bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Laws for the Government of any Territory’: Section 122 of the Constitution
Authors: Zines Leslie
Published: January 2019

The many problems relating to Commonwealth power to make laws for a Territory have arisen because the power itself was a constitutional afterthought. The late Professor Ross Anderson described the Commonwealth of Australia as ‘the child of as hard-headed a mariage de convenance as was ever arranged in the salons of France ’. The marriage was, however, between the self-governing colonies which later became the States. Those who arranged the marriage were concerned primarily with the health and prosperity of the parties to, and the issue of, the union. Whether they were in favour of granting large powers to the Commonwealth or were staunch believers in ‘State Rights’ or whether they were for or against Federation, the chief issue was whether and to what extent each of the colonies should voluntarily reduce its own governmental power by giving some of it to a new self-governing colony which would in area and population embrace all the existing colonies.
Commonwealth Digest
Authors: Cork A. , Cunliffe I. G. , Pascoe J. H.
Published: January 2019

This Digest is intended to provide lawyers with a key to those questions and Ministerial Statements in the Commonwealth Parliament in which they are most likely to be interested, and it is, of course, selective. It covers the period 21 February to 8 November 1967, and is compiled from the published debates of the Parliament of the Commonwealth of Australia.
Mr Justice Evatt and the Constitution
Authors: Zines Leslie
Published: January 2019

In a recent work dealing with Dr Evatt, the politician, he is described in the title as an “enigma”. Perhaps there is some enigmatic quality in Evatt, the High Court judge and constitutional lawyer. In the ten years he was on the High Court (1930-1940) a number of dominant themes can be detected in his judgments on constitutional law which at first sight seem to be not fully consistent with each other. In many cases they show a concern to prevent the undermining of State executive and legislative authority and a tendency to restrict Commonwealth power. In other cases, his judgments propound a rather broad interpretation of Commonwealth powers.
Attitude stabilization and test validation of underactuated post-capture combination with multiple disturbances
Authors: Chen Shiyu , Sun Chong , Guo Linli , Zhu Zhanxia , Wang Zheng , Yuan Jianping
Published: January 2019

This paper aims to address attitude stabilization control of an underactuated post-capture combination and achieve test validation based on the magnetism–buoyancy hybrid micro-gravity experiment system (MBHMES). Using a precise reduced model, a cascade control law is proposed to solve the issue theoretically. First, an advanced quaternion-based kinematic control law is proposed to stabilize the attitude of the non-symmetric post-capture combination. This control law can overcome the singularity brought about by the small initial attitude under the consideration of uncontrolled angular velocity. Then, considering the existence of multiple disturbances introduced by the fluid flow and electromagnetic force, an effective adaptive dynamic controller is proposed to meet the attitude requirement and reduce the negative effect of the multiple disturbances. For test demonstrations, a scenario of a base body capturing the target with robotics, to achieve attitude stabilization expectation, is described. Simulation results demonstrate the performance of the cascade control laws and test data show the effectiveness of the proposed method.
To Merge, Sell, or Liquidate? Socioemotional Wealth, Family Control, and the Choice of Business Exit
Authors: Chirico Francesco , Gómez-Mejia Luis R. , Hellerstedt Karin , Withers Michael , Nordqvist Mattias
Published: January 2019

We take the perspective that considering the affective motives of dominant owners is essential to understanding business exit. Drawing on a refinement of behavioral agency theory, we argue that family-controlled firms are less likely than non-family-controlled firms to exit and tend to endure increased financial distress to avoid losses to the family’s socioemotional wealth (SEW) embodied in the firm. Yet, when confronted with different exit options and when performance heuristics suggest that exit is unavoidable, family firms are more likely to exit via merger, which we argue saves some SEW, although it is less satisfactory financially. In contrast, nonfamily firms are more likely to exit via sale or dissolution, options that are more prone to offer higher financial returns than mergers. Family and nonfamily firms thus show different orders of exit options. We find support for these arguments in a longitudinal matched sample of privately held firms.
What Is the Return on Investment for Public Workforce Programs? An Analysis of WIA and TAA in Virginia
Authors: Harper-Anderson Elsie
Published: January 2019

Decreasing funding and devolution have put public workforce programs under constant scrutiny by federal, state, and local officials wanting to get the most for their investment. Besides asking whether invested dollars are yielding a return, policy makers want to know under what conditions those returns are maximized and which program components have the most influence. Using Return on Investment (ROI) and regression analysis to examine two of Virginia’s publicly funded programs, I find that ROI can be positive under the right circumstances. Further, participation in training as a component improves the outcome. Obtaining a credential for that training yields an even higher ROI and certain credentials yield the highest returns. However, results are differentiated by training type, credential type, and program. Results here suggest that even in the current era wherein streamlining and cuts are the new normal, strategic investment of scarce workforce dollars can potentially yield real returns.
Critical Computation: Digital Automata and General Artificial Thinking
Authors: Parisi Luciana
Published: January 2019

As machines have become increasingly smart and have entangled human thinking with artificial intelligences, it seems no longer possible to distinguish among levels of decision-making that occur in the newly formed space between critical reasoning, logical inference and sheer calculation. Since the 1980s, computational systems of information processing have evolved to include not only deductive methods of decision, whereby results are already implicated in their premises, but have crucially shifted towards an adaptive practice of learning from data, an inductive method of retrieving information from the environment and establishing general premises. This shift in logical methods of decision-making does not simply concern technical apparatuses, but is a symptom of a transformation in logical thinking activated with and through machines. This article discusses the pioneering work of Katherine Hayles, whose study of the cybernetic and computational infrastructures of our culture particularly clarifies this epistemological transformation of thinking in relation to machines.
The affective politics of precarity: Home demolitions in occupied Palestine
Authors: Joronen Mikko , Griffiths Mark
Published: January 2019

