bluuebunny/crossref_metadata_2025_split huggingface dataset:
Propofol EDTA and Reduced Incidence of Infection
Authors: Jansson J-R. , Fukada T. , Ozaki M. , Kimura S. 
Published: January 2019

Propofol formulated in a lipid vehicle supports the growth of microorganisms. There have been worldwide reports of extrinsic microbial contamination of propofol leading to outbreaks of serious postoperative nosocomial infections. Therefore it is essential that medical professionals follow strict aseptic precautions when handling propofol, as recommended by manufacturers of propofol and the Centers for Disease Control and Prevention. Non-adherence to these recommendations increases the risk of nosocomial postoperative infections, which impose a heavy burden of morbidity and mortality and have serious economic consequences. It has also been recommended that the use of EDTA-containing formulations of propofol be considered. In vitro studies have confirmed that EDTA added to propofol retards microbial growth. Data on the incidence of nosocomial infections before and after the introduction of propofol with EDTA indicates that there have been no further cluster outbreaks and individual nosocomial infections appear to have been reduced. The addition of EDTA is an additional safety precaution to good aseptic practice.
Positive End-expiratory Pressure Ventilation Increases Extravascular Lung Water Due to a Decrease in Lung Lymph Flow
Authors: Maybauer D. M. , Talke P. O. , Westphal M. , Maybauer M. O. , Traber L. D. , Enkhbaatar P. , Morita N. , Traber D. L. 
Published: January 2019

Positive end-expiratory pressure (PEEP) is used to improve gas exchange, increase functional residual capacity, recruit air spaces, and decrease pulmonary shunt in patients suffering from respiratory failure. The effect of PEEP on extravascular lung water (EVLW), however, is still not fully understood. This study was designed as a prospective laboratory experiment to evaluate the effects of PEEP on EVLW and pulmonary lymph flow (QL) under physiologic conditions. Twelve adult sheep were operatively prepared to measure haemodynamics of the systemic and pulmonary circulation, and to assess EVLW. In addition, the lung lymphatic duct was cannulated and a tracheostomy performed. The animals were then mechanically ventilated in the awake-state without end-expiratory pressure (PEEP 0). After a two-hour baseline period, PEEP was increased to 10 cmH2O for the duration of two hours, and then reduced back to 0 cmH2O. Cardiopulmonary variables, QL, and arterial blood gases were recorded intermittently; EVLW was determined two hours after each change in PEEP. The increase in PEEP resulted in a decrease in QL (7±1 vs 5±1 ml/h) and an increase in EVLW (498±40 vs 630±58 ml; P<0.05 each) without affecting cardiac output. As PEEP was decreased back to baseline, QL increased significantly (5±1 vs 10±2 ml/h), whereas EVLW returned back to baseline. This study suggests that institution of PEEP produces a reversible increase in EVLW that is linked to a decrease in QL.
Cricothyroidotomy: A Short-term Measure for Elective Ventilation in a Patient with Challenging Neck Anatomy
Authors: Paw H. G. W. , Sharma S. 
Published: January 2019

Cricothyroidotomy is a well established technique of airway management in emergency situations where translaryngeal intubation cannot be achieved. This case report describes a case where cricothyroidotomy was used for elective ventilation for short period of 48 hours in a patient who had a vocal cord palsy, supraglottic oedema and inflammation. Surgical tracheostomy was considered the preferred option, but this was deemed impossible due to the challenging neck anatomy in this case.
Data Linkage Enables Evaluation of Long-Term Survival after Intensive Care
Authors: Williams T. A. , Dobb G. J. , Finn J. C. , Knuiman M. , Lee K. Y. , Geelhoed E. , Webb S. A. R. 
Published: January 2019

