bluuebunny/crossref_metadata_2025_split huggingface dataset:
Drug Abuse and Dependency during Pregnancy: Anaesthetic Issues
Authors: Ludlow J. , Chrislmas L. , Paech M. J. , Orr B. 
Published: January 2019

Drug abuse is a significant social problem that can lead to serious obstetric complications, some of which may be confused with pregnancy-related disease states. Substance abuse poses a number of challenges with respect to the management of pain and the conduct of anaesthesia in the peripartum period. This review was based on information from a literature search of epidemiological, research and review papers on substance abuse during pregnancy, obtained for the purpose of preparing a background paper for the Ministerial Council on Drug Strategy, Commonwealth Government of Australia. Given that almost 80% of substance-abusing parturients require anaesthetic services in the perinatal period, early antenatal referral for anaesthetic review is recommended. To optimise the care of these vulnerable patients, obstetricians, general practitioners and midwives should attempt to identify substance-abusing parturients and refer them to an anaesthetist. A careful anaesthetic evaluation with non-judgemental questioning is essential, with management tailored to individual patient needs and the urgency of obstetric intervention for vaginal delivery or caesarean section. Opioid-dependent women, in particular, benefit from antenatal pain management planning. Patients recovering from drug addiction should also have a well-documented analgesic strategy. A multidisciplinary approach will involve obstetricians, anaesthetists and staff of the Drug and Alcohol Service. In acute admissions of women by whom antenatal care was not accessed, a high index of suspicion for illicit drug use should arise. Because illicit substance use is so prevalent, if untoward reactions occur during an otherwise uneventful anaesthetic, the possibility of drug abuse should be considered.
A Comparison of 4% Succinylated Gelatin Solution versus Normal Saline in Stable Normovolaemic Sheep: Global Haemodynamic, Regional Blood Flow and Oxygen Delivery Effects
Authors: Wan L. , Bellomo R. , May C. N. 
Published: January 2019

The objective of this study was to compare the effects on regional blood flow and regional oxygen delivery of 4% succinylated gelatin solution (Gelofusine®, B. Braun) with those of normal saline. This was a randomised, controlled, crossover large animal study, which took place at the animal laboratory of university physiology institute. The subjects were seven merino cross-ewes. We implanted flow probes around the aorta, coronary, renal and mesenteric arteries. We randomised animals to observation (control), normal saline (one litre over 15 minutes) or Gelofusine* (one litre over 15 minutes). We measured central haemodynamics, organ blood flows, arterial blood gases and haemoglobin every 30 minutes for 210 minutes. Compared to control, both Gelofusine* and normal saline significantly and similarly increased mean arterial pressure, stroke volume, cardiac output and central venous pressure in the first hour (P <0.05). Such changes, however, were transient except for the increase in cardiac output seen with Gelofusine®. Normal saline significantly increased mesenteric blood flow in the first hour (P <0.05), while Gelofusine* caused a specific, sustained and progressive increase in renal blood flow and conductance (P <0.05). Both fluids increased urine output and creatinine clearance (P <0.05), but, due to haemodilution, both decreased renal oxygen delivery in the first hour (P <0.05). Normal saline and Gelofusine® have transient, volume expansion-related systemic haemodynamic effects, which are greater for Gelofusine®. Saline had a more pronounced early effect on mesenteric blood flow, while Gelofusine* had a sustained and progressive greater effect on renal blood flow. The transient increase in urine output and creatinine clearance seen with both fluids occurred while renal oxygen delivery decreased.
Effectiveness of Superior versus Inferior Subconjunctival Anaesthesia for Cataract Surgery
Authors: Yuen J. S. , Prineas S. , Pham T. , Liu H. 
Published: January 2019

