bluuebunny/crossref_metadata_2025_split huggingface dataset:
Costs, Severity of Illness and Outcome in Intensive Care
Authors: Slatyer M. A. , James O. F. , Moore P. G. , Leeder S. R. 
Published: January 2019

Severity of illness (Therapeutic Index Severity Score, Classes 1-4) and direct clinical costs (labour costs, diagnostic costs, drugs, disposables, etc.) were determined for 100 consecutive patients admitted to Royal Newcastle Hospital Intensive Care Unit over six weeks. Outcome was assessed using mortality, quality of life, functional status, productivity and mental status one month after separation from the Unit. The mean total admission cost was $1,357 (Class 4 mean = $3,706) but for over 70% of patients costs were less than $1,000. The main component of cost was labour (about 60% for all classes). TISS proved a strong predictor (P<0.001) of total admission costs. Survival to one month was 89% and optimal association between cost and survival was found with those with low costs more likely to survive (P<0.001). On the other hand, no association was found between total admission cost and resulting quality of life. However, there was an association between pre-admission and follow-up quality of life (P<0.0005).
Shivering Related to Epidural Blockade with Bupivacaine in Labour, and the Influence of Epidural Pethidine
Authors: Brownridge P. 
Published: January 2019

A prospective survey of two hundred patients who received an epidural block in labour was performed in order to determine the incidence and severity of shivering, and the influence of likely associated factors. Twenty-two of the patients who shivered took part in a double-blind trial to see if epidural pethidine 25 mg, versus saline, had any effect upon shivering. Fifty per cent of patients shivered soon after the initial dose of bupivacaine. Shivering was more common among patients who had experienced shivering before epidural block, and in those who had received nitrous oxide (P<0.005). Prior intramuscular injection of pethidine did not significantly affect the incidence of shivering, and it was not influenced by the concentration of epidural bupivacaine used (0.5 or 0.25%). Shiverers were more likely to feel cold than non- shiverers (P<0.001) but shivering was generally regarded by patients as a trivial symptom, only 13 % describing it as very irritating. Shivering was abolished or considerably diminished within ten minutes in all patients who received epidural pethidine 25 mg, whereas there was no change in eight out of eleven patients who received epidural saline. These results are significant (P<0.01), and demonstrate that shivering following epidural blockade can be effectively treated with small epidural doses of pethidine.
Acute Cardiovascular Responses to Internal Carotid Artery Occlusion during Carotid Endarterectomy and to the Restoration of Internal Carotid Flow
Authors: Kane C. M. , Le Cheminant D. , Horan B. F. 
Published: January 2019

Heart rate, central venous pressure, radial artery pressure and electrocardiograph were recorded in 14 patients undergoing carotid endarterectomy under general anaesthesia supplemented with fentanyl and halothane and muscle relaxation as required. Induction of anaesthesia was followed by a significant reduction in systolic arterial pressure and a rise in central venous pressure (CVP). Thereafter CVP did not vary significantly and heart rate did not change significantly at any stage. After internal carotid artery occlusion, mean systolic pressure at one minute, 143 (SD 17) mmHg, and three minutes, 160(SD27) mmHg, were both significantly higher than prior to occlusion, 132 (SD 17) mmHg (P< 0.01 and P< 0.002 respectively). Similar significant changes occurred in diastolic pressure after carotid occlusion (P< 0.02 and P <0.002 respectively). The restoration of flow through the internal carotid artery in patients operated on without a shunt was associated with a significant reduction in mean systolic pressure. The mean systolic pressure at one minute, 145 (SD 20) mmHg, and three minutes, 135 (SD 19) mmHg, were both significantly lower than that before restoration of flow, 159 (SD 17) mmHg (P < 0.02 and P< 0.05 respectively). Changes in mean diastolic pressure in this group at these times, while in the same direction, were not significant. The observed hypertensive response to carotid occlusion may assist in preserving cerebral perfusion while the internal carotid artery is occluded, but may be hazardous for patients with ischaemic heart disease.
Total Intravenous Anaesthesia Using Propofol Infusion — 50 Consecutive Cases
Authors: Galletly D. C. , Short T. G. 
Published: January 2019

