bluuebunny/crossref_metadata_2025 huggingface dataset:
A new species of the genus Elasmopus from Miyako Island, Japan (Crustacea: Amphipoda: Maeridae)
Authors: NAKAMURA YASUHIRO , NAKANO TAKAFUMI , OTA YUZO , TOMIKAWA KO
Published: January 2019

A new species of the maerid amphipod, Elasmopus nkjaf, from Miyako Island, Ryukyu Islands, Japan, is named and described. Additionally, nucleotide sequences of nuclear 28S ribosomal RNA and histone H3 as well as mitochondrial cytochrome c oxidase subunit I and 16S ribosomal RNA from its holotype and paratype were determined. Elasmopus nkjaf sp. nov. belongs to the rapax-group, and distinguished from the other rapax-group species by long setae on ventral margin of epimeral plate 3, gland cone of peduncular article 2 of antenna 2 not reaching to end of peduncular article 3, propodus of gnathopod 1 facially setose, length of propodus of male gnathopod 2 shorter than 3 times as long as length of carpus, medial face of propodus of male gnathopod 2 shallowly hollowed, posterior margin of epimeral plate 3 without denticles. A key to the species of Elasmopus species occurring Japanese and adjacent waters is provided.
A new species of Laurenceomyia Wagner & Stuckenberg, with a key to species and new records for Psychodidae (Diptera) from Uruguay
Authors: CANNEVA BRUNO
Published: January 2019

A species list and a key to species of Psychodidae (Diptera, Nematocera) from Uruguay is presented, with the description of Laurenceomyia martinezae sp. nov., and first records of Brumptomyia guimaraesi (Coutinho & Barreto), Nyssomyia neivai (Pinto), Paramormia furcata (Kincaid), Psychoda savaiiensis Edwards, Psychoda zetoscota Quate, and Trichomyia Haliday in Curtis. Discussion on the medically important species is provided.
A Stochastic Representation of Subgrid Uncertainty for Dynamical Core Development
Authors: Subramanian Aneesh , Juricke Stephan , Dueben Peter , Palmer Tim
Published: January 2019

Numerical weather prediction and climate models comprise a) a dynamical core describing resolved parts of the climate system and b) parameterizations describing unresolved components. Development of new subgrid-scale parameterizations is particularly uncertain compared to representing resolved scales in the dynamical core. This uncertainty is currently represented by stochastic approaches in several operational weather models, which will inevitably percolate into the dynamical core. Hence, implementing dynamical cores with excessive numerical accuracy will not bring forecast gains, may even hinder them since valuable computer resources will be tied up doing insignificant computation, and therefore cannot be deployed for more useful gains, such as increasing model resolution or ensemble sizes. Here we describe a low-cost stochastic scheme that can be implemented in any existing deterministic dynamical core as an additive noise term. This scheme could be used to adjust accuracy in future dynamical core development work. We propose that such an additive stochastic noise test case should become a part of the routine testing and development of dynamical cores in a stochastic framework. The overall key point of the study is that we should not develop dynamical cores that are more precise than the level of uncertainty provided by our stochastic scheme. In this way, we present a new paradigm for dynamical core development work, ensuring that weather and climate models become more computationally efficient. We show some results based on tests done with the European Centre for Medium-Range Weather Forecasts (ECMWF) Integrated Forecasting System (IFS) dynamical core.
Response of a Coastal Plume Formed by Tidally Modulated Estuarine Outflow to Light Upwelling-Favorable Wind
Authors: Yankovsky Alexander E. , Voulgaris George
Published: January 2019

This study presents observations of a buoyant plume off Winyah Bay, South Carolina, which was formed under conditions of high freshwater discharge and upwelling-favorable wind forcing. Analysis of observations demonstrates that the response of the anticyclonic bulge formed by tidally modulated estuarine outflow to the light upwelling-favorable wind is more complex than the previously studied far-field response. The latter can be described by a slab-like model with mixing concentrating at the offshore edge of a buoyant layer. The observed plume depth increased from ~3 m near the mouth to 6 m at the offshore edge, with plume depth changing in a steplike fashion rather than continuously. CTD profiles near these steps revealed overturning indicative of vigorous mixing. Estimates of the gradient Richardson number confirmed the likelihood of mixing/entrainment not only at the offshore edge of the plume but also in the proximity of the observed steps. We hypothesize that these steps represent tidal fronts that undergo geostrophic adjustment and are advected offshore by the superimposed Ekman drift. Scaling analysis suggests that mixing and entrainment at the observed interior fronts can be enhanced by superposition of geostrophic and wind-induced shear.
WMO Interlaboratory Comparison in Europe with Loops Linkage and Data Processing
Authors: Bojkovski Jovan , Drnovšek Janko , Groselj Drago , Knez Joško , Begeš Gaber
Published: January 2019