This study compared the efficacy of two different injection sites for subconjunctival anaesthesia (SCA) in cataract surgery. One-hundred-and-three eyes of 99 consecutive patients undergoing routine cataract surgery were randomised to receive SCA either to the superior bulbar conjunctiva (n=52) or the inferior bulbar conjunctiva (n=51). Pain experienced during anaesthetic administration and at various stages of the perioperative period was assessed using a simplified scale. Assessment of subconjunctival haemorrhage and chemosis was made by the surgeon. The percentage of patients reporting any pain on administration of superior SCA was 46% compared to 67% with inferior SCA (P=0.036). Moderate to severe pain on SCA injection was experienced by 15% and 18% of those in the superior and inferior SCA groups respectively. The cataract procedure was well tolerated in both groups. There was no difference between the groups for duration of surgery (P =0.25), anaesthetic related complications including chemosis (P =0.28), subconjunctival haemorrhage (P=0.38) or intraoperative complications (P =0.50). We found that subconjunctival anaesthesia is effective for routine cataract surgery. There was no difference in block efficacy between superiorly and inferiorly delivered SCA. However, superior SCA appeared to be less painful on injection compared to inferiorly delivered SCA.
Geoffrey Kaye—a man of many parts
Authors: Westhorpe R. N. 
Published: January 2019

Geoffrey Kaye was primarily an anaesthetist, but there were many facets to his life, not all of them involving medicine. He was also a researcher, author, teacher, engineer, inventor, metalworker, organiser, traveller, visionary and collector. Geoffrey Kaye had a vision for Australian anaesthesia. He put many of his own resources into the establishment of a ‘centre of excellence’ where the needs of a specialist society could be accompanied by an active educational and research facility. He was so far ahead of his time that his vision foundered on lack of enthusiasm from others. There is no doubt that Geoffrey is best remembered for his lasting legacy, the Geoffrey Kaye Museum of Anaesthetic History, now housed at the Australian and New Zealand College of Anaesthetists in Melbourne. It is his core collection of equipment, documents and memorabilia that now gives us insight into the development of our specialty. His collecting extended beyond his love of medicine. He was renowned for his collection and knowledge of exquisite tableware, porcelain, and furniture, much of which now remains in the Ian Potter Museum collection, also in Melbourne.
The Manhattan Legacy
Authors: Holmes C. McK. 
Published: January 2019

The Manhattan Project was the highly secret American atomic research study which led to the making of the atom bomb. What is not so well known is that before the Project, fluorine was a difficult and dangerous element, while afterwards it became a key ingredient in all the new inhalational anaesthetics. Prior to this, the only practical inhalational agents available apart from nitrous oxide, ethylene and cyclopropane, (and a few others of short-lived popularity like acetylene) were non-halogenated ethers and some chlorinated compounds such as chloroform and ethyl chloride. When chemists learnt how to handle fluorine, a whole new world opened up, first with the ‘Freons’ as used in refrigeration and then the halogenated anaesthetics. Along the way, many halogenated compounds other than ethers were tried but abandoned, and now we are left effectively with two halogenated ethers. Is this the end of the line for inhalational anaesthesia?
History of Analgesia and Regional Anaesthesia through Philately
Authors: Rangappa P. 
Published: January 2019

Medical philately is the study of postage stamps commemorating events and pioneers in the field of medicine. In 1929, Dr Fielding H. Garrison, doyen of medical history, remarked that stamps were a great resource for the medical fraternity, something he hoped that physicians would soon recognise. His prediction has hardly come to fruition in the years since then, with medical philatelic articles rarely seen in the medical press. The history of pain medicine is unique, diverse and extremely interesting, with many chemists, physicists, philosophers, contributing in their own way over centuries to pave the path to present day pain medicine.
From Collection to Museum: The Development of the Geoffrey Kaye Museum of Anaesthetic History
Authors: Triarico E. 
Published: January 2019

Located at the Australian and New Zealand College of Anaesthetists (ANZCA) headquarters in Melbourne, Victoria, this internationally significant collection was founded in 1935 by renowned Australian anaesthetist Dr Geoffrey Kaye (1903 to 1986). Although it has always been referred to as a museum, it lacked the necessary management structure and infrastructure to meet museum standards. In March 2003, the first full-time professionally trained Museum Curator, Ms Elizabeth Triarico, was employed by ANZCA to work with the Honorary Curator, Dr Rod Westhorpe, and the Honorary Assistant Curator, Dr Christine Ball, to build on past achievements and to develop the collection into an accessible and relevant modern museum. Ms Triarico has extensive museum management experience with emphasis on management of major projects, collection management, strategic planning, marketing, interpretation and exhibition development. This paper outlines the management issues and innovative strategies involved in developing this important collection into a professionally managed museum based on best practice standards. It illustrates the benefits of introducing a clear vision and an agreed longterm management plan based on Museums Australia (Victoria) Museum Accreditation Program guidelines.
A National Survey on the Practice and Outcomes of Mechanical Ventilation in Korean Intensive Care Units
Authors: Koh Y. , Lim C. M. , Koh S. O. , Ahn J.-J. , Kim Y. S. , Jung B. H. , Cho J. H. , Lee J. H. , Lee M. G. , Jung K. S. , Kwon O. J. , Lee Y. J. 
Published: January 2019