In this article we discuss the precarities induced by the threat of home demolitions in occupied Palestine. Drawing on fieldwork from four separate sites, the discussion begins by showing how the threat of demolition exposes Palestinians to a powerfully affective future of a violence that will arrive at an uncertain time. From this we develop the notion of ‘affectual demolition’ to describe how the anticipatory affective dimensions of demolition structure the present and the ways that precarities are embodied in Palestinian communities living under the threat of demolition. The discussion then moves on to further consider how anticipatory affects relate to different practices, including ways of acting on and against induced vulnerabilities and insecurities. We thus argue that the continued threat of home demolitions evokes precarities that are (politically) induced and (ontologically) productive and that they hold significant world-making and -annulling capacities.
Exercise interventions on patients with end-stage renal disease: a systematic review
Authors: Zhao Qiu-Ge , Zhang Hong-Rui , Wen Xin , Wang Yu , Chen Xue-Mei , Chen Niu , Sun Ying , Liu Han , Lu Ping-Jing
Published: January 2019

Objective:

This study aimed to conduct an up-to-date systematic review of the literature to evaluate the effects of exercise on fatigue, anxiety, depression, physical activity, and quality of life (QOL) in patients with end-stage renal disease.

Data sources:

We searched PubMed (October 2018), Embase (from 1966 to October 2018), Web of Science (from 1900 to October 2018), The Cochrane Library (October 2018), and references of papers.

Methods:

This study includes randomized controlled trials that analyzed the combined effects of exercise intervention on patients with end-stage renal disease. Two reviewers independently screened the retrieved records, extracted data, and assessed the risk of bias for inclusion in the study. The effects of exercise intervention were conducted in the meta-analysis using RevMan 5.3 software.

Results:

A total of 614 participants were included in 13 randomized controlled studies. The study revealed that exercise can improve fatigue, anxiety, depression, physical activity, and QOL. The effect value results were as follows: (1) fatigue, −0.97 (95% confidence interval (CI) −1.32 to −0.62, P < 0.00001); (2) anxiety, −0.78 (95% CI −1.17 to −0.39, P < 0.0001); (3) depression, −0.85 (95% CI −1.13 to −0.56, P < 0.00001) (4) physical activity, 38.15 (95% CI 21.20 to 55.10, P < 0.0001); (5) QOL, the physical component of the 36-item Short-Form Health Survey (SF-36), 4.73 (95% CI 1.92 to 7.54, P = 0.0010); and (6) the mental component of the SF-36, 3.42 (95% CI 0.27 to 6.56, P = 0.03).

Conclusion:

Exercise intervention is more effective in fatigue, anxiety, depression, physical activity, and QOL. However, large-scale randomized controlled trials are needed to confirm the appropriate types of exercise and optimal time for patients with end-stage renal disease.
Connections Between Adolescents’ Parasocial Interactions and Recollections of Childhood Imaginative Activities
Authors: Gleason Tracy R. , Theran Sally A. , Newberg Emily M.
Published: January 2019

Parasocial interactions (PSIs; one-sided communication imagined with a media figure) in adolescence and imaginative activities in childhood, such as imaginary companions and role play, have a shared foundation in that both use imagination for social purposes. This commonality in both cognitive processes and social uses begs the question of whether they are related phenomena. We examined PSI’s connection to retrospective reports of childhood imaginative activities in the context of the social environment, including relationship functioning (attachment style and social support) and well-being (self-esteem and depressive symptoms), in 151 adolescents ( Mage = 14.8 years). PSI and reports of childhood imagination were unrelated to each other and differentially related to the social environment, suggesting that each form of social imagination relates to the developmental task it addresses rather than to individual differences in predilection for fantasy or social functioning.
Tracheal Intubation with the Macintosh Laryngoscope versus Intubating Laryngeal Mask Airway in Adults with Normal Airways
Authors: Kihara S. , Watanabe S. , Taguchi N. , Suga A. , Brimacombe J. R.
Published: January 2019

We tested the hypothesis that haemodynamic changes to intubation and postoperative pharyngolaryngeal morbidity are similar for blind intubating laryngeal mask (ILM)-guided compared with laryngoscope-guided tracheal intubation in adults with normal airways. We also compared intubation success rates and airway complications. One-hundred and fifty paralysed, anaesthetized adult patients undergoing elective surgery were randomly assigned to one of three equal-sized groups: 1. blind intubation via the ILM using a straight, silicone tube; 2. intubation with a Macintosh laryngoscope using a straight silicone tube and 3. intubation with a Macintosh laryngoscope using a polyvinyl chloride tube (controls). A standard sequence of adjusting manoeuvres was followed if intubation was difficult. The number of adjusting manoeuvres and intubation attempts, time to intubation, intubation success rate (first attempt and within 3 min), haemodynamic changes (pre-induction, post-induction, post-intubation), oesophageal intubation, mucosal trauma (blood detected), hypoxia (SpO2 <95%) and postoperative pharyngolaryngeal morbidity (double-blinded) were documented. Time to successful intubation was longer (57 vs 35s), and more intubation attempts were required in the ILM group (P<0.0001). The intubation success rate was 100% (all first attempt) for the laryngoscope groups and 94% (56% first attempt) for the ILM group. There were no significant differences in heart rate or blood pressure among groups. Oesophageal intubation (26 v 0%) and mucosal trauma (19 v 2%) were more common in the ILM group. Hypoxia and postoperative pharyngolaryngeal morbidity were similar among groups. Blind intubation through the ILM offers no advantages over the Macintosh laryngoscope for adult patients requiring intubation for elective surgery with normal airways, but it is a feasible alternative.
The Effect of PVC Packaging on the Acidity of 0.9% Saline
Authors: Story D. A. , Thistlethwaite P. , Bellomo R.
Published: January 2019

