Duncan Galletly - Academia.edu (original) (raw)

Papers by Duncan Galletly

Neuropharmacology, 1992

The effects of fentanyl and midazolam, administered intrathecally, on somatosympathetic reflexes ... more The effects of fentanyl and midazolam, administered intrathecally, on somatosympathetic reflexes evoked by tibial nerve stimulation were investigated in 12 anaesthetized and paralysed dogs. Fentanyl depressed both the C and A delta fibre evoked reflexes in a dose ratio of approx 1:2. In contrast, midazolam had a greater effect on A delta compared with C fibre reflexes; while A delta reflexes were abolished by a total dose of 3 mg midazolam, C fibre reflexes were depressed by only 50%. The effect of fentanyl was reversed by naloxone (2 mg, i.v.) and that of midazolam by flumazenil (1 mg, i.v.). The results suggest that fentanyl and midazolam have different relative effects on A delta and C fibre pathways.

British medical journal (Clinical research ed.)

Respiratory physiology & neurobiology, Jan 30, 2010

Respiratory sinus arrhythmia (RSA) is the beat-to-beat fluctuation in heart rate at the frequency... more Respiratory sinus arrhythmia (RSA) is the beat-to-beat fluctuation in heart rate at the frequency of the respiratory cycle. While it is common to study RSA under conditions of controlled breathing, where respiratory frequency, and sometimes tidal volume and inspiratory:expiratory ratio are controlled, the effect of controlled breathing on RSA is not clear. While not all studies exploring the effects of controlled breathing on RSA magnitude are consistent, some of the best-designed studies addressing this question did find a significant effect. In addition to respiratory timing influencing heartbeats, there is evidence that cardiac timing also influences respiratory timing, termed cardioventilatory coupling. Thus, the timing interactions between the cardiac and respiratory systems are complex, and bi-directional. Controlled breathing eliminates one aspect of this relationship, and studies designed to understand cardiorespiratory physiology conducted under these conditions need to be ...

The New Zealand medical journal, Jan 12, 2003

Resuscitation skills such as cardiopulmonary resuscitation (CPR) are taught as an optional compon... more Resuscitation skills such as cardiopulmonary resuscitation (CPR) are taught as an optional component of the New Zealand school curriculum. This study was conducted to determine the frequency of, and factors influencing, CPR teaching in New Zealand primary and secondary schools. At the end of the 2001 school year, we surveyed by questionnaire every school in New Zealand asking which schools taught CPR skills during 2001, what other resuscitation skills were taught, and what the barriers to greater teaching of resuscitation were. Seven hundred and fifty four of 2205 (34.9%) primary schools and 173 of 456 (38.6%) secondary schools returned the survey. Of primary schools, 37.5% taught resuscitation skills during 2001, as did 81% of secondary schools. In secondary schools, resuscitation was most commonly taught during year 12 (pupil age 16-17 years), but then only as an elective subject to 10-30% of students. For both primary and secondary schools there was a positive correlation between...

Respiratory Physiology & Neurobiology, 2004

We examined interbreath interval (IBI) time series of 19 term infants during active and quiet sle... more We examined interbreath interval (IBI) time series of 19 term infants during active and quiet sleep for fractal properties using Fano factor analysis. For each time series we calculated the fractal exponent (α), comparing α for the original time series with two forms of surrogate data, a temporally independent surrogate set and an autoregressive surrogate set. α values were normally distributed between 0.79 and −0.22, and did not differ with sleep state. The fractal characteristics of the original time series were not retained in the temporally independent surrogate time series indicating that the distribution of intervals alone was not fractal, but were retained using autoregressive surrogates with an order of 10, suggesting that the fractal properties of the IBI time series were related to correlations between successive breaths. These observations suggest that some of the respiratory variability that occurs during sleep in infants, which in the past has been regarded as stochastic noise, may be the product of deterministic processes.

