bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low-Dose Remifentanil Infusion during Ventilator Weaning and Tracheal Extubation in Postoperative Intensive Care Unit Patients Sedated with Propofol-Remifentanil: A Randomised Clinical Trial
Authors: Kim S. Y. , Yang S. Y. , Na S. W. , Jo Y. Y. , Koh S. O. 
Published: January 2019

Discontinuation of sedatives for ventilator weaning and extubation can be associated with hyperdynamic responses, including hypertension and tachycardia. We examined the effects of a maintained low dose of remifentanil infusion on cardiovascular responses and coughing during extubation in postoperative intensive care unit patients sedated with propofol-remifentanil. Fifty patients who required mechanical ventilation after major abdominal surgery were randomised into remifentanil group (n=25) or control group (n=25). Sedation during mechanical ventilation was maintained with remifentanil and propofol via a target-controlled infusion system. These drugs were titrated to the target sedation range, bispectral index values of 60 to 75 and Richmond Agitation Sedation Scale values of −3 to −2. When weaning was initiated, propofol was stopped in both groups. In the control group, remifentanil infusion was also stopped; in the remifentanil group, remifentanil infusion was maintained until extubation at a target effect site concentration of 1.0 ng/ml. Extubation was performed if the patient's respiratory, haemodynamic states were stable and if the patient was able to follow commands. Heart rate, mean arterial pressure and cough severity were evaluated. The mean arterial pressure, heart rate and cough severity did not differ between the two groups during extubation. The time from stopping of propofol infusion to extubation was significantly longer in the remifentanil group compared to that in the control group (P=0.020). Maintaining a low-dose remifentanil infusion during ventilator weaning delayed tracheal extubation without any differences in haemodynamic changes or coughing in postoperative intensive care unit patients.
The Development and Preliminary Evaluation of a Proposed New Scoring System for Videolaryngoscopy
Authors: Swann A. D. , English J. D. , O'Loughlin E. J. 
Published: January 2019

Clear documentation of anaesthetic technique, difficulties and complications is an essential part of good anaesthetic practice, particularly in the area of airway management. The current convention of describing intubation using a videolaryngoscope only in terms of a Cormack and Lehane score is at best unhelpful and at worst dangerous. In an attempt to address the inadequacy of a Cormack and Lehane score to describe videoscopic intubation, we propose a three part scoring system: view, ease and device - the ‘Fremantle Score’. Preliminary evaluation of this system in a diverse group of anaesthetists utilising four available videolaryngoscopes in a simulated normal and difficult airway manikin has demonstrated that the system is easy to use, easy to understand and relevant. In three of the eight device and manikin combinations studied, the videolaryngoscopic view correlated with the ease of intubation. This highlights the need for an alternative tool to describe intubation with a videolaryngoscope. We consider this development of a specific videoscopic scoring system a first step in better describing intubation by a videolaryngoscope and improving patient care.
Long-Term Use of Nerve Block Catheters in Paediatric Patients with Cancer Related Pathologic Fractures
Authors: Burgoyne L. L. , Pereiras L. A. , Bertani L. A. , Kaddoum R. N. , Neel M. , Faughnan L. G. , Anghelescu D. L. 
Published: January 2019

We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control.
A Prospective, Observational Study Comparing Postoperative Residual Curarisation and Early Adverse Respiratory Events in Patients Reversed with Neostigmine or Sugammadex or after Apparent Spontaneous Recovery
Authors: Cammu G. V. , Smet V. , De Jongh K. , Vandeput D. 
Published: January 2019

