bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of Patient-Ventilator Asynchrony as Predictors of Prolonged Mechanical Ventilation
Authors: Gogineni V. K. , Brimeyer R. , Modrykamien A. 
Published: January 2019

Patient-ventilator asynchrony has been associated with adverse outcomes. The largest body of investigation has focused on ineffective ventilator triggering. Nevertheless, the effect of other patterns of asynchrony on patient outcomes is unknown. The purpose of this study was to assess the performance of specific patterns of asynchrony in their ability to predict prolonged mechanical ventilation. Patients mechanically ventilated within 48 hours of intensive care unit admission were included. Subjects with tracheostomy, mechanical ventilation dependency and treatment with neuromuscular blockers were excluded. Asynchrony patterns were collected on daily evaluations for three days. Analysed patterns were missed, double and auto-triggering, dish-out and overshoot of the pressure waveform, delayed termination and auto-positive end-expiratory pressure. Pattern-specific and composite asynchrony indices were calculated. Demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) II, PaO2/FiO2, positive end-expiratory pressure (PEEP) and Richmond Agitation Sedation Scale were collected. Receiver operating characteristic curves to assess the ability of each index to predict prolonged mechanical ventilation were constructed. Twenty-eight patients were deemed eligible. The average age was 54±17, with 71% of male gender. APACHE II, PaO2/FiO2 and PEEP were 18±7, 249±117 and 5.8±2.4 respectively. Richmond Agitation Sedation Scale was −3.1±1.3. The average number of days on mechanical ventilation was 5.4±6.5. Areas under the curve (AUC) for missed and double-triggering indices were 0.66±0.12 and 0.60±0.12 respectively. AUC for the dish-out index was 0.88±0.09. AUC for overshoot, delay termination and composite indexes were 0.55±0.12, 0.62±0.12 and 0.70±0.10 respectively. Dish-out index is the best predictor of prolonged mechanical ventilation, compared with other patterns of patient-ventilator asynchrony.
Point-of-Care Testing of Coagulation and Fibrinolytic Status during Postpartum Haemorrhage: Developing a Thrombelastography®-Guided Transfusion Algorithm
Authors: Hill J. S. , Devenie G. , Powell M. 
Published: January 2019

Thrombelastography® is a monitor of coagulation and fibrinolytic status, with point-of-care applications in managing haemorrhaging patients. Advocates have suggested a possible role in managing obstetric haemorrhage. This study aims to develop a pregnancy-specific thrombelastography-guided transfusion algorithm, which could be integrated into the management of postpartum haemorrhage. In this prospective observational study, 57 healthy, term-parturients provided pre-caesarean whole blood specimens for thrombelastography analyses. Specimens were processed according to a standardised protocol involving simultaneous analyses using three assays: native (non-activated); kaolin-activated; and kaolin and tissue factor-activated (RapidTEG®). For each assay, the following thrombelastography parameters were measured: reaction time (minutes); clot formation kinetics time (minutes); maximum amplitude (mm); and α angle (degree). Subsequent reference values were used to establish assay-specific reference intervals. For all thrombelastography parameters studied, reference values obtained using a non-activated assay differed from the corresponding values obtained using activated assays, and also demonstrated greater inter-sample variability. From the assay-specific reference intervals obtained, it was possible to establish a pregnancy-specific thrombelastography-guided transfusion algorithm. Specific features of this transfusion algorithm included the preferential use of activated assays, the need for duplicates and a recommendation that an initial baseline thrombelastography measurement is established for subsequent serial comparisons. This transfusion algorithm has been developed to assist with assessment of coagulation and fibrinolytic status during postpartum haemorrhage.
The Self-Pressurising Air-Q® Intubating Laryngeal Airway for Airway Maintenance during Anaesthesia in Adults: A Report of the First 100 Uses
Authors: Galgon R. E. , Schroeder K. , Joffe A. M. 
Published: January 2019