Emergency Medicine Journal, 2005

British Journal of Anaesthesia, 1991

A possible interaction between betamethasone and vecuronium was examined in 20 rat phrenic nerve-... more A possible interaction between betamethasone and vecuronium was examined in 20 rat phrenic nerve-hemidiaphragm preparations. Ten preparations were bathed in a physiological solution with betamethasone 1 [imol litre' 1 added and, after a 30-min period were exposed to vecuronium at concentrations of 4, 6, 8 and 10 nmol litre' 1 with vecuronium free washings between each exposure. Ten control experiments were performed also using a betamethasone-free bathing solution. In comparison with control, the betamethasone group had significantly (P = 0.0008) less depression of muscle contraction (twitch) force at all concentrations of vecuronium. The calculated ED X (50% depression of muscle contraction force) was 5.65 JMTIOI litre' 1 for controls and 7.39 fjmol litre' 1 for betamethasone-pretreated preparations. This study confirms our previous clinical observations that an interaction occurs between vecuronium and betamethasone which is characterized by resistance to neuromuscu/ar block.

BJA: British Journal of Anaesthesia, 1992

In the interesting paper [1] on the possible mechanisms for resistance to vecuronium observed in ... more In the interesting paper [1] on the possible mechanisms for resistance to vecuronium observed in patients receiving chronic treatment with corticosteroids, Parr and colleagues did not mention the steroid-induced proliferation of acetylcholine receptors (AChR) observed by Kaplan and co-workers on cultured human muscle. They reported that dexamethasone seems to act "by inducing de novo AChR synthesis rather than by stimulating insertion of pre-existing AChR into the plasma membrane" [2]. Another important observation is that the response to dexamethasone seems to be species-specific and is not accompanied by alterations in acetylcholinesterase activity.

Autonomic Neuroscience, 2005

This study examines respiratory sinus arrhythmia (RSA) in the isoflurane-anesthetized rat. In fif... more This study examines respiratory sinus arrhythmia (RSA) in the isoflurane-anesthetized rat. In fifteen female Sprague-Dawley rats, we recorded continuous ECG and respiratory airflow before and after bilateral vagotomy. RSA was assessed using power spectral analysis and by plotting the normalised changes in heart period as a function of the time during the respiratory cycle. Contrary to descriptions of RSA in conscious rats, we observed in all rats in the current study a dreversedT pattern of RSA in which heart rate decelerated during inspiration. Elimination of vagal efferent fibres to the heart by vagotomy did not abolish the presence of reversed RSA suggesting that the pattern of heart period variation is not neural, and may be largely mechanical. Vagotomy altered breathing by increasing respiratory period, tidal volume, and the time to peak inspiratory flow. These changes did not alter the magnitude of RSA but reduced the latency period between inspiratory onset and the onset of respiratory related prolongation of heart period. Periods of positive pressure ventilation were associated with reversal of the inspiratory cardiac-deceleration pattern of RSA to resemble the more widely described pattern of inspiratory cardiac-acceleration. We conclude that RSA is not a suitable measure of vagal tone during anesthesia in the rat and reiterate the caution that needs to be taken when working with anesthetized experimental models of cardiac control.

