bluuebunny/crossref_metadata_2025_split huggingface dataset:
Massive Intraoperative Pulmonary Embolism: It may not be as Bad as it Looks …
Authors: Forrest A. P. , Sutton B. 
Published: January 2019

An elderly patient suffered a cardiac arrest while undergoing repair of a pathological femoral fracture. Intraoperative transoesophageal echocardiography demonstrated massive pulmonary embolism. Pulmonary embolectomy was considered inappropriate in view of her underlying terminal disease, so a decision was made to withdraw all further supportive measures. Despite this, the patient's haemodynamics improved spontaneously. The embolic material was presumed to be bone marrow fat. Fat may traverse the pulmonary circulation; hence the clinical consequences (and management implications) of massive intraoperative pulmonary embolism may vary, depending on the composition of the embolic material. As there are no reliable means of determining the composition of embolic material intraoperatively, the clinical suspicion of fat embolism poses a management dilemma. Should these cases be managed surgically or conservatively?
Talc-induced Interstitial Pneumonitis with Respiratory Failure
Authors: Griffo S. , Musumeci A. , De Luca G. , Saccenti A. , Grande L. M. , Stassano P. 
Published: January 2019

Talc is the most frequently used chemical agent to induce pleurodesis and complications after this procedure, usually benign and self-limiting, are resolved easily. Pneumonitis with acute respiratory distress after talc pleurodesis is a rare complication, it requires intensive treatment and may be fatal. We describe a patient who developed pneumonitis with bilateral interstitial infiltrates and respiratory distress after talc pleurodesis. This complication required the transfer of the patient into the intensive care unit and an aggressive treatment management. After an uneventful talc pleurodesis, close surweillance of the patient and a high index of suspicion are mandatory.
The Effects of Dexmedetomidine and Fentanyl on Emergence Characteristics after Adenoidectomy in Children
Authors: Erdil F. , Demirbilek S. , Begec Z. , Ozturk E. , Ulger M. H. , Ersoy M. O. 
Published: January 2019

This randomised controlled study evaluated the effects of fentanyl and dexmedetomidine on emergence characteristics of children having adenoidectomy and anaesthetised with sevoflurane. Ninety children, two to seven years of age and ASA physical status I, were studied. Children were randomly assigned to one of three groups of 30 children, with the study intervention injection given intravenously after intubation. Children in Group F received fentanyl 2.5 μg.kg−1 children in Group D received dexmedetomidine 0.5 μg.kg−1 and children in Group C received saline solution. Anaesthesia was induced with 50% N2O and 8% sevoflurane in O2 by mask and atracurium 0.6 mg.kg−1 was administered for tracheal intubation. All children received paracetamol 40 mg/kg rectally one hour preoperatively and dexamethasone 0.5 mg.kg−1 intravenously. The time to extubation was shorter in Group D than Group F. The eye-opening time was longer in Group F (16.1∓5.3 minutes) than in Groups C (12.0∓4.2 minutes) and D (12.7∓3.2 minutes). The proportion of pain-free children in early recovery was significantly higher in Groups D (47%) and F (43%) than Group C (13%) (P <0.05). The proportion of children with agitation scores >3 was lower in Groups D 17% (5/30) and F 13% (4130) than in Group C 47% (14/30) (P <0.05). Fentanyl 2.5 μg.kg−1 and dexmedetomidine 0.5 μg.kg−1 had similar haemodynamic effects and emergence characteristics. Fentanyl has been safely used in children for many years. Further studies of dexmedetomidine safety and its interaction with other anaesthetic agents are required before recommending its routine use during general anaesthesia in children.
Web-Based Formative Assessment Case Studies: Role in a Final Year Medicine Two-Week Anaesthesia Course
Authors: Critchley L. A. H. , Kumta S. M. , Ware J. , Wong J. W. 
Published: January 2019