A study was undertaken to describe the practice and outcomes of mechanical ventilation throughout Korea. This prospective cohort study was conducted over a three-month period enrolling patients (n=519) who received mechanical ventilation for more than 72 hours in 21 university hospital intensive care units throughout Korea. The most common indication for mechanical ventilation was acute respiratory failure. The most common cause of acute-on-chronic respiratory failure was tuberculous lung disease. The most common initial mode for ventilation was volume-controlled ventilation. The mean tidal volume of acute respiratory distress syndrome patients was 7.6 ml/kg of the predicted body weight and the mean positive end-expiratory pressure was 9.4 cmH2O. The weaning success rate at 28 days was 50.3%. Pressure support and the T-piece were most commonly used as initial and final weaning modes respectively. Preventive measures against deep vein thrombosis during mechanical ventilation were performed more frequently in intensive care units with full-time critical care physicians than those without such physicians. Multivariate analysis showed that the APACHE II score, indication for mechanical ventilation, respiratory rate at 72 hours, enteral feeding and prophylaxis of deep vein thrombosis were prognostic factors for survival. In Korean intensive care units, tuberculous lung disease remains an important cause for mechanical ventilation. The practice of mechanical ventilation in Korean intensive care units in general appeared to comply with the current international recommendations with regard to lung protection and weaning. However, intensive care units lacking critical care physicians seemed to be adopting fewer ancillary measures, such as deep vein thrombosis prophylaxis.
Some Scientific Reflections on Possible Mechanisms of General Anaesthesia
Authors: Carmody J. J. 
Published: January 2019

The challenge to achieve a gestalt understanding of general anaesthesia is really dependent upon an understanding of the elusive concept of consciousness. Until very recently, anaesthesia has been understood to depend fundamentally on the lipid solubility of anaesthetic agents, unsurprisingly a misleading view which has followed from the greater simplicity of lipid chemistry compared with protein chemistry and, it is contended here, from a serious misunderstanding of the older experimental data. Nonetheless, because an over-simplistic view of lipids pertains in much pharmacological thinking about anaesthesia, this paper devotes some attention to potentially relevant aspects of lipid function and also to concepts of anaesthesia which are based on the properties of intracellular and extracellular water. It is argued that the more correct pharmacological explanation is likely to be action at hydrophobic sites of crucial functional molecules, most plausibly protein molecules: empirical data which support such actions are presented and considered. Anaesthetic actions on a range of such proteins are discussed, with the emphasis on general neurophysiological principles, with the intent of avoiding the mire into which detailed consideration of actions at specific sites of putative function in the central nervous system can lead. Those experimentally-documented actions include influences on the proteins which constitute the Na+-ion conductance channels in axonal membranes (which are the basis for action potentials); on the Ca2+-ion channels which are crucial for neurotransmitter secretion from nerve terminals; on the properties of the ion channels in the post-synaptic membranes of the neurons which are the targets for transmitter action; on components of the “second messenger” systems of target neurons; as well as actions on metabolically significant enzymes (notably cytochrome P450). The overall argument is that the concept of anaesthetic actions on lipids should be abandoned in favour of one which is consistent with the general pharmacological principle of drug action at specific receptor sites, i.e. a targeted action at unique loci on relevant proteins.
Prevalence of Vitamin Deficiencies on Admission: Relationship to Hospital Mortality in Critically Ill Patients
Authors: Corcoran T. B. , O'Neill M. A. , Webb S. A. R. , Ho K. M. 
Published: January 2019