Outcomes of intensive care are important to the patient and for assessment of benefit. Short-term outcomes after critical illness are well described, but less is known about long-term outcomes. This study describes the use of data linkage, combining intensive care unit (ICU) clinical data with administrative morbidity and mortality data, to assess long-term outcomes after treatment in ICU. The hospital-based cohort study was conducted in a 22-bed general ICU in a metropolitan teaching hospital. All patient admissions admitted to ICU from 1 January 1987 to 31 December 2002 were included. The prospective ICU clinical database with patient demographics, ICU diagnoses, severity of illness, daily assessment of organ failures and common daily treatments used was linked using probabilistic methods to the state-wide hospital morbidity and mortality databases to describe long-term survival. There were 26,019 ICU admissions (22,980 patients) with 25,972 records (99.8%) linked to a hospitalization event that included the index ICU admission. Unadjusted survival was 84.7% at 1 year decreasing progressively to 50.7% at 15 years. Age, type of admission, severity of illness (measured by Acute Physiologic and Chronic Health Evaluation (APACHE) II and the presence of organ failure), ICU length of stay, comorbidity (Chronic Health Evaluation and Charlson comorbidity index) and ICU admission diagnosis, were all associated with survival at 1, 3, 5, 10, and 15 year follow-up (P<0.001 at all time points). Linkage of clinical and administrative data provides a feasible method for ascertaining long-term survival after critical illness. Age, admission severity of illness, diagnosis and comorbidity influenced long-term unadjusted survival.
The Cardiovascular Effects of Adrenaline, Dobutamine and Milrinone in Rabbits Using Pressure-Volume Loops and Guinea Pig Isolated Atrial Tissue
Authors: Royse C. F. , Royse A. G. , Rohrlacf R. , Wright C. E. , Angus J. A. 
Published: January 2019

This study evaluated the effects of milrinone, adrenaline and dobutamine with pressure-volume loops and isolated atrial tissue. Agonist dose-response curves to incremental drug infusions were acquired in 11 anesthetised rabbits using pressure-volume loops and preload recruitable stroke work indicated contractility. Agonist concentration-response curves were completed in eight guinea pig isolated atria, for effects on atrial rate and force. Adrenaline and dobutamine increased contractility (P=0.006 and 0.044), whereas milrinone did not (P=0.895). Only adrenaline increased myocardial stiffness (P<0.001). Milrinone decreased vascular resistance (P<0.001) and elicited the greatest fall in mean arterial pressure (P<0.001) and increased ejection fraction (P<0.001). Adrenaline decreased heart rate (P<0.001), whereas dobutamine and milrinone increased it (P=0.006 and 0.011). Milrinone increased the force of left atrial contraction, but its inotropic effect was weak and significantly less than with dobutamine and adrenaline (P <0.001). Adrenaline acted as an inoconstrictor, dobutamine an inodilator and milrinone predominantly a vasodilator.
The Effects of Acidosis and Hypothermia on Blood Transfusion Requirements following Factor VII Administration
Authors: Hall K. , Forrest P. , Sawyer C. 
Published: January 2019

While there is laboratory evidence that the activity of recombinant activated factor VII (rFVIIa) is reduced by the presence of acidosis and hypothermia, there is limited clinical data to support this observation. Recombinant FVIIa may be used as rescue therapy in surgical patients who have bleeding that is refractory to conventional therapy. However, these patients are also frequently acidotic and hypothermic at the time the drug is administered. In this retrospective study, the records of 38 adult surgical patients who received rFVIIa intraoperatively or within six hours postoperatively were reviewed. The requirements for red cell transfusion in the two hours following the administration of rFVIIa and the need for repeated doses of rFVIIa were recorded. The relationship between red cell transfusion and pH and temperature of the patient at the time of rFVIIa administration was assessed by multiple regression analysis. The major finding was an inverse relationship between the degree of acidosis at the time of rFVIIa administration and the requirement for either subsequent blood transfusion or repeat dosing of rFVIIa (P=0.003 and P <0.001 respectively). For patients with apH <7.2 vs. pH >7.2, the odds ratio for receiving two or more packs of red blood cells within two hours of rFVIIa administration was 15:1. This effect was not observed for hypothermia. The implication of this study is that rFVIIa may be less effective when administered to severely acidotic patients. Further studies are required to examine whether this is related to the acidosis directly, or is secondary to other intraoperative variables affecting acidosis. The clinical utility of rFVIIa in acidotic patients also requires further investigation.
Attitudes towards and Evaluation of Medical Emergency Teams: A Survey of Trainees in Intensive Care Medicine
Authors: Jacques T. , Harrison G. A. , Mclaws M.-L. 
Published: January 2019

