bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Cutaneous Histamine Release by Neuromuscular Blocking Agents
Authors: Galletly D. C. 
Published: January 2019

Normal values of cutaneous wheal diameter following intradermal injection of six neuromuscular blocking drugs were determined. The relative cutaneous histamine-releasing ability of each drug was derived from calculated dose-response relationships. Equipotent neuromuscular blocking doses were found to have a cutaneous histamine releasing ability relative to pancuronium (=1) of vecuronium 1.1; suxamethonium 1.7; alcuronium 5; atracurium 52; d-tubocurarine 172. A significant (P<.001) variation was found between the dose-response slopes perhaps suggesting a variation in the mechanism of histamine release.
Problems with Automating Anaesthetic Records
Authors: Roessler P. , Brenton M. W. , Lambert T. F. 
Published: January 2019

A truly automated recording system is one which measures the parameters selected and requires nothing more than attaching the monitors to the patient. It should be capable of being easily and rapidly started when appropriate. The user should then be able to enter quantitative and qualitative information about drug and fluid therapy in a manner which is less distracting than the present long-hand method. A system is described which has gone a considerable way towards achieving good automated physiological monitoring. The system has not resolved the problems of data entry which must be overcome before such equipment is made available for general use. The problems of automation which we encountered are presented and some possible solutions considered.
Postanaesthetic Patterns of Care in Minor Gynaecological Surgery
Authors: Hann G. J. , Ross A. W. 
Published: January 2019

A survey of 408 patients undergoing minor gynaecological procedures was undertaken to determine the optimal pattern of postoperative observation and feeding in the general surgical ward setting. Sixty per cent of all complications occurred within the first two hours after return to the ward. The rest were all of a visible nature, not requiring vital sign recording for detection. Oral intake was tolerated as soon as patients were conscious and co-operative. It is concluded that routine observations need not be recorded for more than two hours after return to the ward after minor gynaecological surgery.
Arterial Oxygen Saturation in Anaesthetised Patients during Transfer from Induction Room to Operating Room
Authors: Riley R. H. , Davis N. J. , Finucane K. E. , Christmas P. 
Published: January 2019

There is no published study that examines oxygenation of anaesthetised patients during transport from anaesthesia induction room to operating room. Arterial oxygen saturation (S a O 2 ) was measured in twenty-five anaesthetised patients before and during transfer to an adjacent operating room and continuously recorded on a calibrated chart recorder. A telemetry ECG recorder was used to detect cardiac dysrhythmias. All anaesthetists followed their usual anaesthetic practice. Patients ventilated via face-mask and via endotracheal tube were studied. During transfer patients were either apnoeic (n = 8) or breathing room air spontaneously (n= 17) Mean S a o 2 before induction was 95.4 (SD 2.5)%, was higher after induction of anaesthesia, 98.5 (SD 1.4)% and fell after transfer, 95.7 (SD 2.6)%. A fall in S a O 2 was recorded for 21 patients. No S a O 2 value below 90% was seen. The decrease in S a O 2 was related to the time taken to transfer the patients and spontaneous ventilation (Multiple regression analysis); it was not related to the body mass index although two of the greatest decreases were seen in obese patients. Transfer time averaged 51 seconds (range: 24–97 s). No changes in cardiac rhythm were seen. Transfer of anaesthetised patients was accompanied by variable falls in S a O 2 which related to duration of transfer and spontaneous breathing of room air and which were not associated with new dysrhythmias.
Acid Aspiration Prophylaxis in Australian Obstetric Hospitals — A Survey
Authors: Burgess R. W. , Crowhurst J. A. 
Published: January 2019

During 1987 a confidential survey of all hospitals in Australia providing obstetric services was undertaken to determine the antacid medications used routinely as prophylaxis against acid aspiration pneumonitis. Of the 567 hospitals surveyed, 379 (67%) responded. Of these, 243 hospitals provide an obstetric service which includes caesarean section, and 67% of these perform less than 500 deliveries per annum. Aspiration prophylaxis during labour was used in 22.4% of responding hospitals. Prior to elective caesarean section, 11.5% used no prophylaxis, and 39.4% used particulate antacids such as magnesium trisilicate mixture (33.3%) or Mylanta® (6.1%). Sodium citrate mixture was the most popular therapy (37%). Results were similar in the emergency caesarean section group. The use of cimetidine or ranitidine was uncommon in all groups. Results of this survey suggest marked differences in attitudes towards acid aspiration prophylaxis between Australian and British obstetric anaesthetic practices.
Steroids in Croup: Do they Increase the Incidence of Successful Extubation?
Authors: Freezer N. , Butt W. , Phelan P. 
Published: January 2019