The self-pressurising air-Q® Intubating Laryngeal Airway is a new, commercially available, supraglottic airway device that incorporates a self-regulating periglottic cuff. In this retrospective review, we describe our initial clinical experience using the device in 100 patients. The ease and number of insertion attempts, airway seal pressure, device positioning, intubation success and oropharyngeal morbidity were recorded. The air-Q Intubating Laryngeal Airway was successfully inserted in all 100 patients and functioned adequately as a primary airway in 70 of the 72 patients in which it was used for this purpose. The median (interquartile range [range]) airway seal pressure was 22 (19-29, [10-40]) cmH2O. Intubation via the air-Q Intubating Laryngeal Airway was successful in 28 of 29 (97%) patients. Eleven percent of patients complained of sore throat postoperatively before discharge. In our series, the air-Q Intubating Laryngeal Airway performed adequately as a primary airway during anaesthesia with respect to ease of insertion, adequacy of airway maintenance and as a conduit for intubation in both anticipated and unanticipated difficult airways. Although our initial experience is positive, further investigation with larger numbers of observations are needed as the upper limits of the 95% confidence intervals for device failure (the worst failure rate the clinician could expect) are still high.
An Audit of Level Two and Level Three Checks of Anaesthesia Delivery Systems Performed at Three Hospitals in South Australia
Authors: Sweeney N. , Owen H. , Fronsko R. , Hurlow E. 
Published: January 2019

Anaesthetists may subject patients to unnecessary risk by not checking anaesthetic equipment thoroughly before use. Numerous adverse events have been associated with failure to check equipment. The Australian and New Zealand College of Anaesthetists and anaesthetic delivery system manufactures have made recommendations on how anaesthetic equipment should be maintained and checked before use and for the training required for staff who use such equipment. These recommendations are made to minimise the risk to patients undergoing anaesthesia. This prospective audit investigated the adherence of anaesthetic practitioners to a selection of those recommendations. Covert observations of anaesthetic practitioners were made while they were checking their designated anaesthetic machine, either at the beginning of a day's list or between cases. Structured interviews with staff who check the anaesthetic machine were carried out to determine the training they had received. The results indicated poor compliance with recommendations: significantly, the backup oxygen cylinders’ pressure/contents were not checked in 45% of observations; the emergency ventilation device was not checked in 67% of observations; the breathing circuit was not tested between patients in 79% of observations; no documentation of the checks performed was done in any cases; and no assessment or accreditation of the staff who performed these checks was performed. It was concluded that the poor compliance was a system failing and that patient safety might be increased with training and accrediting staff responsible for checking equipment, documenting the checks performed, and the formulation and use of a checklist.
Sevoflurane Alone and Propofol with or without Remifentanil for Electroconvulsive Therapy—a Randomised, Crossover Study
Authors: Begeç Z. , Kayhan G. Erdoğan , Toprak H. İ. , şahin T. , Konur H. , Çolak C. , Durmuş M. , Ersoy M. Ö. 
Published: January 2019

We compared the effectiveness of three anaesthetic regimens (propofol alone, propofol with remifentanil and sevoflurane alone), with respect to seizure duration and seizure quality in patients undergoing electroconvulsive therapy. Thirty-nine patients underwent a total of 234 electroconvulsive therapy treatments in this prospective, observer blinded, crossover study. Each patient received either propofol 1 mg/kg alone (Group P), propofol 0.5 mg/kg and remifentanil 1 μg/kg (Group R), or sevoflurane alone 6% (Group S) for their initial electroconvulsive therapy session. The patients subsequently received an alternative regimen in their next session, such as from propofol 1 mg/kg alone to propofol 0.5 mg/kg and remifentanil 1 μg/kg, from propofol 1 mg/kg alone to propofol 0.5 mg/kg and remifentanil 1 μg/kg to sevoflurane alone 6%, or from sevoflurane alone 6% to a continuing alternation between drugs at each session, until their sixth session. Muscle paralysis was achieved with 1 mg/kg succinylcholine. Seizure duration, postictal suppression index, early and midictal amplitude were recorded. The mean motor and electroencephalogram seizure durations were significantly longer in Groups P and R compared to Group S ( P <0.001). The postictal suppression index and early and midictal amplitude values were not significantly different among the groups. These findings indicate that the three anaesthetic regimens had similar effects on seizure quality parameters, although sevoflurane was associated with shorter seizure durations than propofol or propofol-remifentanil.
Tracheostomy in the Critically Ill: The Myth of Dead Space
Authors: Joseph M. J. , Khoury A. , Mendoza A. E. , Adams S. , Short K. A. , Charles A. G. 
Published: January 2019