This article describes the interlaboratory comparison (ILC) of meteorological and hydrological calibration laboratories in the field of temperature (−30° to 40°C), humidity (10%–95% RH at room temperature), and pressure (800–1100 hPa). The ILC was organized by the World Meteorological Organization (WMO) Regional Instrument Centre (RIC) at the Slovenian Environment Agency and University of Ljubljana, Faculty of Electrical Engineering, Laboratory of Metrology and Quality as an accredited interlaboratory comparison (proficiency testing) provider according to the ISO/IEC 17043:2010 standard. The ILC was organized in the target area of WMO Regional Association VI (Europe). The protocol and procedure for ILC were developed within European Metrology Research Project (EMRP) MetoMet2. The participants used their standardized procedures for calibration. Because of the large number of participating laboratories (18) from 17 countries, the ILC was organized in two loops, which were linked via four linking laboratories and evaluated using the En number. The equipment used in both loops exhibited stability and uncertainty, which enabled evaluation of the laboratories’ capabilities. The article presents the data processing, the linkage procedure, and the main results for all three categories (temperature, humidity, and pressure). It was observed that some of the laboratories had unusually low uncertainties. From the metrological point of view, the authors present some comments and suggestions to the laboratories, the results of which differ from the reference ones. The conclusions can help also other meteorological laboratories and organizations that did not participate in the ILC with their everyday work.
Intergovernmental Lobbying in the United States: Assessing the Benefits of Accumulated Knowledge
Authors: Jensen Jennifer M.
Published: January 2019

In the last fifteen years, there has been a significant accumulation of research on lobbyists and lobbying offices that represent state and local governments either in Washington or in state capitals. This essay seeks to review the scope of these and earlier efforts and assess where our knowledge is deepest and where significant unanswered questions remain. In general, there is substantially more research on lobbyists who represent governors than those representing other types of public officials. Further, research has paid more attention to lobbying in the federal arena than to lobbying in state capitals. Recent research on local government lobbying, however, has led to significant gains in our ability to measure the financial benefits of intergovernmental lobbying.
Tracheo-Innominate Fistula after Initial Percutaneous Tracheostomy
Authors: Cokis C. , Towler S.
Published: January 2019

We report a tracheo-innominate fistula formation after tracheostomy in a 68-year-old man with Guillain-Barré syndrome. The initial percutaneous tracheostomy had to be revised surgically after the tube dislodged from its insertion site in the trachea. Three days later, massive bleeding occurred and emergency surgery revealed a fistula. This was surgically repaired but subsequently re-bled with a fatal outcome. The post mortem report found an aneurysmal ectatic innominate artery with a fistula involving the anterior tracheal wall. The aetiology, diagnosis and management of tracheo-innominate fistula are discussed.
The Effect of the Biopatch, a Chlorhexidine Impregnated Dressing, on Bacterial Colonization of Epidural Catheter Exit Sites
Authors: Mann T. J. , Orlikowski C. E. , Gurrin L. C. , Keil A. D.
Published: January 2019

We performed a prospective, randomized study in 55 ASA 1 to 3 women undergoing elective gynaecological surgery followed by postoperative epidural analgesia. We compared the incidence of bacterial colonization at the epidural exit site following catheter removal between a control group and an experimental group who received a chlorhexidine impregnated dressing (Biopatch, Johnson and Johnson, Arlington, TX, U.S.A.). Positive culture results were found in 11 of 27 (40.1%) patients in the control group compared with one of 29 (3.4%) patients whose epidural catheters were dressed with the Biopatch. We concluded that the Biopatch was effective in reducing bacterial colonization of the epidural catheter exit site.
Withholding and Withdrawal of Therapy in Patients with Acute Renal Injury: A Retrospective Cohort Study
Authors: Ho K. M. , Liang J. , Hughes T. , O'Connor K. , Faulke D.
Published: January 2019