Applied Physiology, Nutrition, and Metabolism, 2013

Cardiac baroreflex gain is usually quantified as the reflex alteration in heart rate during chang... more Cardiac baroreflex gain is usually quantified as the reflex alteration in heart rate during changes in blood pressure without considering the effect of the rate of change in blood pressure on the estimated gain. This study sought to (i) characterize baroreflex gain as a function of blood pressure oscillation frequencies using a repeat sit-to-stand method and (ii) compare baroreflex gain values obtained using the sit-to-stand method against the modified Oxford method. Fifteen healthy individuals underwent the repeated sit-to-stand method in which blood pressure oscillations were driven at 0.03, 0.05, 0.07, and 0.1 Hz. Sixteen healthy participants underwent the sit-to-stand and modified Oxford methods to examine their agreement. Sit-to-stand baroreflex gain was highest at 0.05 Hz (8.8 ± 3.2 ms·mm Hg(-1)) and lowest at 0.1 Hz (5.8 ± 3.0 ms·mm Hg(-1)). Baroreflex gains at 0.03 Hz (7.7 ± 3.0 ms·mm Hg(-1)) and 0.07 Hz (7.5 ± 3.3 ms·mm Hg(-1)) were not different from the baroreflex gain at 0.05 Hz. There was moderate correlation between phenylephrine gain and sit-to-stand gain (r values ranged from 0.52 to 0.75; all frequencies, p < 0.05), but no correlation between sodium nitroprusside gain and sit-to-stand gain (r values ranged from -0.07 to 0.22; all p < 0.05). Bland-Altman analysis of phenylephrine gain and sit-to-stand gain showed poor agreement and a positive proportional bias. These results show that baroreflex gains derived from these 2 methods cannot be used interchangeably. Furthermore, cardiac baroreflex gain is frequency dependent between 0.03 Hz and 0.1 Hz, which challenges the conventional practice of summarizing baroreflex gain as a single number.

Anaesthesia, 1993

Morphine and tubocurarine may release histamine by direct mast cell degranulation which may resul... more Morphine and tubocurarine may release histamine by direct mast cell degranulation which may result in systemic effects such as cutaneous.pushing, local wheal andjare formation and hypotension. This randomised, double-blind study examined whether preoperative combined oral terfenadine (60 mg) and ranitidine (1.50 mg) attenuates the reduction in blood pressure and cutaneous JIushing after the administration of tubocurarine and morphine in 60 patients undergoing elective gynaecological surgery. In addition, investigation was made of whether tubocurarine and morphine cause a signijkant decrease in gastric pH in comparison to the nonhistamine-releasing agents fentanyl and vecuronium. Patients were randomly assigned to one of three groups receiving either pre-operative terfenadine and ranitidine and intra-operative tubocurarine and morphine (group A) ; pre-operative placebo and intra-operative tubocurarine and morphine (group B) ; pre-operative placebo and intra-operative fentanyl and vecuronium (group C). Compared to group B, group A had less hypotension and tachycardia but no significant decrease in cutaneous flushing immediately following morphine and tubocurarine (p > 0.05). There were no signgrant differences in haemodynamic changes between the groups A and C. In those patients not pretreated with terfenadine and ranitidine (groups B and C) , gastric pH decreased between 5 and 10 min following bolus administration of morphine and tubocurarine (group B). whereas patients receiving fentanyl and vecuronium (group C) had an increase in gastric pH. This suggests that histamine release following administration of morphine and tubocurarine is suficient to increase gastric acidity. These results indicate that for routine prophylaxis of high risk patients and for patients who have had a previous anaesthetic anaphylactoid reaction, oral premedication with the newer H , and H2 receptor antagonists may be useful. Furthermore, systemic liberation of histamine may cause a signijcant decrease in gastric pH with the attendant risk of aspiration pneumonitis.

Anaesthesia, 2007

Sixty one patients who had suffered intra‐operative anaphylactoid reactions were studied. Intrade... more Sixty one patients who had suffered intra‐operative anaphylactoid reactions were studied. Intradermal testing identified the causative agent in 84% of cases and, in 75% of these, muscle relaxants were responsible. Predisposing factors in patients sensitive to muscle relaxants were: female sex, previous allergy and atopy. The incidence of previous exposure was considerably higher than that reported in the literature. Pancuronium is suggested to be the least likely currently available agent to provoke a major anaphylactoid reaction.

Anaesthesia and Intensive Care, 1991

A simple schema of anaesthesia system error evolution is described. This was used, with a modifie... more A simple schema of anaesthesia system error evolution is described. This was used, with a modified critical incident technique, as a framework for data gathering and error analysis. The outline places emphasis on recovery pathways and, in addition to causal and contributory factors, was able to identify many factors which aided or hindered the processes of error detection, diagnosis and management. On average, 8.1 factors were identified which were considered to have significantly influenced the genesis and evolution of each reported error. Differences were apparent in the type of factors which determined error production and aspects of the recovery sequence. The described schema is suggested to be of value for data generation, and as a tool for discussion as part of anaesthesia quality assurance.

