bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Central Venous Silastic Catheter Infections Using Hydrochloric Acid
Authors: Worthley L. I. G. 
Published: January 2019

Patients receiving long-term home parenteral nutrition through a subcutaneously tunnelled central venous silastic catheter underwent a trial of 1.5 ml of 2M hydrochloric acid instilled into the catheter each time an episode of catheter sepsis was diagnosed. Four patients had eleven episodes of central venous catheter infection, with the hydrochloric acid clearing the infection on seven occasions, and unblocking the catheter once. The mainstay of therapy for catheter sepsis is removal of the catheter. However, in patients with subcutaneously tunnelled central venous silastic catheters, if reinserting the catheter is anticipated to be a major problem then a small dose of hydrochloric acid in an attempt to clear the infection may be worth a trial.
Cardiac Pacing in Intensive Care
Authors: Donovan Karl D. 
Published: January 2019

Cardiac pacing techniques and equipment have developed dramatically in recent years. Bradycardias and tachycardias may be effectively treated by pacing. Bradyarrhythmias: It is generally accepted that pacing is indicated for a sustained symptomatic bradycardia. Prophylactic pacing for‘high-risk’ bundle branch block in acute myocardial infarction is more controversial. A new era in cardiology has been introduced with the advent of‘physiological pacing’, i.e. pacing of the heart with the maintenance of atrioventricular synchrony and varying the heart rate according to the body's metabolic leads. Modern pacing systems, which allow the atria and ventricles to contract in sequence, improve cardiac haemodynamics, result in subjective improvement and increase exercise tolerance. There are, however, pacemaker-associated and pacemaker-mediated tachyarrhythmias. Further advances in technology should overcome these problems. Tachyarrhythmias: Intracardiac electrocardiograms are often useful in the diagnosis of tachyarrhythmias, especially wide complex tachycardias. Rapid pacing of the atria in certain supraventricular tachycardias or of the ventricle in ventricular tachycardia is an alternative to cardioversion in many instances. This form of treatment is usually utilised in conjunction with drug therapy.
Acute Enteric Sepsis: Bacteriology and Antibiotic Cover
Authors: Steele T. W. 
Published: January 2019

Most cases of enteric sepsis are caused by both aerobic and anaerobic organisms which form the normal flora of the mouth and lower gastrointestinal tract. This flora is extremely variable and subject to change due to disease and antimicrobial treatment. Bacteriological investigation of patients with severe enteric sepsis is important and should be undertaken before antibiotic treatment is commenced. The choice of antibiotics depends on the nature of the infection and its location. Initially they should be given in maximum dosage. If polymicrobial infection is suspected both aerobes and anaerobes should be covered to prevent bacteraemic shock and abscess formation. If abscesses have formed or the patient fails to respond to appropriate antibiotics, surgical exploration and drainage remain the treatment of choice. Antibiotics often fail to eradicate organisms from established abscesses and are responsible for some serious complications.
Acute Abdominal Disorders in the Paralysed Patient
Authors: Worthley L. I. G. 
Published: January 2019

In the paralysed and sedated patient, acute abdominal diseases are difficult to diagnose. Clinical signs such as tenderness, rebound, guarding and rigidity are often misleading or absent and in the fully monitored, critically ill patient, the abdominal X-ray, ultrasound and CT scan may be associated with a high incidence of artifact abnormality. The acute abdominal disorders commonly found in the critically ill patient are listed, the diagnostic approach using standard clinical and investigational methods is considered, and the problems commonly encountered by the clinician are highlighted.
Total Parenteral Nutrition in Acute Illness
Authors: Phillips G. D. 
Published: January 2019

