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Princess Margaret Hospital

Research and Publications - Anaesthesia & Pain Management

Publications

Current Research

The Anaesthetic and Pain Management department at PMH is dedicated to ensure that quality patient care is delivered safely; part of that commitment is improving and reviewing current practice through research and providing resources to ensure this process occurs.

The research group in the department is headed by Winthrop Professor Britta Regli-von Ungern-Sternberg, Chair of Paediatric Anaesthesia. Britta graduated from the University of Freiburg/Germany after studying Medicine at the Universities of Freiburg/Germany, Cape Town/South Africa and Sydney/Australia. She holds the Swiss Specialist of Anaesthesia, German Specialist of Anaesthesia as well as the European Specialist in Anaesthesiology. She did her PhD at the University of Szeged/Hungary in collaboration with the University of Geneva, Switzerland.

Her main interests are the research into the prediction and prevention of respiratory complication in paediatric anaesthesia and lung function changes in the perioperative period. In Britta's absence, Dr. Mary Hegarty, Consultant Anaesthetist, has the acting coordination and supervision role for all projects. Her particular interest lays on the impact of anaesthesia in the developing brain.
Coordinating and overseeing the research projects on a daily basis within the department is fulfilled by the anaesthetic research nurses (Kylie Davies, Deborah Butcher, Helen Dawson). All staff within the department support and contribute to research and maintaining quality practice and improving patient outcomes.

Our research group works in close collaboration with several local, national and international research groups. On a national basis, the main collaborators are Prof. Andrew Davidson and his team at the Royal Children's Hospital in Melbourne and Prof. Peter Sly and his team at the Queensland Children's Medical Research Institute in Brisbane. On an international basis, our research group works closely with Prof. Thomas Erb and his team at the University Children's Hospital, Basel, Switzerland, Prof. Walid Habre and his team at the Geneva Children's Hospital, University of Geneva, Switzerland, Prof. Zoltan Hantos and his team at the University of Szeged, Hungary and Prof. Lena Sun and her team at Columbia University, USA.

The anaesthetic research group would like to acknowledge and thank Princess Margaret Hospital (PMH), the PMH Foundation, Woolworths and the University of Western Australia (UWA) for their continuous financial support.

Current Research/Audits:

  • A study to compare general with regional anaesthesia for babies having hernia surgery. Effect on breathing in the early postoperative phase and long term outcome. Multicentre study coordinated via Melbourne
  • Timing of laryngeal mask removal in children with a high risk for postoperative respiratory complications – awake or anaesthetised
  • Impact of topical lignocaine on the incidence of perioperative respiratory complications in children undergoing larnyngo-tracheo-bronchoscopies – a double blind randomised controlled pilot study
  • Randomised controlled trial: Respiratory complications in infants undergoing general anaesthesia with a laryngeal mask airway versus and endotracheal tube
  • Perpherally Inserted Central Catheters: Prospective Study of Complications and Parental/Child Satisfaction
  • Randomised Control Trial: Intravenous versus inhalational induction in infants and children (0-8 years) with a high risk for respiratory complications undergoing minor elective surgical procedures with laryngeal masks airways
  • Performance of two commonly used supraglottic devices in paediatric anaesthesia: laryngeal mask airways vs. I-Gel: A randomised controlled trial
  • A pilot study of the use of gabapentin to aid in the management of mucositis pain in children undergoing myeloablative chemotherapy
  • Anaesthesia and Neurodevelopmental study
  • Difficult Intubation Trolley survey
  • Manipulation under anaesthesia and lignocaine spray audits
  • Children's attitude towards anaesthesia
  • Impact of salbutamol on respiratory mechanics in children with a recent upper respiratory tract infection undergoing anaesthesia
  • Impact of body mass index on respiratory function changes before and after induction of anaesthesia

Completed Research/Audits pending publication:

  • Impact of different methods of spraying lignocaine on the vocal cords prior to endotracheal intubation – a quality of care service
  • Prediction and Prevention of Respiratory Complications in Paediatric Anaesthesia
  • The correlation between measures of illness severity scores and the anaesthetic risk in preterm babies
  • Incidence of pharyngolaryngeal, neck and jaw discomfit after anaesthesia with a cuffed or uncuffed endotracheal tube in school children undergoing day case sugery
  • Risk factors for postoperative agitation in children undergoing anaesthesia
  • Impact of standardised anaesthesia techniques on CT imaging quality in children with CF
  • Impact of new fasting guidelines on fasting times in children undergoing day case surgery
  • Minimising the risk for adverse events by lowering laryngeal mask airway cuff pressures in paediatric anaesthesia – pro seal laryngeal mask
  • BIS in children taking stimulant medication versus controls
  • Laryngoscopic view comparisons before versus after difficult intubation
  • Effect of protocolized take home medication on postoperative pain
  • Dose finding and efficacy trial of parecoxib in tonsillectomy
  • Population pharmacokinetics of parecoxib in paediatrics
  • Audit of fasting times at PMH
  • Impact of a new fasting protocol on fasting times in day case surgery
  • Immunologic markers to predict respiratory complications in high risk children
  • Extubation – awake or anaesthetised – in high-risk patients undergoing adenotonsillectomy

Publications

2014

Regli A, von Ungern-Sternberg BS. Anesthesia and ventilation strategies in children with asthma: Part I – preoperative assessment. Current Opinion in Anesthesiology 2014 accepted

Regli A, von Ungern-Sternberg BS. Anesthesia and ventilation strategies in children with asthma: Part II – intraoperative management. Current Opinion in Anesthesilogy 2014 accepted.

Drake-Brockman TFE, Hegarty M, Chambers NA, von Ungern-Sternberg BS. Monitoring Temperature in children undergoing anaesthesia: a comparison of methods. Anaesthesia and Intensive Care 2014 accepted.

Ing CH, DiMaggio CJ, Malacova E, Whitehouse AJ, Hegarty MK, Feng T, Brady JE, von Ungern-Sternberg BS, Davidson AJ, Wall MM, Wood AJJ, Li G, Sun LS. Comparative analysis of outcome measures used in examining neurodevelopmental effects of early childhood anesthesia exposure. Anesthesiology 2014 accepted.

Neumann RP, von Ungern-Sternberg BS. The neonatal lung – physiology and ventilation. Pediatric Anesthesia 2014, 24: 239-48.

von Ungern-Sternberg BS. Respiratory complications in the pediatric post-anesthesia care unit. Anesthesiology Clinics 2014; 32: 45-61

Dorkham MC, Chalkiadis GA, von Ungern Sternberg BS, Davidson AJ. Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions. Paediatr Anaesth. 2014; 24: 239-48.

2013

Russel P, von Ungern-Sternberg BS, Schug SA. Perioperative analgesia in pediatric surgery. Current Opinion in Anesthesiology 2013; 26: 420-7

Erb TO, Keller K, Frei FJ, von Ungern-Sternberg BS. A reply. Anaesthesia 2013; 68: 535-6.

Stanko D, Bergesio R, Davies K, Hegarty M, von Ungern-Sternberg BS. Postoperative pain, nausea and vomiting following adeno-tonsillectomy – a long term follow-up. Pediatric Anaesthesia 2013, 23: 690-6.

Hegarty, MK, Davies K, Calder A, Meyer T, Christiansen E, Shave M, von Ungern-Sternberg BS. Does take-home hospital analgesia improve post-operative pain after elective day case surgery? A comparison of hospital versus parent-supplied analgesia. Pediatric Anesthesia 2013; 23: 385-9

von Ungern-Sternberg BS, Davies K, Hegarty M, Erb TO, Habre W. The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: A prospective, randomised, controlled trial. European Journal of Anaesthesiology 2013; 30: 529-36.

Sims C. Absent expiratory valve missed by automated check in Dräger Primus anaesthesia workstation (letter). Anaesth Int Care 2013;41:681-2.

Sims C.  A suction catheter is a simple technique to aid nasal intubation with the Glidescope (letter). Pediatric Anesthesia 2013;23:874

Direct Laryngoscopy after potential difficult intubation in children only predicts standard Cormack and Lehane view to within one grade. Chambers NA. Hullett B. Pediatric Anaesthesia Nov 2013; p1002-5

2012

von Ungern-Sternberg BS, Hegarty M. Local reaction to a scented facemask in a child. Pediatric Anesthesia 2012, accepted.

Ing C, DiMaggio C, Whitehouse A, Hegarty M, Brady J, von Ungern-Sternberg BS, Davidson A, Wood AJJ, Li G, Sun LS. Long-Term Differences in Cognitive and Language Ability after Exposure to Anesthesia in Early Childhood. Pediatrics 2012, accepted.