Intravenous fluids in polyvinyl chloride (PVC) packaging are known to be acidic. We proposed to determine the effect of PVC packaging on the pH of 0.9% saline solutions by comparing the predicted and measured pH of 0.9% saline equilibrated with atmospheric carbon dioxide and the measured pH of commercial solutions of 0.9% saline in PVC and polypropylene packaging. Calculation of pH was made from available physical chemistry constants and data. Measurement was made of the pH of 12 samples of prepared 0.9% saline equilibrated with atmospheric carbon dioxide. Comparison with the pH of seven commercial samples of saline in PVC packaging for intravenous use was undertaken. Further comparison was made between commercial samples of 0.9% saline in PVC or polypropylene packaging. The calculated pH of 0.9% saline was 5.61 at 20°C. The median pH of the prepared samples was statistically significantly less acidic than the median pH of the PVC packaged samples for intravenous use: 5.47 vs 4.60, P<0.05. The median pH of the PVC packaged saline was also statistically significantly more acidic than the pH of the polypropylene packaged saline: 4.62 vs 5.71, P<0.05. The acidity of the intravenous solutions of 0.9% saline packaged in PVC was much greater than expected and is only partially explained by dissolved carbon dioxide. This acidity could be a result of packaging in PVC.
Anaesthesia and Fatigue: An Analysis of the First 10 Years of the Australian Incident Monitoring Study 1987–1997
Authors: Morris G. P. , Morris R. W.
Published: January 2019

The Australian Incident Monitoring Study (AIMS) database of the Australian Patient Safety Foundation (APSF) was reviewed from its inception in April 1987 to October 1997. A total of 5600 AIMS reports were lodged in that period. Reports in which fatigue was listed as a Factor Contributing to Incident were examined. This occurred in 152 reports, or 2.7% of all reports. Confidence interval analysis suggested that fatigue was associated with various concurrently reported factors. These included pharmacological incidents (especially syringe swaps) and time of day. Other factors significantly associated with fatigue reports were haste, distraction, inattention and failure to check equipment. Relieving anaesthetists and healthy patients were reported more often as factors minimizing incidents. Anaesthetists reporting fatigue more often reported incidents during induction. These data suggest that fatigue alleviation strategies and equipment checking routines, improved workplace design (including drug ampoule and syringe labelling protocols) and regulation of working hours will facilitate minimization of fatigue-related incidents. Definitive prospective studies might be most usefully targeted at these and related interventions.
Postoperative Confusion Preceded by Decreased Frontal Lobe Haemoglobin Oxygen Saturation
Authors: Madsen P. L. , Secher N. H.
Published: January 2019

We describe a 58-year-old male patient with confusion and prolonged recovery after liver transplantation. A cause was not apparent for the confusion, but during surgery, monitoring of the frontal lobe cerebral haemoglobin oxygen saturation by near-infrared spectrophotometry showed cerebral hypo-oxygenation despite optimization of conventional cardiovascular parameters. It is possible that intraoperative cerebral ischaemia is the cause of post-surgical confusion and with near-infrared spectrophotometry this hypothesis may be tested clinically.
Acute Heart Failure in the Parturient—Do Not Forget Phaeochromocytoma
Authors: Gill P. S.
Published: January 2019

Phaeochromocytoma is a rare condition and extremely rare in pregnancy. Diagnosis is notoriously difficult, as phaeochromocytoma may present a broad spectrum of clinical manifestations. The key to a successful outcome is a high index of suspicion of its existence and its early diagnosis.
Mortality from Peripartum Meningitis
Authors: Choy J. C.
Published: January 2019

A young primigravid parturient had an uneventful labour under epidural analgesia and delivered a healthy male infant. She returned 48 hours later with fever, vomiting and severe headache, but was misdiagnosed as having endometritis. Further signs of meningitis appeared six hours later, however she succumbed to the infection and died four weeks later despite intensive care and high-dose antibiotic management.

Causes of meningitis in the peripartum period are discussed. The possibility of a causal association between the patient's epidural analgesia and her infection are considered and preventive measures discussed.
Variable Cytochrome P450 2D6 Expression and Metabolism of Codeine and Other Opioid Prodrugs: Implications for the Australian Anaesthetist
Authors: Wilcox R. A. , Owen H.
Published: January 2019

Codeine is a popular opioid prodrug dependent on the activity of the specific cytochrome P450 enzyme 2D6 (CYP2D6). This enzyme catalyses the production of the potent analgesic metabolite morphine, but genetic studies have demonstrated that individuals from different ethnic groups exhibit considerable variability in the functional capacities of their expressed CYP2D6 enzymes, and pharmacological studies have shown many commonly prescribed drugs can reduce the action of CYP2D6 enzymes. These findings have significant clinical implications for the rational prescription of effective analgesia, especially in a multicultural country like Australia.
The Influence of “Sputum-Like Gel” Viscosity on Crackle Characteristics in a Mechanically Ventilated Porcine Lung Model
Authors: Jones A. Y. M. , Jones R. D. M. , Kwong K. , Burns Y.
Published: January 2019