The incidence of withholding and withdrawal of therapy in the setting of multi-organ failure in critically ill patients has increased. Epidemiological data on the decision-making process of withholding or withdrawal of therapy from Australian and New Zealand intensive care units is sparse. We examined the clinical and electronic records of 179 consecutive patients, admitted to the ICU between 1st January 2000 and 31st December 2001, who had acute renal injury. Acute renal replacement therapy was offered in 11.2% of patients. Therapy was withheld or withdrawn in 21.2% of patients. The levels of supportive care were comparable between those who had therapy withheld or withdrawn and those who had full intensive care therapy until such a decision was made. Predicted mortality (OR 1.04, 95%CI: 1.01–1.08, P=0.03) and age (OR 1.04, 95%CI: 1.00–1.08, P=0.03) were independently associated with the decision to withhold or withdraw therapy. The mean ICU stay of those with withdrawal or withholding of therapy was much shorter than those with full therapy (2.5 vs 5.7 days). This was likely to be due to an older age of our cohort, rapid progressive nature of the acute disease, a different clinical approach to treating critically ill elderly patients, or a combination of these factors. This pattern of practice was quite different from those reported from ICUs in other parts of the world. A prospective multi-centre observational study will clarify the pattern of practice in this important area of intensive care practice in Australasia.
Paraesthesiae during Needle-through-Needle Combined Spinal Epidural versus Single-shot Spinal for Elective Caesarean Section
Authors: McAndrew C. R. , Harms P.
Published: January 2019

The aim of this study was to compare the incidence of paraesthesiae during spinal needle insertion in a needle-through-needle combined spinal-epidural (CSE) versus a single-shot spinal (SSS) technique. Eighty-nine women presenting for elective caesarean section at a tertiary referral obstetric unit were randomized to receive either needle-through-needle CSE or SSS. Equipment used was a 16 gauge/26 gauge combined spinal-epidural kit and a 26 gauge pencil-point spinal needle with introducer (both Sims Portex, Australia) The presence and distribution of paraesthesiae was recorded by an observer at spinal needle insertion and again on day one postoperatively. There were three failures to perform the intended block. One patient was lost to follow-up at postoperative day one.

Seventeen of forty-six (37%) women in the needle-through-needle CSE group and four of forty-three (9%) in the SSS group had paraesthesiae upon spinal needle insertion (P<0.05, Chi-squared test). No patient had persistent neurological symptoms at postoperative day one. We postulate that the higher incidence of paraesthesiae with needle-through-needle CSE may be related to deeper penetration of the subarachnoid space with this technique.
Correlation and Linear Regression between Blood Pressure Decreases after a Test Dose Injection of Propofol and that following Anaesthesia Induction
Authors: Sato J. , Saito S. , Jonokoshi H. , Nishikawa K. , Goto F.
Published: January 2019

Propofol reduces systemic vascular resistance and suppresses cardiac function when injected rapidly. In this study we investigated whether blood pressure decrease after a minimal dose (test-dose) injection of propofol correlates with that after an induction-dose injection.

Patients were randomly divided into two groups; anaesthesia was induced in group A (n=60) using 1.5 mg/kg propofol and in group B (n=61) using 2.0 mg/kg. Blood pressure reduction after a minimal dose injection (0.4 mg/kg) was examined non-invasively prior to anaesthetic induction. Bispectral Index monitoring was measured and sedation level scored to evaluate anaesthetic depth.

After the minimal dose injection, 18 of 121 patients showed behaviour suggesting minor disinhibition, five patients were sedated and seven were drowsy. Oxygen saturation was not significantly changed after test-dose injection. Reduction in systolic blood pressure (mean±SD) was 17±11 mmHg after the minimal dose injection, 42±20 mmHg after a 1.5 mg/kg induction dose injection, and 42±22 mmHg after a 2.0 mg/kg induction-dose injection. In both groups, blood pressure after induction was significantly lower than the control value (P<0.05). In both groups, a positive correlation was observed between blood pressure reduction after the minimal dose injection and that after the induction-dose injection [P<0.01, R value for systolic blood pressure correlation in group A 0.712 (P<0.01) and in group B 0.758 (P<0.01)].

