can Learning to Sustain Life be BASIC? Teaching for the Initial Management of the Critically Ill in Australia and New Zealand
Authors: Douglas A. E. , Holley A. , Udy A. , Lipman J. , Gomersall C. D. , Joynt G. M. , Freebairn R. C. , Boots R. J. 
Published: January 2019

Commonly in Australia and New Zealand, initial intensive care support of critically ill patients is by non-intensive care trained medical and nursing staff. Basic Assessment and Support in Intensive Care (BASIC) is an internationally run short course to assist practitioners to gain knowledge and skills to manage the early hours of critical illness. The aim of this study was to assess the performance and acceptance of the BASIC course as conducted in an Australian metropolitan teaching hospital and a major regional centre in New Zealand. Performance on pre- and post-course multiple choice examinations and the overall course assessment by all participants attending between 2005 and 2009 was analysed. Of 796 participants, 338 (42%) were in Australia and 458 (58%) in New Zealand. Compared to New Zealand, Australian non-intensive care consultants and junior medical staff attended more commonly at 9% vs 4% and 62% vs 42% respectively, while nurses more frequently attended in New Zealand (47% compared to 12%, P <0.001). The pre-course open book examination result averaged 79% (95% confidence interval 78 to 80) and the post-course closed book examination was 64% (95% confidence interval 63 to 65). The post-course examination score was predicted by pre-course examination score (β =0.22, 95% confidence interval 0.17 to 0.27), nursing occupation, (β=-3.96, 95% confidence interval -5.03 to -2.90) and the availability of a scenario-based simulation module (β=0.22, 95% confidence interval 0.17 to 0.27, R2=0.38, P <0.001). Participants generally found they had learned a great deal from the program and that the course material was of an appropriate level. The BASIC course was found to be a positive learning experience for health care practitioners inexperienced in the management of the critically ill.
Predictors of Severity in Deep Neck Infections Admitted to the Intensive Care Unit
Authors: Garcia T. , Rios M. , Paiva J. A. 
Published: January 2019

A retrospective study was performed on adult patients admitted for surgical drainage of deep neck infections and admitted to the intensive care unit (ICU) during a period of 52 months. Severe infection was defined as septic shock/severe sepsis, mediastinitis, empyema or necrotising fasciitis. Complicated course was defined as ICU stay >8 days, reintubation, tracheostomy, renal replacement therapy, critical illness, myopathy or mortality. Chi-square or Fisher's exact test were used to assess differences and the significance level was controlled for multiple comparisons applying Bonferroni's correction. Fifty-four patients were studied. Variables associated with severe infection (43%) were abscess location (retropharyngeal [52 vs 7%; P P=0.002]), Acute Physiology and Chronic Health Evaluation II >7 (78 vs 13%; P 29 (73 vs 21%; P 2 (77 vs 21%; P P 7 (67 vs 14%; P=0.001), Simplified Acute Physiology Score II >29 (62 vs 18%; P=0.002) and Sequential Organ Failure Assessment score >2 (68 vs 17%; P <0.001). Serious complications occur frequently in patients with deep neck infections surgically drained and admitted to the ICU. Higher severity scores are associated with both severe infection and a complicated course. Retropharyngeal and parapharyngeal locations are associated with severe infection and a complicated course respectively.
Approaching Families for Organ Donation—Intensivists’ Perspectives
Authors: Mullins G. C. , Simes D. , Yuen K. J. 
Published: January 2019

In Australia the initial approach to families for organ donation is almost always undertaken by intensivists. There is, however, a paucity of literature on intensivists’ views on this approach and how their approach compares with recommendations in published literature on this subject. This study consisted of a survey of the views of intensive care consultants and senior intensive care registrars in the four major teaching hospitals in Perth, Western Australia, on how they approached families for organ donation. The study also includes a review of recently published literature on approaching families for organ donation. The survey results indicate that most intensive care consultants felt adequately trained to approach families for organ donation, but almost half of the group surveyed would prefer a collaborative approach with either a donor co-ordinator or a colleague with additional training on this subject. Despite recommendations in the literature and from the Australian and New Zealand Intensive Care Society to determine the registration status of potential donors on the Australian Organ Donation Registry prior to discussions with families, this was not always undertaken. In addition, the benefits of organ donation were not always discussed with families, nor were the reasons for refusal of consent sensitively explored.
The Venturi Bronchoscopic Attachment—Paediatric Considerations
Authors: Brown T. C. K. 
Published: January 2019

Experiments on puppies were carried out during bronchoscopy to ascertain how the principle of intermittent inflation using a high-pressure gas source via a needle in the lumen of the bronchoscope could be safely applied to children under relaxant anaesthesia. The effects on blood gases, intratracheal pressure and temperature with different source pressures were studied. The dangers and disadvantages of high source pressures are discussed. PaCO2 and PaO2 were maintained with source pressures of 20 pounds per square inch (psi) at 30 breaths per minute, and at this level intratracheal pressures were also safe. Temperature was shown to fall. It has been safely applied clinically and two children were studied using 20 psi source pressure.
The Effect of Hyoscine and Atropine on the Lower Oesophageal Sphincter
Authors: Brock-Utne J. G. , Rubin J. , McAravey R. , Dow T. G. B. , Welman S. , Dimopoulos G. E. , Moshal M. G. 
Published: January 2019

The effects of intravenous hyoscine 0·4 mg and atropine 0·6 mg on lower oesophageal sphincter tone were studied in normal human subjects. Hyoscine and atropine both decreased the lower oesophageal sphincter (L.O.S) pressure by approximately 11 cm H2 O (p <0·01). There was also an increased incidence of reflux as seen by an indwelling pH electrode in the lower oesophagus. These findings are relevant to the preoperative preparation of patients presenting for emergency obstetrical anaesthesia; since gastro-oesophagus reflux and pulmonary aspiration of acid gastric content continues to be a significant cause of morbidity and mortality.
The Effect of Metoclopramide on the Lower Oesophageal Sphincter in Late Pregnancy
Authors: Brock-utne J. G. , Dow T. G. B. , Welman S. , Dimopoulos G. E. , Moshal M. G. 
Published: January 2019

The effects of intravenous metoclopramide (Maxolon) on the lower oesophageal sphincter (LOS) were studied in three groups of patients, one group being normal control and the other two being pregnant females, one without heartburn and the other with. Metoclopramide increases the LOS pressure 20.5, 15.2 and 10.2 cm H2 O respectively (p<0.005, p<0.005 and p<0.05). These findings suggest that for patients undergoing elective or emergency obstetrical anaesthesia, intravenous metoclopramide may help reduce the incidence of regurgitation of gastric contents.
Increases in Cuff Volume and Pressure in Red Rubber Endotracheal Tubes during Anaesthesia
Authors: Thompson W. R. , Oh T. E. 
Published: January 2019

Increases in endotracheal tube cuff volume and pressure during anaesthesia have been reported to be due to the diffusion of nitrous oxide into the cuff. This study compared cuff volume and pressure changes in anaesthetized intubated patients who were ventilated with those allowed to breath spontaneously. The cuffs of Magill red rubber endotracheal tubes were inflated with either air or a nitrous oxide-oxygen mixture. Serial pressure and volume recordings confirmed that both parameters increased when the cuff was inflated with air. The increase in cuff pressure was however, greater during intermittent positive pressure ventilation than for spontaneous respiration. There were no significant changes when the cuff was inflated with the nitrous oxide-oxygen mixture.