Between January 1983 and July 1988, 2623 patients with croup were admitted to the Royal Children's Hospital, Melbourne. A total of 416 patients (16%) were admitted to the Intensive Care Unit and 176 of these patients required intubation. Of these patients 117 patients were successfully extubated at the first attempt and 59 needed reintubation. Of the patients who were reintubated 35 were given steroids prior to subsequent extubation attempts. Only one patient who had received steroids failed extubation. Of those who did not receive steroids 59% required reintubation. In patients with croup who fail the first extubation the results of this study suggest that steroids significantly increase the success of subsequent extubations.
Monitoring Epidural Analgesia in the Parturient
Authors: Crowhurst J. A. , Burgess R. W. , Derham R. J. 
Published: January 2019

Appropriate monitoring during obstetric epidural analgesia consists of: 1. Indirect BP and pulse monitoring before epidural insertion, frequently after every dose, and intermittently thereafter. 2. The aspiration test before all injections. 3. Frequent clinical monitoring for signs of intravascular injection during administration of small intermittent doses (not more than 3–5 ml at a time). 4. Frequent clinical monitoring for sympathetic, sensory and motor signs indicating upward extension of the block. 5. Frequent monitoring of the fetal heart rate (FHR) and other signs of fetal welfare. In many instances continuous tocogram with fetal heart rate (CTG) monitoring is useful. We do not believe CTG use is mandatory for epidural analgesia in the uncomplicated pregnancy, but we do advocate that it (and other appropriate fetal monitoring techniques) be used when risk factors or complications, either fetal or maternal, are present or suspected. The anaesthetist should be familiar with fetal monitoring techniques, their use and interpretation. He or she should be prepared to recommend their use when it is considered appropriate to do so.
The Stability of Atracurium in Clinical Practice
Authors: Russell W. J. , Meyer-Witting M. 
Published: January 2019

Atracurium has an unusual intrinsic Hofmann elimination which is increased by an alkaline environment and increased temperature. Normally the relaxant is stored at pH 3.3 and kept at a temperature of 4°C. However, it is convenient to have a reasonable quantity available within the operating theatre. This study examined the rate of degradation of atracurium in the operating theatre environment of 20°C. Atracurium within one month of its expiry date was placed in the drawer for anaesthetic drugs in each of three operating theatres. At the end of each month, further drug was added to the stock. At the end of the study, atracurium which had been stored continuously at 4°C, was at 102.9% of nominal strength, having started with 113.5% at manufacture. Atracurium which had been at room temperature for one, two and three months respectively retained 99%, 95% and 92% strength respectively. These results show that even three months’ exposure to room temperature does not cause enough deterioration to be clinically significant.
C-reactive Protein as a Diagnostic Test of Sepsis in the Critically Ill
Authors: Matson A. , Soni N. , Sheldon J. 
Published: January 2019

Changes in the plasma concentration of C-reactive protein were assessed as a diagnostic test for sepsis in critically ill patients. Forty-nine episodes of secondary sepsis were identified in 31 patients. In 43 out of the 49 episodes there was a 25% or greater change in the concentration of C-reactive protein on the day that sepsis was diagnosed but in six episodes of sepsis the change was less than 25%. A 25% rise in the plasma concentration of C-reactive protein in the absence of other non-infective causes of a raised C-reactive protein, such as inflammation, tissue injury or surgery, is highly suggestive of infection, but failure of the C-reactive protein to rise does not eliminate a diagnosis of sepsis.
A Comparison of Two-Lung High Frequency Positive Pressure Ventilation and One-Lung Ventilation plus 5 cm H2O Non-Ventilated Lung CPAP, in Patients Undergoing Anaesthesia for Oesophagectomy
Authors: Tsui S. L. , Chan C. S. , Chan A. S. H. , Wong S. J. , Lam C. S. , Jones R. D. M. 
Published: January 2019

