bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatotoxicity and Halothane Metabolism in an Animal Model with Application for Human Toxicity
Authors: Cousins Michael J. , Sharp J. Howard , Gourlay Geoffrey K. , Adams John F. , Haynes W. David , Whitehead Richard 
Published: January 2019

Centrilobular necrosis and a ten-fold elevation in serum alanine amino-transferase (ALT) consistently followed 2 hours of 1% halothane anaesthesia in an animal model. Conditional factors were the presence of enzyme induction and moderate hypoxia (14% oxygen), indicating an association between reductive metabolism and hepatotoxicity. Under these conditions there was at least a four-fold increase in reductive metabolites detected in the exhaled air. In clinical studies, reductive metabolites were also detected in the exhaled air of all patients examined, even after halothane anaesthesia with 100% oxygen. The amounts of reductive metabolites were comparable in man and the model, following equivalent halothane doses. It appears that a model with a similar route and rate of halothane biotransformation to man has been identified. The lesion of halothane hepatotoxicity in this model appears to be similar to that reported in man — centrilobular hepatic necrosis.
Adverse Effects of Plasma Volume Expanders
Authors: Isbister James P. , Fisher Malcolm Mcd. 
Published: January 2019

Plasma protein solutions and synthetic plasma substitutes have an established role in therapy in many areas of clinical medicine. Although there have been many advances in the field of plasma volume expanders, an effective, stable, readily available and economical solution, free from side effects remains elusive. In particular, all plasma volume expanders may be associated with a small, but significant incidence of side effects. Allergic and anaphylactoid reactions are the most feared, but questions about prolonged storage and effects on haemostasis and renal function should be considered. Plasma protein fraction may be associated with hypotension, probably due to kinin activation. In the fully conscious patient, features of vasodilatation including flushing, fullness in the head, nasal stuffiness, may also be noted. There have also been reports of true anaphylactic type reactions occurring in atopic subjects after the infusion of small amounts of plasma protein solution. Modified fluid gelatins are well known to release histamine when infused rapidly. The reactions are usually confined to the skin and present clinically as pruritis, urticaria or flushing. There are also reports of anaphylactic reactions not related to dosage which are probably immune in origin. The dextrans are well recognised to cause such anaphylactoid reactions. Accepting that anaphylactoid and anaphylactic reactions may occur in association with plasma volume expanders, anticipation, diagnosis and rapid institution of therapy determine the outcome of these reactions.
Microfiltration of Stored Blood
Authors: Loong E. D. 
Published: January 2019

Microaggregates begin to develop within a few hours of storage of blood in plastic or glass containers, but their numbers increase mainly towards the end of the first week. They include degenerated platelets, leucocytes, fibrin strands, denatured proteins and fragmented red cells, and range in size from 10 to 40 μm or more in diameter. The rate of formation is related to the platelet and leucocyte concentrations prior to storage and the anticoagulant used. While clinical and experimental evidence of deleterious pulmonary effects of these unwanted particles has been limited and contradictory, recent studies have demonstrated that significant increases in pulmonary arteriovenous shunting and alveolar-arterial oxygen differences occur in patients transfused more than 20% of their blood volume through the standard 170 μm filters. These changes are not seen when the blood is passed through a 20 μm Dacron wool filter. Other methods of reducing the microaggregate content of transfused blood include the use of fresh blood (less than 2 days), glycerol-frozen fresh blood correctly thawed, or saline-washed packed red cells. Since none of these is feasible for routine use at present, removal by microfiltration prior to transfusion is employed. Of the filters currently available, the 40 μm screen filters appear to offer important practical advantages over the alternative depth filters. Routine filtration of all stored blood transfused is advocated.
Pharmacology of Pain and Analgesia
Authors: Wilson Peter R. , Yaksh Tony L. 
Published: January 2019

Physiological events involved in nociception and pain perception are examined. Substance P could be a primary afferent transmitter of certain nociceptive information. Transmission of this information can be modulated within the spinal cord by intrinsic and descending mechanisms. The intrinsic mechanism involves inhibitory opiate effects within substantia gelatinosa. Centres for descending systems are located in medulla and periaqueductal gray matter. They are activated by exogenous narcotic agonists, and by regional connections. Descending inhibitory pathways are serotonergic and noradrenergic. GABA and glycine are also possibly involved in antinociception. Narcotics have been shown to produce analgesia when administered to the intrathecal or epidural spaces of humans. These routes are still experimental. The place of clinical modification of transmitter system is discussed, but no conclusions or recommendations can be made at this early stage.
Atrax Robustus Envenomation
Authors: Fisher M. McD. , Carr G. A. , McGuinness R. , Warden J. C. 
Published: January 2019

