bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuing Medical Education: A Needs Analysis of Anaesthetists
Authors: Tucker A. P. , Miller A. , Sweeney D. , Jones R. W. 
Published: January 2019

The continuing medical education (CME) needs of anaesthetists within Australia, New Zealand, Hong Kong, Malaysia and Singapore have been largely unknown. The aim of this study was to undertake a comprehensive survey of the attitude to CME, learning preferences, attitudes and abilities relating to self-paced material, literature and information searching, preferred content and preferred approach to CME of anaesthetists within these countries. A survey tool was developed and refined for ease of use by pilot-testing. The survey was mailed to 3,156 anaesthetists throughout Australia, New Zealand, Hong Kong, Malaysia and Singapore. Three options for data return were offered; postal reply, facsimile and a data entry web-page. There were 1800 responses, which represented a response rate of 57%. The demographics of the respondents were similar to the overall demographics of Fellows of the Australian and New Zealand College of Anaesthetists. A large majority of respondents (92%) stated that their involvement in CME improved patient care. However, almost half the respondents reported that they have difficulty either in participating in current CME activities (31 %) or implementing new knowledge into their workplace (14%). Anaesthetists within this region appear to be motivated by the need to make better decisions based on independent standards of practice. While Australia is a world leader in flexible education, it is still emerging as a discipline. Flexible education may be used to facilitate anaesthetists’ participation in CME activities and in implementation of new knowledge in their workplace.
Increasing the Use of an Existing Medical Emergency Team in a Teaching Hospital
Authors: Jones D. A. , Mitra B. , Barbetti J. , Choate K. , Leong T. , Bellomo R. 
Published: January 2019

Cultural barriers in hospital ward staff may limit the use of a Medical Emergency Team (MET) service. In December 2000 the role of the existing Code Blue team in our hospital was expanded to incorporate review of patients fulfilling commonly employed MET criteria. Between January 2001 and June 2003, the average call rate was only 9.8 calls/1000 admissions. Anecdotal feedback and a group-administered questionnaire conducted in July 2003 demonstrated a number of obstacles to initiating calls and the system was modified in October 2004. Specifically, emergency response calls were separated into Code Blue calls (for cardiorespiratory arrests) and MET calls (with physiological and worried criteria). Further, loud overhead chimes as well as anaesthetist and cardiologist attendance were used only in the case of Code Blue calls (suspected arrests). Finally, the heart rate and respiratory rate criteria for MET service activation were modified. In the 12 months before the intervention (October 2003 to September 2004) there were 817 emergency response calls and 51,963 admissions (15.7 calls/1000 admissions). In the 12 months after the intervention there were 1349 emergency response calk (Code Blue plus MET calk) and 54,593 admissions (24.7 calls/1000 admissions [OR 1.59; 95% CI=1.45–1.73; P<0.0001]). Our findings suggest that increasing the use of an existing service to review patients fulfilling MET criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization.
Pseudoanaphylaxis
Authors: Russell W. J. , Smith W. B. 
Published: January 2019

Profound hypotension and cardiac arrest after commencement of combined spinal and general anaesthesia in a patient for knee replacement surgery raised the suspicion of anaphylaxis. This seemed to be confirmed when a mast cell tryptase test taken about 90 minutes after the onset of the hypotension was elevated. However, subsequent intradermal skin testing twelve weeks later did not identify a causal drug. Repeat mast cell tryptase at the time showed the same elevation, which led to the correct diagnosis of mastocytosis and a secondary diagnosis that the patient's hypotension and cardiac arrest were the result of her spinal anaesthesia. If the serum tryptase is elevated during the event but no allergic agent can be identified, a further serum tryptase should be taken several weeks later to exclude a persistent elevation due to mastocytosis.
The Contribution of Newspapers and Their Advertisements to the History of Colonial Anaesthesia
Authors: Newson A. J. 
Published: January 2019