Erb TO, von Ungern-Sternberg BS, Keller K, Frei FJ. The effect of intravenous lidocaine on respiratory reflex responses in anaesthetised children. Anaesthesia 2012 accepted.

Hegarty M, Erb TO, von Ungern-Sternberg BS. Does topical lidocaine before tracheal intubation attenuate airway responses in children? An Observational audit – Reply. Pediatric Anesthesia 2012; 22: 727

Calder A, Hegarty M, Erb TO, von Ungern-Sternberg BS. Reply. Pediatric Anesthesia. 2012; 22: 596-7.

Sims C, von Ungern-Sternberg BS. The normal and the challenging airway. Pediatric Anesthesia 2012; 22: 521-6.

Hamilton ND, Hegarty M, Calder A, Erb TO, von Ungern-Sternberg BS. Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit. Pediatric Anesthesia 2012; 22: 345-50.

Calder A, Hegarty M, Erb TO, von Ungern-Sternberg BS. Predictors of Post-Operative Sore Throat in Intubated Children. Pediatric Anesthesia 2012; 22: 239-43.

Ing RJ, Ames WA, Chambers NA. Paediatric cardiomyopathy and anaesthesia. Br J Anaesthesia. 2012 Jan;108(1):4-12

Chambers NA, Pascoe E, Kaplanian S, Forsyth I. Ingestion of stimulant medications does not alter bispectral index or clinical depth of anesthesia at 1 MAC sevoflurane in children. Pediatric Anesthesia. 2012 Apr;22(4):341-4

Stacey J, Heard AMB, Chapman G, Wallace CJ, Hegarty M, Vijayasekaran S, von Ungern-Sternberg BS. The 'Can't Intubate Can't Oxygenate" scenario in Pediatric Anesthesia: A comparison of different devices for needle-cricothyroidotomy. Pediatric Anesthesia accepted 04.09.2012

Calder A, Hegarty M, Davies K, von Ungern-Sternberg BS. The Difficult Airway Trolley: An International Survey of Experience and Training. Pediatric Anesthesia accepted 04.09.2012

2011

von Ungern-Sternberg BS. Old Dogma or new science? Der Anaesthesist. 2011; 60: 1063-4.

Keating M, Johnson C, Erb TO, von Ungern-Sternberg BS. CT changes of alveoli and airway collapse post laryngospasm. Anaesthesia and Intensive Care 2011; 39: 958-60.

von Ungern-Sternberg BS, Muscle relaxants are obligatory for paediatric intubation : Con. Der Anaesthesist . 2011; 60: 476-8.

Habre W, Albu G, Janosi TZ, Fontao F, von Ungern-Sternberg BS, Beghetti M, Petak F. Prevention of bronchial hyper reactivity in a rat model of precapillary pulmonary hypertension. Respir Res. 2011;12: 58ff

von Ungern-Sternberg BS, Habre W. Changes in lung volume during spells in children with Tetralogy of Fallot under general anesthesia. Pediatric Critical Care Medicine 2011; 12: e40-2

Sims C, Johnson C. Your guide to paediatric anaesthesia. Mc Graw Hill, North Ryde 2011.

2010

von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W. Risk assessment for respiratory complications in pediatric anesthesia - A prospective cohort study. The Lancet 2010; 376: 773-83

Erb TO, von Ungern-Sternberg BS, Keller K, Rosner GL, Craig D, Frei FJ. Fentanyl does not reduce the incidence of laryngospasm in children anesthetized with sevoflurane. Anesthesiology 2010; 113: 41-7

Keating M, von Ungern-Sternberg BS. Case Report: Compression of the common carotid artery following clavicle fracture in a 12 year-old. Anaesthesia and Intensive Care 2010; 38: 759-60

von Ungern-Sternberg BS, Habre W. Changes in lung volume during spells in children with Tetralogy of Fallot under general anesthesia. Pediatric Critical Care Medicine 2010 epub ahead of print

William A, Chambers NA, Erb TO, von Ungern-Sternberg BS. Incidence of sore throat in children following use of flexible laryngeal mask airways – impact of an introducer device. Pediatric Anesthesia 2010; 20: 839-43

Hockings L, Heaney M, Chambers NA, Erb TO, von Ungern-Sternberg BS. Reduced air leakage by adjusting the cuff pressure in pediatric laryngeal mask airways during spontaneous ventilation. Pediatric Anesthesia 2010; 20: 313-7