Two patients who developed massive pulmonary oedema, profound vasoconstriction and hypertension followed by hypotension after Atrax Robustus envenomation are described. The pulmonary oedema is due to increased pulmonary capillary membrane permeability which may be due to neurogenic or toxic causes. Use of artificial ventilation with high level PEEP, isoprenaline and high dose steroids allowed support of the patients during volume replacement with albumin. When the circulation was stable and airway frothing ceased, conventional dehydration therapy further improved lung function. Both patients were discharged well.
Predisposing Factors in Anaphylactoid Reactions to Anaesthetic Drugs in an Australian Population: The Role of Allergy, Atopy and Previous Anaesthesia
Authors: Laforest M. , More D. , Fisher M. 
Published: January 2019

One thousand patients undergoing anaesthesia in an Australian hospital were assessed by questionnaire to determine the incidence of previous anaesthesia, allergy and atopy. The patients were compared with a British group and with 85 patients who had life-threatening anaphylactoid reactions. The Australian and British groups were not significantly different. The Australian patients who had reactions showed a higher incidence of allergy, atopy, asthma and previous adverse reactions than the general population. The incidence was higher in females than males. Although the incidence is higher in the group of patients who reacted, the incidence is not sufficiently great to make pretreatment of patients with a history of allergy or atopy a reasonable prophylactic manoeuvre.
Initial Assessment of Acute Haemorrhage
Authors: More David G. 
Published: January 2019

The assessment of the patient with acute blood loss may be conveniently divided into three phases. The first involves the recognition that acute blood loss has occurred. Further assessment of the site and magnitude of the blood loss will continue in parallel with resuscitation. The second phase of the assessment is the localising of the source or sources of bleeding to allow for control of continuing loss and to plan definitive therapy for the control of ongoing haemorrhage if necessary. The third phase of assessment is to estimate the quantity of blood and fluid loss to allow for the rational planning of resuscitation. The third phase is divided into two sections: the first is the initial assessment of the magnitude of the loss, the second the ongoing assessment of the patient's status as resuscitation proceeds. Successful resuscitation depends on repeated assessment of the patient while treatment proceeds.
Muscle Strength following Anaesthesia with Atracurium and Pancuronium
Authors: O'Connor M. , Russell W. J. 
Published: January 2019

Postoperative recovery from muscle weakness was investigated by handgrip strength after general anaesthesia using short- and long-acting muscle relaxants. Handgrip strength was measured on four occasions, preoperatively, before and after premedication, and postoperatively, both as soon as the patient could sustain a five-second headlift and one hour later. Twenty patients received either atracurium 0.6 mg/kg or pancuronium 0.1 mg/kg as part of a general anaesthetic technique with neostigmine reversal. Compared with their initial preoperative hand strengths, the two relaxant groups showed only an insignificant decrease in grip strength to 92% after premedication. Postoperatively when a five-second headlift was achieved, the patients in both groups were weak. The group given atracurium had a mean of 60% of their initial grip strength and those given pancuronium had a mean of 44%. This difference in strength was statistically significant from the initial level and from each other. However, there was no difference between the groups in the time interval from administering reversal to achieving a sustained headlift. One hour later in both groups grip strength was much better, within 80% of that seen after premedication in most patients, and no significant difference in grip strength was seen between the groups. This study demonstrates that patients who receive relaxant anaesthesia have substantial muscle weakness in the recovery phase. When neostigmine reversal is used, pancuronium appears to have a similar return of voluntary muscle power to that seen with atracurium. The marked difference in elimination kinetics of these two relaxants seems to be of little importance when neostigmine reversal is used.
A Study of the Clinical Usefulness of Dobutamine Administered Orally
Authors: Noda Y. , Yazaki S. , Suzuki H. , Shibanoki S. , Ishikawa K. 
Published: January 2019

Dobutamine 300 mg was administered orally to both healthy volunteers and to patients with circulatory failure. After the 300 mg dose of dobutamine, subjects were found to have a higher concentration of the drug in their plasma than the effective levels of 37.5 (SD 2.9) ng/ml (n = 5) normally seen during intravenous infusion of the clinically effective (5 μg/kg/min) dose. This increased concentration waned within 90 minutes. A clinical effect of dobutamine on the circulation was observed in both the healthy volunteers and the patients. An increase in the cardiac index of the patients continued longer than 90 minutes. An unidentified substance was noticed on chromatography measuring plasma dobutamine concentrations, which may have contributed to the increased cardiac index, although its chemical formula could not be determined. The results suggest that the oral administration of dobutamine may be expected to have a long-lasting and significant therapeutic effect on patients with chronic circulatory failure.
The Cytokine Network in the Critically Ill
Authors: Bellomo R. 
Published: January 2019