We concluded there was a positive correlation between blood pressure reduction after a minimal (test-dose) injection and that after an induction-dose injection.
Serum Procalcitonin and C-reactive Protein as Markers of Sepsis and Outcome in Patients with Neurotrauma and Subarachnoid Haemorrhage
Authors: O'Connor E. , Venkatesh B. , Mashongonyika C. , Lipman J. , Hall J. , Thomas P.
Published: January 2019

This prospective study evaluated serum procalcitonin (PCT) and C-reactive protein (CRP) as markers for systemic inflammatory response syndrome (SIRS)/sepsis and mortality in patients with traumatic brain injury and subarachnoid haemorrhage. Sixty-two patients were followed for 7 days. Serum PCT and CRP were measured on days 0, 1, 4, 5, 6 and 7.

Seventy-seven per cent of patients with traumatic brain injury and 83% with subarachnoid haemorrhage developed SIRS or sepsis (P=0.75). Baseline PCT and CRP were elevated in 35% and 55% of patients respectively (P=0.03). There was a statistically non-significant step-wise increase in serum PCT levels from no SIRS (0.4±0.6 ng/ml) to SIRS (3.05±9.3 ng/ml) to sepsis (5.5±12.5 ng/ml). A similar trend was noted in baseline PCT in patients with mild (0.06±0.9 ng/ml), moderate (0.8±0.7 ng/ml) and severe head injury (1.2±1.9 ng/ml). Such a gradation was not observed with serum CRP. There was a non-significant trend towards baseline PCT being a better marker of hospital mortality compared with baseline CRP (ROC-AUC 0.56 vs 0.31 respectively). This is the first prospective study to document the high incidence of SIRS in neurosurgical patients. In our study, serum PCT appeared to correlate with severity of traumatic brain injury and mortality. However, it could not reliably distinguish between SIRS and sepsis in this cohort. This is in part because baseline PCT elevation seemed to correlate with severity of injury. Only a small proportion of patients developed sepsis, thus necessitating a larger sample size to demonstrate the diagnostic usefulness of serum PCT as a marker of sepsis. Further clinical trials with larger sample sizes are required to confirm any potential role of PCT as a sepsis and outcome indicator in patients with head injuries or subarachnoid haemorrhage.
Early and Late Reversal of Rocuronium with Pyridostigmine during Sevoflurane Anaesthesia in Children
Authors: Oh A. Y. , Kim S. D. , Kim C. S.
Published: January 2019

This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children.

Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch®, rocuronium (0.6 mg/kg) were then administered.

Maximal block occurred 1.1±0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T25) was 40.1±8.8 min and the recovery index (time between T25 and T75) 19.9±9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups.

When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.
The Effect of Increasing Operating Room Capacity on Day-of-surgery Cancellation
Authors: Yoon S.-Z. , Lee S. I. , Lee H. W. , Lim H. J. , Yoon S. M. , Chang S. H.
Published: January 2019

Several studies have been conducted to evaluate the utilisation of the operating room, a fixed resource, in terms of conditions that prevent day-of-surgery cancellation due to deficient operative capacity. In this study, we surveyed the causes and overall rates of elective surgery cancellation and then compared the number of cancellations that occurred before and after the installation of additional operating rooms.

We surveyed all patients undergoing elective surgery for 100 days prior to and after the installation of additional operating rooms. The causes for cancellations were divided into six categories: departmental issues, abnormal laboratory results, patient denial, inadequate preparation, over-booking and other issues. The departmental causes were further divided into four categories: ward overflow, scheduling date errors, unavailable surgeons and other issues.

The number of overall cancelled cases and scheduled cases increased following the increase in operating room capacity, although this increase was not statistically significant. However, the cancellation ratio rose significantly after the operating room capacity was increased. The primary reasons for cancellation prior to the increase in operating room capacity were departmental issues, over-booking and abnormal laboratory data, in that order. After the operating room capacity was increased, the primary reasons for cancellation were departmental issues, abnormal laboratory data and over-booking, in that order. Taken together, the results of this study indicate that increased operating room capacity can prevent cancellation due to over-booking. However, the numbers of cancellations due to ward overflow exceeded the numbers of cancellations that occurred as a result of over-booking.