Six years ago, a study performed in our department reported that the incidence of postoperative residual curarisation (PORC) was 39%. The reassessment of neuromuscular monitoring and reversal of neuromuscular block in routine anaesthetic practice is relevant now that sugammadex has become available. The incidence of PORC, defined by a train-of-four (TOF) <90%, was evaluated at post-anaesthesia care unit (PACU) arrival in patients whose neuromuscular block had been reversed with neostigmine or sugammadex and those in whom reversal was felt unnecessary (adequate spontaneous recovery). During the PACU stay we recorded the oxygen saturation (SpO2) at arrival, episodes of SpO2 <90%, airway manoeuvres and/or stimulation required to maintain SpO2 >90%, and the need for re-intubation. In total, 624 patients were studied. Fifteen percent (66/441) of the patients who were not reversed, 15% (21/139) of those who were reversed with neostigmine and 2% (1/44) of those who received sugammadex exhibited PORC (P=0.06). No patient required reintubation in the PACU. The absence of neuromuscular monitoring and pharmacological reversal before extubation were not associated with PORC. A TOF <90% at PACU arrival was not associated with SpO2 <90% during the PACU stay. Body mass index was the only independent predictor of SpO2 <90% during the stay in the PACU. These findings indicate that in recent years, the incidence of PORC, defined by a TOF <90%, has dramatically decreased in our institution. The differences in PORC were not statistically significant between patients who received sugammadex for reversal and patients with spontaneous recovery or neostigmine reversal.
Plasma Proteins and Dose Requirements of Tubocurarine
Authors: Shanks C. A. , Penny R. 
Published: January 2019

Two groups, totalling 64 patients, were examined in an attempt to correlate the timed dosage of d-tubocurarine with plasma protein measurements. When dosage requirements were assessed on clinical grounds, three significant correlations emerged, but there were none when neuromuscular response was held at zero. It is suggested that twitch response could be held at a steady level of depression to obtain a time-limited dose of relaxant, enabling dosage comparisons to be made with non-depolarisers.
A Dose-Response Study in Man of the Metabolism of Enflurane Used as a Supplement
Authors: Lowry C. J. , Sharp J. H. , Shumacher J. E. , Cousins M. J. 
Published: January 2019

The metabolism of enflurane, used as a supplement to muscle relaxant and nitrous oxide anaesthesia, was studied in 19 healthy adult male surgical patients; seven control patients received halothane. Patients receiving enflurane were randomly allocated to three groups: Group I—1/2 MAC for 1/2 hour (dosage=1/4 MAC hour) Group II—1/2 MAC for 2 hours (dosage=1 MAC hour) Group III—1/2 MAC for 4 hours (dosage=2 MAC hours) Metabolism of enflurane to inorganic fluoride (F-) was indicated by elevated serum F-concentration and elevated urinary excretion of F-. Peak serum F- concentration was measured in samples collected immediately at the end of enflurane anaesthesia and fell thereafter, approaching pre-operative levels at 48 hours; mean peak serum F- was 23·6± 4·2 μmol/l after 2 MAC hours of enflurane, 17·7±2·8 μmol/l after 1 MAC hour and 10·5± 0·9 μmol/l after 1/4 MAC hour. Nephrotoxic levels of serum F- (50 μmol/l) were not reached in any patient. Post anaesthetic renal function, including response to vasopressin, was normal in all groups. A dose-response relationship between enflurane dose and F- in serum and urine was established.
The Epidemiology and Clinical Features of Anaphylactic Reactions in Anaesthesia
Authors: Fisher M. McD. , More D. G. 
Published: January 2019

Severe anaphylactoid reactions during anaesthesia in 116 patients are described. The majority of patients who reacted to induction agents had previous exposure to the drug, while the majority of patients who reacted to muscle relaxants had not. There was a statistically significant increased incidence of allergy, atopy, asthma and previous reactions in patients who had reactions compared with a control group undergoing uneventful anaesthesia. There was no correlation between abnormalities in immunoglobulins or resting complement levels and a history of allergy or atopy. Antihistamines, steroids and bronchodilators alone did not prevent reactions and three patients reacted to test doses with Althesin. Reactions usually occurred during induction of anaesthesia, but may occur at any time in the perioperative period. No one drug produced reactions that differed in severity or clinical features from any other drug. Clinical features included skin changes, oedema, cardiovascular collapse, bronchospasm, gastrointestinal symptoms, prolonged unconsciousness, convulsions and pulmonary oedema. Four patients died.
Postoperative Vomiting in Children
Authors: Rowley M. P. , Brown T. C. K. 
Published: January 2019