There is increasing experimental and clinical evidence that a number of cytokines play a major role in the response to injury and infection and in the development of organ damage in critically ill patients. Tumour necrosis factor (TNF) is now proposed to be a key mediator of organ injury during sepsis. It is elevated early in the course of septic shock and high levels correlate with unfavourable outcome. In animals it can produce the effects of endotoxin. The prophylactic administration of anti-TNF antisera protects mice and rabbits from lethal effects of lipopolysaccharide. Interleukin-1 (IL-1) is an endogenous pyrogen which induces leukocytosis and muscle catabolism. It causes hypotension and tachycardia by reducing smooth muscle contractility. IL-1 receptor blockers have been shown to diminish mortality in experimental endotoxic shock. Interleukin-6 (IL-6) is a pyrogen and lymphocyte activator. It is the major stimulus to acute phase protein production by the liver. A recently described neutrophil-activating peptide (Interleukin-8; IL-8) may be involved in the pathogenesis of ARDS. High blood levels of IL-8 have been found in patients with septic shock. Platelet-derived growth factor (PDGF) has been shown to stimulate TNF production, leukocyte chemotaxis and pulmonary vasoconstriction in response to endotoxin. Other cytokines and growth factors have not yet been studied in critical illness. The cytokine network can be either protective or damaging. Its activation during critical illness triggers complex and still poorly understood interactions. A better comprehension of its role in protection from infection and in the pathogenesis of multiple organ failure may allow therapeutic manipulations aimed at minimising adverse effects while retaining immunological protection.
Plasma Catecholamine Levels following Topical Application versus Infiltration of Adrenaline for Nasal Surgery
Authors: van Hasselt C. A. , Low J. M. , Waldron J. , Gibb A. G. , Oh T. E. 
Published: January 2019

Plasma catecholamine concentrations were measured after vasoconstrictor solutions were administered either by instillation (Moffett's method) or by submucosal infiltration in twenty patients undergoing elective nasal surgery. Following infiltration with 4.4 ml of 1:80,000 adrenaline and 2% lignocaine, plasma adrenaline concentrations increased by 44.3 times to a peak of 9.9 nmol.l-1 (1813 pg.ml-1) within one minute. In contrast the peak level of adrenaline in the patients receiving Moffett's solution containing 1 ml of 1:1,000 adrenaline was 1.27 nmol.l-1 (232 pg.ml-1) occurring 10 minutes after instillation of the solution. The difference in the adrenaline concentrations between the groups was statistically significant (P < 0.01). The lack of sympathoneuronal response was confirmed by simultaneous measurements of plasma noradrenaline concentrations, which did not change significantly. The operative field was subjectively assessed to be better in the infiltrated patients and the mean operating time and measured blood loss were less in this same group of patients.
Preoperative Rectal Indomethacin for Analgesia after Laparoscopic Sterilisation
Authors: Crocker S. , Paech M. 
Published: January 2019

A randomised, double-blind, placebo-controlled study was conducted among 56 day-case patients to determine the effect of the preoperative administration of rectal indomethacin on postoperative pain and opioid requirements after laparoscopic sterilisation. Outcome in women receiving indomethacin did not differ significantly from the placebo group, but there was a trend to lower subjective pain scores, reduction in early postoperative pain assessed objectively and lower parenteral pethidine requirements in the first three hours postoperatively. Indomethacin did not appear either to cause side-effects or to significantly reduce morbidity from the other postoperative sequelae of laparoscopy. Despite evidence for postoperative analgesic effect, the clinical benefits of premedication with rectal indomethacin were minor.
Transfusion: Morbidity and Mortality
Authors: Nicholls M. D. 
Published: January 2019

Homologous, and to a significantly lesser extent, autologous blood transfusion is associated with definable and potentially serious risk. The increasing professional and public awareness has led to a critical evaluation of transfusion practices and a change in transfusion philosophy towards optimising transfusion therapy for individual patients. This involves the provision of the safest blood and the minimisation of homologous blood exposure. Autologous blood transfusion is not without risk as misidentification of patient or unit, bacterial contamination and volume overload can occur; consequently, the indications for the transfusion of autologous blood, as per homologous units, must be appropriate to the clinical circumstances. Appropriate transfusion criteria are being developed and lower haemoglobin levels are becoming accepted. Transfusion-related mortality and morbidity data is infrequently reported. Ongoing transfusion surveillance programs have reported adverse reactions in 3.5% of transfusion episodes and fatalities have resulted from ABO-incompatible acute haemolytic transfusion reactions, most commonly with group O recipients of group A or B red cells. A significant number of such deaths are attributable to misidentification of patient or units and are preventable by obsessional attention to clerical details. The risks should be considered in the evaluation of the risk-benefit equation and in the resultant decision to administer blood.
A Comparison between Direct and Calculated Oxygen Saturation in Intensive Care
Authors: Johnson P. A. , Bihari D. J. , Raper R. F. , Haughton M. A. , Fisher M. M. , Herkes R. G. 
Published: January 2019