Benefits and advantages of tracheostomy have been vigorously debated. There is a lack of consensus as to whether perceived clinical improvement is attributable to fundamental changes in respiratory dynamics. We compare the effect of tracheostomy versus endotracheal tube on dead space, airway resistance and other lung parameters in critically ill ventilated patients. Data collected included patients who were admitted to surgical, burn and neurosurgical intensive care units at the University of North Carolina. Twenty-four intubated patients were included in our analysis with various aetiologies of respiratory failure. Tracheostomy was deemed necessary either for severe neurological devastation or failure to wean from the ventilator. The diameter of the endotracheal tubes ranged from 6–8 mm and the tracheostomy tube diameters were from 6.4–8.9 mm. Internal diameters between endotracheal tube and tracheostomy tubes, ventilator settings and sedation were kept consistent throughout the study. Respiratory parameters were measured using the Respironics’ non-invasive cardiac output 2 device (Phillips, Andover, MA) immediately prior to tracheostomy and repeated within 24 hours of tracheostomy. Only two (8%) of the patients had slight improvement (>6% decrease in dead space). The average dead space of endotracheal versus tracheostomy tubes was 41±12.6% and 40±14.6%, respectively ( P=0.75). The remaining 22 patients (92%) had no significant change in dead space, compliance or other respiratory parameters. This study shows that there is no significant difference in respiratory mechanics and dead space with a tracheostomy versus endotracheal tube.
Pain Relief and Opioid Requirements in the First 24 Hours after Surgery in Patients Taking Buprenorphine and Methadone Opioid Substitution Therapy
Authors: Macintyre P. E. , Russell R. A. , Usher K. A. N. , Gaughwin M. , Huxtable C. A. 
Published: January 2019

The number of patients in buprenorphine opioid substitution therapy (BOST) or methadone opioid substitution therapy (MOST) programs is increasing. If these patients require surgery, it is generally agreed that methadone should be continued perioperatively. While some also recommend that buprenorphine is continued, concerns that it may limit the analgesic effectiveness of full mu-opioid agonists have led others to suggest that it should cease before surgery. However, no good evidence exists for either course of action. Therefore, we undertook a retrospective cohort study comparing pain relief and opioid requirements in the first 24 hours after surgery in 22 BOST and 29 MOST patients prescribed patient-controlled analgesia. There were no significant differences in pain scores (rest and movement), incidence of nausea or vomiting requiring treatment, or sedation between the BOST and MOST patient groups overall, or between those patients within each of these groups who had and had not received their methadone or buprenorphine the day after surgery. There were also no significant differences in patient-controlled analgesia requirements between BOST and MOST patient groups overall, or between patients who did or did not receive MOST on the day after surgery. BOST patients who were not given their usual buprenorphine the day after surgery used significantly more patient-controlled analgesia opioid ( P=0.02) compared with those who had received their dose. These results confirm that continuation of buprenorphine perioperatively is appropriate.
Treatment of Pain of Carcinoma of the Tongue and Floor of the Mouth
Authors: Dwyer Brian 
Published: January 2019

Fifty-two patients with uncontrolled pain due to carcinoma of the tongue and floor of the mouth were treated by the author as a member of a pain clinic. The pain involved in part or in whole the sensory distribution of the trigeminal, facial, glossopharyngeal and vagus nerves and the superficial branches of the cervical plexus. Treatment required attention to the general care of the patient through psychotherapy, reassurance, nutrition, etc.; the use of analgesics, antidepressants and sedatives; and sensory denervation of the affected areas. Sensory denervation was achieved by chemical neurolysis with absolute alcohol in preference to direct surgical attack. The methods used follow the standard nerve block procedures with Bonica's technique for intrathecal alcohol preferred for the cervical plexus. Eighty per cent of these patients received significant pain relief from this approach. Those who were unrelieved were managed by increasing doses of narcotic analgesics until their death. The value of a pain clinic in the assessment and management of this form of intractable pain and the importance of the anaesthetist's role is emphasized.
Management of Acute Renal Failure
Authors: Hayes J. M. 
Published: January 2019