The first news to reach New Zealand about the beneficial effects of inhalation of ether during surgical operations arrived in Wellington on Sunday July 4 1847. This was 283 days after the first successful demonstration in Boston. The mail services that brought this news and the original source of this news are described. After this news had reached Wellington, it then took another 84 days before the first successful trial of the agent took place in the recently opened Wellington Colonial Hospital. This period of eighty-four days com-pares unfavourably with those for Sydney and Cape Town. The reasons for this delay are discussed and using information available in the local Sydney and Wellington newspapers, the delay is shown to have been due to the unavailability of supplies of the necessary chemical reagents.
The Inventors
Authors: Holland R. 
Published: January 2019

Amongst Australian anaesthetists there have been many whose ingenuity and mechanical knowledge produced ingenious devices. Lidwill and Geoffrey Kaye come immediately to mind, and their contributions are well-described elsewhere. In this paper, two inventions with contrasting fates are described: the Grant Humidifier and the Komesaroff single-use analgesia device. Graham Grant's invention addressed the problem of rain-out in a most ingenious manner. The device was compact, efficient and deserved greater commercial success, but a similar apparatus developed in New Zealand was better supported and captured most of the market. Grant has a degree in engineering, acquired before his medical degree, but David Komesaroff spent only a year in the Engineering Faculty before transferring to Medicine. Nevertheless, he has remained interested and in touch with technical matters, and has a number of other devices to his credit. Mention is briefly made of others: Stokes (of the suction bullet), Bill Cole (an early volatile specific vaporiser), Fisk (the paediatric ventilator) and Noel Cass (the Cass needle) These achievements are by no means the end of the road. Already an Australian-designed single-use laryngoscope is being manufactured and launched on both the national and international markets.
Perioperative Complications in Patients with Drug-Eluting Stents: A Three-Year Audit at Geelong Hospital
Authors: Conroy M. , Bolsin S. N. C. , Black S. A. , Orford N. 
Published: January 2019

Drug-eluting stents are a recommended treatment for lesions in the coronary arteries. Stent insertion requires the patient remain on antiplatelet medication for a minimum of six months after insertion. A serious consequence of ceasing antiplatelet medication is late stent thrombosis leading to myocardial infarction in the territory of the drug-eluting stent. Continuing antiplatelet medication can lead to excessive bleeding at the time of surgery. Understanding the risk of complications attributable to bleeding or myocardial ischaemia will help in defining the optimal management of these patients at the time of noncardiac surgery. This study is a retrospective database analysis and case note review of all patients with drug-eluting stents presenting for noncardiac surgical procedures over a three-year period in one centre. Twenty-four patients with drug-eluting stents inserted presented for 43 noncardiac surgical procedures. Severe bleeding problems were encountered in one case. Three of 15 patients (20%) who ceased clopidogrel prior to surgery without alternative anti-thrombotic prophylaxis suffered myocardial infarction due to stent thrombosis. Four patients who received alternative anti-thrombotic prophylaxis did not suffer complications. All 19 patients who ceased clopidogrel remained on aspirin prior to surgery. Patients treated with drug-eluting stents for coronary artery stenosis represent a challenging group of patients for subsequent perioperative management. The risk of myocardial infarction when clopidogrel is stopped prior to surgery is 20%, if alternative anti-thrombotic prophylaxis is not used. This risk persists beyond one year after insertion of drug-eluting stents. Some treatments appear to be effective in reducing the risk of myocardial infarction.
Methods of endotracheal tube placement in patients undergoing pelviscopic surgery
Authors: Hwang J.-Y. , Rhee K.-Y. , Kim J.-H. , Park Y.-S. , Han S.-H. 
Published: January 2019