We investigated the discrepancy between calculated and spectrophotometrically determined oxygen saturation, and the corresponding effect of this difference on calculated oxygen uptake in 46 arterial-venous sample pairs from 28 critically ill patients. The range of discrepancy between the two methods showed limits of agreement (mean ±2SD) of -2.26 to +0.70% for arterial samples, and - 5.52 to + 4.96% for the corresponding venous samples. The effect of this variation on oxygen uptake showed limits of agreement of -43.2 to 36.0 ml/min when the discrepancy between oxygen uptake, calculated using the direct measure of saturation, was compared to that using the derived value. Multiple regression analysis showed that Pco2, temperature and 2,3 diphosphoglycerate were significantly related to saturation discrepancy with an R-squared value of 0.64 (P< 0.0001) for a subgroup of 25 venous samples. The precision of the Po2 electrode was also found to be a major contributory component to the discrepancies, particularly at venous Po2 values. Thus the use of calculated oxygen saturation may result in clinically significant inaccuracies in the assessment of some oxygen flux variables.
Enteral Feeding, Gastric Colonisation and Diarrhoea in the Critically Ill Patient: Is There a Relationship?
Authors: Levinson M. , Bryce A. 
Published: January 2019

In this prospective study we aimed to determine whether there is any relationship between enteral feeding, gastric colonisation and diarrhoea in the critically ill patient. Sixty-two critically ill patients from an intensive care unit of a major teaching hospital, who satisfied the usual criteria for enteral feeding, were randomised to receive enteral feeding or not for three days followed by a second randomisation to enterally feed or not for three days. Diarrhoea was recorded and cultures taken of both gastric aspirates and stool. There was no significant difference in the incidence of diarrhoea between the groups. Gastric colonisation was unrelated to feeding practice and to the development of diarrhoea. We conclude that in the critically ill patient, enteral feeding does not cause or promote diarrhoea.
The Influence of Obesity on the Relationship between Body Mass Index and the Distance to the Epidural Space from the Skin
Authors: Watts R. W. 
Published: January 2019

This study confirms that distance to the epidural space from the skin at the L3–4 interspace is only moderately correlated with body mass index in obstetric patients. A similar moderate linear correlation was found in the non-obstetric patients. However, in obese patients (BMI>25), distance to epidural space from the skin correlated poorly with body mass index.
Parental Attitudes to Presence at Induction of Paediatric Anaesthesia
Authors: Henderson M. A. , Baines D. B. , Overton J. H. 
Published: January 2019

Previous studies of parental presence at induction of anaesthesia in children have examined parental reaction to being present and the benefits gained from their presence. This study was undertaken specifically to assess parents’ attitudes to being present at induction of their child's anaesthetic. A total of 154 questionnaires were distributed over a two-week period to parents of children presenting to the Day Stay Unit for procedures requiring general anaesthesia. Eighty-eight percent would have liked to be present at induction. Only 41% of parents expected to be present and only 40% of parents were actually present for their child's induction. Of those parents present, 94% felt it helpful to their child, 65% helpful to themselves and 41% helpful to the anaesthetist. No-one felt their presence to have been unhelpful. These results may provide an incentive for anaesthetists to review their current paediatric anaesthetic practices.
Difficult Intubation: An Analysis of 2000 Incident Reports
Authors: Williamson J. A. , Webb R. K. , Szekely S. , Gillies E. R. N. , Dreosti A. V. 
Published: January 2019

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the incidence and circumstances of problems with endotracheal intubation; 85 (4%) indicated difficulties with intubation. One third of these were emergency cases, one third involved an initially unassisted trainee and one fifth were outside normal working hours. Failure to predict a difficult intubation was reported in one third of the cases, with another quarter presenting serious difficulty despite preoperative prediction. Difficulties with ventilation were experienced in 1 in 7 of the 85 reports; there was one cardiac arrest, but no death. Endotracheal intubation was not achieved in one fifth of the cases. The commonest complications reported amongst the 85 incidents were oesophageal intubation (18 cases), arterial desaturation (15 cases), and reflux of gastric contents (7 cases). Emergency trans-tracheal airways were required in 5 cases. Obesity, limited neck mobility and mouth opening, and inadequate assistance together accounted for two thirds of all the contributing factors. The most successful intubation aid in this series was a gum elastic bougie. A capnograph contributed to management in 28% and a pulse oximeter in 12% of the cases in which they were used. The most serious desaturations were associated with accidental oesophageal intubation. These data suggest a lack of reliable preoperative assessment techniques and skills for the prediction of difficult intubations. They also suggest the need for a greater emphasis on ensuring that the necessary equipment is available, and on teaching and learning drills for difficult intubation and any associated difficulty with ventilation.