Formative Assessment Case Studies (FACS) are an e-learning resource consisting of a case scenario punctuated with decision-making steps (multiple-choice questions) and feedback for wrong answers. FACS was developed to enhance clinical decision-making skills. We wrote six FACS scenarios covering preoperative assessment topics and made them accessible to 149 final year medical students as part of their two-week anaesthesia module. A data management system recorded usage and performance by each student. Eighty-one percent of students attempted FACS (six cases 53%, five cases 17%, one to four cases 9%) and 61 to 70% completed all steps. On average FACS was attempted 1.5 times. Students required 44 to 95% more steps than the minimum to complete each case. There were two patterns of use: some students completed the cases within five to seven minutes (first quartile) focusing on the questions, while others spent over 22 to 35 minutes (fourth quartile) exploring the FACS and feedback. FACS usage correlated (r2=0.32: P <0.01) with written case report marks. The students’ evaluation of FACS was high. FACS is an e-learning resource that is interactive and facilitates higher learning. It can be applied successfully to disciplines less well represented in the medical curriculum, such as anaesthesia. FACS facilitated our teaching of preoperative assessment to a group of final year medical students. It was well received and shown to facilitate the learning of decision-making skills. The students’ usage of FACS could have been enhanced by making FACS compulsory and using summative FACS for assessment.
A Comparison of Transcutaneous Doppler Corrected Flow Time, B-Type Natriuretic Peptide and Central venous Pressure as Predictors of Fluid Responsiveness in Septic Shock: A Preliminary Evaluation.
Authors: Sturgess D. J. , Pascoe R. L. S. , Scalia G. , Venkatesh B. 
Published: January 2019

Aortic corrected flow time (FTc) is easily measured by Doppler techniques. Recent data using transoesophageal Doppler suggest that it may predict fluid responsiveness in critical care. This use of FTc has not previously been evaluated in septic shock, nor have any studies incorporated transcutaneously measured FTc. Furthermore, no comparison has been made between FTc, plasma B-type natriuretic peptide concentration (BNP) or central venous pressure. The aim of this preliminary study was to compare FTc, BNP and central venous pressure as predictors of fluid responsiveness in septic shock patients without cardiac dysrhythmia. This was a prospective study of 10 consecutive adult septic shock patients (in sinus rhythm; 60% mechanically ventilated) treated with intravenous fluid challenge (4% albumin 250 ml over 15 minutes) in a mixed medical/surgical tertiary intensive care unit. Mean ± SD Acute Physiological and Chronic Health Evaluation II score was 21.8±12.7. Haemodynamic assessment incorporating transcutaneous aortic Doppler (USCOM®) occurred before and five minutes after fluid challenge. Concurrent with initial assessment, blood samples were collected for BNP assay (ADIVA Centaur®). Four patients demonstrated an increase in stroke volume ≥15% (responders). Percent change in stroke volume strongly correlated with baseline FTc (r=-0.81, P=0.004) but not BNP (r=-0.3, P=0.4) or central venous pressure (r=-0.4, P=0.2). Baseline FTc <350 ms discriminated responders from non-responders (P=0.047). Our data support FTc as a better predictor of fluid responsiveness than either BNP or central venous pressure in septic shock. Transcutaneous aortic Doppler FTc offers promise as a simple, completely non-invasive predictor of fluid responsiveness and should be evaluated further.
Accuracy of Weight and Height Estimation in an Intensive Care Unit
Authors: Maskin L. P. , Attie S. , Setten M. , Rodriguez P. O. , Bonelli I. , Stryjewski M. E. , Valentini R. 
Published: January 2019

We report the findings from a prospective study determining the magnitude of errors in the visual estimation of weight and height of critically ill patients. Forty-two consecutive patients were weighed by a physician with a calibrated stretcher scale and length measured with a steel measuring tape. The predicted body weight was calculated using the ARDSnet formulae. Attending physicians and nurses were asked to estimate patient's actual weight, predicted weight and height. The average percent errors in estimation of actual and predicted weight were 11.4 and 14.6%, respectively. Errors greater than 20% in patient's actual and predicted weight were observed in 15 and 24% of cases, respectively. The majority of height estimations (86%) had an error <10%. There were non-significant differences between the estimations made by intensive care unit physicians and nurses. Our study shows that estimations of patient's weight made by intensive care unit staff are often inaccurate. In contrast, estimations of height made by intensive care unit staff are usually adequate. Estimated body weight of critically ill patients has implications for drug and respiratory therapy and should be used with caution.
A Comparison of Low dose Hyperbaric Levobupivacaine and Hypobaric Levobupivacaine in Unilateral Spinal Anaesthesia
Authors: Kaya M. , Öztürk İ. , Tuncel G. , Şenel G. Özalp , Eskiçirak H. , Kadioĝullari N. 
Published: January 2019