This study investigated the influence of airway secretion viscosity on the characteristics of crackle sounds produced using a mechanically ventilated porcine lung model. Aqueous ultrasonic methylene blue stained gel solutions of viscosity 100, 150 and 200 P were prepared and instilled into 15 isolated, mechanically ventilated, porcine lungs immersed in water. Sound signals recorded by a hydrophone before and after instillation of gel were subjected to both fast Fourier transform and wave-form analysis. At the completion of sound recording, the main bronchi were dissected and the location of the stained gel was photographically recorded. Wave-form analysis demonstrated that expiratory phase crackle incidence and amplitude were both significantly higher than inspiratory phase data. This study demonstrates that crackle duration and amplitude are inversely related to gel viscosity and that electronic lung sound analysis can provide indirect evidence of sputum viscosity.
Supraclavicular Regional Anaesthesia Revisited—The Bent Needle Technique
Authors: Cornish P. B.
Published: January 2019

A new technique for achieving brachial plexus anaesthesia through the supraclavicular fossa is described. Its objectives are to minimize risk to the lung and provide for continuous as well as single-shot options. The plexus is approached through the lateral aspect of the supraclavicular fossa, and a bend in the shaft of the needle permits the tip of the needle to be directed tangential to the chest wall. An audit of 572 cases associated with the development of this technique is presented.
Anticoagulation and Cataract Surgery: A Review of the Current Literature
Authors: Konstantatos A.
Published: January 2019

The anticoagulated patient presenting for cataract surgery presents many dilemmas for anaesthetist and surgeon alike. Current evidence suggests that warfarin therapy significantly improves prognosis in patients with atrial fibrillation with coexisting cerebrovascular disease, and those with non-tissue prosthetic heart valves. Inadequate anticoagulation in these groups exposes them to higher risk of systemic embolic complications, which are frequently devastating.

Warfarin is an extremely complex drug. Attempted cessation and recommencement of warfarin therapy may not only reverse anticoagulation for unpredictable periods of time but may also expose patients to a transient yet dangerous hypercoagulable state. In most instances this state represents an additive risk to the untreated disease for which warfarin is being prescribed.

It is difficult to accurately measure risks of local anaesthetic blockade in anticoagulated patients as techniques are not standardized. Smaller needles and single injections appear safer with deep eye blocks, while sub-Tenon's block and topical techniques appear safer still, and acceptable provided patients and surgeons are happy with the conditions so created.

Retrobulbar haemorrhage appears to occur more frequently in anticoagulated patients who have their anticoagulation continued up to the time of cataract surgery. Retrobulbar haemorrhage is also more frequent in this same group even when anticoagulation is ceased prior to surgery when compared to non-anticoagulated patients. Prognosis for visual acuity with retrobulbar haemorrhage is generally good, given an experienced surgeon is present to rapidly decompress the eye.
An Evaluation of Nitric Oxide and Nitrogen Dioxide Absorbers and Filters
Authors: Carter B. G. , Horsnell B. , Hochmann M. , Osborne A. , Tibballs J.
Published: January 2019

The absorbance of NO (5–90 ppm) and NO2 (0.5–4 ppm) by a number of absorbers and filters was assessed via bench testing. All absorbers (Sodasorb, Purafil CP, Purafil Select, Sofnolime, Sofnofil and 50/50 mix of Sofnolime/Sofnofil) except Sodasorb absorbed NO almost completely. Only Sofnolime absorbed NO 2 completely while Sodasorb and the Sofnolime/Sofnofil 50/50 mix had absorbances between 47% and 90%. The absorbance of four filters (ILF100, ILF150, ILF200 and HgCONO) as well as Sofnolime and the Sofnolime/Sofnofil 50/50 mix was tested in the expiratory port of a Servo 900C ventilator. All absorbers and filters produced a change in ventilator pressures. The HgCONO filter, Sofnolime and the Sofnolime/Sofnofil 50/50 mix all absorbed NO. At 80 ppm NO, the HgCONO filter had 100% absorbance for four hours while Sofnolime's absorbance was significantly reduced after one hour. All filters and absorbers tested on the ventilator except the Sofnolime/Sofnofil 50/50 mix and the ILF150 filter absorbed NO 2 completely for a period ranging from 90 minutes to four hours. We recommend the HgCONO filter and Sofnolime to absorb both NO and NO 2. If absorption of NO 2 only is required we recommend the HgCONO, ILF100 or ILF200 filters or the Sofnolime absorber.
Edrophonium Antagonism of Cisatracurium-Induced Neuromuscular Block: Dose Requirements in Children and Adults
Authors: Abdulatif M. , El-Sanabary M.
Published: January 2019