Fifty consecutive patients in the authors’ practice were anaesthetised with a total intravenous technique using propofol infusion, fentanyl, vecuronium and oxygen in air. Patients were predominantly elderly and undergoing major upper gastrointestinal surgery for a mean duration of 133 minutes (range 20 minutes to 7 hours). Twenty-one patients had significant concomitant medical illness. Propofol was found to give a rapid, smooth induction with wide variation in dose requirement (0.5 to 2.9 mg/kg). There was a mean systolic blood pressure fall of 27% from preoperative values, greatest in elderly patients. Depth of anaesthesia was readily adjusted by alteration in infusion rate according to standard clinical criteria. The dose of propofol required for maintenance was highly variable (range 2–15 mg/kg/hr in the first hour). Three patients reported dreaming and two of these had shown signs of light anaesthesia. Recovery was rapid, with few side-effects, and a mean time to open eyes on command of 8.5 minutes from the end of infusion. Propofol was considered to be a satisfactory intravenous agent for the induction and maintenance of anaesthesia in the majority of patients studied. The most significant problem was hypotension following the induction dose.
A Double-Blind Comparative Study of Three Formulations of Diazepam in Volunteers
Authors: Forrest P. , Galletly D. C. 
Published: January 2019

The sedation and subsequent recovery following administration of three formulations of diazepam (propylene glycol, mixed micelle and lipid emulsion) were compared in a randomised, double-blind, crossover study of twelve male volunteers. Following intravenous injections of 10 mg of each formulation, sedation was assessed for ten minutes using a six-point ordinal sedation score and subsequent recovery was assessed using a psychomotor/sedation battery including simple reflex time, letter deletion test, a simple arithmetic exercise, digit recall and a linear analogue sedation scale. Diazepam in propylene glycol was found to be more sedating that diazepam, either in a lipid formulation or as mixed micelles and appeared faster in its rise to peak effect than the lipid formulation. Subsequent recovery did not differ between the three groups. A significant increase in the level of sedation achieved by the preparations was found with each study day indicating that subject or testing factors were also important in determining the sedative response. Our results suggest that the new solvent systems, and in particular the lipid emulsion, primarily alter initial drug efficacy.
Hypoxia in Children following General Anaesthesia
Authors: Tomkins D. P. , Gaukroger P. B. , Bentley M. W. 
Published: January 2019

The oxygen saturations of 152 children were studied for the first 30 minutes following general anaesthesia with a pulse oximeter. Thirty-six patients (24%) recorded oxygen saturations of less than 90% while breathing room air and in all cases this occurred during the first ten minutes. Intubation (P < 0.001), use of muscle relaxants (P < 0.01), intravenous induction (P < 0.01) and duration of anaesthesia of greater than one hour (P < 0.02) were all associated with an increased incidence of hypoxaemia. There was no significant correlation with age, weight, procedure, time to wakening, or use of opiates. Clinical signs correlated poorly with hypoxaemia and it is recommended that all children should receive supplementary oxygen during transport to recovery wards and for at least the first ten minutes in recovery following general anaesthesia.
Post-Cholecystectomy Pulmonary Function following Interpleural Bupivacaine and Intramuscular Pethidine
Authors: Oxorn D. C. , Whatley G. S. 
Published: January 2019

Twenty-four patients who were to undergo cholecystectomy were randomised into two groups, one to receive postoperative analgesia with interpleural bupivacaine, 20 ml of a 0.5% solution with adrenaline 5 μg/ml, and the other to receive intramuscular pethidine, 1 mg/kg. Preoperative and postoperative pulmonary function, postoperative pain scores, and days from operation to hospital discharge were recorded and statistically compared. There was no significant difference in pain scores, nor in days to discharge; however, postoperative pulmonary mechanics were significantly poorer in the interpleural group. A hypothesis to explain the differences is offered.
A Double-Blind Comparison of Epidural Bupivacaine and Bupivacaine-Fentanyl for Caesarean Section
Authors: Paech M. J. , Westmore M. D. , Speirs H. M. 
Published: January 2019