Successful total parenteral nutrition in acute illness requires an appreciation of the pathophysiology of the illness and an understanding of the nutritional state of the patient, as well as a knowledge of the principles of total parenteral nutrition. Management of the acutely ill patient's general condition is essential prior to the introduction of nutritional support. A basic regimen which includes administration of 1–2g/kg/day of protein, and 8,400 kJ (2,000 kcal)/day of energy, part glucose and part lipid, together with all minerals, vitamins and zinc, in an appropriate amount of water, should be provided. Modifications to this regimen may be indicated to accommodate cardiac, respiratory, liver or renal failure. The questions of the optimum mix of carbohydrate and lipid, the ideal amount of protein and the correct mix of amino acids for a particular period in an individual patient's illness, are still debated. The fact that recent research supports many of the postulates of the Scandinavian pioneers of total parenteral nutrition suggests we may be returning to a correct approach.
Temperature Maintenance in Infants Undergoing Anaesthesia and Surgery
Authors: Gauntlett I. , Barnes J. , Brown T. C. K. , Bell B. J. 
Published: January 2019

A study has been conducted on infants under six months of age during induction and anaesthesia to compare the effect on heat loss when a warming blanket, a humidifier and an overhead heater were used. The combination of all three was associated with significantly less heat loss than when the blanket was used alone. The particular benefit of the overhead heater during prolonged preparation for neurosurgery was also demonstrated. It is recommended that overhead heaters should be used during induction of anaesthesia in infants.
Extracorporeal CO2 Removal in Severe Adult Respiratory Distress Syndrome
Authors: Hickling K. G. 
Published: January 2019

Sixty-five per cent survival has been achieved in a group of patients with severe ARDS and a predicted mortality of 92%, by the use of Gattinoni's technique of extracorporeal CO2 removal. In patients and animals the technique has usually resulted in rapid improvement in the radiographic appearance and lung function. There are several possible mechanisms by which the technique may facilitate lung repair, including improvement of lung tissue oxygenation, the avoidance of high airway pressures and regional alkalosis in the lung, a reduction in oxygen toxicity, and the frequently observed reduction in pulmonary artery pressure. The apparent effectiveness of the technique and other associated evidence have implications which should lead us to reconsider some aspects of our conventional management of patients with severe ARDS.
Manual Resuscitators and Portable Ventilators
Authors: Phillips G. D. , Skowronski G. A. 
Published: January 2019

This paper reviews the state of the art in Australia of manually operated, self-inflating bag resuscitators, including the Laerdal, Air Viva and Ambu; manually operated bags dependent upon an oxygen supply, including Mapleson B, C, E and F, the CIG Medishield Oxy-Saver and modified Oxy-Viva Resuscitator 3, and the Komesaroff Oxy-Resuscitator RD85; oxygen-powered resuscitators, including the Oxy-Viva Resuscitator 3 with Demand and RM2 Valves, and the Oxylife FM85; and portable ventilators, including the Drager Oxylog, and Ohmeda Logic 07. Specific comment is made to the effect that the design of the resuscitator is often less important than the knowledge and ability of the operator in using the equipment to achieve adequate lung ventilation. The simplest, cheapest, most useful resuscitators are the manually operated self-inflating bag assemblies. With special training, use of more complex equipment can be justified in some circumstances. The more complex the equipment, the greater the risk of inappropriate use, and the greater the risk of equipment malfunction unless a regular maintenance program is followed.
Pain Relief after Surgery
Authors: Nimmo W. S. , Duthie D. J. R. 
Published: January 2019

Relief of pain after surgery remains poor for the majority of patients. The pain is unpleasant, and is associated with arterial hypoxaemia, venous thrombosis, myocardial ischaemia and a more florid hormonal response to surgery. Regional analgesia, systemic, subarachnoid or extradural opioids and antiprostaglandin drugs are all used to treat pain after surgery. Systemic opioids are used usually, because regional and axial techniques are labour intensive and antiprostaglandin drugs ineffective. Opioids given orally undergo extensive first pass metabolism and intramuscular doses are absorbed unpredictably. Intravenous administration avoids both problems and excellent results have been obtained using Patient Controlled Analgesia devices, but these machines are expensive. A simple regimen suitable for application to large numbers of surgical patients is required. Continuous infusion of fentanyl 100 μg h−1 IV begun two hours before surgery and supplemented by a single bolus dose of fentanyl 100 μg IV provided an effective background of analgesia.
The Effects of Formulation and Addition of Adrenaline to Cocaine for Haemostasis in Intranasal Surgery
Authors: Lips F. J. , O'Reilly J. , Close D. , Beaumont G. D. , Clapham M. 
Published: January 2019