Vitamin deficiency is believed to be common in critical illness. Water soluble and antioxidant vitamins are those most frequently used for supplementation in these patients. There are no data to confirm the prevalence of vitamin deficiencies in high-risk emergently admitted intensive care patients, nor their association with hospital mortality. One hundred and twenty-nine consecutive, critically ill patients who were emergently admitted to intensive care were enrolled in this prospective observational cohort study. Patient data including diagnosis, source of admission and severity of illness scores were prospectively collected. Within the first 48 hours of admission, concentrations of C-reactive protein, Vitamins A, E, B1, B12 and folate were measured on arterial blood. Multivariate stepwise logistic regression modelling was performed to examine the association of vitamin concentrations with hospital mortality. Fifty-five patients (43%) had a biochemical deficiency of one of the five vitamins on admission to the intensive care unit. A total of 18 patients died (14%) during their hospital stay (15 of those in the intensive care unit). Moderate correlations with C-reactive protein concentrations were demonstrated for Vitamins B12, A and E (Spearman's r=0.309, −0.541 and −0.299, P=0.001, 0.001 and 0.007 respectively). Hospital mortality was significantly associated with age, APACHE II score, admission and maximum Sequential Organ Failure Assessment scores and admission source in the univariate analyses. Multivariate analysis did not demonstrate an association between biochemical deficiency and mortality. Biochemical deficiencies of water-soluble and antioxidant vitamins are common on admission in unplanned or emergency admissions to the intensive care unit, but we could not demonstrate an independent association with hospital mortality.
Anaesthesia and Right Ventricular Failure
Authors: Forrest P. 
Published: January 2019

Acute right ventricular (RV) failure has until recently received relatively little attention in the cardiology, critical care or anaesthesia literature. However, it is frequently encountered in cardiac surgical cases and is a significant cause of mortality in patients with severe pulmonary hypertension who undergo non-cardiac surgery. RV dysfunction may be primarily due to impaired RV contractility, or volume or pressure overload. In these patients, an increased pulmonary vascular resistance (PVR) or a decreased aortic root pressure may lead to RV ischaemia, resulting in a rapid, downward haemodynamic spiral. The key aspects of ‘RV protection’ in patients who are at risk of perioperative decompensation are prevention, detection and treatment aimed at reversing the underlying pathophysiology. Minimising PVR and maintaining systemic blood pressure are of central importance in the prevention of RV decompensation, which is characterised by a rising central venous pressure and a falling cardiac output. Although there are no outcome data to support any therapeutic strategy for RV failure when PVR is elevated, the combination of inhaled iloprost or intravenous milrinone with oral sildenafil produces a synergistic reduction in PVR, while sparing systemic vascular resistance. Levosimendan is a promising new inotrope for the treatment of RV failure, although its role in comparison to older agents such as dobutamine, adrenaline and milrinone has yet to be determined. This is also the case for the use of vasopressin as an alternative pressor to noradrenaline. If all else has failed, mechanical support of the RV should be considered in selected cases.
Communication Failure in the Intensive Care Unit – Learning from a near Miss
Authors: Hendel S. A. , Flanagan B. T. 
Published: January 2019

A 51-year-old female patient with Guillain-Batré syndrome was given three times the intended dose of intravenous human immunoglobulin while admitted to a tertiary intensive care unit. The error went unnoticed for seven hours and appears to have been the result of several successive breakdowns in communication between key staff. The patient, fortunately, made a full recovery. This report analyses the communication failure and explores possible ways of avoiding similar occurrences in the future.
The Influence of Gender and Experience on Intubation Ability and Technique: A Manikin Study
Authors: Waddington M. S. , Paech M. J. , Kurowski I. H. S. , Reed C. J. , Nicholls G. J. , Guy D. T. , Day R. E. 
Published: January 2019