In conclusion, increasing the operating room capacity is not an appropriate option for preventing the cancellation of operations.
In Vivo Evaluation of Tissue Microflow under Combined Therapy with Extracorporeal Life Support and Intra-aortic Balloon Counterpulsation
Authors: Jung C. , Lauten A. , Roediger C. , Fritzenwanger M. , Schumm J. , Figulla H. R. , Ferrari M.
Published: January 2019

Treatment with, percutaneous extracorporeal mechanical assist devices provides the ultimate therapeutic option to improve the macrocirculation in patients suffering from refractory cardiac arrest, severe cardiogenic shock or during high-risk interventions. However, the flow in the smallest vessels in these critical periods is poorly understood but prognostically of high importance. Using sidestream darkfield intravitalmicroscopy, we visualised the sublingual microflow in a patient suffering from severe cardiogenic shock supported by extracorporeal membrane oxygenation and intra-aortic balloon pump. Our results show that intra-aortic balloon counterpulsation applied in addition to extracorporeal membrane oxygenation further improves the microflow. This in vivo finding supports pilot studies favouring the application of devices supporting cardiac output (extracorporeal membrane oxygenation) together with devices aimed at pulsatility (intra-aortic balloon pump).
A Technique that may Improve the Reliability of Endobronchial Blocker Positioning during Adult One-lung Anaesthesia
Authors: Ho A. M. H. , Ng S. K. , Tsang K. H. S. , Au S. W. , Ng C. S. H. , Critchle L. A. H. , Karmakar M. K.
Published: January 2019

We describe a novel technique, previously applied to small children, for adult one-lung anaesthesia in which a single-lumen endotracheal tube is used with an endobronchial balloon blocker. The main aims of the technique are to reduce the likelihood of cephalad displacement of the balloon into the trachea and to facilitate directional placement of the endobronchial balloon. We present five illustrative cases of one-lung anaesthesia in patients of adult size, in which the endotracheal tube-endobronchial balloon technique was considered preferable to the use of a double-lumen tube technique. The situations included difficult intubation, need for postoperative ventilation, a tortuous trachea and an unexpected need to perform one-lung anaesthesia. The technique involved deliberate placement of the endotracheal tube tip near the carina to block cephalad dislodgement of the blocker. The chance of the balloon blocking the endotracheal tube tip could be further reduced by having the intraluminal endobronchial balloon blocker emerge through the Murphy eye.
A Failure of M-Entropy™ to Correctly Detect Burst Suppression Leading to Sevoflurane Overdosage
Authors: Hart S. M. , Buchannan C. R. , Sleigh J. W.
Published: January 2019

Electroencephalogram depth of anaesthesia monitors are increasingly being used, with the aim of reducing awareness during anaesthesia. Most literature concentrates on the ability of these monitors to predict when a patient is likely to be aware. This case report highlights the opposite problem, where the monitor (M-Entropy™) indicated an awake state but the patient was in fact deeply anaesthetised. If the anaesthetist is unable to interpret the raw electroencephalogram and understand the limitations of the monitor being used, excessive doses of anaesthetic may be given with potentially serious consequences.
Comparison of Extent of Sensory Block following Posterior and Subcostal Approaches to Ultrasound-Guided Transversus Abdominis Plane Block
Authors: Lee T. H. W. , Barrington M. J. , Tran T. M. N. , Wong D. , Hebbard P. D.
Published: January 2019