Anaesthesia and Intensive Care, 1991

Patient movement during neurosurgery is often inconvenient and may be potentially hazardous. We r... more Patient movement during neurosurgery is often inconvenient and may be potentially hazardous. We report two cases of unexpected movement during neurosurgical procedures which we believe were related to the administration of betamethasone, a corticosteroid given preoperatively to reduce raised intracranial pressure. CASE REPORTS Case 1: A 49-year-old 85 kg male presented with a five-year history of gradual hearing loss in his right ear and a one-year history of right frontal headaches. He had no other significant history and was not receiving any medication. CT scan revealed a right posterior fossa lesion. He was commenced on betamethasone 4 mg qds and underwent posterior fossa craniotomy six days later. The anaesthetic technique consisted of premedication with temazepam 20 mg, induction with thiopentone 300 mg, fentanyl 200 ~g and vecuronium 16 mg. He was ventilated with air/02 and isoflurane (0.5-1.0%) to an end-tidal CO 2 of 4.0 KPa and received an alfentanil infusion of 0.5-1.0 ~g/kg/min.

Anaesthesia and Intensive Care, 1991

A confidential survey was conducted among medical practitioners in New Zealand with a stated inte... more A confidential survey was conducted among medical practitioners in New Zealand with a stated interest in anaesthesia to ascertain the proportion of those currently engaged in anaesthetic practice (thought to be approximately 325), who knowingly omit or alter undesirable physiological parameters from the anaesthetic record. Two hundred and forty-five replies were received from currently active anaesthetists. The reported frequency of occasional data omission or falsification was 55%. Those anaesthetists who intentionally manipulated data were more likely to be dissatisfied with their current anaesthetic record form, to view the record as an intraoperative distraction and less likely to perceive the record as being important for the use of future anaesthetists. There was no correlation between data manipulation and concerns over the medicolegal uses of the record.

Neuropharmacology, 1992

The effects of fentanyl and midazolam, administered intrathecally, on somatosympathetic reflexes ... more The effects of fentanyl and midazolam, administered intrathecally, on somatosympathetic reflexes evoked by tibial nerve stimulation were investigated in 12 anaesthetized and paralysed dogs. Fentanyl depressed both the C and A delta fibre evoked reflexes in a dose ratio of approx 1:2. In contrast, midazolam had a greater effect on A delta compared with C fibre reflexes; while A delta reflexes were abolished by a total dose of 3 mg midazolam, C fibre reflexes were depressed by only 50%. The effect of fentanyl was reversed by naloxone (2 mg, i.v.) and that of midazolam by flumazenil (1 mg, i.v.). The results suggest that fentanyl and midazolam have different relative effects on A delta and C fibre pathways.

British medical journal (Clinical research ed.)

Respiratory physiology & neurobiology, Jan 30, 2010

Respiratory sinus arrhythmia (RSA) is the beat-to-beat fluctuation in heart rate at the frequency... more Respiratory sinus arrhythmia (RSA) is the beat-to-beat fluctuation in heart rate at the frequency of the respiratory cycle. While it is common to study RSA under conditions of controlled breathing, where respiratory frequency, and sometimes tidal volume and inspiratory:expiratory ratio are controlled, the effect of controlled breathing on RSA is not clear. While not all studies exploring the effects of controlled breathing on RSA magnitude are consistent, some of the best-designed studies addressing this question did find a significant effect. In addition to respiratory timing influencing heartbeats, there is evidence that cardiac timing also influences respiratory timing, termed cardioventilatory coupling. Thus, the timing interactions between the cardiac and respiratory systems are complex, and bi-directional. Controlled breathing eliminates one aspect of this relationship, and studies designed to understand cardiorespiratory physiology conducted under these conditions need to be ...