A survey was conducted to explore the perception of intensive care registrars on the impact of activities outside the intensive care unit (ICU), particularly in medical emergency teams, on their training and the care of patients. An anonymous mail-out survey was sent to 356 trainees registered with the Joint Faculty of Intensive Care Medicine, half of whom were determined to be involved in ICU duties. No patients were involved and respondents participated voluntarily. The main outcome measures were barriers and predictors of satisfaction with ICU training. One-hundred-and-thirty-six (38%) trainees responded. Seventy-eight percent had participated in a medical emergency team, of whom 99% of respondents stated the medical emergency team included an ICU registrar but rarely (3%) an ICU consultant. Sixty-six percent of respondents reported that medical emergency team involvement had a positive effect on training but 77% reported little or no supervision of team duties. While trainees did not believe they spent too much time performing medical emergency team duties, the time spent on medical emergency teams at night, when ICU staffing levels are at their lowest, was the same as during the day. Serious concern was expressed about the negative impact of medical emergency team activities on their ability to care for ICU patients and the additional stress on ICU medical and nursing staff. Overall, ICU trainees regarded participation in a medical emergency team as positive on training and on patient care in wards, but other results have resource implications for the provision of clinical emergency response systems, care of patients in ICUs and the training of the future intensive care workforce.
Comparison of Caudal Epidural Bupivacaine with Bupivacaine plus Tramadol and Bupivacaine plus Ketamine for Postoperative Analgesia in Children
Authors: Choudhuri A. Hom , Dharmani P. , Kumar N. , Prakash A. 
Published: January 2019

This study compared the effect of single-dose caudal epidural bupivacaine, bupivacaine plus ketamine and bupivacaine plus tramadol for postoperative pain management in children having surgery for inguinal hernia. Following ethics committee approval and informed parental consent, 75 children ASA PS I and II, between three and nine years of age and scheduled for elective unilateral inguinal hernia repair with general anaesthesia were recruited. The patients were randomly divided into three groups to receive 0.5 ml/kg caudal bupivacaine 0.25% (group B), bupivacaine 0.25% plus tramadol 1 mg/kg (group BT) or bupivacaine 0.25% plus ketamine 0.5 mg/kg (group BK). The injections were performed under general anaesthesia. Mean arterial pressure, heart rate, pulse oximetry, respiratory rate and sedation and pain scores were recorded at defined intervals following recovery from anaesthesia. The groups were similar in age, weight and duration of operation (P >0.05). No patient experienced hypotension, bradycardia or respiratory depression. Duration of analgesia was (mean±SD) 6.5±4.1 h in group B, 9.2±3.9 h in group BK, and 8.5±3.1 h in group BT (P <0.05). More patients in group B required supplementary analgesics in the first 24 h (P <0.05). Sedation scores were comparable in all groups. Incidence of emesis and pruritus was similar in all the groups. Caudally administered 0.5 ml/kg bupivacaine 0.25% plus ketamine or bupivacaine 0.25% plus tramadol 1 mg/kg provided significantly longer duration of analgesia without an increase in the adverse effects when compared to bupivacaine alone.
Comparison of 2% Lignocaine with Adrenaline and Fentanyl, 0.75% Ropivacaine and 0.5% Levobupivacaine for Extension of Epidural Analgesia for Urgent Caesarean Section after Low Dose Epidural Infusion during Labour
Authors: Sng B. L. , Pay L. L. , Sia A. T. H. 
Published: January 2019

Low dose local anaesthetic and fentanyl epidural solutions are commonly ‘topped-up’ for urgent caesarean section. However, the block characteristics associated with newer local anaesthetics such as ropivacaine 0.75% and levobupivacaine 0.5% have not been fully determined. In a randomised double-blinded controlled clinical trial, we compared 2% lignocaine with adrenaline and fentanyl (LAF), 0.75% ropivacaine and 0.5% levobupivacaine for extension of low dose epidural analgesia for urgent caesarean section in 90 Asian parturients. There was no significant difference in the median, interquartile range, time to T4 loss of sensation to cold between LAF (9.5, 7.0 to 13.3 minutes), 0.75% ropivacaine (10.0, 7.0 to 15.0 minutes) and 0.5% levobupivacaine (10.0, 7.0 to 15.0 minutes). No woman required conversion to general anaesthesia. The supplementation rate did not differ between groups. Levobupivacaine provided a longer duration of sensory block compared to LAF, but a similar duration to 0.75% ropivacaine. Under the conditions of this study there was no significant difference in time to surgical readiness (defined as loss of sensation to cold to T4) between LAF, 0.75% ropivacaine and 0.5% levobupivacaine groups. Ropivacaine and levobupivacaine are suitable alternatives for extending epidural analgesia for urgent caesarean section.
Non-Invasive Cardiac Output Measurement using a Fast Mixing Box to Measure Carbon Dioxide Elimination
Authors: Killick C. J. , Parkin W. G. 
Published: January 2019