The effect of adding fentanyl 100 mcg to bupivacaine 0.5% plain to establish epidural anaesthesia for elective caesarean section was investigated in a randomised, double-blind study of sixty healthy women. The quality of intraoperative analgesia as assessed by both patients and anaesthetists was significantly improved with fentanyl. The onset and duration of sensory anaesthesia, degree and duration of motor block, and other characteristics of epidural anaesthesia were unaltered. No adverse maternal side-effects (except mild pruritis) were noted and neonatal outcome was unaffected. The pharmacokinetics of epidural fentanyl administration were investigated by plasma fentanyl assays from maternal and cord blood taken at delivery. Epidural bupivacaine-fentanyl combination is a valuable therapeutic approach to the conduct of epidural anaesthesia for caesarean section in healthy women and foetuses. Further neonatal evaluation of the premature or compromised foetus is suggested before the universal application of this technique.
Does the Radial Arterial Line Degrade the Performance of a Pulse Oximeter?
Authors: Morris R. W. , Nairn M. , Beaudoin M. 
Published: January 2019

The presence of radial arterial lines may diminish distal digital perfusion. Using a pair of pulse oximeters on the index fingers of cannulated and noncannulated arms the saturation and oximeter pulse strength were assessed. Three hundred paired measurements in fifty consecutive Intensive Care patients were undertaken more than two hours after cannula insertion. The pulse strength was 19.7 (SD 6.1) and 19.7 (SD 5.7) on the cannulated and noncannulated sides while the saturation was 97.3 (SD 2.3) and 97.1 (SD 2.4) respectively. These differences are not clinically important and the study demonstrates that reliable pulse oximetry measurements may be made distal to a radial artery cannula. It is recommended that in each individual the placement of the sensor be such as to ensure the best signal and the most stable saturation readings.
Flumazenil: A Twelve-Month Survey of Use in a New Zealand Public Hospital
Authors: Galletly D. C. , Ure R. , Turley A. 
Published: January 2019

As part of a program of postmarketing surveillance, the use of flumazenil was monitored prospectively in a New Zealand public hospital for a period of twelve months. A questionnaire on usage, efficacy and side-effects was completed by clinicians for 118 patients receiving the drug. Our conclusions are these: 1. Flumazenil was used most frequently after anaesthesia and in the initial management of intentional drug overdose. 2. In two-thirds of cases, flumazenil was used to antagonise benzodiazepines in the presence of non-benzodiazepine drugs and its efficacy was primarily determined by the presence of these latter drugs. 3. The complications of flumazenil are mild although important complications may arise from interaction with other drugs and unmasking of conditions such as postoperative pain. 4. Resedation was common (24%), although rarely a problem unless large doses of benzodiazepine agonist had been administered or if other hypnosedatives were given subsequently.
Response to Nondepolarizing Muscle Relaxants in Children with Tumours
Authors: Brown T. C. K. , Gregory M. , Bell B. , Clare D. 
Published: January 2019

The rate of onset of action of d-tubocurarine (64 patients) or alcuronium (36 patients) was studied electromyographically in 100 children who had abdominal, bone or cerebral tumours. It was found that there was a significantly delayed onset (over three times longer than controls) or additional doses were required in patients with malignant liver, renal and bone tumours who received d-tubocurarine. The onset of alcuronium blockade was also prolonged but to a lesser extent. When tumours with an abnormal prolongation of onset of relaxation were successfully treated by chemotherapy and/or surgery, the response reverted to normal. Children with benign tumours or masses had normal responses. In contrast, neuroblastomas were associated with little prolongation of onset. Cerebral tumours showed a variable response, with the observed changes being unreliable indicators of degree of malignancy.
Persistence of Allergy to Anaesthetic Drugs
Authors: Fisher M. M. , Baldo B. A. 
Published: January 2019

Intradermal testing and RIA testing for specific IgE antibodies to neuromuscular blocking drugs (NMBDs) were performed in patients referred to an Anaesthetic Allergy Clinic. Six patients were initially investigated four to 29 years after clinical anaphylaxis during anaesthesia and two of these patients and sixteen others were investigated by intradermal testing on two occasions at least four years apart. Seven patients had RIA tests for NMBD-specific IgE antibodies on two occasions at the time of skin testing. In all but two patients the evidence for drug-specific antibodies persisted 4–29 years after the reactions. In one patient all tests became negative and in another the skin test became negative but the positive RIA persisted. Evidence of antibodies to NMBDs persisted in 21 of 22 patients who had had anaphylactic reactions to these drugs during anaesthesia. In the absence of evidence of allergy diminishing with time in the majority of patients it would seem wise to avoid drugs responsible for reactions for the rest of the patient's life.
The Relationship between a Person's Height and Appropriate Endotracheal Tube Length
Authors: Eagle C. C. P. 
Published: January 2019