Transversus abdominis plane block provides postoperative analgesia following abdominal surgery by targeting thoracolumbar nerves between the internal oblique and transversus abdominis muscles. Posterior and subcostal approaches using ultrasound guidance have been described. However, there have been inconsistent results in relation to the extent of the sensory block. This observational study evaluated the distributions of sensory block following either a posterior or subcostal approach and the quality of analgesia achieved. Following ethics committee approval, 50 patients undergoing minimally invasive and major abdominal surgery were recruited. A total of 81 transversus abdominis plane blocks were performed preoperatively under real-time ultrasound guidance. Postoperatively, patients received multimodal analgesia including morphine via patient-controlled pumps. Ninety-eight percent of patients had some degree of demonstrable sensory block and the dermatomal spread differed between posterior and subcostal approaches (P <0.001). The posterior approach produced a median sensory block of three dermatomal segments (interquartile range 2 to 4), the most cephalad being T10 (interquartile range T9 to T10), while the subcostal approach blocked a median of four segments (interquartile range 3 to 5), the most cephalad being T8 (interquartile range T7 to T9, P <0.001). Maximum dermatomal block distribution was observed at 30 minutes and usually regressed by 24 hours. Median cumulative morphine consumption was 40.8 mg (interquartile range 17 to 50 mg) at 24 hours. Median pain scores at rest and with coughing were 20 (interquartile range 10 to 35) and 50 (interquartile range 29 to 67) respectively at 24 hours. The posterior approach appears to be more appropriate for lower abdominal surgery and the subcostal approach better suited to upper abdominal surgery. Whichever approach is used, transversus abdominis plane block is only one component of a multimodal analgesic technique.
Effects of Fluid Preload (Crystalloid or Colloid) Compared with Crystalloid Co-Load Plus Ephedrine Infusion on Hypotension and Neonatal Outcome during Spinal Anaesthesia for Caesarean Delivery
Authors: Gunusen I. , Karaman S. , Ertugrul V. , Firat V.
Published: January 2019

Preload with crystalloid or colloid solution is widely recommended for the prevention of maternal hypotension during spinal anaesthesia. A combination of simultaneous rapid crystalloid infusion with vasopressor has also been suggested. This study tested the hypothesis that ephedrine infusion with crystalloid loading at spinal anaesthesia would reduce hypotension and alter neonatal outcome compared with fluid preloading.

One hundred and twenty women undergoing elective caesarean delivery were randomly allocated to one of three groups to receive rapid infusion of lactated Ringer's solution (20 ml.kg-1, n=40) or 4% succinylated gelatin solution (500 ml, n=40) before spinal anaesthesia or an ephedrine infusion (1.25 mg.minute-1) plus lactated Ringer's solution (1000 ml, n=40) after spinal anaesthesia. The incidence of hypotension (moderate and severe) and the ephedrine dose used to treat hypotension were compared. Neonatal outcome was assessed using Apgar scores and umblical venous and arterial blood gas analysis.

The frequency of moderate or severe hypotension was lower in the ephedrine group than in the crystalloid or colloid preload group (10% vs 51% and 38%; 5% vs 21% and 23% respectively, P <0.05). The incidence of nausea was significantly different between the crystalloid preload and ephedrine group. Umbilical blood gas analysis and Apgar scores were similar in all groups.

A combination of an ephedrine infusion at 1.25 mg.minute-1 with a crystalloid co-load was more effective than fluid preloading with crystalloid or colloid in the prevention of moderate and severe hypotension.
Effect of Intravenous Ondansetron on Sensory and Motor Block after Spinal Anaesthesia with Hyperbaric Bupivacaine
Authors: Samra T. , Bala I. , Chopra K. , Podder S.
Published: January 2019

Ondansetron is a potent antiemetic and a competitive antagonist at serotonin receptors, which are also involved in modulation of pain. This study was designed to assess the effect of systemic ondansetron on sensory and motor block after subarachnoid anaesthesia with hyperbaric bupivacaine. Sixty patients undergoing transurethral resection of bladder tumours were randomly assigned to one of two groups. Group 1 received 2 ml (4 mg) of ondansetron whereas patients in group 2 received 2 ml of normal saline 15 minutes prior to administration of subarachnoid block with 2.5 ml of hyperbaric bupivacaine 0.5%. Time to attain peak sensory block (P=0.27), time to two segment regression (P=0.19) and time to regression to the S2 dermatome (P=0.84) did not significantly differ between the two groups. No differences in regression of sensory block were noted at any time. The mean duration of motor block also did not differ (P=0.44), with similar regression of block at all time intervals except at 90 minutes.