A survey of the frequency of postoperative vomiting in children was conducted over a two-month period. Completed questionnaires were obtained for 1183 patients. The important findings were a lower incidence of vomiting in children under three years of age and a significantly increased incidence of vomiting in patients premedicated with paparveretum and hyoscine. This clinical review highlighted areas where improvements could be made, particularly in the management of patients who vomit frequently. It also provides information which can be used for setting up more detailed controlled studies.
Opiate Anaesthesia
Authors: Stanley T. H. 
Published: January 2019

Current use of opioids in anaesthesia is reviewed with particular emphasis on the use of opioids in anaesthetic doses, techniques that recently have become popular in cardiovascular anaesthesia. A major benefit of opioid anaesthesia (particularly fentanyl) is the cardiovascular stability which obtains during induction and throughout operation, even in patients with severely impaired cardiac function. Anaesthetic doses of morphine are associated with a higher incidence of cardiovascular disturbances and other problems. Pethidine is unsuitable for cardiovascular surgery because of severe haemodynamic disturbances when high doses are given. Sufentanil and alfentanil may prove more suitable alternatives. High doses of opioids can reduce or prevent hormonal and metabolic responses to the stress of surgery. Even very large doses of fentanyl or its new analogues do not prevent marked increases in plasma catecholamine concentrations in response to cardiopulmonary bypass. The reduction in hormonal and metabolic stress response does not appear to continue postoperatively.
Combined Morphine-Bupivacaine Caudals for Reconstructive Penile Surgery in Children: Systemic Absorption of Morphine and Postoperative Analgesia
Authors: Wolf A. R. , Hughes D. , Hobbs A. J. , Prys-Roberts C. 
Published: January 2019

We wished to determine if the addition of a small dose of morphine (0.05 mg.kg−1) to a caudal solution of 0.25% bupivacaine could extend the duration of analgesia after major reconstructive penile surgery and also to measure the systemic absorption of morphine after caudal injection. Thirty children undergoing reconstructive penile surgery received a caudal injection of 0.25% bupivacaine 0.75 ml.kg−1 with or without morphine 0.05 mg.kg−1. All patients awoke pain-free, but eight of the fifteen patients receiving bupivacaine alone required supplementary injections of opioid postoperatively, whereas none of the patients receiving the bupivacaine-morphine mixture required additional opioids. The incidence of side-effects was similar for the two groups. Morphine was absorbed rapidly after caudal injection to reach a peak plasma level of 21.2 (±4.8) ng.ml−1 at ten minutes and then fell to 10.1 (±3.8) ng.ml−1 at one hour and 4.1 (±2.6) ng.mh−1 at three hours. These levels are low compared with plasma levels associated with systemic analgesia. We conclude that the extended duration of analgesia from morphine 0.05 mg/kg given caudally is due at least in part to specific spinal analgesia.
Does Combined Epidural Lignocaine and Fentanyl Provide Better Anaesthesia for ESWL than Lignocaine Alone?
Authors: Cook R. J. , Neerhut R. , Thomas D. G. 
Published: January 2019

The efficacy of epidural fentanyl combined with lignocaine 1.5% with adrenaline 1:200,000 was studied in a randomised, double-blind, controlled trial of two hundred patients undergoing extracorporeal shock wave lithotripsy with or without ancillary procedures. The quality of anaesthesia was assessed using linear analogue pain scores, the patient's impression, and the rate of intra-operative intervention by the anaesthetist. Postoperative symptomatology was also recorded. The only significant difference lay postoperatively in that the fentanyl-ancillary procedure sub-group had less pain approximately one hour postoperatively (P = 0.01). In the context of this study and in the presence of an adequate autonomic and somatic local anaesthetic blockade, the addition of epidural fentanyl does not appear to confer any significant advantage other than to enhance postoperative analgesia.
Fibreoptic Bronchoscopy in the Critically Ill: A Prospective Study of its Diagnostic and Therapeutic Value
Authors: Bellomo R. , Tai E. , Parkin G. 
Published: January 2019