This study investigated the accuracy of a new technique for measuring cardiac output using the derivative Fick principle based on the ratio of change in the partial pressures of end-tidal and mixed expired carbon dioxide produced by short periods of partial rebreathing. A prospective clinical study involving 24 patients following cardiopulmonary bypass for coronary artery bypass grafting or valvular surgery was undertaken in the intensive care unit of a university-affiliated hospital. Haemodynamic measurements were performed after admission to the intensive care unit. Cardiac output was measured simultaneously by bolus pulmonary artery thermodilution and by a noninvasive carbon dioxide partial rebreathing technique. Cardiac output measurement using the new technique demonstrated a significant but consistent underestimate, with a bias of -0.60 ± 0.87 l/min. This new adaptation of the partial rebreathing technique is reliable in measuring cardiac output in postoperative patients. Reasons for the consistent discrepancy between thermodilution and partial rebreathing techniques are discussed.
Glomerular Hyperfiltration and Albuminuria in Critically ILL Patients
Authors: Fuster-Lluch O. , Gerónimo-Pardo M. , Peyró-García R. , Lizán-García M. 
Published: January 2019

Glomerular hyperfiltration and albuminuria are two pathological conditions that could alter renal drug elimination, but they have been rarely studied in a critical care setting. The aims of this descriptive, prospective study performed on 89 critically ill patients are to determine rates of glomerular hyperfiltration (main objective) and albuminuria (secondary objective). On admission, 17.9% of patients presented with glomerular hyperfiltration, climbing to rates as high as 30% during the first week of admission. Seventy-five percent showed albuminuria on admission, with rates remaining high throughout the week of the study. Since glomerular hyperfiltration as well as albuminuria are frequent pathophysiological conditions in critical care patients, the implications that these phenomena may have regarding drug elimination need further evaluation.
Airway Management for Infants with Severe Micrognathia Having Mandibular Distraction Osteogenesis
Authors: Brooker G. E. , Cooper M. G. 
Published: January 2019

We retrospectively reviewed the charts of seven neonates and infants with severe micrognathia and upper airway obstruction who underwent mandibular distraction osteogenesis as an alternative to long-term tracheostomy at the Children's Hospital at Westmead, Sydney, from 2004 to 2007. All patients required a variety of airway interventions at an early age and had poor feeding or failure to thrive. These children had other anomalies and required many investigations and procedures and presented repeated airway challenges for the anaesthetist. The mean number of anaesthetics per child in this series was 6.7 (range 4 to 13). Under anaesthesia, four patients had grade 4 laryngoscopy, one was grade 3 but two were only grade 2. Patients with a preoperative grade 4 laryngoscopy were very likely to need fibreoptic endotracheal intubation. Duration of intubation after surgery for mandibular distraction was a mean of 8.17 days (range 1 to 19). Three were extubated in the operating theatre and three in intensive care. Five patients had an improved laryngoscopy grade after completion of mandibular distraction and one remained grade four. The remaining patient had a tracheostomy from birth.
Fibreoptic Assessment of Paediatric Sized Laryngeal Mask Airways
Authors: von Ungern-Sternberg B. S. , Wallace C. J. , Sticks S. , Erb T. O. , Chambers N. A. 
Published: January 2019

Laryngeal mask airways (LMA) are commonly used in paediatric anaesthesia. A well-placed LMA should provide a direct view of the vocal cords facilitating bronchoscopy or fibreoptic intubation. The aim of this audit was to assess the bronchoscopie view of the glottis obtained through an LMA with regard to its size. We prospectively assessed the position of LMAs in relation to the glottic aperture in 350 children (zero to seven years) undergoing elective fibreoptic examination of the upper and/or lower airways. Following induction of anaesthesia and positioning of the LMA, a fibreoptic evaluation of the view of the glottis was performed (complete, partial or no visualisation). Chest movement on manual ventilation was judged as good in the majority of patients and adequate for the remainder. No overt signs of airway obstruction were noted in any patient. However, a complete view of the glottic aperture was present in only 50% of size 1 LMAs, 57.5% of size 1.5, 72.7% of size 2 and 77.8% of size 2.5. The epiglottis impinged on the LMA opening, partially obstructing the view of the glottis in 36.3% of size 1 LMAs, 31.5% of size 1.5, 21% of size 2 and 17.8% of size 2.5. In 13.7% of size 1 LMAs, 11% of size 1.5, 6.3% of size 2 and 4.4% of size 2.5, the epiglottis was completely downfolded, obstructing the view of the glottic aperture. The findings indicate that even if ventilation is judged as adequate, smaller paediatric LMAs are more commonly associated with suboptimal anatomical positioning with partial obstruction of the glottic aperture than larger LMAs, and therefore may require repositioning more often.
Fentanyl Dosage and Timing when Inserting the Laryngeal Mask Airway
Authors: Wong T. H. K. , Critchley L. A. H. , Lee A. , Khaw K. S. , Kee W. D. Ngan , Gin T. 
Published: January 2019

