bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relative Hypotension in the Beach-Chair Position: Effects on Middle Cerebral Artery Blood Velocity
Authors: McCulloch T. J. , Liyanagama K. , Petchell J. 
Published: January 2019

When anaesthetising patients for arthroscopic shoulder surgery, it is common practice to sit the patient in the beach-chair position and to optimise arthroscopy by allowing relative hypotension. There is little published information regarding the cerebral haemodynamic effects of hypotension in the sitting position during general anaesthesia. In this study, 19 patients scheduled for shoulder surgery were anaesthetised with desflurane. Phenylephrine and/or remifentanil were used to control blood pressure. Cerebral haemodynamics were assessed by monitoring middle cerebral artery blood velocity with transcranial Doppler, and by invasive arterial pressure monitoring with the transducer kept level with the external auditory meatus. Pressure and velocity waveforms were analysed to calculate apparent zero flow pressure and resistance area product. Cerebral haemodynamics in patients anaesthetised supine at the pre-induction blood pressure were compared with haemodynamics while seated at 45 degrees with hypotension. According to our routine practice, blood pressure management was guided by non-invasive measurement of systolic pressure using an arm cuff. Changing from supine/normotensive to sitting/hypotensive caused mean arterial pressure at the auditory meatus to decrease 47±7% and middle cerebral artery blood velocity to decrease 22±7%. In the beach-chair position, systolic pressure was 96±10 mmHg in the arm and 76±10 mmHg at the auditory meatus (P <0.0001). Both resistance area product and apparent zero flow pressure decreased, suggesting decreases in cerebrovascular resistance and critical closing pressure. Although there was some evidence of an autoregulatory response, middle cerebral artery blood velocity decreased when relative hypotension was induced in patients anaesthetised with desflurane in the beach-chair position.
Clinical Characteristics and Outcomes of Patients with Obstructive Sleep Apnoea Requiring Intensive Care
Authors: Hang L. W. , Chen W. , Liang S. J. , Lin Y. C. , Tu C. Y. , Chen H. J. , Chiu K. L. 
Published: January 2019

We reviewed the clinical characteristics, required intervention and short- and long-term outcomes in obstructive sleep apnoea (OSA) patients requiring intensive care. A retrospective, single-centre, observational cohort study was undertaken in a multidisciplinary teaching medical and surgical intensive care unit. Adult patients with OSA (apnoea-hypopnoea index of 5 or higher) requiring intensive care from January 2000 to January 2005 were included. Thirty-seven OSA patients (age: 58±14 years, male:female 27:10) were admitted due to respiratory (n=12, 32%), cerebrovascular (n=8, 22%), cardiovascular (n=16, 43%) and infectious events (n=1, 2.7%). Comparing the clinical features, polysomnographic data and outcome among these groups, we found that OSA patients admitted due to respiratory events had significantly higher Acute Physiology and Chronic Health Evaluation II scores, lower arterial blood gas pH, higher PaCO2, a higher incidence of respiratory failure (92%) and required non-invasive ventilation after extubation (73%), and higher intensive care unit readmission rates than patients admitted due to cerebrovascular events and cardiovascular events (P <0.05). No difference was found in the in-hospital and long-term mortality rate. The most common reason for intensive care unit admission in critically ill OSA patients was a cardiovascular event, followed by respiratory and cerebrovascular events. The baseline polysomnographic data of the OSA patients were not correlated with their clinical features and outcomes in the intensive care unit. A more complicated clinical course and higher intensive care unit readmission rate were encountered in OSA patients admitted due to respiratory events. Further studies would be required to evaluate the efficacy of non-invasive ventilation for facilitation of extubation in OSA patients presenting with hypercapnic respiratory failure.
The Second-Generation Air-Q® Intubating Laryngeal Mask for Airway Maintenance during Anaesthesia in Adults: A Report of the First 70 Uses
Authors: Joffe A. M. , Liew E. C. , Galgon R. E. , Viernes D. , Treggiari M. M. 
Published: January 2019