A randomised prospective controlled study was conducted during a one-year period on patients scheduled/or oesophagectomy via a right thoractomy approach. Twenty-two patients received one-lung ventilation (OLV group) and twenty patients received high frequency positive pressure ventilation (HFPPV group). Episodic hypoxaemia (SaO2 < 90% for > 30 seconds, FiO2 1.0) occurred in eleven patients in the OLV group and six patients in the HFPPV group. No patient in the HFPPV group had a severe desaturation episode (SaO2 < 80%, FiO2 1.0) compared with nine patients in the OLV group (P < 0.05). The mean peak inspiratory pressure and average mean airway pressure were significantly lower in the HFPPV group 28.8 (SD 7.7) and 7.2 (SD 2.4) cm H2O respectively, compared with the OLV group, 40.0 (SD 9.9) and 11.9 (SD 4.9) cm H2O (P < 0.05). Two-lung high frequency positive pressure ventilation has some advantages over one-lung ventilation during the thoracotomy phase of oesophagectomy because it is easy to administer, does not significantly compromise the surgical exposure and is associated with fewer severe undesirable physiological disturbances.
The Influence of Epidural Pethidine on Shivering during Lower Segment Caesarean Section under Epidural Anaesthesia
Authors: Sutherland J. , Seaton H. , Lowry C. 
Published: January 2019

A prospective study of 94 patients undergoing elective lower segment caesarean section under epidural anaesthesia was performed in order to determine the incidence of shivering and the influence of epidural pethidine. Epidural anaesthesia was established with bupivacaine 0.5% with adrenaline, with or without additional lignocaine 2% with adrenaline, to total 20–25 ml. With the injection of epidural local anaesthesia an extra 5 ml of solution was administered into the epidural space – pethidine 25 mg preservative-free, in normal saline, or normal saline alone. Patient, administering anaesthetist and observer were blinded to the nature of the test substance. Shivering was assessed by an independent observer and subsequently rated by the patient. Other side-effects also recorded were nausea, vomiting, pruritis and drowsiness. The incidence of shivering was 36% in the control (saline) group and 11% in the pethidine group. The difference was highly significant (P < 0.01). There was no significant difference in the incidence of maternal nausea, vomiting, drowsiness or pruritis, or neonatal Apgar scores. Cord blood samples were assayed for pethidine, revealing low or absent pethidine concentrations.
Postoperative Hospital Admission from a Day Surgery Unit: A Seven-Year Retrospective Survey
Authors: Biswas T. K. , Leary C. 
Published: January 2019

Postoperative hospital admissions from a hospital-based Day Surgery Unit were reviewed during the period 1984 to 1990. There were 18,321 procedures performed in different specialties. Of these, 225 patients required hospital admissions — a rate of 1.2%. Highest admission rate was found in gynaecological surgery (100 out of 225). Laparoscopic procedures accounted for 64 admissions, of which 13 were due to visceral perforations Urological surgery resulted in 35 admissions (4.5% of the urological caseload). Perhaps this reflects the patient age group and preexisting medical conditions. Interestingly, there were 13 admissions for social reasons. Many of these admissions were due to either multiple procedures or surgery more extensive than planned. Even with the higher rate of admissions, hospital-based centres probably provide a better quality care for those who require major surgery or develop some complications in the perioperative period.
Propofol is a ‘Safe’ Anaesthetic Agent in Malignant Hyperthermia Susceptible Patients
Authors: McKenzie A. J. , Couchman K. G. , Pollock N. 
Published: January 2019

In this study we investigated in vitro and in vivo effects of propofol in malignant hyperthermia susceptible (MHS) patients in order to assess the safety of propofol infusion as a non-triggering anaesthetic technique for diagnostic and therapeutic procedures. In vitro, human MHS muscle samples were exposed to propofol and changes in (a) baseline tension and (b) contracture tension on exposure to halothane and caffeine were measured. In vivo, (a) anaesthesia was induced in ten muscle biopsy positive MHS patients with propofol 2.5 mg/kg and (b) anaesthesia was produced in five muscle biopsy positive MHS patients with infusions of propofol up to 10 mg/kg/hr. In vitro, human MHS muscle did not develop contractures with propofol alone. Propofol had no significant effect on contracture development in response to halothane and caffeine. In vivo, no evidence of an MH response was detected following induction or maintenance of anaesthesia with propofol. Our results and literature review are in agreement that propofol is a ‘safe’ induction and maintenance agent in MHS patients. Propofol can be used for muscle biopsy anaesthesia because it does not alter the sensitivity of diagnostic muscle biopsy testing.
The Effects of Oxytocin on the Pulmonary and Systemic Circulation in Pregnant Ewes
Authors: Roberts N. V. , Keast P. J. , Brodeky V. , Oates A. , Ritchie B. C. 
Published: January 2019