Accidental endobronchial intubation is reported frequently during laparoscopic gynaecological surgery. We performed a prospective randomised study to compare three different methods of endotracheal tube placement in terms of susceptibility of accidental endobronchial intubation in patients undergoing laparoscopic gynaecologic surgery. The endotracheal tube was positioned by one of three methods: it was secured by palpating at the suprasternal notch while holding the pilot balloon (Group); by placing the 21 cm mark at the upper incisors (Group21cm); or by placing a guide mark, which was made on the surface of the tube 2 cm above the proximal end of the cuff, at the level of the vocal cords (GroupVC). The distance from the tip of endotracheal tube to the carina was measured with the patient in a neutral position (DTC0) and after the formation of pneumoperitoneum in the Trendelenburg position (DTC1). Eighty-eight patients were enrolled. Pneumoperitoneum and Trendelenburg position caused inward movement of the endotracheal tube toward the carina in 99%. In each group, the mean value of DTC1 was significantly shorter than DTC0 (Group Cuff 3.0 ± 1.1 vs. 1.7 ± 1.0, Group21cm2.5 ± 0.8 vs. 1.1 ± 0.9, Groupvc 3.5 ± 0.7 vs. 2.3 ± 0.8, DTc0 vs. DTC1 respectively)(all P <0.01). Accidental endobronchial intubation occurred in 14%, with the lowest frequency in Groupvc (2.6 %, P <0.01) and the highest in Group21cm, although this was not significantly (P=0.09) different from GroupCuff (26.7% vs. 10.0%). The incidence of endobronchial intubation was lowest in Groupvc but endobrochial intubation could not be avoided using any of these methods.
Alpha1-adrenergic Receptor mRNA and Inflammatory Mediator Expression in Circulating Leucocytes after Cardiac Surgery
Authors: Kalkoff M. , Chan-dominy A. , Sleigh J. W. , Jogia P. M. , Cursons R. T. , Towers R. , La Pine M. 
Published: January 2019

Vasodilation after coronary artery bypass surgery is a common complication. Inflammatory mediators influence the expression of alpha 1-adrenergic receptors. Do patients requiring high doses of postoperative inotropic support have down-regulated alpha-adrenergic receptors'? Is there a characteristic pattern of preoperative inflammatory mediator expression that could predict a complicated course after the operation? Forty-four patients undergoing cardiac bypass surgery with extracorporeal circulation were prospectively investigated. Five perioperative blood samples were taken (preoperative, two hours, 12 hours, 36 hours and 72 hours postoperative). The leucocyte mRNA-expression of the three alpha 1-adrenergic receptor subtypes (A, B and D) and 11 different pro-inflammatory mediators were investigated with the real-time reverse transcriptase polymerase chain reaction. The patients were divided into three groups (No-noradrenaline [No-NA]=0 μg/min, Low-noradrenaline [Low-NA]=0.1-7 μg/min, High-noradrenaline [High-NA] >7 ixglmin), according to their postoperative noradrenaline requirements. Preoperatively, alpha 1A-receptor expression was 4.9-fold (High-NA) and 18.7-fold (Low-NA) higher than the No-NA group (P=0.005) and plasma noradrenaline levels were higher in the High-NA group (P=0.005). Across all groups at 12 hours after the operation, alpha 1A-receptor expression decreased to approximately one-fifth of preoperative levels (P=0.01); but with greater duration and magnitude of relative decrease in the High-NA group. Patients in the No-NA group had significant postoperative increases in leucocyte inflammatory mediator expression for IL-1β, TLR4, TREM, MPO, MMP9 and TNF genes, whereas the changes in the Low-NA and High-NA groups were not significant. Low preoperative levels of noradrenaline and low expression of alpha 1A-adrenoreceptors in leucocytes was associated with less probability of requiring noradrenaline support after cardiac surgery.
Sedation and Delirium in the Intensive Care Unit: An Australian and New Zealand Perspective
Authors: Shehabi Y. , Botha J. A. , Boyle M. S. , Ernest D. , Freebairn R. C. , Jenkins I. R. , Roberts B. L. , Seppelt I. M. 
Published: January 2019