The relationship between a person's height and the dimensions of that person's upper airways has been studied in adult subjects. Using this relationship, formulae have been derived which predict appropriate lengths for endotracheal tubes. The formulae are as follows: 1. Orotracheal tube (teeth to mid-point of trachea) [Formula: see text] 2. Orotracheal tube (teeth to mid-point of trachea + 3 cm) [Formula: see text] 3. Nasotracheal tube (external naris to mid-point of trachea) [Formula: see text] These formulae are not foolproof but provide a useful working guide. All usual comfirmatory tests of correct placement should be employed.
Red Cell, Plasma and Albumin Transfusion Decision Triggers
Authors: Nicholls M. D. , Whyte G. 
Published: January 2019

Hypothetical clinical cases were used to investigate transfusion-related decision-making. Three red cell, three fresh frozen plasma (FFP) and three albumin transfusion decision cases were administered by questionnaire to 228 medical staff. The transfusion decision triggers were identified and comparisons made between resident and specialist groups and between Melbourne and Sydney participants. Factors important in red cell transfusion decisions included haemoglobin, symptoms of anaemia, presence of co-morbidities or surgery, gender, period of hospitalisation and the degree of documented blood loss. FFP administration was influenced by an abnormal coagulation test, the presence of co-morbidities and by the number of red cell units transfused. The administration of albumin, concentrated or 5% SPPS, was influenced by the period of hospitalisation and clinical circumstances such as a falling urine output postoperatively, and by the presence of hypotensive complications. Different transfusion responses were noted: resident staff transfused red cells and FFP earlier than specialists; Sydney specialists were more conservative of red cell transfusion; Melbourne specialists more conservative of FFP administration and surgeons were four times more likely to transfuse patients than physicians or anesthetists at certain haemoglobin values.
Alterations in Endotracheal Tube Position during General Anaesthesia
Authors: Yap S. J. , Morris R. W. , Pybus D. A. 
Published: January 2019

The effect of head and neck movement and Trendelenburg tilt on endotracheal tube position, relative to the carina, was studied in fifty adult patients requiring intubation for elective surgery. On average, inward movement, that is shortening of the distance between the endotracheal tube tip and the carina, resulted from neck flexion (mean = −5.5 mm), whereas outward movement occurred with neck extension (mean = 6.3 mm). Neck rotation, to right and left, and Trendelenburg tilt did not show any trend towards inward nor outward movement (mean = 0.3 mm/1.7 mm/—0.6 mm, respectively). Whilst these mean positional changes for flexion and extension confirm the findings of earlier investigations, our range of maximum inward and outward displacement for flexion (23 mm in/19 mm out), extension (21 mm in/33 mm out), rotation to right (19 mm in/17 mm out), to left (22 mm in/19 mm out) and Trendelenburg tilt (22 mm in/16 mm out) indicate that for any given postural change in any one patient, the direction and magnitude of endotracheal tube displacement is not readily predictable.
The Effect of Oral Cisapride Premedication on Fasting Gastric Volumes
Authors: Kluger M. T. , Owen H. , Plummer J. L. , Mclean C. 
Published: January 2019

The aim of this study was to determine whether fasting gastric volumes could be reduced by preoperative administration of cisapride. One hundred and twenty-one patients undergoing elective general anaesthesia were randomly allocated to receive either cisapride 20 mg plus diazepam 10 mg or placebo tablets plus diazepam 10 mg, two hours prior to induction. Immediately following induction blind gastric aspiration was performed using a 16Fr multiorificed orogastric tube. Gastric volume, pH, and cisapride blood concentration were measured at this time. Gastric volumes were significantly smaller in the cisapride group, 20.5 (SD 22.2) ml compared to placebo 28.2 (SD 26.0) ml but there was no significant difference with respect to pH. Some patients in both groups had large gastric volumes despite fasting. No significant adverse effects were noted with cisapride.
The Impact of Heat and Moisture Exchanging Humidifiers on Work of Breathing
Authors: Johnson P. A. , Raper R. F. , Fisher M. Mcd. 
Published: January 2019