Riemensberger, P. Pediatric and Neonatal Mechanical Ventilation: From Basics to Bedside. In press. Chapter "Monitoring of the Mechanical Behavior of the Respiratory System during Controlled Mechanical Ventilation, respiratory system resistance" von Ungern-Sternberg BS and Schulzke SM. 11/2009

von Ungern-Sternberg BS, Frei FJ, Erb TO. Intraossäre Infusion für alle und alles? Der Anaesthesist 2010; 59: 258–60

von Ungern-Sternberg BS, Erb TO. Is fibreoptic scoring a valuable means to assess proper positioning of the classic larngeal mask airway in paediatric patients? – author reply. Anaesthesia and Intensive Care 2010; 38: 592-3

von Ungern-Sternberg BS, Wallace CJ, Stick S, Erb TO, Chambers NA. Fibreoptic assessment of paediatric sized laryngeal mask airways. Anaesthesia and Intensive Care 2010; 38: 50-4

von Ungern-Sternberg BS, Habre W, Regli A, Pache J-Cl, Fontao F, Janosi TZ, Beghetti M, Petak F. Precapillary pulmonary hypertension leads to reversible bronchial hyperreactivity in rats. Experimental Lung Research 2010; 36: 129-39

2009

Hullett B. Chambers NA, Preuss J, Zamudio I, Lange J, Pascoe E, Ledowski T. Monitoring Electrical Skin Conductance: A Tool for the assessment of Postoperative Pain in Children? Anaesthesiology September 2009; 111 (3) pp 513-517.

von Ungern-Sternberg BS, Habre W. Hypnosis as an alternative to avoid general anesthesia in a child with severe pulmonary arterial hypertension. Pediatric Anesthesia 2009, 19: 182-3.

Chambers NA, Andrews D, Frew E, Kelly R, Cole C. rFV11a and paediatric open heart surgery: thrombosis in the cardiopulmonary bypass circuit in spite of adequate markers of anticoagulation. Anaesthesia, Volume 64, Issue 6, pages 683-686, June 2009.

Wallace CJ, Chambers NA, Erb TO, von Ungern-Sternberg BS. Pressure Volume Curves of Paediatric Laryngeal Mask Airways. Anaesthesia. 2009; 64: 527-531.

von Ungern-Sternberg BS, Erb TO, Habre W, Sly PD, Hantos Z. Impact of oral premedication with midazolam on respiratory function in children. Anesthesia & Analgesia 2009, 108: 1771-6.

von Ungern-Sternberg BS, Petak F, Hantos Z, Habre W. Changes in functional residual capacity and lung mechanics during surgical repair of congenital heart diseases: effects of preoperative pulmonary hemodynamics. Anesthesiology 2009, 110: 1348-55.

Wong JGL, Heaney M, Chambers NA, Erb TO, von Ungern-Sternberg BS. Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children. Paediatric Anesthesia 2009, 19: 464-9.

Stick SM, Brennan S, Murray C, Douglas T, von Ungern-Sternberg BS, Garratt L, De Klerk N, Linnane B, Ranganathan S, Robinson P, Robertson C, SlyPD. Bronchiectasis in infants and pre-schoolers diagnosed with cystic fibrosis following newborn screening. Journal of Pediatrics 2009;155:623-8

von Ungern-Sternberg BS, Trachsel D, Erb TO, Hammer J. Forced Expiratory Flows and Volumes in Intubated Infants and Children. Normative Data up to 4 years of age. Journal of Applied Physiology 2009, 107: 105-11.

von Ungern-Sternberg BS, Erb TO, Chambers NA, Heaney M. Laryngeal mask airways – to inflate or to deflate after insertion? Pediatric Anaesthesia 2009; 19: 837-843.

von Ungern-Sternberg BS, Habre W, Erb TO, Heaney M. Salbutamol premedication in children with a recent respiratory tract infection. Pediatric Anaesthesia 2009;19:1064-9

von Ungern-Sternberg BS. Cuff pressure monitoring in paediatric laryngeal mask airways – is it worth the pain? Australasian Anaesthesia 2009/2010

von Ungern-Sternberg BS, Habre W, Regli A, Pache J-Cl, Fontao F, Janosi TZ, Beghetti M, Petak F. Precapillary pulmonary hypertension leads to reversible bronchial hyperreactivity in rats. Experimental Lung Research accepted 7/2009.

von Ungern-Sternberg BS, Wallace CJ, Stick S, Erb TO, Chambers NA. Fibreoptic assessment of paediatric sized laryngeal mask airways. Anaesthesia and Intensive Care accepted 7/2009

2008

von Ungern-Sternberg BS. Impact of anaesthesia on lung function in children. European Respiratory Review 2008; 17: 107, 26-9.

von Ungern-Sternberg BS, Johnson C, Habre W. Laryngeal Mask Airway and Children’s Risk of Perioperative Respiratory Complications – a reply. Anesthesiology 2008; 108: 1155.