This randomized, controlled study compared edrophonium dose requirements to antagonize cisatracurium-induced neuromuscular block in children and adults. Sixty children, aged two to 10 years, and 60 adults aged 20 to 60 years, all subjects ASA physical status 1 or 2, having propofol, fentanyl and isoflurane-N 2 O anaesthesia, were studied. Cisatracurium 0.1 mg.kg -1 was given for muscle relaxation. Neuromuscular block was monitored with accelerometry. Edrophonium 0.1, 0.2, 0.4 or 1 mg.kg -1 or no anticholinesterase (controls) was given by random allocation to antagonize 90% neuromuscular block in each of the study groups (n=12). Atropine 5 to 10 μg.kg -1 was given according to edrophonium dose. Onset time of cisatracurium-induced block in children was mean (SD) 2.4 (0.8) versus 4.1 (2.3) minutes in adults, P<0.01. The times to 10% spontaneous recovery of the first twitch (T1) were respectively, 28.4 (5.2) and 41.8 (6.1) minutes in children and adults, P<0.01. Spontaneous and antagonist assisted neuromuscular recovery was more rapid in children. Adequate neuromuscular recovery (train of four (TOF) ratio 80%) was achieved in children at 3 and 10 minutes after edrophonium 1.0 mg.kg -1 and 0.4 mg.kg -1, respectively. A TOF ratio of 80% was not achieved, within 10 minutes, with any of the four dose levels of edrophonium in adults. The dose of edrophonium to achieve a TOF ratio of 80% (EDTOF-80 ) after 5 and 10 minutes in children were, respectively, mean (SD) 0.85 (0.38) and 0.38 (0.19) mg.kg -1. The equivalent ED TOF-80 in adults was outside the edrophonium dose range studied.
Coagulation Studies in Preoperative Neurosurgical Patients
Authors: Schramm B. , Leslie K. , Myles P. S. , Hogan C. J.
Published: January 2019

Unselected preoperative coagulation testing is known to have low positive yield. However, no study has specifically evaluated neurosurgical patients. A retrospective study of 1211 patients having neurosurgery over a one-year period was therefore conducted. Preoperative test results (activated partial thromboplastin time [aPTT], prothrombin time [PT] and platelet count) and historical factors indicating a potential bleeding tendency were recorded. Abnormality was defined as a test result outside the normal range for our laboratory. Seventeen per cent of all test results were abnormal. However, if abnormality was redefined as a test result indicating potential bleeding tendency (low platelet count, prolonged aPTT and/or PT), only 7.2% of results were abnormal. Many patients had factors on history indicating a potential bleeding tendency, but only a prolonged aPTT, cranial surgery and the use of anti-hypertensive and anaesthetic drugs preoperatively predicted postoperative bleeding. Prolonged aPTT was predictable on history in most patients. We conclude that routine screening of all preoperative neurosurgical patients in our hospital is unnecessary.
Effect of Age on Recovery from Remifentanil Anaesthesia
Authors: Lai A. , Hung C. T.
Published: January 2019

In a prospective, randomized study, the effect of age on recovery from remifentanil anaesthesia was evaluated. Twenty consecutive patients classified as ASA 1 and 2 and having elective laparotomy were recruited to one of two groups based on age (Group 1 age <60 y and Group 2 age >60 y). Remifentanil boluses and infusion were used for induction and maintenance of anaesthesia. Dosage was titrated against clinical response to perioperative stimulation and the infusion was terminated at the end of the operation. Time intervals between termination of remifentanil infusion and 1) spontaneous respiration, 2) adequate respiration, 3) eye opening, 4) limb movement, 5) extubation, 6) Aldrete score >9, 7) discharge to recovery room and 8) discharge to the ward were recorded. Patient controlled analgesia with morphine was used for postoperative pain control.

Student's t test was used to compare the differences in these time intervals between Groups 1 and 2. AP value <0.05 was taken as significant. We found that the younger age group regained spontaneous respiration (0.8±0.7 min vs 3.2±3.6 min), adequate respiration (3.4±3.7 min vs 7.6±5.8 min), opened their eyes (0.9±1.0 min vs 3.6±4.4 min), had their endotracheal tubes removed (5.0±4.6 min vs 9.0±6.5 min) and were discharged to recovery room (8.8±4.3 min vs 14.5±7.1 min) earlier than their older counterparts. In conclusion, age was a co-variate for recovery from remifentanil anaesthesia.
Laryngeal Mask Airway Insertion in Paediatric Anaesthesia: Comparison between the Reverse and Standard Techniques
Authors: Soh C. R. , Ng A. S. B.
Published: January 2019

Sixty-seven children between one and 15 years of age were randomized to have Laryngeal Mask Airway (LMA) insertion using either the standard technique (Group A) as described by Brain or the “reverse technique” (involving a 180° turn after insertion with the cuff facing the palate) (Group B). A blinded observer using a fibreoptic bronchoscope assessed the final position of the LMA. The LMA had to be placed within 15 seconds for the procedure to be considered “successful”. The success rate using the standard technique was 90.3% (28/31) and 100% (36/36) using the reverse technique (P value 0.06). The 95% confidence interval for the difference in success rates between Group B and A (B-A) was –0.73% to 20.1%. It is our opinion that the reverse technique of insertion of the LMA is an acceptable alternative to the standard technique.
Anaesthesia in the United Nations Military Hospital, Dili, East Timor
Authors: Bradley J. P. , Lee D.
Published: January 2019

An analysis of the anaesthesia caseload of the United Nations Military Hospital and its predecessors over the first 12 months of operation from September 1999 has been performed. Most patients were East Timorese civilians or Australian Military personnel. General anaesthesia using the ULCO Portable Field Anaesthesia Machine was most commonly administered.
Tracheal Intubation Using Suspension Laryngoscopy in an Infant with Goldenhar's Syndrome
Authors: Chen P. P. , Cheng C. K. , Abdullah V. , Chu C. P. W.
Published: January 2019