Acute renal failure has oliguria and uraemia as its cardinal manifestations. The syndrome may be due to acute tubular necrosis, glomerulonephritis, urinary tract obstruction and occlusive vascular disease. The renal damage due to acute tubular necrosis is of uncertain aetiology. Renal cortical ischaemia and depression of glomerular filtration rate are important in the pathogenesis. Activation of the renin-angiotensin system and glomerular coagulation may prove to be important in these changes. The differentiation between reversible oliguria and established renal failure is generally accomplished on clinical grounds and the response to a therapeutic trial of mannitol. Measurement of urinary sodium concentration and osmolality are valuable adjuncts. The keystone of management is the prevention of symptomatic uraemia. Infection and haemorrhage have now replaced pulmonary oedema and hyperkalaemia as the major causes of death. The mortality rate remains high in acute tubular necrosis and a significant mortality occurs in the diuretic phase.
The Management of Infants for Cardiac Surgery under Deep Hypothermia
Authors: Brown T. C. K. , Clarke C. P. , Shanahan E. A. , McKie B. D. , Wood H. M. , Thorp E. A. 
Published: January 2019

Deep hypothermia is now employed for open heart surgery in infants. The method of surface cooling infants to 25° C and then by-pass cooling down to 15–20° C prior to exsanguination is described. This provides a still heart and ideal operating conditions. The infants are re-warmed on by-pass. Some of the physiological effects of hypothermia and the methods employed to counteract these are discussed. The aims are to reduce temperature gradients, improve cerebral oxygen supply, avoid arrhythmias and secure haemostasis. The experience in 33 operations is outlined. Seventeen patients were under one year of age.
The Effect of Positive End Expiratory Pressure on Rebreathing and Gas Dilution in the Ayre's T-Piece System—A Laboratory Study
Authors: Dobbinson T. L. , Fawcett E. R. , Bolton D. P. G. 
Published: January 2019

The effect of positive end expiratory pressure on the function of the Ayre's T-Piece System was studied using a simple lung model. Positive end expiratory pressure did not affect end tidal CO 2 during “controlled breathing” but caused an increase during “spontaneous breathing” when fresh gas flow was less than 3 times the minute volume. Gas dilution did not occur under any of the test conditions.
Neurolytic Lumbar Sympathetic Blockade: Duration of Denervation and Relief of Rest Pain
Authors: Cousins M. J. , Reeve T. S. , Glynn C. J. , Walsh J. A. , Cherry D. A. 
Published: January 2019

In an objective evaluation, 386 patients with rest pain due to occlusive vascular disease were studied before and after neurolytic lumbar sympathectomy by either 100% alcohol (n = 35), 6% phenol in water (n = 151) or 10% phenol in Conray 420 contrast medium (n = 200). A trained independent observer made assessments of:— (a) Completeness and duration of sympathetic ablation; (b) Degree and duration of pain relief; (c) Changes in skin temperature and skin plethysmography; (d) Completeness of coverage of antero-lateral aspects of L2, L3, and L4, by contrast medium (in patients receiving 10% phenol). (e) Side effects, including L1 neuralgia and postural hypotension. Mean duration of sweat test modification (6.0 ± 1.0 months) and pain relief (5.9 ± 0.6 months) were similar; onset of pain relief also coincided with onset of sympathetic blockade and increase in skin blood flow. This strongly pointed to sympathetic denervation as the basis for the relief of rest pain rather than a placebo response. Complete pain relief was achieved in 49% of patients, 31% had partial relief and 20% none. In the absence of pre-existing gangrenous changes a higher percentage of patients had complete or partial relief (84%) compared to those with gangrenous changes (56%). Significant postural hypotension was not observed. Frequency of L, neuralgia differed markedly for the three agents: 100% alcohol > 6% phenol in water > 10% phenol in Conray. It is concluded that neurolytic lumbar sympathectomy is an effective method of relief of rest pain with the advantage over surgical sympathectomy of performance without general anaesthesia on an outpatient basis. It is estimated that, in a series of the size reported in this paper, the potential economic benefit could be a saving of the order of $360,000. The technique deserves further controlled evaluation in comparison to surgical sympathectomy.
Body Temperature Changes during Transurethral Prostatectomy
Authors: Rawstron R. E. , Walton J. K. 
Published: January 2019