The New Zealand medical journal, Jan 12, 2003

Resuscitation skills such as cardiopulmonary resuscitation (CPR) are taught as an optional compon... more Resuscitation skills such as cardiopulmonary resuscitation (CPR) are taught as an optional component of the New Zealand school curriculum. This study was conducted to determine the frequency of, and factors influencing, CPR teaching in New Zealand primary and secondary schools. At the end of the 2001 school year, we surveyed by questionnaire every school in New Zealand asking which schools taught CPR skills during 2001, what other resuscitation skills were taught, and what the barriers to greater teaching of resuscitation were. Seven hundred and fifty four of 2205 (34.9%) primary schools and 173 of 456 (38.6%) secondary schools returned the survey. Of primary schools, 37.5% taught resuscitation skills during 2001, as did 81% of secondary schools. In secondary schools, resuscitation was most commonly taught during year 12 (pupil age 16-17 years), but then only as an elective subject to 10-30% of students. For both primary and secondary schools there was a positive correlation between...

Respiratory Physiology & Neurobiology, 2004

We examined interbreath interval (IBI) time series of 19 term infants during active and quiet sle... more We examined interbreath interval (IBI) time series of 19 term infants during active and quiet sleep for fractal properties using Fano factor analysis. For each time series we calculated the fractal exponent (α), comparing α for the original time series with two forms of surrogate data, a temporally independent surrogate set and an autoregressive surrogate set. α values were normally distributed between 0.79 and −0.22, and did not differ with sleep state. The fractal characteristics of the original time series were not retained in the temporally independent surrogate time series indicating that the distribution of intervals alone was not fractal, but were retained using autoregressive surrogates with an order of 10, suggesting that the fractal properties of the IBI time series were related to correlations between successive breaths. These observations suggest that some of the respiratory variability that occurs during sleep in infants, which in the past has been regarded as stochastic noise, may be the product of deterministic processes.

Emergency Medicine Journal, 2005

British Journal of Anaesthesia, 1991

A possible interaction between betamethasone and vecuronium was examined in 20 rat phrenic nerve-... more A possible interaction between betamethasone and vecuronium was examined in 20 rat phrenic nerve-hemidiaphragm preparations. Ten preparations were bathed in a physiological solution with betamethasone 1 [imol litre' 1 added and, after a 30-min period were exposed to vecuronium at concentrations of 4, 6, 8 and 10 nmol litre' 1 with vecuronium free washings between each exposure. Ten control experiments were performed also using a betamethasone-free bathing solution. In comparison with control, the betamethasone group had significantly (P = 0.0008) less depression of muscle contraction (twitch) force at all concentrations of vecuronium. The calculated ED X (50% depression of muscle contraction force) was 5.65 JMTIOI litre' 1 for controls and 7.39 fjmol litre' 1 for betamethasone-pretreated preparations. This study confirms our previous clinical observations that an interaction occurs between vecuronium and betamethasone which is characterized by resistance to neuromuscu/ar block.

BJA: British Journal of Anaesthesia, 1992

In the interesting paper [1] on the possible mechanisms for resistance to vecuronium observed in ... more In the interesting paper [1] on the possible mechanisms for resistance to vecuronium observed in patients receiving chronic treatment with corticosteroids, Parr and colleagues did not mention the steroid-induced proliferation of acetylcholine receptors (AChR) observed by Kaplan and co-workers on cultured human muscle. They reported that dexamethasone seems to act "by inducing de novo AChR synthesis rather than by stimulating insertion of pre-existing AChR into the plasma membrane" [2]. Another important observation is that the response to dexamethasone seems to be species-specific and is not accompanied by alterations in acetylcholinesterase activity.