The haemodynamic effects of oxytocin on the pulmonary and systemic circulation were studied in six awake, pregnant (> 140 days gestation) ewes. Bolus doses of oxytocin 0.2 units/kg and then 0.8 units/kg were administered. A dose of 0.2 units/kg resulted in small but significant increases in mean pulmonary artery pressure (14%, P < 0.05) and pulmonary vascular resistance (24%, P < 0.05. A bolus of 0.8 units/kg resulted in a significant increase in mean arterial pressure (20%, P < 0.05) and systemic vascular resistance (33%, P < 0.05). Acute pulmonary hypertension was then induced with glass bead microemboli (150–200 μm), with an increase in pulmonary artery pressure of 26 mmHg and pulmonary vascular resistance of 448 dyn. s. cm−5. Boluses of oxytocin 0.2 and 0.8 units/kg were then administered. There were no significant changes, except for a 30% increase in systemic vascular resistance at one minute after oxytocin, 0.8 units/kg (P < 0.05).
Ondansetron 4 mg for the Prevention of Nausea and Vomiting after Minor Laparoscopic Gynaecological Surgery
Authors: Suen T. K. L. , Gin T. A. , Chen P. P. , Rowbottom Y. M. , Critchley L. A. H. , Ray A. K. 
Published: January 2019

We studied the efficacy and safety of intravenous ondansetron 4 mg for the prevention of postoperative nausea and vomiting after minor gynaecological laparoscopic surgery in Oriental women. This double-blind randomised study compared ondansetron with placebo, given before the induction of anaesthesia. The anaesthetic technique used thiopentone, fentanyl, atracurium, nitrous oxide and isoflurane. Patients were studied for 24 h with nausea assessed using a verbal numeric scale from 0-10 and emetic episodes recorded as they occurred. Results were available for 102 patients in each group. In the first postoperative hour, fewer patients in the ondansetron Group (12%) had emetic episodes compared with the placebo group (33%, P <0.01). Nausea score over the first hour (sum of three readings at 0, 30 and 60 min) was lower in the ondansetron group (median 1.6) compared with the placebo group (3.1, P <0.05). Over the 24 h period, fewer patients in the ondansetron group had emetic episodes (25%) or nausea (43%) compared with patients in the placebo group (56%, P <0.01) and (58%, P <0.05) respectively. No adverse events were seen. Ondansetron 4 mg was more effective than placebo in preventing postoperative nausea and vomiting throughout the 24 h after minor laparoscopic surgery.
Intensive Care Costing Methodology: Cost Benefit Analysis of Mask Continuous Positive Airway Pressure for Severe Cardiogenic Pulmonary Oedema
Authors: Holt A. W. , Bersten A. D. , Fuller S. , Piper R. K. , Worthley L. I. G. , Vedig A. E. 
Published: January 2019

Costing data for intensive care admissions is important, not only for unit funding, but also for cost outcome analysis of new therapies. This paper presents an intensive care episode costing methodology using the example of a cost-benefit analysis of mask CPAP for severe cardiogenic pulmonary oedema (CPO). This analysis examines the intervention of admitting all patients with severe CPO to the intensive care unit for mask CPAP, compared with the previous practice of admitting only patients failing conventional non-CPAP treatment and requiring mechanical ventilation. The episode costs were determined from a prospective study which showed mask CPAP reduced the need for mechanical ventilation from 35% to 0%. The mean cost of a mask CPAP episode was $1,156, with a mean stay of 1.2 days, compared with ventilated patients, $5,055 and 4.2 days. The major contributors to cost in both groups were nursing and medical salaries, and hospital overheads. The cost of previous estimated yearly caseload of 35 ventilated patients ($176,925) was greater than the cost associated with an increased caseload of 100 mask CPAP patients ($115,600). We conclude that, despite an increase in admissions, mask CPAP for severe CPO is cost-effective.
The Use of Steroids and Nebulised Adrenaline in the Treatment of Viral Croup over a Seven Year Period at a District Hospital
Authors: Mcdonogh A. J. 
Published: January 2019