The aim of this study was to compare the clinical effects and characteristics of hyperbaric and hypobaric levobupivacaine for unilateral spinal anaesthesia. Sixty patients were randomly allocated into two groups to receive either 7.5 mg (1.5 ml) hyperbaric levobupivacaine 0.5% or 7.5 mg (4 ml) hypobaric levobupivacaine 0.1875% for elective arthroscopic surgery of the knee under spinal anaesthesia. The level and duration of sensory block, intensity and duration of motor block were recorded. Unilateral sensory block was observed in 27 patients (90%) in the hyperbaric group and 24 patients (80%) in the hypobaric group in the lateral position. After 15 minutes, patients were turned to supine to redistribute the spinal block toward the non-operative side, but spinal anaesthesia was still unilateral in 18 patients (60%) in the hyperbaric group and 10 patients (33%) in the hypobaric group (P=0.038). Time to readiness for home discharge and complete recovery of sensory block were similar in both groups. In the hyperbaric group, the motor block scores were higher on the operative side during first 10 minutes than they were in the hypobaric group (P <0.002). Motor block regression was faster in the hyperbaric group (P=0.01). Hyperbaric and hypobaric levobupivacaine both provided satisfactory unilateral spinal anaesthesia with good haemodynamic stability for arthroscopic surgery, but with more frequent unilateral spinal anaesthesia in the hyperbaric group.
A Comparison of Electronic and Handwritten Anaesthetic Records for Completeness of Information
Authors: Wrightson W. A. G. 
Published: January 2019

Complete documentation in anaesthetic records is important for patient management, research and quality assurance and has medicolegal implications. This study compares the completeness of information contained in electronic versus handwritten intraoperative anaesthetic records. A sample of 70 handwritten records was randomly selected from anaesthesia performed in the month prior to implementation of the Integrated Injectable Drug Administration and Automated Anaesthesia Record System and compared to a similar sample of electronic records generated eight months later. A comprehensive scoring system, based on the Australian and New Zealand College of Anaesthetists’ guideline PS6, was used to compare the completeness of information throughout the entire intraoperative record. There was no significant difference in the total score for completeness between electronic (78%) and handwritten (83%) records (P=0.16). Handwritten records were more complete with respect to weight (P <0.0001), American Society of Anesthesiologists’ physical status score (P <0.0001), the size and type of artificial airway used (P=0.003) and a record of the surgeons involved (P=0.0004). Electronic records were more complete with respect to a record of drug administration including intravenous drugs (P <0.0001), vapour (P=0.0001) and nitrous oxide/oxygen (P <0.0001), a record of end-tidal carbon dioxide monitoring (P=0.006) and the level of trainee supervision (P=0.0002). There was no overall difference in the completeness of electronic versus handwritten records. Several differences did exist however, highlighting both clinically important advantages and deficiencies in the electronic system. Records from both systems sometimes lacked important information.
Accuracy of Recorded Body Temperature of Critically Ill Patients Related to Measurement Site: A Prospective Observational Study
Authors: Nonose Y. , Sato Y. , Kabayama H. , Arisawa A. , Onodera M. , Imanaka H. , Nishimura M. 
Published: January 2019

Accurate measurement of body temperature is an important indicator of the status of critically ill patients and is therefore essential. While axillary temperature is not considered accurate, it is still the conventional method of measurement in Asian intensive care units. There is uncertainty about the accuracy of thermometers for the critically ill. We compared the accuracy and precision of bladder, axillary and tympanic temperature measurements in critically ill patients. A total of 73 critically ill patients admitted to the intensive care unit of a teaching hospital were prospectively enrolled. Every four hours, we measured body temperature at three sites (bladder, axillary and tympanic). If the patient had received an indwelling pulmonary artery catheter, blood temperature was also recorded and this was compared with bladder, axillary and tympanic temperature readings. For all patients, axillary and tympanic temperature readings were compared with bladder temperature readings. Accuracy and precision were analysed using Bland-Altman analysis. When blood temperature data was available, the mean difference between blood and bladder temperature readings was small (0.02±0.21°C). Compared with bladder temperature, mean difference for axillary temperature was −0.33±0.55°C and for tympanic temperature it was −0.51±1.02°C. For critically ill patients, recorded axillary temperature was closer to bladder temperature than tympanic temperature.
Wrong Gas Connections
Authors: Hood John W. 
Published: January 2019