The second-generation air-Q® intubating laryngeal airway is a newer commercially available supraglottic airway device. In this retrospective review, we describe our initial clinical experience of 70 insertions. The ease and number of insertion attempts, airway leak pressure, device positioning, duration of use, success of fibreoptic-aided intubation and oropharyngeal morbidity were recorded. The intubating laryngeal airway was successfully inserted in all 70 patients and functioned adequately as a primary airway in all 57 patients in which it was used. The median airway leak pressure was 25 and 30 cmH2O for the single-use and reusable devices (P=0.001), respectively. Fibreoptic-aided intubation using the intubating laryngeal airway as a conduit was successful in 12/13 (92%) cases. One in four (26%) patients complained of mild sore throat postoperatively before discharge. In our series, the 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. Further investigation is warranted regarding the role of the intubating laryngeal airway as a conduit for both blind and fibreoptic-aided intubation. In addition, the incidence of postoperative throat complaints deserves further scrutiny.
Long-Term Follow-up of Patients with Post-Traumatic Refractory High Intracranial Pressure Treated with Lumbar Drainage
Authors: Llompart-Pou J. A. , Abadal J. M. , Pérez-bárcena J. , Molina M. , Brell M. , IbáÑEz J. , Raurich J.-M. , IbáÑEz J. , Homar J. 
Published: January 2019

Drainage of cerebrospinal fluid by means of external lumbar drainage (ELD) is controversial in the adult population with traumatic brain injury. We report our experience with ELD in the treatment of post-traumatic high intracranial pressure (ICP) and the results of the long-term follow-up in these patients. We undertook clinical evaluation of 30 patients with traumatic brain injury and high ICP treated with second-tier measures or with first-tier measures if second-tier measures were contraindicated. The study involved a retrospective review of collected data. Outcome at intensive care unit discharge and three to five years after injury were evaluated with the Glasgow Outcome Scale. The mean age of patients was 34.9±12.5 years and 25 (83%) were male. The median (interquartile range) Glasgow Coma score was 8 (7 to 10). ICP before and one hour after ELD placement was 33.7±9.0 and 12.5±4.8 mmHg respectively, a decrease in 21.2±8.3 mmHg (P <0.0001). ELD was placed after a mean of 8.6±3.9 days. Cerebrospinal fluid drainage was maintained for a mean of 6.6±3.5 days. Four patients (13%) required ELD replacement and one patient developed a cerebrospinal fluid infection (3%). No pupillary changes were noted within 48 hours of ELD placement. Long-term outcome was favourable (good recovery or moderate disability) in 62% of the patients studied. The use of ELD resulted in a marked decrease in ICP. These patients presented a good outcome in 62% of the cases in the long-term evaluation. Few complications related with ELD use were noted.
Post-Craniotomy Pain in a Paediatric Population
Authors: Teo J. H. , Palmer G. M. , Davidson A. J. 
Published: January 2019

There is little information about analgesia use or pain experienced in children after neurosurgery. The aims of this study were to assess the degree of pain experienced by children after neurosurgery and the analgesic regimens used, and to identify factors associated with significant pain. Data for 52 children who underwent craniotomy were collected contemporaneously over 72 hours. Data included demographics, intraoperative surgical and anaesthetic details, postoperative medications and postoperative pain scores as routinely collected by nursing staff. Pain was also assessed by an independent observer (auditor) using an age and developmentally appropriate tool, on a scale from zero to 10. For most of the time the children had little or no pain. Over the 72 hours the median pain score recorded by nursing staff was 0.7 and by the auditor was 1.3. However, in spite of the low median scores, 42% of children had at least one episode of a pain score ≥3. Postoperatively, 71% of children received parenteral morphine, 92% of children received paracetamol, 35% oxycodone, 19% oral codeine, 4% tramadol and 2% ibuprofen. Using multivariate regression, duration of procedure was the only factor associated with parenteral morphine use for >24 hours, and older age was the only factor associated with having an episode of pain scoring >3. No episodes of significant respiratory depression were noted. At our institution, children receive multimodal analgesia after neurosurgery, commonly parenteral morphine, and this is usually associated with low pain scores.
Australian Paediatric Hyperbaric Oxygen Therapy 1998–2011
Authors: Frawley G. , Bennett M. , Thistlethwaite K. , Banham N. 
Published: January 2019