In this study the resistive work or breathing (WOB) associated with eleven commercially available heal and moisture exchangers (HMEs) was evaluated for gas flow rates of 20 to 60 l.min-1. The Gibeck Humid-Vent 2S Flex was also assessed after 24 hours patient usage (n=50). The WOB associated with these devices was compared with that of standard endotracheal tubes and standard humidifying circuits with flex-tube connectors. The range of work imposed by the eleven HMEs approximated the range shown by water bath circuitry when used with two different commonly used flex-tube connectors. The excess WOB attributed to the HMEs was significantly less than that imposed by standard endotracheal tubes. After 24 hours of patient use, 96% of the Gibeck HMEs tested demonstrated a resistive WOB within the range of the two flex-tube connectors. To assess the clinical significance of this circuit-related WOB, we compared respiratory variables in 40 patients breathing on either CPAP or pressure support ventilation, using a variation in flex-tube resistance which imposed a range of WOB comparable to that shown by the HMEs. A small but statistically significant reduction was found for both the peak flow (48±1.4 vs 45±1.1 l.min-1, P<0.0005) and the minute volume (8.6±0.35 vs 7.9±0.31 l, P < 0.0005). These data suggest that the range of resistive work imposed by commercially available HMEs has a small but potentially significant effect on clinical respiratory parameters.
Comparison of Patient-Controlled Epidural Analgesia with Patient-Controlled Intravenous Analgesia Using Pethidine or Fentanyl
Authors: Kee W. D. Ngan , Lam K. K. , Chen P. P. , Gin T. 
Published: January 2019

We compared patient-controlled epidural analgesia (PCEA) with patient-controlled intravenous analgesia (PCIA) using pethidine or fentanyl in a randomized, double-blind crossover study of 80 patients after caesarean section. Patients received pethidine by PCEA or PCIA, or fentanyl by PCEA or PCIA, with a crossover of the route of administration at 12h. For pethidine, pain scores were lower with PCEA vs PCIA from 4 to 16 h (P<0.05). Pethidine consumption was lower with PCEA vs PCIA from 12 to 24 h (P=0.0005). Patients preferred PCEA to PCIA (P=0.015). For fentanyl, pain scores were lower with PCEA vs PCIA at 12 h (P=0.045). Fentanyl consumption was lower with PCEA vs PCIA from 0 to 12 h (P=0.0007). Patients had similar preference for PCEA and PCIA. Pain scores and side-effects were similar between drugs. Plasma pethidine was similar between groups. Plasma fentanyl was higher with PCIA vs PCEA at 12 h (P=0.002). PCEA has advantages over PCIA and pethidine may be the preferred drug.
Charging for Intensive Care using Direct Nursing Hours as the Cost Marker
Authors: Havill J. H. , Caspari M. , McConnell H. , Alexander M. , Montgomery C. 
Published: January 2019

The hypothesis that direct nursing hours correlate with the cost of a patient stay in intensive care was tested. One hundred and thirty-nine patients were studied and the data collected included: (a) direct nursing hours applied to each patient; (b) a daily TISS score: (c) a detailed costing of each patient (all costs are shown in N.Z.$). There was a strong correlation between the direct nursing hours and the total cost per patient (r2=0.98) (total cost=54xdirect nursing hours+344). Also a strong correlation existed between the total TISS scores and the total costs per patient (r2=0.96) (total cost=67.13xTISS). Direct nursing hours offer a relatively simple and logical method of allocating costs per patient.
Labour Ward Midwifery Staff Epidural Knowledge and Practice
Authors: Vandendriesen N. M. , Lim W. , Paech M. J. 
Published: January 2019

A survey was conducted amongst labour ward midwives at our hospital to evaluate education, knowledge and attitudes toward the management of epidural analgesia in labour. Sixty of 80 distributed forms were returned, giving a 75% response rate. Forty-two per cent of respondents had more than ten years’ practice experience. Only 51% achieved a predetermined pass score for knowledge about epidural analgesia. Though most had received formal education about epidural analgesia, 35% felt postgraduate education was insufficient. A majority of midwives supported epidural analgesia on demand (78%), during established labour (74%), or for women at increased risk of caesarean section (82%). Midwives with lower knowledge levels were more likely to recommend epidural analgesia early in labour to multiparous women (P=0.001) and to women with either a small or a large baby (P=0.06). The majority of midwives (93%, 70% and 65%) would “almost always” top-up women with cardiac or medical diseases, multiple pregnancy or hypertensive disease, respectively. A clear requirement for ongoing education, with input from the anaesthetic department, was identified, irrespective of personal experience. Practice patterns are discussed and recommendations made with respect to improvement of epidural analgesia management and continuing education.