We present a case of a ten-month-old boy with Goldenhar's syndrome and significant retrognathia in whom a tracheostomy was performed to relieve upper airway obstruction. Tracheal intubation was facilitated by direct suspension laryngoscopy using a slotted rigid laryngoscope. We propose this technique as an alternative method for tracheal intubation in infants and young children with a difficult airway. The management of the difficult airway in children with Goldenhar's syndrome is discussed.
The Peripherally Inserted Central Catheter (PICC): A Prospective Study of its Natural History after Cubital Fossa Insertion
Authors: Loewenthal M. R. , Dobson P. M. , Starkey R. E. , Dagg S. A. , Petersen A. , Boyle M. J.
Published: January 2019

A prospective cohort study was undertaken to describe the natural history of the cubital fossa peripherally inserted central catheter (PICC), determine which factors influenced the hazard of complication and develop a standard methodology for evaluation of a PICC service. A total of 4349 patient days of PICC observation were analysed using survival analysis techniques. The median time to PICC removal for a complication was 60 days. The most common complications were phlebitis, malposition and tip migration. Complications usually occurred during the first week. There was only one episode of line-related sepsis. Size 3 French gauge catheters had a complication rate of 7.3 per 1000 line days compared to 14.2 for 4 French catheters (hazard rate 1.26 90% CI 1.02 to 1.55). PICCs requiring two or more attempts at insertion were more likely to develop complications than those inserted at the first attempt: 20 per 1000 line days vs 10.5 but the confidence intervals were wide (hazard rate 1.91, 90% CI 0.90 to 4.05). Operator (amongst the four experienced operators who inserted all PICCs), arm of placement, or medial or lateral placement in the cubital fossa did not influence PICC survival.
Multi-Organ Failure Secondary to Catastrophic Anti-Phospholipid Syndrome
Authors: Ihle B. U. , Oziemski P.
Published: January 2019

We describe the case of a young woman with a known history of thrombocytopenia, who developed respiratory and circulatory failure thought to be caused by sepsis. She subsequently was shown to have high titres of anticardiolipin antibodies as well as lupus anticoagulant. Serological tests for various connective tissue diseases were negative. Multiple cerebral ischaemic lesions led to a poor outcome. This case highlights the potential difficulties in differentiating catastrophic anti-phospholipid syndrome from disseminated intravascular coagulation.
Tracheobronchial Injury Secondary to Blunt Chest Trauma: Diagnosis and Management
Authors: Chu C. P. W. , Chen P. P.
Published: January 2019

Tracheobronchial injury is an uncommon complication in blunt chest trauma. The typical clinical features include haemoptysis, dyspneoa, and air leak. Tracheobronchial injury occurs after high energy impact and is commonly associated with injuries of other vital organs. If tracheobronchial injury is undetected and left untreated, it may cause persistent air leak which can render ventilation difficult and inefficient. Diagnosis of tracheobronchial injury should be made and confirmed by flexible bronchoscopy. The essence of airway management is to bypass the lesion by means of endobronchial intubation to the healthy bronchus with a single-lumen or double-lumen endotracheal tube. Such manoeuvres can also facilitate surgical access if thoracotomy is indicated. Taking into account the size of the lesion and the resulting respiratory status, surgical reconstruction of the injured airway is often necessary. More severe injury may even require lobectomy or pneumonectomy. Late complications of untreated tracheobronchial injury include bronchial stenosis, recurrent pneumonia and bronchiectasis. Prompt diagnosis and treatment generally lead to good functional recovery.
Association of Serum Albumin Concentration and Mortality Risk in Critically Ill Patients
Authors: Yap F. H. Y. , Joynt G. M. , Buckley T. A. , Wong E. L. Y.
Published: January 2019

In this study we aimed to examine the association between serum albumin concentration and mortality risk in critically ill patients.

We retrospectively studied 1003 patients admitted to our Intensive Care Unit (ICU) over an 18-month period. Serial albumin measurements over 72 hours were compared between survivors and non-survivors, and medical and surgical patients were also compared.

Our results showed that serum albumin decreased after ICU admission, most rapidly in the first 24 hours, in both survivors and non-survivors. Serum albumin was lower in non-survivors than in survivors, but albumin concentrations poorly differentiated the two groups. Medical patients had higher admission albumin levels than surgical patients, but both subgroups showed a similar albumin profile over 72 hours. We evaluated the prognostic value of serum albumin using receiver operator characteristic (ROC) curves. We constructed ROC curves for APACHE II score, admission albumin, albumin at 24 and 48 hours. We also combined APACHE II with albumin values and constructed the corresponding ROC curves. Our data showed that serum albumin had low sensitivity and specificity for predicting hospital mortality. Combining APACHE II score with serum albumin concentrations did not improve the accuracy of outcome prediction over that of APACHE II alone.
The Use of Glyceryl Trinitrate Ointment with EMLA Cream for IV Cannulation in Children Undergoing Routine Surgery
Authors: Andrew M. , Barker D. , Laing R.
Published: January 2019

This prospective randomized controlled double-blind trial was performed to investigate whether glyceryl trinitrate (GTN) ointment, applied ten minutes after the removal of a eutectic mixture of local anaesthetic cream, lignocaine/prilocaine (EMLA), influences site selection for intravenous cannulation in children. Eighty children aged between five and 15 years, having general surgery as day patients, received EMLA cream on both hands for 90 minutes prior to transfer to the theatre suite. Acting as their own controls, the children received GTN on one hand, and placebo on the other, after removal of the EMLA cream and ten minutes prior to the insertion of an intravenous cannula. The application of GTN or placebo to left or right hand was blinded and randomized.