Gas-driven ventilators are being increasingly used in anaesthesia. Industrial type fittings are commonly used at various points in the gas lines that drive these ventilators. These fittings do not have the Pin Index or the Diameter Index. They allow the possibility of the oxygen hose connected to a Boyle apparatus accidentally supplying a gas other than oxygen. These potentially dangerous fittings are discussed, methods of modifying them suggested, and a new alternative adaptor described.
The Fat Embolism Syndrome Treated with Oxygen, Diuretics, Sodium Restriction and Spontaneous Ventilation
Authors: Worthley L. I. G. , Fisher M. McD. 
Published: January 2019

The fat embolism syndrome is a self limiting disease with its mortality related to the degree of respiratory failure. Treatment therefore is directed at maintaining satisfactory pulmonary gas exchange throughout the course of the disease. In 28 consecutive patients diagnosed with fat embolism syndrome and severe respiratory failure, therapy consisted of oxygen, diuretics, sodium restriction and a trial of spontaneous ventilation. There was no mortality.
Perioperative Management of Neonatal Aortic Isthmic Coarctation
Authors: Jones R. D. M. , Duncan A. E. , Mee R. B. B. 
Published: January 2019

Aortic isthmic coarctation is a common cardiovascular cause of neonatal mortality. This study reviews retrospectively sixty-one consecutive neonates operated on for this condition at the Royal Children's Hospital, Melbourne, in the years 1978-1983 inclusive. In this series, the overall mortality has fallen from 50% and 67% in 1978 and 1979 respectively, to 11% in 1983. In the last three years of this review, there have been no early hospital deaths and the late deaths relate to associated congenital anomalies. The decrease in mortality is ascribed to methods of perioperative support, non-invasive cardiac investigation, and surgical repair with subclavian aortoplasty. Prior to surgery, all infants are paralysed, mechanically ventilated and infused with prostaglandin E1 to reopen the ductus arteriosus, and dopamine to support the failing myocardium. The physical status of all infants improved with these maneouvres. This paper reviews the pathophysiology of neonatal aortic coarctation, the current modes of management, results and complications.
New Generation Ventilators
Authors: Bersten A. D. , Skowronski G. A. , Oh T. E. 
Published: January 2019

Desirable features of new generation intensive care ventilators include the ability to ventilate a wide range of patient sizes, an uncomplicated control panel, an appropriate but not excessive variety of ventilatory patterns, adequate patient monitoring and alarm functions, and simplicity of cleaning and routine maintenance. Examples of currently available ventilators include the Servo 900-C, CPU-1, Engstrom Erica, Bear 5, Drager EV-A and Hamilton Veolar. The incorporation of microcomputer control into some of these ventilators has resulted in improved flexibility and a limited number of automatic responses to detected patient changes. However, the function of components provided to allow spontaneous ventilation, such as demand valves, requires considerable improvement. Current trends in ventilator design include further refinement of computer control and the provision of graphic displays showing the results of continuous sophisticated analysis of respiratory function. The extent to which these developments will prove clinically useful will require careful evaluation.
In-Hospital Cardiopulmonary Resuscitation: Prospective Survey of Management and Outcome
Authors: Woog R. H. , Torzillo P. J. 
Published: January 2019

A sixteen-month prospective survey of in-hospital cardiac arrests indicated that of 168 patients who received cardiopulmonary resuscitation, 27(16%) survived to leave hospital. Ninety-three per cent of these patients were ambulant and 81 % were able to care for themselves. Poorest outcome was associated with initial rhythm of asystole, prolonged resuscitation and arrest in the Intensive Care Units. When compared with recent and past literature, these figures suggest that the incidence of successful outcome for cardiopulmonary resuscitation in hospitals has not changed significantly over the past twenty years.
The Functional Deadspace of Needle-free Injection Ports
Authors: Smart N. G. 
Published: January 2019