Female anaesthetists in early training commonly question whether their strength is adequate for tracheal intubation. This study investigated the influence of gender and experience on intubation ability and laryngoscopic technique. A manikin model and purpose-designed force-transducing laryngoscope was used to test three cohorts at different levels of experience (novice, intermediate and experienced males and females, n = 65) for the axial force and torque exerted, best laiyngoscopic view obtained, success with and time for intubation and laryngoscopic technique. There were no significant differences between novice or experienced female and male intubators in markers of their ability to intubate or in the forces generated. For novice females compared with novice males, mean success rate was 90% (80.2 to 99.9) versus 97% (91.1 to 100, P=0.29); and mean time to intubate 24 seconds (19 to 29 seconds) versus 18 seconds (14 to 21 seconds, P=0.057). With experience, the forces generated during intubation reduced and ability improved. Proximal laiyngoscope grips (close to the blade) generated lower forces than distal grips. Female and male intubators did not differ in ability to intubate or in the forces they exerted during direct laiyngoscopy.
Hypercapnia Test and Weaning outcome from Mechanical Ventilation in COPD Patients
Authors: Raurich J. M. , Rialp G. , Ibáñez J. , Ayestarán I. , Llompart-Pou J. A. , Togores B. 
Published: January 2019

We evaluated the hypercapnia response test as a weaning outcome predictor from mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD). We studied 44 COPD intubated patients considered ready for a weaning trial. The hypercapnia test was based on the modified method of re-inhalation of expired air. Through the hypercapnic test we calculated the ratio of the change in minute volume (VE) to the change in PaCO2 (ΔVE/ΔPaCO2), the change in airway occlusion pressure at 0.1 second of inspiration (P0.1) to change in PaCO2 (ΔP0.1/ΔPaCO2), the ratio of the change in P0.1 to baseline PaCO2 (ΔP0.1/PaCO2) and the ratio of the change in VE to baseline PaCO2 (ΔVE/PaCO2). Nineteen patients were successfully weaned and 25 patients failed. No differences in baseline clinical characteristics were found between the two groups. Weaning failure COPD patients had lower ΔP0.1/ΔPaCO2 (0.19±0.11 and 0.34±0.20 cm H2O/mmHg respectively, P=0.006) and lower ΔVE/ΔPaCO2 (0.21±0.15 and 0.40±0.22 l/min/mmHg respectively, P=0.002) than successfully weaned patients. The area under the receiver operating characteristic curve to discriminate weaning outcome was for the baseline PaCO2 0.81 (95% confidence interval: 0.66 to 0.91), hypercapnic PaCO2 0.76 (0.61 to 0.88), hypercapnic drive response 0.74 (0.59 to 0.86), hypercapnic ventilatory response 0.76 (0.60 to 0.87), ΔP0.1/PaCO2 0.76 (0.60 to 0.87) and for the ΔVE/PaCO2 0.81 (0.67 to 0.91). COPD patients with weaning failure have a significantly more blunted response to the hypercapnia response test than weaning success patients. This test could be useful to predict weaning failure patients if the combined values of the hypercapnic drive and hypercapnic ventilatory response were below the threshold values.
Incidence and Risk Factors for Chronic Pain after Caesarean Section under Spinal Anaesthesia
Authors: Sng B. L. , Sia A. T. H. , Quek K. , Woo D. , Lim Y. 
Published: January 2019

This study investigated the incidence and risk factors associated with chronic pain after elective caesarean section under spinal anaesthesia in an Asian population. A prospective cohort study was conducted among subjects who underwent elective caesarean section under spinal anaesthesia, with morphine patient-controlled analgesia administered for 24 hours postoperatively. Perioperative, surgical and obstetric factors were investigated prospectively. Phone surveys were conducted to identify risk factors associated with chronic pain. A total of 857 subjects completed both the perioperative study and phone survey. The incidence of wound scar pain for three months after surgery was 9.2% (79). Of the 51 subjects with persistent pain at the time of subsequent survey, 9.8% (n=5) had constant pain, 9.8% (n=5) had daily pain and 23.5% (n=12) had pain intermittently, at an interval of days. The independent risk factors for development of chronic pain were higher pain scores recalled in the immediate postoperative period (odds ratio [OR, 95% confidence interval] 1.348 [1.219 to 1.490], P=0.0001), pain present elsewhere (OR 2.471 [1.485 to 4.112], P=0.001) and non-private insurance status (OR 1.679 [1.034 to 2.727], P=0.036). The two most common sites of pain other than wound pain were back pain (n=316) and migraine (n=87).