Twenty patients presenting for submucous resection of the nasal septum under general anaesthesia were randomly allocated to four groups to receive either 1.0 ml 25% cocaine HCl in paraffin paste, 1.0 ml 25% cocaine HCl combined with 0.1% adrenaline in paraffin paste, 4.0 ml aqueous 4% cocaine HCl combined with 0.05% adrenaline or 4.0 ml aqueous 4% cocaine HCl on ribbon gauze applied to the nasal mucosa. Mean intraoperative blood loss was significantly decreased when the 25% cocaine 0.1% adrenaline combination in paraffin paste was used (11 (SD 8) ml, 60 (SD 30) ml, P<0.05, for adrenaline and plain paste respectively). Combination of adrenaline with cocaine in the aqueous formulation was not associated with a significant decrease in blood loss compared with aqueous cocaine alone (75 (SD 51), 96 (SD 66) ml respectively). Cocaine adrenaline paste and plain cocaine paste were associated with higher mean maximum cocaine blood concentrations (1.6 (SD 1.4), 2.0 (SD 1.5) μg/ml respectively) when compared with aqueous cocaine adrenaline and aqueous cocaine alone (0.03 (SD 0.003), 0.5 (SD 0.3) μg/ml respectively). Heart rate and blood pressure changes were similar in all four groups and cardiovascular toxicity was not observed. One ml of topical intranasal 25 % cocaine HCl with 0.1 % adrenaline in paraffin paste provided the best haemostasis for nasal septal surgery.
A Comparison of Rectal Indomethacin with Placebo for Pain Relief following Spinal Surgery
Authors: McGlew I. C. , Angliss D. B. , Gee G. J. , Rutherford A. , Wood A. T. A. 
Published: January 2019

Rectal indomethacin was compared with placebo in a randomised, double-blind study of 100 patients undergoing spinal surgery, in which postoperative pain scores, pethidine, diazepam and metoclopramide consumption, bleeding time, blood loss and oral fluid and food tolerance were measured. Side-effects of indomethacin and pethidine were compared in the two groups. In the indomethacin group, pain scores were significantly less for all measurements made during the first three postoperative days, pethidine and diazepam consumption were significantly less on all three days, bleeding time was significantly increased, although still within the clinically normal range, intraoperative and postoperative blood losses were not significantly affected, coagulation was not significantly impaired as assessed clinically, patients tolerated oral feeding significantly earlier, there was no significant increase in the incidence of gastro-intestinal side-effects except for diarrhoea, and there was no significant reduction in the incidence of side-effects associated with the use of pethidine.
The King Edward Memorial Hospital 1000 Mother Survey of Methods of Pain Relief in Labour
Authors: Paech M. J. 
Published: January 2019

A survey of one thousand women having a vaginal delivery in an obstetric teaching hospital was conducted in order to ascertain maternal opinions of various methods of pain relief in labour. Women were questioned on the day following delivery as to their pain experience, the degree of analgesia obtained, their satisfaction with and criticisms of the analgesic method or methods used, and their overall satisfaction with their childbirth experience. More pain than expected was reported significantly more often by primiparous women (P < 0.001) and those having induced or augmented labour (P < 0.04). Epidural analgesia was significantly more effective and resulted in greater satisfaction than other methods alone, or when used in combination (P < 0.0001). ‘Inadequate analgesia’ was also reported less frequently by women using non-pharmacological methods alone (P < 0.0001). Dissatisfaction with their experience was reported by 5% of women and was most frequently related to inadequate pain relief. Although uncommonly cited as a reason, instrumental delivery was statistically associated with dissatisfaction (P < 0.003). The incidence of dissatisfaction did not significantly differ with respect to the analgesic method or methods used.
Does Regional Block Improve Outcome after Surgery?
Authors: Rigg J. R. A. 
Published: January 2019