At induction, the hand with the visually best quality veins was selected and cannulated. The primary outcome was selection between the EMLA/GTN hand and EMLA/placebo hand. The selection having been made, the number of attempts at cannulation, ease of insertion and pain scores (VAS) for cannulation were also recorded.

The choice of hand was positively influenced by the use of GTN, with the GTN hand chosen in 51 of 72 (70%) children who completed the protocol (P=0.001). The findings of this study suggest that the application of GTN after EMLA removal may be clinically useful in aiding cannulation in children.
Ketamine Dependence
Authors: Pal H. R. , Berry N. , Kumar R. , Ray R.
Published: January 2019

Ketamine hydrochloride is a safe and rapid-acting non-opioid, lipid soluble anaesthetic with a short elimination half-life that is used for medical and veterinary purposes. It produces a state of “dissociative anaesthesia”, probably from action on N-methyl-D-aspartate (NMDA) receptors. The psychotropic effects of ketamine range from dissociation and depersonalization to psychotic experiences and include a sensation of feeling light, body distortion, absence of time sense, novel experiences of cosmic oneness and out-of-body experiences. Abuse of ketamine has been reported, the typical abuser being an individual who uses multiple drugs and has some contact with medical agencies. This case demonstrates the effects of large doses of ketamine in a person with polysubstance abuse. The case also highlights development of significant tolerance to ketamine without prominent withdrawal symptoms. Caution in use of ketamine is reiterated in light of its abuse liability.
The Shikani Seeing Stylet™ for Difficult Intubation in Children: Initial Experience
Authors: Pfitzner L. , Cooper M. G. , Ho D.
Published: January 2019

The Shikani Seeing Stylet™ is a recently introduced reusable intubating stylet, produced in adult and paediatric versions. It combines features of a fibreoptic bronchoscope and a lightwand.

Inside a malleable stainless steel sheath, the Shikani Seeing Stylet™ has a fibreoptic cable leading to a distal light source and high-resolution lens. In use, the stylet is placed in the lumen of the selected endotracheal tube and the light source enables the stylet to be used as a lightwand, while the fibreoptic capability enables visualization of the laryngeal inlet. It is portable, relatively inexpensive and easy to maintain.

This report describes the use of the stylet on eight occasions in seven children, all of whom were assessed preoperatively as being potentially difficult to intubate. Three had been difficult to intubate previously. All were anaesthetized using inhalational anaesthesia. Once an adequate depth of anaesthesia had been achieved, conventional direct laryngoscopy was performed and identified as Grade 3 in six of the patients and Grade 1 in one.

Tracheal intubation was then attempted using the Shikani Seeing Stylet™. On six of the eight occasions the attempt was made by different anaesthetists, none of whom had any prior clinical experience with the stylet. There were seven successful intubations and one failure in a patient who could not be intubated by any method.

The Shikani Seeing Stylet™ seems a useful device for use in children with difficult airway problems, suspected cervical spine instability or limited mouth-opening.
Severe Pulmonary Hypertension in a Patient with Bronchiectasis Complicated by Cor Pulmonale and a Right-to-left Shunt Presenting for Surgery
Authors: Yim C. F. , Lim K. S. , Low T. C.
Published: January 2019

A patient with advanced bronchiectasis, severe pulmonary hypertension complicated by cor pulmonale and a right-to-left shunt at atrial level presented for sigmoid colectomy. We outline the potential perioperative problems of this situation, discuss the perioperative risks and describe our clinical approach. A total intravenous anaesthetic technique using midazolam, fentanyl, ketamine and rocuronium was used to minimize changes in pulmonary and systemic vascular resistance and not induce bronchospasm. Preoperative nebulized salbutamol and ipratroprium were given to prevent bronchospasm and adrenaline and noradrenaline were infused to maintain cardiac output and the balance between systemic and pulmonary vascular resistance.
Successful Use of Oral Methadone after Failure of Intravenous Morphine and Ketamine
Authors: Sartain J. B. , Mitchell S. J.
Published: January 2019

We describe an opioid-tolerant patient with severe acute pain which was unrelieved by morphine and ketamine via intravenous patient-controlled analgesia, but almost totally relieved by methadone. In the previous 24 hours, 509 mg of intravenous morphine and 769 mg of ketamine had been used and this was replaced by 200 mg of oral methadone. This implies that the success of methadone in morphine tolerant patients chiefly involves factors other than its role as an N-methyl-D-aspartate receptor antagonist, and that methadone should be considered as a replacement for morphine when the N-methyl-D-aspartate antagonist ketamine has proved ineffective.
A Painful Pulsatile Abdominal Mass in a Young Man with Elevated Blood Pressures: An Unusual Presentation of Phaeochromocytoma
Authors: Lee B. M. K. , Ti L. K.
Published: January 2019

We report an unusual presentation of phaeochromocytoma in a young man with a painful, pulsatile abdominal mass and elevated blood pressures. This led to a delay in diagnosis and resulted in the administration of triggers of catecholamine release, possibly causing a catecholamine surge. This caused the development of catecholamine-induced cardiomyopathy and multiple organ failure, requiring inotropic and ventilatory support, intra-aortic balloon pump and dialysis. Fortunately, his condition reversed with supportive treatment and alpha-adrenergic blockade. This illustrates the importance of having a high index of suspicion of phaeochromocytoma, especially in young patients with elevated blood pressures.
Appropriate Size of Laryngeal Mask Airway for Children
Authors: Loke G. P. Y. , Tan S. M. , Ng A. S. B.
Published: January 2019