For a large number of ischaemic, infective, inflammatory or traumatic conditions, hyperbaric oxygen therapy is either the only treatment or an adjunct that significantly reduces morbidity and mortality. The primary aim of this review is to identify clinical conditions treated in a paediatric population referred to Australian hyperbaric units. Secondary aims are to describe outcomes of treatment and detail any complications occurring during treatment or during transfer between units. This was a retrospective cohort study (January 1998–December 2011) of children treated at four Australian hyperbaric medical units. A total of 112 children underwent 1099 hyperbaric treatments for 14 indications. Ages were not normally distributed with a median age of 14 years (interquartile range 11–16; range 0.25–16 years). Treatments were completed as planned in 81.5% of cases with 25 patients’ treatment terminated at the request of physicians, parents or patients. Complications relating to hyperbaric oxygen therapy occurred in 58 treatments (5.3%). Central nervous system oxygen toxicity occurred in 1:366 treatments. Our findings indicate that provision of hyperbaric oxygen therapy to children is feasible in major regional hyperbaric units and is associated with low complication rates. Management of children in an adult hyperbaric facility, however, requires significant cooperation between paediatric, intensive care and hyperbaric consultants, as the need for transfer to another hospital and prolonged transports often impacts on optimal ongoing surgical and intensive care management.
The Anaesthetic Pre-Admission Clinic is Effective in Minimising Surgical Cancellation Rates.
Authors: Emanuel A. , Macpherson R. 
Published: January 2019

Pre-admission clinics (PAC) are now well-established in most hospitals. However, there have been few studies examining the efficacy of PACs in minimising day of surgery cancellations due to anaesthetic reasons. A retrospective cross-sectional descriptive study was carried out in a metropolitan tertiary hospital over a four-year period to assess reasons for anaesthetic-related day of surgery cancellations in elective surgical patients who attended the PAC. Of 12,537 patients who attended the PAC during the study period, 58 (0.46%) were cancelled on the day of surgery for anaesthetic reasons. The most common cause was non-preventable misadventure such as acute respiratory tract infections, seen in 19 patients (33% of all anaesthetic cancellations). The next most common cause was classified as being due to patient or system error (16 patients). This included patients’ failure to adhere to fasting or medication guidelines, or a failure to detect and respond to abnormal laboratory results. Clinical disagreement between anaesthetic assessment at the PAC and the attending anaesthetist on the day of surgery was low (12 patients, 21%), and clinical deterioration in a pre-existing condition (six patients, 10%) accounted for the majority of other cancellations. Although patient misadventure constituted the major cause of anaesthetic cancellations, non-adherence to fasting and medication guidelines constituted the next major reason for surgery cancellation due to anaesthetic causes. This is important as such cancellations are potentially preventable and the overall cancellation rate could potentially be improved by instituting relatively simple changes to clinic function.
Spontaneous Intracranial Hypotension and Epidural Blood Patch: A Report Involving Seven Cases
Authors: Ferraro F. , Marano E. , Petruzzi J. , Tedeschi E. , Santulli L. , Elefante A. 
Published: January 2019

Spontaneous intracranial hypotension is a rare condition caused by spontaneous cerebrospinal fluid leak. It is characterised by orthostatic headache, diffuse pachymeningeal enhancement on brain imaging and low cerebrospinal fluid pressure. Seven patients with spontaneous intracranial hypotension were treated conservatively: of these, four responded to drug treatment and three underwent a lumbar autologous epidural blood patch (EBP). A complete response was obtained in two patients after a single EBP; one patient underwent a second EBP and then became asymptomatic. Clinical improvement coincided with a dramatic reduction of pachymeningeal enhancement. The aetiology and brain imaging findings, and the technique and effectiveness of EBP are discussed.
Duration of Cortisol Suppression following a Single Dose of Dexamethasone in Healthy Volunteers: A Randomised Double-Blind Placebo-Controlled Trial
Authors: Elston M. S. , Conaglen H. M. , Hughes C. , Tamatea J. A. U. , Meyer-Rochow G. Y. , Conaglen J. V. 
Published: January 2019