This study examined six needle-free injection ports comprising three taps (Sorenson Intralock®, Top type L, Viggo Connecta®), a one-way valve (Braun RV 1000) and two cannulae with integral injection ports (Vasofix, Venflon® 2) with regard to deadspace, protection against blood spillage, and potential difficulties in use. A conventional bung (Baxter), requiring needle use for drug administration, was included for comparison. Where necessary, ports were combined with cannulae in order to simulate clinical practice and allow fair comparison with the Vasofix and Venflon cannulae. Total deadspace was then calculated by filling with normal saline and measuring weight increase. Deadspace (0.10 to 0.43 ml) varied with injection port type and cannula size. Such volumes can contain significant amounts of drug and may be hazardous if not flushed after injection. Only the Vasofix and Venflon Cannulae and the Braun RV1000 protected adequately against blood spillage. Costs varied widely (A$0.19 to A$2.20 excluding cannula). The Vasofix and Venflon 2 cannulae were found to be nearest the ideal.
Diclofenac in Combination with Opiate Infusion after Joint Replacement Surgery
Authors: Anderson S. K. , Shaikh B. A. Al 
Published: January 2019

The effect of intramuscular diclofenac or placebo on analgesia obtained and on opiate and antiemetic requirements was observed in a randomised double-blind study of sixty patients receiving continuous intravenous papaveretum. Those patients receiving diclofenac required less papaveretum (P = 0.001) than those receiving placebo. They also had lower visual analogue pain scores (VAS) at four hours (P < 0.05) and decreased requirement for antiemetics (P < 0.02). No gastrointestinal complications were observed in either group and blood loss did not differ significantly between the two.
Estimation of Cardiac Output by Noninvasive Echocardiographic Techniques in the Critically Ill Subject
Authors: McLean A. S. , Needham A. , Stewart D. , Parkin R. 
Published: January 2019

We evaluated the accuracy of cardiac output estimations by three transthoracic echocardiographic techniques in critically ill subjects. This study was a prospective comparison study carried out in a general intensive care unit of a teaching hospital. The subjects had a broad range of diagnoses including pulmonary embolus, cardiogenic shock, septic shock, Legionnaire's disease and perioperative myocardial infarction. All patients requiring pulmonary artery catheterization underwent echocardiographic cardiac assessment with comparison of findings to those obtained by thermodilution techniques. Nineteen studies on eighteen patients were performed, with cardiac output calculated by the two-chamber Simpson's, four-chamber Simpson's, and left ventricular outflow tract (LVOT) Doppler methods. Acceptable data was obtained in those patients without mitral regurgitation. There was good correlation between the thermodilution technique and Simpson's two-chamber method (r=0.91), but less so with the Simpson's four-chamber method (r=0.77). All studies were included in the LVOT Doppler method with a good correlation (r=0.94). A plot of differences between methods using the Bland and Altman statistical method indicated that only the LVOT Doppler method demonstrated acceptable agreement with a mean of 0.2 litres/minute, standard deviation of 0.82 litres/minute and 95% limits of agreement of –1.5 to +1.9 litres/minute. We concluded that the LVOT Doppler method was the only one which demonstrated acceptable agreement between the thermodilution method and echocardiographic techniques in all critically ill patients studied.
Propofol-Thiopentone Admixture—Hypnotic Dose, Pain on Injection and Effect on Blood Pressure
Authors: Jones D. , Prankerd R. , Lang C. , Chilvers M. , Bignell S. , Short T. 
Published: January 2019

This study examined some pharmacodynamic characteristics of two admixtures of propofol and thiopentone. Ninety unpremedicated ASA 1 or 2 patients were group-randomized to receive, in a double-blinded manner, one of the following mixtures for induction of anaesthesia: Group P50: propofol 1% 10ml/thiopentone 2.5% 10 ml; Group P75: propofol 1% 15 ml/thiopentone 2.5% 5 ml; Group P100: propofol 1% 20 ml/lignocaine 1% 4 ml. An additional 30 randomized but unblinded patients from the same patient cohort received thiopentone 2.5% to provide predictive dose data for groups P50 and P75. Haemodynamic data were collected pre- and post-induction. The required induction dose of both mixtures of propofol and thiopentone found an additive rather than a synergistic interaction with no significant difference between predicted and observed dose. Thiopentone resulted in significantly more rapid induction of anaesthesia than propofol/lignocaine or propofol/thiopentone. The addition of thiopentone to propofol was found to be as efficacious as the mixing of lignocaine with propofol in reducing pain on injection. The fall in systolic blood pressure was significantly less in group P50 compared with groups P75 or P100. Admixture of thiopentone with propofol results in an additive hypnotic effect, a reduction in pain of injection (comparable with addition of lignocaine) and a reduced hypotensive response compared to propofol injection alone during induction.