The medical records of 787 patients admitted with a diagnosis of viral croup between January 1986 and December 1992 were examined. The study was prompted by an observed change in the pattern of admissions to the intensive care unit at a large district hospital during the late 1980s. Changes in the pattern of use of adrenaline and steroids were noted. An increase in the dose and frequency of administration of steroids and nebulised adrenaline occurred during the years of the study. In 1992 one-third of patients were given nebulised adrenaline on admission. In the same year 87% of patients were given a dose of steroid. Despite an increase in the number of patients admitted with viral croup, there was a marked reduction in the number of patients requiring admission to intensive care or intubation during the years of the study. This information supports the early aggressive use of steroids and nebulised adrenaline in the management of moderate to severe viral croup.
External Abdominal Aortic Compression: A Study of a Resuscitation Manoeuvre for Postpartum Haemorrhage
Authors: Riley D. P. , Burgess R. W. 
Published: January 2019

External aortic compression is an emergency manoeuvre proposed to reduce postpartum haemorrhage and permit time for resuscitation and control of bleeding. To assess this technique, a prospective study was performed on twenty normal non-bleeding parturients. The abdominal aorta was compressed by firm pressure with a closed fist just above the umbilicus. Leg and arm arterial blood pressures were measured and femoral artery pulsation felt before, during and after compression. Leg blood pressure was completely obliterated in 55% and significantly reduced (P < 0.01) in a further 10% of subjects. All of these subjects with reduced or absent leg blood pressure also had obliteration of the femoral pulse with compression. Systemic arterial blood pressure was not significantly elevated by successful aortic occlusion. Discomfort with the manoeuvre was significantly increased (P < 0.05) in the group of subjects that had successful aortic occlusion. It is recommended that external aortic compression be considered in severe life-threatening postpartum haemorrhage, particularly during stabilisation or transport of the patient. This simple manoeuvre may be used as an adjunct to other measures and could prove of benefit, especially in locations or situations where advanced medical assistance is geographically or temporally removed.
Polyurethane Central Venous Catheters, Hydrochloric Acid and 70% Ethanol: A Safety Evaluation
Authors: McHugh G. J. , Wild D. J. C. , Havill J. H. 
Published: January 2019

Three groups of polyurethane central venous catheters (CVC) were infused daily for twenty days with 0.1 normal hydrochloric acid, 70% ethanol and normal saline (control) respectively to look for any changes in microscopic structural integrity. A 1 cm segment was cut from the distal end of each CVC daily. All sections were examined in a scanning electron microscope, looking for evidence either of damage to the lumen surface or of wall thinning. No significant damage to the lumen surfaces was observed with either treatment. Sporadic fine surface-pitting appeared late in the study without any clear temporal or treatment-related pattern. The mean CVC wall thickness did not change significantly over the study period (P=0.15). Qualitative softening of ethanol treated catheters was observed, and this finding limits the recommendations for the use of ethanol. 0.1N HCl does not compromise the structural safety of the catheters, and its use should be considered when polyurethane CVC become occluded.
Plasma Lignocaine Concentration following Nebulization for Awake Intubation
Authors: Parkes S. B. , Butler C. S. , Muller R. 
Published: January 2019

Nebulization of lignocaine is a common technique for preparing the airway prior to awake intubation. The aim of the study was to assay the serum levels of lignocaine. Ten ASA I volunteers had 6 mg/kg of 10% lignocaine solution nebulized via facemask. Blood assays for peak levels were performed. Mean peak serum lignocaine level was 0.29 mg/l with a highest measurement of 0.45 mg/l. This peak occurred 30 minutes following commencing nebulization. No subject developed symptoms or signs of lignocaine toxicity. Peak plasma lignocaine levels were an order of magnitude below the accepted toxic threshold of 5 mg/l. This indicates that supplemental doses of lignocaine via the bronchoscope can be given with safety.