The synthetic glucocorticoid dexamethasone is administered to many patients receiving a general anaesthetic to reduce the risk of postoperative nausea and vomiting. Dexamethasone is known to suppress the hypothalamic-pituitary-adrenal axis; however, the duration of this suppression following the standard anti-emetic intravenous dose of 4 to 8 mg used with anaesthesia is unknown. A randomised controlled double-blind crossover trial assessing the effects of 8 mg intravenous dexamethasone versus saline control was performed in ten healthy male volunteers. The adrenal, thyroid and gonadal axes and glucose levels were assessed over a four-day period after dexamethasone administration. All participants had normal baseline hypothalamic-pituitary-adrenal axis function. No difference in Cortisol levels was demonstrated at four or eight hours after dexamethasone administration compared with placebo. At 24 hours post dexamethasone, the Cortisol had dropped to less than 5% of baseline and returned to normal during the subsequent day. Increased plasma glucose levels were also observed in the dexamethasone group as compared with placebo. A dose of 8 mg of dexamethasone results in significant suppression of the hypothalamic-pituitary-adrenal axis and elevated plasma glucose levels. The Cortisol suppression is maximal at approximately 24 hours post dose.
Mental Health and Welfare in Australian Anaesthetists
Authors: Mcdonnell N. J. , Kaye R. M. , Hood S. , Shrivaslava P. , Khursandi D. C. S. 
Published: January 2019

This survey was designed to evaluate the factors affecting mental health and welfare in Australian anaesthetists and to investigate current sources of support. An electronic survey was sent to 500 randomly selected Fellows and trainees of the Australian and New Zealand College of Anaesthetists. Questions were related to: anxiety, stress, depression, substance misuse, self-medication, suicide, reporting illness, and help-seeking. Current psychological wellbeing was assessed using the Kessler Psychological Distress Scale (K10). A total of 191 completed surveys were received (a response rate of 38%): 26% had attended their general practitioner for mental health issues, of whom half had been diagnosed with a mental illness; 7% of all respondents were currently prescribed medication for this; 25% had previously self-prescribed psychoactive medication; 17% admitted to using alcohol to deal with stress, anxiety or depression; and 8% responded that mental illness had at some point impaired clinical care. Sixteen percent of all respondents reported previous suicidal ideation. Despite a low response rate, and the possibility of responder bias, the mental health of Australian anaesthetists would appear to be subject to common and persistent risk factors, many of which are well described in previous studies. We identify general practitioners as particularly valuable in targeting initiatives for improvements in mental health and welfare. The significant prevalence of suicidal ideation and reluctance to approach senior colleagues with concerns about mental health or welfare issues are specific causes for concern and suggest that further investigation, education and a potential review of support networks is required.
Type 2 Diabetes Mellitus, Independent of Insulin Use, is Associated with an Increased Risk of Cardiac Complications after Vascular Surgery
Authors: Barker E. J. , Valentijn T. M. , Van De Luijtgaarden K. M. , Hoeks S. E. , Voute M. T. , Goncalves F. B. , Verhagen H. J. , Stolker R. J. 
Published: January 2019

Previous reports on the prognostic value of diabetes mellitus for cardiac complications after vascular surgery show divergent results, especially in regards to the role of type 2 diabetes as a cardiac risk factor, which remains unclear. The aim of this study was to assess the impact of type 2 diabetes on 30-day cardiac complications after vascular surgery. Patients undergoing elective vascular surgery between 2002 and 2011 were included in this retrospective cohort study. Previous diagnosis of type 1 and 2 diabetes and use of oral glucose-lowering medications and insulin were recorded. Patients with type 1 diabetes were excluded from the analysis. The main outcome parameter was cardiac complications, a composite of cardiovascular death, non-fatal myocardial infarction, congestive heart failure, severe arrhythmia and asymptomatic troponin release within 30 days of surgery. In multivariate analysis, corrections were made for comorbidities, demographics, medication use and surgical risk. Of 1462 patients, 329 (22.5%) patients had type 2 diabetes. Cardiac complications occurred in 155 (13.7%) patients without diabetes and in 68 (20.7%) with type 2 diabetes. In multivariate analysis, type 2 diabetes was associated with a significantly increased risk of 30-day cardiac complications (odds ratio 1.80; 95% confidence interval 1.25 to 2.60). Results were similar for type 2 diabetes patients managed with (odds ratio 1.84; 95% confidence interval 1.01 to 3.37) and without (odds ratio 1.79; 95% confidence interval 1.19 to 2.70) insulin. Type 2 diabetes is an independent risk factor for cardiac complications after vascular surgery and should be treated as such in preoperative cardiac risk stratification.
Anaesthesia for Thyroid Surgery
Authors: Holmes J. L. , Hooper M. J. , Barraclough B. H. , White B. , Reeve T. S. 
Published: January 2019