A survey was conducted to determine sedation and delirium practices in Australian and New Zealand intensive care units. The survey was in two parts, comprising an online survey of reported sedation and delirium management (unit survey) and a collection of de-identified data about each patient in a unit at a given time on a specified day (patient snapshot survey). All intensive care units throughout Australia and New Zealand were invited by email to participate in the survey. Twenty-three predominantly metropolitan, level III Australian and New Zealand intensive care units treating adult patients participated. Written sedation policies were in place in 48% of units, while an additional 44% of units reported having informal sedation policies. Seventy percent of units routinely used a sedation scale. In contrast, only 9% of units routinely used a delirium scale. Continuous intravenous infusion is the primary means of patient sedation (74% of units). While 30% of units reported routinely interrupting sedation, only 10% of sedated patients in the snapshot survey had had their sedation interrupted in the preceding 12 hours. Oversedation appears to be common (46% of patients with completed sedation scales). Use of neuromuscular blockade is low (10%) compared to other published studies. Midazolam and propofol were the most frequently used sedatives. The proportion of patients developing delirium was 21% of assessable patients. Failed and self-extubation rates were low: 3.2% and 0.5% respectively. In Australian and New Zealand intensive care units, routine use of sedation scales is common but not universal, while routine delirium assessment is rare. The use of a sedation protocol is valuable and should be encouraged.
Remifentanil-Induced Abdominal Pain: A Randomised Clinical Trial
Authors: Jahanbakhsh S. , Bameshki A. , Khashayar P. 
Published: January 2019

Remifentanil is an ultra-short-acting opioid, widely used for induction and maintenance of anaesthesia in various types of operations. We recently noted that a great number of patients receiving remifentanil in their anaesthetic regimen experienced postoperative abdominal pain. As a result, we performed this study to investigate its incidence. This randomised single-blinded clinical trial was conducted on 300 patients who were undergoing elective cataract surgery under general anaesthesia. The patients were randomly divided into two groups. In the control group (n=150), anaesthesia was induced with fentanyl and propofol and maintained with propofol by infusion and 60% N2O. In the remifentanil group, anaesthesia was induced with remifentanil and propofol and maintained with remifentanil infusion and inhalation of 60% N2O. Atracurium was used for muscle relaxation in both groups. Abdominal pain was observed in 79 patients (52.6%) in the remifentanil group, 10 of whom required a therapeutic intervention, but in only three patients in the control group, none of whom required an intervention (P value = 0.001). Postoperative nausea and vomiting were reported in seven and 10 patients (4.7%) in the remifentanil and control group, respectively. These findings indicate that abdominal pain is very common in patients receiving remifentanil by infusion for cataract surgery.
Creutzfeldt-Jakob Disease – Implications for Anaesthetists in New Zealand
Authors: Telfer J. M. 
Published: January 2019

Since 1996 with the recognition of a variant form, Creutzfeldt-Jakob disease has become more prominent in the medical literature. Of particular interest to anaesthetists is the risk of iatrogenic spread of the disease. In this article, the relevant literature is reviewed and the experience within New Zealand examined. The presentation, pathology and incidence of the disease is reviewed and the current guidelines for the preoperative management of patients with known or suspected Creutzfeldt-Jakob disease are outlined.
The Functional Outcome and Recovery of Patients Admitted to an Intensive Care Unit following Drug Overdose: A Follow-Up Study
Authors: O'Brien B. P. , Murphy D. , Conrick-Martin I. , Marsh B. 
Published: January 2019

Patients who have overdosed on drugs commonly present to emergency departments, with only the most severe cases requiring intensive care unit (ICU) admission. Such patients typically survive hospitalisation. We studied their longer term functional outcomes and recovery patterns which have not been well described. All patients admitted to the 18-bed ICU of a university-affiliated teaching hospital following drug overdoses between 1 January 2004 and 31 December 2006 were identified. With ethical approval, we evaluated the functional outcome and recovery patterns of the surviving patients 31 months after presentation, by telephone or personal interview. These were recorded as Glasgow outcome score, Karnofsky performance index and present work status. During the three years studied, 43 patients were identified as being admitted to our ICU because of an overdose. The average age was 34 years, 72% were male and the mean APACHE II score was 16.7. Of these, 32 were discharged from hospital alive. Follow-up data was attained on all of them. At a median of 31 months follow-up, a further eight had died. Of the 24 surviving there were 13 unemployed, seven employed and four in custody. The median Glasgow outcome score of survivors was 4.5, their Karnofsky score 80. Admission to ICU for treatment of overdose is associated with a very high risk of death in both the short- and long-term. While excellent functional recovery is achievable, 16% of survivors were held in custody and 54% unemployed.
Cricothyroidotomy: Comparison of three Different Techniques on a Porcine Airway
Authors: Mariappa V. , Stachowski E. , Balik M. , Clark P. , Nayyar V. 
Published: January 2019