Seventy-five years have elapsed since the first claim that the use of local anaesthetics improved surgical outcome. Despite extensive research, the literature provides contradictory views of the role of regional block in improving outcome. This paper attempts to reconcile these contradictions by examining biological hypotheses underlying the research question and reviewing relevant epidemiological clinical research methodology. The paper concludes with recommendations to prospective investigators for strategies in design, planning and execution of randomised trials to assess the efficacy of regional block in determining outcome after surgery.
CPAP, Effective Respiratory Support in Patients with AIDS-related Pneumocystis Carinii Pneumonia
Authors: Prevedoros H. P. , Lee R. P. , Marriot D. 
Published: January 2019

Human Immunodeficiency Virus (HIV) related Pneumocystis carinii pneumonia (PCP) associated with severe respiratory failure is an increasingly common problem in major centres and is associated with a high mortality in previous and recent studies. Early in the epidemic, alternatives to invasive intensive care treatment were utilized in our institution and found to be successful. When respiratory failure developed, mask CPAP was used instead of intubation and ventilation. A retrospective review of 175 cases of HIV infected patients with confirmed first presentation PCP was undertaken. Treatment with our protocol resulted in an overall hospital mortality of 9%. Those patients who did not require supplemental oxygen or respiratory support had no in-hospital mortality. The group who required supplemental oxygen had a mortality of 10%. If respiratory failure supervened (severe respiratory distress, Pao2 < 50 mmHg, SaO2 < 90% on mask oxygen), CPAP was introduced. The mortality in this group was 22%. Only two patients were admitted to the intensive care unit for respiratory support after failure of CPAP. Both patients were intubated and received intermittent positive pressure ventilation (IPPV). Both patients died.
A Comparison of Five Devices for the Bedside Monitoring of Heparin Therapy
Authors: O'Neill A. I. , McAllister C. , Corke C. F. , Parkin J. D. 
Published: January 2019

Five instruments were tested for their capacity to monitor heparin therapy on whole blood at the bedside. The instruments were 512 Coagulation Monitor (Ciba-Corning), Thrombotrack (Nycomed), Automated Coagulation Timer (Hemotec), Hemochron-ACT and Hemochron-APTT (International Technidyne Corporation). Fifty subjects with various levels of heparinisation were tested on each instrument and were also assayed for antithrombin III, fibrinogen, haematocrit, platelet count and plasma heparin level. The results were compared with a reference APTT performed on the Automated Coagulation Laboratory 300R (Instrumentation Laboratories). The Hemochron-ACT correlated least well. The Hemotec and Thrombotrack were unsuitable in a clinical setting because of pipetting requirements, although the Thrombotrack did correlate well with the reference parameters. The 512 Coagulation Monitor was the simplest to use, but its maximum response corresponded to the midpoint of the reference APTT therapeutic range. The Hemochron-APTT was simple to use, had an adequate response range and correlated well with reference parameters.
Oral Midazolam is an Effective Premedication for Children Having Day-Stay Anaesthesia
Authors: Parnis S. J. , Foate J. A. , van der Walt J. H. , Short T. , Crowe C. E. 
Published: January 2019

The effect of oral premedication was studied in a double-blind, randomised trial of 200 children undergoing day-stay anaesthesia. Midazolam 0.25 mg/kg, midazolam 0.5 mg/kg, diazepam 0.5 mg/kg or a placebo was given orally one hour prior to anaesthesia. Patient state was assessed at nine stages, from administration of the premedication up to and including induction of anaesthesia, using a four-point behavioural scale. Patient state was also assessed postoperatively in the recovery area and the day-stay ward. There was no difference between the four groups until induction of anaesthesia. At this stage 82% of children were either asleep or awake and calm. Patients who received midazolam 0.5 mg/kg were more likely to be asleep or awake and calm at induction rather than other groups (P= 0.05). Children receiving midazolam 0.5 mg/kg or diazepam 0.5 mg/kg slept longest in the post anaesthetic recovery room (P < 0.005), and spent most time there (P <. 005). There was no difference between groups in the length of time spent in the day-stay ward or in the number of overnight admissions. The study shows that a high proportion of unsedated children are calm at induction of anaesthesia and that oral midazolam is an effective premedication in children for day-stay anaesthesia.
Patient-Controlled Epidural Analgesia in Labour — is a Continuous Infusion of Benefit?
Authors: Paech M. J. 
Published: January 2019