Ong M, Chambers NA, Hullet B, Erb TO, von Ungern-Sternberg BS. Laryngeal mask airway and tracheal tube cuff pressures in children: are clinical endpoints valuable for guiding inflation? Anaesthesia 2008; 63: 738-44.

Licina A, Chambers NA, Hullett B, Erb TO, von Ungern-Sternberg BS. Lower cuff pressures improve the seal of pediatric laryngeal mask airways. Paediatric Anesthesia 2008, 18: 952-6.

von Ungern-Sternberg BS, Habre W. Hypnosis as an alternative to avoid general anesthesia in a child with severe pulmonary arterial hypertension. Paediatric Anesthesia 2009, 19: 182-3.

2007

Kaplanian S, Chambers N, Forsyth I. Caudal anaesthesia as a treatment for penile ischaemia following circumcision. Anaesthesia 2007 62 (7) 741-743

Kurowski I, Sims C. Unplanned anaesthesia-related admissions to paediatric intensive care - a 6-year audit. Paediatric Anaesthesia 2007 17 575-580

Lethbridge M, Bouckley A, Chambers N. Patterns of sevoflurane use in a children's hospital: the effects of simple educational intervention. Anaesthesia and Intensive Care 2007 35 550-557

von Ungern-Sternberg BS, Boda K, Schwab C, Sims C, Johnson C, Habre W. Laryngeal Mask Airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections. Anesthesiology 2007 107 714-9

2006

Forsyth, I; Bergesio, R and Chambers, N. 2006. Attention-deficit hyperactivity disorder and anaesthesia. Paediatric Anaesthesia 16 371-373

Hullett, B; Chambers, N; Pascoe, E and Johnson, C. 2006. Tramadol vs morphine during adentotonsillectomy for obstructive sleep apnea in children. Paediatric Anaesthesia 16 648-653

Hullett, B; Shine, N and Chambers, N. 2006. Airway management of three cases of congenital cervical teratoma. Paediatric Anaesthesia 16 794-798

Kaplanian, S and Chambers, N. 2006. Anaesthesia in a child with newly diagnosed Hypertrophic Cardiomyopathy. Paediatric Anaesthesia 16 1080-1083

Lim, S; Chambers, N and Somerville, N. 2006. Can Bispectral Index aid laryngeal mask placement in children? Paediatric Anaesthesia 16 1244-1250

von Ungern-Sternberg BS, Sly PD, Loh RKS, Isidoro A, Habre W. 2006. Value of eosinophil cationic protein and tryptase levels in bronchoalveolar lavage fluid for predicting lung function impairment in
anesthetized, asthmatic children. Anaesthesia 61 1149-54

2005

Borland, M; Bergesio, R; Pascoe, E; Turner, S and Woodger, S. 2005. Intranasal fentanyl is an equivalent analgesic to oral morphine in paediatric burns patients for dressing changes: a randomised double blind crossover study. Burns 31 831-837

Chambers, N. 2005. Left internal jugular catheter tip wedged in the left superior intercostal vein, an inferior tributary of the brachiocephalic. Paediatric Anaesthesia 15 1022-1023

Christiansen, E and Chambers, N. 2005. Induction of anaesthesia in a combative child; management and issues. Paediatric Anaesthesia 15 421-425

Sims, C; Stanley, B and Milnes, E. The frequency of and indications for general anaesthesia in children in Western Australia 2002-2003. Anaesthesia and Intensive Care 33 623-628

Waddington, M and Mullins, G. 2005. Early complication of pediatric central venous cannulation. Paediatric Anaesthesia 15 1001-1005

2004

Philip J, Bresnihan M and Chambers, N. A Christmas tree in the larynx. Pediatric Anaesthesia 2004 14 1016-1020

 
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