We compared three different cricothyroidotomy techniques on a cadaveric porcine airway model to determine the most rapid, successful and safe method in emergency situations. In this observational comparative bench-test, surgical or scalpel cricothyroidotomy (ST), Cook Melker Cricothyrotomy Kit (CM) and Portex Cricothyroidotomy Kit (PCK) were evaluated. After a familiarisation program, four operators performed five procedures using each of the techniques. A dissected pig airway was housed in an airway training manikin. Time to successful completion of the procedure, complications and anatomical variations in the pig larynx were recorded. A patent airway was established in 20 of 20 (100%) attempts with CM technique, 11 of 20 (55%) with ST and six of 20 (30%) with PCK technique. The CM technique was associated with a higher success rate (P <0.001). There was no significant difference (P=0.4) in the median time (interquartile range) taken to achieve a patent airway; CM 50 seconds (40 to 57), ST 47 seconds (41 to 55) and PCK 63 seconds (41 to 150). There was a higher rate of posterior tracheal wall injury with the PCK technique (n=11) and ST technique (n=5). No complications were observed with CM technique. There were no significant anatomical variations in the pig larynxes. We conclude that the CM technique is safe, rapid and has a significantly higher success rate in achieving an artificial airway in this airway model. Overall, all the participants in our study preferred to use this kit in an emergency situation.
Aminoglycoside Clearance is a Good Estimate of Creatinine Clearance in Intensive Care Unit Patients
Authors: Jones T. E. , Peter J. V. , Field J. 
Published: January 2019

The aim of this study was to determine whether creatinine clearance can be estimated as well by clearance of gentamicin/tobramycin as by routine, non-invasive estimates in the intensive care unit. The volume of distribution and clearance values for gentamicin I tobramycin were obtained using first order kinetics and an estimate of creatinine clearance derived. Seven estimates of renal function (Cockroft-Gault, MDRD4 and MDRD6 equations, two- and 24-hour urine estimates, two equations utilising Cystatin C concentrations) were compared to the gentamicin/tobramycin clearance estimate in 100 intensive care unit patients. The gentamicin clearance estimate was at least as reliable as other estimates. The two-hour was less reliable than the 24-hour urine estimate. The Cockroft-Gault appeared to out-perform the MDRD equation estimates. The MDRD4 was not as reliable as the MDRD6 estimate. Cystatin C estimates appeared not as reliable as the gentamicin estimate of renal function. The gentamicin/tobramycin estimate is at least as good as other estimates and it is available sooner than most others. It should be used in all patients who are prescribed gentamicin. The two-hour urine and MDRD4 estimates should not be used in the intensive care unit.
Relative Adrenal Insufficiency in the Intensive Care Population; Background and Critical Appraisal of the Evidence
Authors: Cohen J. , Venkatesh B. 
Published: January 2019

Dysfunction of the hypothalamo-pituitary adrenal axis has become a central feature in descriptions of the pathophysiology of sepsis. However, despite hundreds of published articles including literature reviews and consensus statements, controversy still exists regarding the fundamental nature of the disorder and its relevance to clinical management. Often referred to as ‘relative adrenal insufficiency’, a recent consensus conference has proposed the alternate term ‘critical illness related corticosteroid insufficiency’ and suggested diagnostic criteria of a delta serum cortisol of less than 9 μg/l after adrenocorticotrophic hormone administration or a random total cortisol of under 10 μg/l. This review attempts to establish a critical reappraisal of the evidence for the existence of relative adrenal insufficiency/critical illness related corticosteroid insufficiency in patients with sepsis and examines the background, controversies and possibilities for future research into the condition.