A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia — bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. Up to three additional staff-administered supplements of 0.5% bupivacaine 4 ml (20 mg) were allowed. There was no significant difference between groups with respect to pain relief, supplementary boluses required, satisfaction, side-effects or details of patient-controlled epidural analgesia, with the exception of greater fentanyl usage in the bolus plus infusion group (P < 0.003). Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.
Anaesthesia and Breast-feeding – the Effect on Mother and Infant
Authors: Bond G. M. , Holloway A. M. 
Published: January 2019

In this paper, we summarise the physiology of lactation and discuss the pathophysiology brought about by fasting, stress and anaesthetic drugs. Drug secretion into breast milk and subsequent absorption by the infant is considered. Maternal hydration must be well maintained with intravenous fluids, allowing an added 500 to 1000 ml for daily fluid loss in lactation. Maternal premedication, general anaesthesia and routine postoperative analgesics are also discussed as to the effects on the breast-fed infant. Drug side-effects may be avoided by timing breast feeding just before the next due dose. Sedatives with long half-lives should not be used. Endocrine and metabolic responses to anaesthesia and surgery are less with regional anaesthesia than with general, hence regional anaesthesia is preferred where it is a reasonable alternative technique.
A Comparison of Caudal Epidural Bupivacaine with Adrenaline and Bupivacaine with Adrenaline and Pethidine for Operative and Postoperative Analgesia in Infants and Children
Authors: Kumar T. P. Santhosh , Jacob R. 
Published: January 2019

This study compares the effectiveness of two drug combinations–010-(010a) bupivacaine with adrenaline and (b) bupivacaine with adrenaline and pethidine — on operative and postoperative pain relief when administered by the caudal route in infants and children. A randomised controlled trial was conducted on fifty children below the age of twelve years: 25 children were randomly allocated to each group. Both groups had a significant period of analgesia in the postoperative period. None of the children in either group required parenteral analgesia. Though the group with pethidine had a longer duration of analgesia and sedation, the very high incidence of vomiting and delay in urination observed in this group would preclude the use of pethidine routinely. No respiratory depression was seen in either group.
Postoperative Epidural Fentanyl Infusion—is the Addition of 0.1% Bupivacaine of Benefit?
Authors: Paech M. J. , Westmore M. D. 
Published: January 2019

A randomised, double-blind controlled clinical trial was conducted in 90 women scheduled for major abdominal gynaecological oncology surgery to determine the effect of adding 0.1% plain bupivacaine to a thoracic epidural fentanyl infusion. Following combined epidural and general anaesthesia, patients were randomised to receive epidural fentanyl 10 μg/ml, with (group FB) or without (group F) bupivacaine. After an initial 50 μg bolus of fentanyl, infusion rate was adjusted according to need between 2 and 10 ml/hr for 48 hours. The two groups (n = 40) were similar with regard to age, weight and preoperative status. Analgesia both at rest and with movement were significantly better in group FB (P <0.0001) during the first 24 hours postoperatively, the greatest difference occurring in the 4 to 16 hour period. There was no significant difference between groups from 24 to 48 hours postoperatively. Fentanyl utilisation was significantly lower in group FB (median 41 versus 53 μg/hr, P <0.001), although clinically the fentanyl dose-sparing effect of bupivacaine was small and did not reduce opioid-induced side-effects. There was no significant difference between groups with respect to side-effects or lower limb weakness, although fewer patients in group FB could be mobilised on the morning of the first postoperative day (P <0.01). Nevertherless, all study patients were ambulant by the same afternoon. We concluded that, in this patient population, the addition of 0.1% bupivacaine to a thoracic epidural fentanyl infusion was beneficial in the early postoperative period.