A prospective trial was made to investigate the effects of cold irrigating solutions on body temperatures during transurethral resection of the prostate. In a control group of 45 cases, when the irrigating fluids had a mean temperature of 21.9°C, there was a significant fall in body temperature from 36 ± 0.6°C to 34.9 ± 0.7°C. In test group A of 48 cases, when the irrigating fluids had a mean temperature of 4.96°C, there was a significant fall in body temperature from 36.1 ± 0.6°C to 34.8 ± 0.9°C. In test group B (five cases) when the irrigating fluids had a mean temperature of 10.2 °C there was a significant fall in body temperature from 36.0 ± 0.4 to 34.6 ± 0.8. Comparative analyses between the control group and test group A did not show significant differences in the degrees of cooling in the two groups.
An Academic Department of Anaesthesia in a New Canadian Medical School
Authors: Rigg John R. A. 
Published: January 2019

The development of an academic department of anaesthesia over its first ten years at McMaster Medical School in Hamilton, Ontario, Canada, is described. The organisation and goals of the department are described within the context of the regional organisation of health care delivery and of the functions of the faculty of health sciences. The activities of department members in various educational programmes, particularly the undergraduate and postgraduate programmes, are described in detail and the roles of the department in research and clinical anaesthesia and related clinical activities are also described. The role of an academic department of anaesthesia within a community of specialist anaesthetists is discussed.
Parenteral Administration of Trace Elements to Critically Ill Patients
Authors: Phillips G. D. , Garnys V. P. 
Published: January 2019

Studies of zinc, copper, manganese, chromium, selenium and molybdenum balance were carried out in eight patients in an intensive care unit. In six of these, nickel balance was also measured. The amount of each element in fluid administered to the patients, and the amount lost in urine and gastrointestinal fluid on each of seven days, was measured by atomic absorption spectrometry and cumulative balances calculated. Satisfactory balances of zinc, copper and manganese were obtained when the amounts administered approximated those currently recommended. Chromium balances were variable, while those of molybdenum, selenium and nickel were negative in most patients. Interpretation of balance studies of this type in critically ill patients is made difficult by abnormal renal and gastrointestinal function.
The Diagnosis of Acute Anaphylactoid Reactions to Anaesthetic Drugs
Authors: Fisher M. McD. 
Published: January 2019

Patients with a presumptive diagnosis of an acute anaphylactoid reaction to anaesthesia were investigated to determine the cause of the reaction and the drug responsible by intradermal testing, patch and prick testing, sequential complement measurement, passive transfer testing and challenge. The most valuable information was provided by intradermal testing and a diagnosis could be made in 150 of 165 patients. When anaphylactoid reactions to anaesthetic drugs occur, intradermal testing one month after the reaction and sequential complement measurements in the immediate post reaction period will enable the diagnosis to be established in the majority of cases. Intradermal testing is of no value for trivial reactions or reactions to colloid solutions or contrast media.
Intravenous Nitroglycerin during Surgery for Coronary Artery Disease
Authors: Kaye S. E. , Dimai W. , Gattiker R. 
Published: January 2019

Intravenous infusions of nitroglycerin decreased systemic systolic, pulmonary systolic and wedge pressures in β-blocked patients anaesthetised for coronary artery surgery with high dose of fentanyl without changing heart rate, diastolic pressure, or cardiac index, thus leading to an improvement in endocardial viability ratio. The use of a nitroglycerin bolus to abort an acute myocardial ischaemic episode is described.
Epidemiology and Prevention of Pseudomonas Aeruginosa Chest Infection in an Intensive Care Unit
Authors: Seal D. V. , Strangeways Janet M. 
Published: January 2019

An epidemiological investigation of Pseudomonas aeruginosa in an Intensive Care Neurosurgical Unit has shown that there were epidemic, endemic and endogenous types present simultaneously. These pseudomonads were cultured from purulent sputa postoperatively and sometimes caused systemic disease. The epidemic type was traced to a ventilator and a nebulizer whilst the endemic and endogenous types were not found in environmental sites. Effective decontamination of equipment and the use of bacterial filters where possible are essential in preventing the spread of infection. Staff hygiene remains important, particularly hand washing with antiseptic soap preparations.