Autonomic Neuroscience, 2005

This study examines respiratory sinus arrhythmia (RSA) in the isoflurane-anesthetized rat. In fif... more This study examines respiratory sinus arrhythmia (RSA) in the isoflurane-anesthetized rat. In fifteen female Sprague-Dawley rats, we recorded continuous ECG and respiratory airflow before and after bilateral vagotomy. RSA was assessed using power spectral analysis and by plotting the normalised changes in heart period as a function of the time during the respiratory cycle. Contrary to descriptions of RSA in conscious rats, we observed in all rats in the current study a dreversedT pattern of RSA in which heart rate decelerated during inspiration. Elimination of vagal efferent fibres to the heart by vagotomy did not abolish the presence of reversed RSA suggesting that the pattern of heart period variation is not neural, and may be largely mechanical. Vagotomy altered breathing by increasing respiratory period, tidal volume, and the time to peak inspiratory flow. These changes did not alter the magnitude of RSA but reduced the latency period between inspiratory onset and the onset of respiratory related prolongation of heart period. Periods of positive pressure ventilation were associated with reversal of the inspiratory cardiac-deceleration pattern of RSA to resemble the more widely described pattern of inspiratory cardiac-acceleration. We conclude that RSA is not a suitable measure of vagal tone during anesthesia in the rat and reiterate the caution that needs to be taken when working with anesthetized experimental models of cardiac control.

Applied Physiology, Nutrition, and Metabolism, 2013

Cardiac baroreflex gain is usually quantified as the reflex alteration in heart rate during chang... more Cardiac baroreflex gain is usually quantified as the reflex alteration in heart rate during changes in blood pressure without considering the effect of the rate of change in blood pressure on the estimated gain. This study sought to (i) characterize baroreflex gain as a function of blood pressure oscillation frequencies using a repeat sit-to-stand method and (ii) compare baroreflex gain values obtained using the sit-to-stand method against the modified Oxford method. Fifteen healthy individuals underwent the repeated sit-to-stand method in which blood pressure oscillations were driven at 0.03, 0.05, 0.07, and 0.1 Hz. Sixteen healthy participants underwent the sit-to-stand and modified Oxford methods to examine their agreement. Sit-to-stand baroreflex gain was highest at 0.05 Hz (8.8 ± 3.2 ms·mm Hg(-1)) and lowest at 0.1 Hz (5.8 ± 3.0 ms·mm Hg(-1)). Baroreflex gains at 0.03 Hz (7.7 ± 3.0 ms·mm Hg(-1)) and 0.07 Hz (7.5 ± 3.3 ms·mm Hg(-1)) were not different from the baroreflex gain at 0.05 Hz. There was moderate correlation between phenylephrine gain and sit-to-stand gain (r values ranged from 0.52 to 0.75; all frequencies, p < 0.05), but no correlation between sodium nitroprusside gain and sit-to-stand gain (r values ranged from -0.07 to 0.22; all p < 0.05). Bland-Altman analysis of phenylephrine gain and sit-to-stand gain showed poor agreement and a positive proportional bias. These results show that baroreflex gains derived from these 2 methods cannot be used interchangeably. Furthermore, cardiac baroreflex gain is frequency dependent between 0.03 Hz and 0.1 Hz, which challenges the conventional practice of summarizing baroreflex gain as a single number.

Anaesthesia, 1993

Morphine and tubocurarine may release histamine by direct mast cell degranulation which may resul... more Morphine and tubocurarine may release histamine by direct mast cell degranulation which may result in systemic effects such as cutaneous.pushing, local wheal andjare formation and hypotension. This randomised, double-blind study examined whether preoperative combined oral terfenadine (60 mg) and ranitidine (1.50 mg) attenuates the reduction in blood pressure and cutaneous JIushing after the administration of tubocurarine and morphine in 60 patients undergoing elective gynaecological surgery. In addition, investigation was made of whether tubocurarine and morphine cause a signijkant decrease in gastric pH in comparison to the nonhistamine-releasing agents fentanyl and vecuronium. Patients were randomly assigned to one of three groups receiving either pre-operative terfenadine and ranitidine and intra-operative tubocurarine and morphine (group A) ; pre-operative placebo and intra-operative tubocurarine and morphine (group B) ; pre-operative placebo and intra-operative fentanyl and vecuronium (group C). Compared to group B, group A had less hypotension and tachycardia but no significant decrease in cutaneous flushing immediately following morphine and tubocurarine (p > 0.05). There were no signgrant differences in haemodynamic changes between the groups A and C. In those patients not pretreated with terfenadine and ranitidine (groups B and C) , gastric pH decreased between 5 and 10 min following bolus administration of morphine and tubocurarine (group B). whereas patients receiving fentanyl and vecuronium (group C) had an increase in gastric pH. This suggests that histamine release following administration of morphine and tubocurarine is suficient to increase gastric acidity. These results indicate that for routine prophylaxis of high risk patients and for patients who have had a previous anaesthetic anaphylactoid reaction, oral premedication with the newer H , and H2 receptor antagonists may be useful. Furthermore, systemic liberation of histamine may cause a signijcant decrease in gastric pH with the attendant risk of aspiration pneumonitis.