We concluded that intravenous ondansetron does not affect the intensity or duration of sensory and motor block after spinal anaesthesia with hyperbaric bupivacaine.
The Relationship between Patient Data and Pooled Clinical Management Decisions
Authors: Ludbrook G. L. , O'Loughlin E. J. , Grant C. , Corcoran T. B.
Published: January 2019

A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management.

In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. In the current study, the relationship between patient data and these decisions was examined using binomial logistic regression analysis. Backward stepwise regression was used to identify independent predictors of each decision (at P <0.15), which were then incorporated into a predictive model.

The number of factors related to each decision varied: blood picture (four factors), biochemistry (six factors), coagulation studies (three factors), electrocardiography (eight factors), chest X-ray (seven factors), preoperative outpatient assessment (17 factors), intensive care unit requirement (eight factors) and aspiration prophylaxis (one factor). The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics with the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient data may have utility supporting clinicians’ preoperative decisions.
The Role of Dr Isaac Aaron and the Australian Medical Journal in the Dissemination of Information about Etherisation in the 1840s
Authors: Paull J. D.
Published: January 2019

Isaac Aaron (1804 to 1877), an ambitious young medical practitioner, arrived in Sydney from Britain in 1838 and was registered by the New South Wales Medical Board the following year. After contributing to the Australian Medical Journal, established in August 1846 by William Baker, he became the editor in December and acquired it in May the following year1. Dr Pugh became the most prolific local contributor to the journal but he and the editor had a somewhat ‘prickly’ relationship. Aaron was very critical of etherisation when the first news arrived in Australia, but Pugh chose Aaron's journal in which to report his initial and subsequent experience with the technique. Aaron repeatedly appealed for experimental evidence and rational decision-making to determine the place of etherisation in medical practice. Unfortunately for Australian medicine, Aaron had to suspend the publication of the journal in October 1847, lacking both time and the support of the profession necessary to maintain it. This created an unanticipated adverse outcome for Dr Pugh.
Patient Factors Associated with Frequent Clotting of Dialysers during Haemodiafiltration in Critically Ill Patients: A Post Hoc Analysis of a Randomised Controlled Study
Authors: Ho K. M. , Morgan D. J.
Published: January 2019

Continuous haemodiafiltration (CVVHDF) is the main form of renal replacement therapy in critically ill patients with severe acute kidney injury. Clotting of the dialysers during CVVHDF is frequent, because most patients with acute kidney injury have an increased risk of bleeding and cannot be systemically anticoagulated. Using data from a randomised controlled trial comparing the efficiency of CVVHDF by placing the dialysis catheter tip at the right atrium or superior vena cava, this study assessed the patient factors associated with an increased risk of frequent clotting of the dialysers—defined by > 1 dialysers clotted per day of CVVHDF. Of the 94 patients included in this study, a higher body mass index, a higher platelet count and a lower International Normalized Ratio were associated with an increased risk of frequent clotting of dialysers in the univariate analyses. Use of aspirin or clopidogrel, causes of acute kidney injury and daily dose of unfractionated heparin used were not significantly associated with the risk of frequent clotting of dialysers. In the multivariate parsimony model, only a high body mass index (odds ratio 1.06 per point increment, 95% confidence interval 1.01 to 1.13; P=0.036) and a high platelet count (odds ratio 1.84 per 100×1079/1 increment, 95% confidence interval 1.17 to 2.91; P=0.009), both in a relatively linear fashion, were independently associated with an increased risk of frequent clotting of dialysers. Optimising the position of the tip of the dialysis catheter may be particularly important for patients with a high body mass index and platelet count in order to reduce frequent clotting of dialysers during CVVHDF.
High-Risk Residual Gastric Content in Fasted Patients Undergoing Gastrointestinal Endoscopy: A Prospective Cohort Study of Prevalence and Predictors
Authors: Phillips S. , Liang S. S. , Formaz-Preston A. , Stewart P. A.
Published: January 2019