The study objective was to show that fentanyl given five minutes prior to induction improved insertion conditions for the Classic Laryngeal Mask Airway. Previous work had shown fentanyl at 90 seconds to be unpredictable. A probit analysis design was used in which success I failure rates of different doses of fentanyl were measured and dose-response curves drawn from which the ED50 and ED95 with 95% confidence intervals were determined. Adult Chinese patients with American Society of Anesthesiologists physical status classification I or II and requiring anaesthesia for minor surgery with a laryngeal mask were recruited. They were randomly assigned to one of six dosage groups: 0.25, 0.5, 1.0, 1.5, 2.0 and 3.0 μg.kg-1. Fentanyl was given prior to propofol 2.5 mg.kg-1, and insertion was assessed 90 seconds later using six categories of patient response. Ninety-six patients, aged 18 to 63 years, were studied. The six dosage groups were similar. As the fentanyl dose increased, fewer patients responded to insertion (P <0.01). Dose-responses could be predicted for all categories, except resistance to insertion and laryngospasm. Probit analysis predicted an ED50 of 0.5 μg.kg-1 and ED95 of 7.5 pg.kg-1 for ideal insertion conditions (i.e. no swallowing, gagging, body movement or laryngospasm). Commonly used fentanyl doses of 1 to 2 μg.kg-1 only prevented patients responding to insertion in 70 to 80% of cases. When using propofol 2.5 mg.kg-1, administering fentanyl five minutes before laryngeal mask insertion does not provide ideal insertion conditions in 95% of cases unless excessively large doses are used. An ideal dose of fentanyl that produces optimum insertion conditions could not be determined.
Fentanyl dose for the Insertion of Classic™ Laryngeal Mask Airways in Non-Paralysed Patients Induced with Propofol 2.5 mg/kg
Authors: Tan A. S. B. , Wang C. Y. 
Published: January 2019

The aim of this randomised, controlled trial was to determine the optimum dose of fentanyl in combination with propofol 2.5 mg.kg-1 when inserting the Classic™ Laryngeal Mask Airway. Seventy-five ASA I or II patients were randomly assigned to five groups of fentanyl dosage: 0 μg.kg-1 (placebo), 0.5 μg.kg-1, 1.0 μg.kg-1, 1.5 μg.kg-1 and 2.0 μg.kg-1 Anaesthesia was induced by first injecting the study drug over 10 seconds. Three minutes after the study drug was injected, propofol (2.5 mg.kg-1) was injected over 10 seconds. The Classic™ Laryngeal Mask Airway was inserted four minutes and 30 seconds after injection of the study drug. Insertion conditions were evaluated using a four-category score. Thirty-nine males and 36 females aged 19 to 59 years were studied. The incidence of prolonged apnoea increased as fentanyl dose increased. We found that there was a high rate of successful first attempt at insertion with 1 μg.kg-1 and 1.5 μg.kg-1, 93% and 87% respectively, compared to 87% in the 2.0 μg.kg-1 group. The 1.0 μg.kg-1 group also achieved an 80% optimal insertion conditions score of 4, compared to 73% in the 1.5 μg.kg-1 group and 80% in the 2 μg.kg-1 group. Therefore we recommend 1.0 pg.kg-1 as the optimal dose of fentanyl when used in addition to propofol 2.5 mg/kg for the insertion of the Classic™ Laryngeal Mask Airway.
Evaluation of P Wave and Corrected QT Dispersion in Subarachnoid Haemorrhage
Authors: Hanci V. , Gül S. , Dogan S. M. , Turan I. O. , Kalayci M. , Açikgöz B. 
Published: January 2019

The aim of our study was to investigate P wave dispersion (Pwd), QT, corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) intervals in subarachnoid haemorrhage. Thirty-five subarachnoid haemorrhage patients (Group S) and 35 neurologically normal patients (Group C) were included in this retrospective study. The standard 12 derivations of the electrocardiograms of all patients were analysed and Pwd, QT and QTd intervals were measured. QTc and QTcd intervals were determined with the Bazett formula. There was no significant difference between the study groups according to demographic characteristics, hypertension and diabetes mellutus incidences (P >0.05). The Pwd, QT, QTc, QTd and QTcd durations of Group S were significantly longer than those of Group C (P <0.001). Subarachnoid haemorrhage patients may have a higher likelihood of arrhythmia during anaesthesia and in intensive care due to extended QTcd and Pwd durations.