Anaesthesia, 2007

Sixty one patients who had suffered intra‐operative anaphylactoid reactions were studied. Intrade... more Sixty one patients who had suffered intra‐operative anaphylactoid reactions were studied. Intradermal testing identified the causative agent in 84% of cases and, in 75% of these, muscle relaxants were responsible. Predisposing factors in patients sensitive to muscle relaxants were: female sex, previous allergy and atopy. The incidence of previous exposure was considerably higher than that reported in the literature. Pancuronium is suggested to be the least likely currently available agent to provoke a major anaphylactoid reaction.

Anaesthesia and Intensive Care, 1991

A simple schema of anaesthesia system error evolution is described. This was used, with a modifie... more A simple schema of anaesthesia system error evolution is described. This was used, with a modified critical incident technique, as a framework for data gathering and error analysis. The outline places emphasis on recovery pathways and, in addition to causal and contributory factors, was able to identify many factors which aided or hindered the processes of error detection, diagnosis and management. On average, 8.1 factors were identified which were considered to have significantly influenced the genesis and evolution of each reported error. Differences were apparent in the type of factors which determined error production and aspects of the recovery sequence. The described schema is suggested to be of value for data generation, and as a tool for discussion as part of anaesthesia quality assurance.

Anaesthesia and Intensive Care, 1991

Patient movement during neurosurgery is often inconvenient and may be potentially hazardous. We r... more Patient movement during neurosurgery is often inconvenient and may be potentially hazardous. We report two cases of unexpected movement during neurosurgical procedures which we believe were related to the administration of betamethasone, a corticosteroid given preoperatively to reduce raised intracranial pressure. CASE REPORTS Case 1: A 49-year-old 85 kg male presented with a five-year history of gradual hearing loss in his right ear and a one-year history of right frontal headaches. He had no other significant history and was not receiving any medication. CT scan revealed a right posterior fossa lesion. He was commenced on betamethasone 4 mg qds and underwent posterior fossa craniotomy six days later. The anaesthetic technique consisted of premedication with temazepam 20 mg, induction with thiopentone 300 mg, fentanyl 200 ~g and vecuronium 16 mg. He was ventilated with air/02 and isoflurane (0.5-1.0%) to an end-tidal CO 2 of 4.0 KPa and received an alfentanil infusion of 0.5-1.0 ~g/kg/min.

Anaesthesia and Intensive Care, 1991

A confidential survey was conducted among medical practitioners in New Zealand with a stated inte... more A confidential survey was conducted among medical practitioners in New Zealand with a stated interest in anaesthesia to ascertain the proportion of those currently engaged in anaesthetic practice (thought to be approximately 325), who knowingly omit or alter undesirable physiological parameters from the anaesthetic record. Two hundred and forty-five replies were received from currently active anaesthetists. The reported frequency of occasional data omission or falsification was 55%. Those anaesthetists who intentionally manipulated data were more likely to be dissatisfied with their current anaesthetic record form, to view the record as an intraoperative distraction and less likely to perceive the record as being important for the use of future anaesthetists. There was no correlation between data manipulation and concerns over the medicolegal uses of the record.