The aim of this crossover study was to determine the optimal size of laryngeal mask airway in children weighing 10 to 20 kg. In each of 67 apnoeic anaesthetized children, the size 2 and size 2½ laryngeal mask airways were inserted consecutively by a skilled user and the cuff inflated to 60 cmH 2 O. Each LMA was assessed for the ease of insertion (by the number of attempts), oropharyngeal leak pressure, anatomical position (assessed fibreoptically) and the volume of air required to achieve intracuff pressure of 60 cmH 2 O. During the measurement of oropharyngeal leak pressure, the airway pressure was not allowed to exceed 30 cmH 2 O. There was no failed attempt at insertion with any size. The oropharyngeal leak pressure was significantly less for the size 2 LMA compared to the size 2½ LMA (P<0.001). The oesophagus was visible on three occasions, all with the size 2 LMA. Gastric insufflation occurred in three patients, all with the size 2 LMA. The incidence of low oropharyngeal leak pressure (<10 cmH 2 O) was low (9.0%) and all occurred with the size 2 LMA. The fibreoptic bronchoscope scores were not significantly different between the two sizes of LMAs. The volume of air to achieve intracuff pressure of 60 cmH 2 O was much lower than the maximum recommended volume (5.1 ml for size 2 and 6.2 ml for size 2½ ). We conclude that the size 2½ LMA provides a better fit than size 2 in children 10 to 20 kg.
Target Words for the Word Stem Completion Test in Australian Patients
Authors: Lee L. , Leslie K.
Published: January 2019

A robust test that reliably demonstrates implicit memory during general anaesthesia is required. The Word Stem Completion (WSC) test has been used as a measurement tool in a number of recent studies that have detected implicit memory during anaesthesia. However, target words used in the WSC test need to be culturally appropriate in order to maximize the sensitivity of the test. Therefore, fifty postoperative patients with English as a first language were recruited at The Royal Melbourne Hospital in order to assess the frequency of 98 target words in response to a word stem presentation. This generated a list of 32 target words that is suitable for use in studies of implicit memory during anaesthesia in Australian patients.
Use of a Fogarty Catheter as a Bronchial Blocker through a Single-lumen Endotracheal Tube in Patients with Subglottic Stenosis
Authors: Park H. P. , Bahk J. H. , Park J. H. , Oh Y. S.
Published: January 2019

One-lung ventilation can be achieved with a double-lumen tube or a bronchial blocker. However, the larger outer diameters of double-lumen or Univent tubes may prevent their passage through an area of subglottic stenosiss. We present five cases of subglottic stenosis in which a Fogarty catheter was used as a bronchial blocker through a single-lumen endotracheal tube. The outer diameters of a double-lumen tube, Univent tube and single-lumen tube were compared. Despite special equipment designed for one-lung ventilation, the use of a bronchial blocker through a single-lumen tube, which has the thinnest available wall thickness, seems to be one of the most effective and safest ways of achieving one-lung ventilation in patients with subglottic stenosis or narrowing.
General Anaesthesia in a Child with Larsen Syndrome
Authors: Critchley L. A. H. , Chan L.
Published: January 2019

Larsen syndrome is a rare congenital connective tissue disorder which is characterized by multiple dislocations of major joints, typical facial appearance, cervical spine narrowing and instability and respiratory difficulties secondary to laryngotracheomalacia. A case of general anaesthesia for laparoscopic hernia repair in a male child aged 16 months with this syndrome is presented. Anaesthesia was well tolerated though intubation proved difficult. Cervical spine instability and postoperative respiratory complications are potential problems.
Feasibility, Accuracy and Optimal Location for Oesophageal Core Temperature Measurements Using the ProSeal Laryngeal Mask Airway Drain Tube
Authors: Mitchell S. , Brimacombe J. , Keller C.
Published: January 2019

We determined the feasibility, accuracy and optimal location of oesophageal core temperature measurements using the ProSeal laryngeal mask airway drain tube. Thirty normothermic anaesthetized ventilated adults (ASA 1 to 2, aged 18 to 80 years) were studied. Temperatures were recorded using a thermistor at six different locations (middle of drain tube and at 0 to 20 cm distal to the drain tube in 5 cm increments) and compared to nasopharyngeal (thermistor) and aural (infrared tympanic thermometer) reference core temperatures. The temperature probe was successfully inserted into the oesophagus in all patients at the first attempt. Oesophageal temperature increased with depth from 0 to 5 cm (35.2 v 35.9, P<0.0001) and 5 to 10 cm (35.9 v 36.3, P<0.01), but was unchanged from 10 to 15 cm (36.3 v 36.6) and 15 to 20 cm (36.6 v 36.7). Aural temperature was higher than nasopharyngeal temperature (36.8 v 36.0, P<0.0001). Aural temperature was 0.89 to 1.59°C higher than the oesophagus at 0 to 5 cm and 0.21 to 0.30°C higher than the oesophagus at 15 to 20 cm. Nasopharyngeal temperature was 0.06 to 0.76°C higher than the oesophagus at 0 to 5 cm and 0.62 to 0.84°C lower than the oesophagus at 15 to 20 cm. The lowest temperature was in the mid-point of the drain tube (34.7). We conclude that oesophageal core temperature measurement is feasible and accurate using the ProSeal laryngeal mask airway. The optimal location for the temperature probe is at 15 to 20 cm.