Aim A prospective study was undertaken to assess the diagnostic value and therapeutic usefulness of fibreoptic bronchoscopy in the critically ill. Method Fifty-six bronchoscopies were performed in fifty patients. Biochemical, radiological, microbiological and clinical assessments were made before and after each procedure. Results Eighteen fibreoptic bronchoscopies were performed for therapeutic indications (32.1%) of which ten (55.6%) yielded a useful outcome. Thirty-eight bronchoscopies were for diagnostic purposes (67.8%) of which 22 (5 7.9%) were clinically useful. Broncho-alveolar lavage was performed in twenty-eight cases (50%) and it led to a clinically useful diagnosis in 17 (60.7%). There was no major complication. A subgroup of patients was defined (persistent left lower lobe collapse or consolidation following thoracic or abdominal surgery) in whom fibreoptic bronchoscopy usually did not yield a useful outcome. Conclusion The use of fibreoptic bronchoscopy in the Intensive Care Unit, in combination with the technique of broncho-alveolar lavage, results in a clinically useful outcome in the majority of cases. Fibreoptic bronchoscopy is an effective and safe diagnostic and therapeutic tool in critically ill patients.
Cranial Computed Tomography in the Assessment of Neurological Complications in Critically Ill Patients with Systemic Lupus Erythematosus
Authors: Yang W. T. , Daly B. D. , Li E. K. , Hutchinson R. 
Published: January 2019

The cranial computed tomography findings in 22 critically ill patients with systemic lupus erythematosus in the intensive care unit were reviewed to document the spectrum of pathology encountered and to assess the contribution of cranial computed tomography to the diagnosis and management of such patients, many of whom had severe multisystem disease. Thirty-one scans were performed in 22 patients, all of which were abnormal. Premature cerebral atrophy was identified in fifteen patients (68%), cerebral infarction in five (23 %), intracranial haemorrhage and cerebral oedema in four each (18%), and hydrocephalus in three (14%). Six patients had multiple pathologies. The cranial computed tomography findings confirmed the clinical diagnosis in 13 of 22 cases (59%) and altered it in nine (41%). The contribution to diagnosis and management justifies transportation and computed tomography scanning. The contribution to patient outcome, however, is uncertain as mortality was 91%.
End-Tidal Oxygen Measurement Compared with Patient Factor Assessment for Determining Preoxygenation Time
Authors: Machlin H. A. , Myles P. S. , Berry C. B. , Butler P. J. , Story D. A. , Heath B. J. 
Published: January 2019

Time to adequate preoxygenation was assessed in 200 elective surgical patients, using measurement of end-tidal oxygen concentration. A variety of patient factors were assessed as to their ability to predict the time required to preoxygenate a patient. Of the 200 patients, 23 (11.5%) were unable to be adequately preoxygenated; most of these cases were due to a poor mask fit. The average time for preoxygenation was 154 seconds (range 43–364 seconds). Of those patients who could be preoxygenated, 46 (23%) required more than three minutes. Although a regression equation could be constructed to calculate time required for preoxygenation, the wide standard errors of the coefficients preclude a clinically useful predictive equation. We thus found that we could not accurately predict time required for preoxygenation and that a routine three minutes preoxygenation may not be sufficient for many patients. However, the measurement of end-tidal oxygen concentration is a very useful method of determining the end-point for preoxygenation.
A Study of a Hospital Staff's Knowledge of Pulse Oximetry
Authors: Kruger P. S. , Longden P. J. 
Published: January 2019

A selection of medical and nursing staff and anaesthetic technicians at work on a particular day at a regional Base Hospital were invited to complete a questionnaire to assess their knowledge of the principles of pulse oximetry. A 98.5% response rate (203 respondents) was achieved from staff in a broad cross section of hospital wards participating in the study. Most of the participants (nursing [N] 87%, medical [M] 91%, anaesthetic technicians [AT] 100%) used pulse oximetry regularly in their daily work. Less than half of the participants (N 36%, M 48% and AT 50%) felt they had adequate training in the use of pulse oximetry. Only 68.5% of participants correctly stated what pulse oximeters measure. Answers to the questions regarding the principles of pulse oximetry, potential errors, normal ranges or the physiology of oxygen haemoglobin dissociation varied but generally reflected limited understanding. As the use of pulse oximeters extends beyond the operating theatre and intensive care environment, appropriate staff education must ensure a basic understanding of the operating principles of the instrument.
Anaesthesia Workforce in Australia and New Zealand
Authors: Baker A. B. 
Published: January 2019