The principles involved in preoperative assessment and management of the patient who is to undergo thyroidectomy are discussed. The techniques of anaesthesia that have been found most successful for thyroidectomy at The Royal North Shore Hospital of Sydney are described. The effectiveness of these techniques is indicated by reference to the complications found following review of 200 consecutive thyroidectomies.
A Reappraisal of the Multiple Gauze Heat and Moisture Exchanger
Authors: Shanks C. A. , Sara C., A. 
Published: January 2019

The multiple gauze heat and moisture exchanger was assessed under standardized conditions, at five levels of predetermined fresh gas humidity. As predicted theoretically, the unit functioned best when presented with fresh gases with high water vapour content. The ordinary unit moistened arid gases during inspiration to a level unacceptable for prolonged use. Unheated simple humidification systems dampen anhydrous stored gases and combined with the standard condenser-humidifier produce a microclimate suitable for entry into the trachea during spontaneous or controlled ventilation. Quadrupling the number of gauzes improved heat and moisture exchange with all but the saturated fresh gases. However, there was a considerable increase in weight.
Acute Epiglottitis—Management by Intubation
Authors: Sweeney D. B. , Allen T. H. , Steven I. M. 
Published: January 2019

The clinical features of acute epiglottitis are described. A method of managing the condition by nasotracheal intubation is given. The results in a series of 56 cases are discussed. The one death that occurred in this series followed conservative management.
Paediatric Neurosurgical and Neuroradiological Anaesthesia
Authors: Brophy Tess 
Published: January 2019

Summary Anaesthesia for paediatric neurosurgery and neuroradiology involves all the problems pertinent to (i) management of infants and small children during procedures which may be relatively protracted; (ii) avoidance or correction of disturbances of intracranial pressure and cerebral perfusion; (iii) assessment of patients with depression of consciousness or of other neurological functions; (iv) adoption of unusual positions for the conduct of procedures with special risks and limited access for the anaesthetist; (v) providing optimum conditions for radiologists and avoiding radiation risks.
Chest Injury: The Indications for Artificial Ventilation
Authors: James Owen , Quail Anthony , Gibbons Jennifer 
Published: January 2019

During the period April, 1968, to April, 1973, all patients admitted to Royal Newcastle Hospital with respiratory failure following chest injury were managed in the Acute Respiratory Unit. The great majority resulted from motor vehicle accidents. A total of 130 patients suffered respiratory failure following chest injury, and were all seen by at least one of us. Only 21 patients had isolated chest injury, 109 having multiple injuries. Twenty-four patients died, nine from associated cerebral contusion. The place of artificial ventilation in the proper management of chest injuries is discussed and particular stress is laid on those patients with conditions or injuries likely to lead to respiratory failure. In this category are those patients with significant flail segment, associated head or abdominal injury, the obese, and those with pre-existing chest disease.
Cerebral Effects of Circulatory Arrest at 20° C in the Infant Pig
Authors: Fisk G. C. , Wright J. S. , Turner B. B. , Baker W. de C. , Hicks R. G. , Lethlean A. K. , Stacey R. B. , Lawrence J. C. , Lawrie G. M. , Kalnins I. , Rose Margaret 
Published: January 2019

Circulatory arrest at 20° C is used during open heart surgery in infants. It has been stated that significant brain damage does not occur. Piglets between two and six weeks of age were cooled to 20° C using extracorporeal circulation and a membrane oxygenator. After one hour of circulatory arrest the perfusion system was used to rewarm the animals and restore normal circulation. Electroencephalogram was monitored throughout perfusion and surgery, and repeated on surviving animals on the third, fifth, seventh and tenth postoperative days. On the tenth day the animals were killed by injection of pentobarbitone. Other groups were subjected to Continuous perfusion at 20° C, Continuous perfusion at 37° C, Thoracotomy and cannulation, Ischaemia, and Hypoxia. The return of E.E.G. activity was delayed after circulatory arrest compared with those continuously perfused. Lesions were found in the cerebral cortex in all the animals which had circulatory arrest and those subjected to ischaemia and hypoxia. The brains of animals of the other groups were indistinguishable from those killed without any experimental procedure. Despite apparent recovery, brain damage following hypothermic arrest during open heart surgery remains possible.