A survey of anaesthetic workforce was undertaken in departments in Australia and New Zealand approved for specialist training by the Australian and New Zealand College of Anaesthetists. When compared to a previous survey 17 years before, the results showed that the number of anaesthetics administered rose, the number of operating theatres (OTs) remained the same, but the surgical beds were reduced. There was a small increase (20%) in full-time specialists with a number of vacancies in establishment. There was, however, a large increase (80%) in Visiting Medical Officer (VMO) sessions and a 40% increase in Registrar positions. At the same time there were very large increases in Recovery Room nurses (125%) and Anaesthetic Assistants (100%). From this survey and other recent government workforce reports it is possible to derive certain workforce postulates—a specialist anaesthetist will on average anaesthetize approximately 1000 patients per annum, one in every nine people in the population will have an anaesthetic each year, and the working lifespan of a specialist anaesthetist is 30 years with 5% working half-time or less. All of this suggests that the correct Anaesthetists to Population Ratio (APR) should be reset to 1:8,500 for both Australia and New Zealand. The number of trainees required to supply a steady state replacement for this specialist workforce is also derived and the current number of training positions is shown to be in excess of these requirements. When the current shortfall in specialist anaesthetists is corrected there will need to be a gradual reduction (by approximately 40%) in the number of training positions to prevent an oversupply of anaesthetists. The factors which may potentially alter this forecast are addressed and include: change in the general population; ageing of the population; change in the average number of anaesthetics administered per anaesthetist per year; alteration in anaesthetists’ working lifespan; change in the age distribution of anaesthetists; increased economic usage of operating theatres and changes in the number of College approved training positions.
Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Lumbar Epidural Anaesthesia for Lower Limb Orthopaedic Surgery
Authors: McGlade D. P. , Kalpokas M. V. , Mooney P. H. , Buckland M. R. , Vallipuram S. K. , Hendrata M. V. , Torda T. A. 
Published: January 2019

The purpose of this study was to compare the epidural use of 0.5% ropivacaine and 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgery. In a double-blind, randomized, multi-centre study involving 67 patients, thirty-two patients received 20 ml of 0.5% ropivacaine and 35 patients received 20 ml of 0.5% bupivacaine at the L2,3 or L3,4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Four patients (3 ropivacaine, 1 bupivacaine) were excluded from the study due to technical failure of the block. The onset and duration of analgesia at the T10 dermatome (median, interquartile range) was 10 (5-15) minutes and 3.5 (2.7-4.3) hours respectively for ropivacaine, and was 10 (6-15) minutes and 3.4 (2.5-3.8) hours respectively for bupivacaine. Maximum block height (median, range) was T6 (T2-T12) for ropivacaine and T6 (C7-T10) for bupivacaine. Nine patients receiving ropivacaine and eight patients receiving bupivacaine developed no apparent motor block. The incidence of complete motor block (Bromage grade 3) was low in both groups, being 4/27 for ropivacaine and 6/34 for bupivacaine. In the ropivacaine group, motor and sensory block were judged to be satisfactory in 78% of patients. In the bupivacaine group, motor and sensory block were judged to be satisfactory in 71% and 62% of patients respectively. Cardiovascular changes were similar in both groups. No statistical differences were found between the two groups regarding any of the study parameters.
Rupert Walter Hornabrook—Australia's First Full-Time Anaesthetist
Authors: Pemberton E. J. 
Published: January 2019

Rupert Walter Hornabrook, born in 1871, was the first physician in Australia to devote his medical practice solely to anaesthesia. He was appointed to the Royal Melbourne Hospital in 1909, after an adventurous earlier career which ranged from service in plague hospitals in India to the Boer War in South Africa. Hornabrook was a colourful character whose work in anaesthesia included popularizing the use of the ethyl chloride-ether sequence in the early 1900s, when chloroform and closed inhalers were the norm. He was also a vigorous campaigner for the recognition of anaesthesia as a branch of medicine in its own right.