In this prospective cohort study, we examined the residual gastric contents of 255 fasted patients undergoing gastrointestinal endoscopy. The volume and pH of residual gastric contents collected by suction under direct visualisation during gastroscopy were accurately quantified. All patients completed the minimum two-hour fast for clear fluids and 97.2% of patients completed the minimum six-hour fast for solids. High-risk residual gastric content, defined as volume >25 ml and pH <2.5, was present in 12.2% (95% CI 8.7% to 16.7%) of patients. We used multiple logistic regression analysis to identify demographic and clinical factors associated with high-risk residual gastric content. The odds of having high-risk residual gastric content were reduced with increase in age (adjusted odds ratio 0.77, 95% CI 0.61 to 0.96, P=0.0230), and use of a proton pump inhibitor or histamine type 2 receptor antagonist (adjusted odds ratio 0.24, 95% CI 0.10 to 0.55, P=0.0013), and were increased in male patients (adjusted odds ratio 2.36, 95% CI 1.06 to 5.28, P=0.0348). Notably, residual gastric content was classified as high-risk in 20.4% of patients who did not take a proton pump inhibitor or histamine type 2 receptor antagonist versus only 5.6% of those who did. Our findings suggest that, despite currently recommended fasting, males presenting for endoscopy are more likely to have high-risk gastric content than females, and that the incidence appears to be reduced with increasing age, and by the use of proton pump inhibitors or histamine type 2 receptor antagonists, we were unable to confirm or exclude an effect of body mass index, peptic pathology, diabetes or other clinical or demographic factors in our study population.
Patient and Community Attitudes toward Perioperative Biobanking and Genomic Research
Authors: Liddell J. , Bain C. , Myles P. S.
Published: January 2019

We surveyed hospital patients and clinicians to ascertain their attitudes to the establishment of a perioperative biobank for future genomics research, and whether the requirements for an opt-out approach to consent can be met. We enrolled hospital patients (n=187), patient spouse/family members (n=64), ethics committee members (n=14), clinical staff (doctors and nurses [n=67]), and unspecified community members (n=10). They were asked to rate and describe their views on medical research and biobanking, the need for individual consent, and the importance of confidentiality. Of 406 survey forms distributed, 342 (84%) were returned. Nearly all participants (98%) indicated that a perioperative biobank is important, 93% were comfortable with de-identified genetic research, and 90% indicated that the hospital should be able to use leftover blood for medical research, provided the research has been approved by an ethics committee and personally identifying information has been removed. Participants were more likely to support biobanking if it used de-identified samples, and if, for this reason, their consent was not sought. Participants with chronic medical and surgical conditions were significantly more supportive and comfortable with genetic research, as were most in the hospital community. Most hospital patients, community members and clinicians are supportive of the development of a perioperative biobank used for genomic research. This supports the adoption of an opt-out approach to consent model.
The Importance of Changes in Body Temperature in Paediatric Surgery and Anaesthesia
Authors: Dilworth Nerida M.
Published: January 2019

An understanding of the maintenance of normal body temperature, and the manner in which surgery, anaesthesia, and related procedures may disturb thermoregulation, is of considerable importance in paediatric anaesthesia. The subject of accidental hypothermia, with particular reference to the newborn infant, is reviewed; and hyperpyrexia is briefly discussed.
Phillip Gett Memorial Lecture Awareness in Anaesthesia
Authors: Utting J. E.
Published: January 2019

An attempt is made to assess the importance of awareness and dreaming in patients subjected to light anaesthesia with muscle relaxants.

Frank awareness is probably an uncommon event if the anaesthetic be given competently, but unpleasant dreams can, in some circumstances, be significant.
The Contrasting Effects of Enflurane on Transplacental Exchange after Methohexitone and Ketamine Induction of Anaesthesia for Caesarean Section
Authors: Downing J. W. , Houlton P. J. C. , Brock-Utne J. G. , Buley R. J. R.
Published: January 2019

Supplementation of general anaesthesia with enflurane 0.6% before delivery of the foetus by elective Caesarean section, produced contrasting effects after methohexitone and ketamine administration. Enflurane, an inhalational agent causing vasodilation and uterine relaxation, enhanced maternal to foetal transplacental exchange following methohexitone induction of narcosis. This beneficial effect of the volatile agent was not seen after ketamine, a vasoconstrictor drug which stimulates myometrial contraction.
Calcium, Phosphate and Parathyroid Disturbances in Acute Renal Failure
Authors: Black A. M. S.
Published: January 2019

Thirteen of sixteen patients with acute renal failure and requiring respiratory and other supportive treatment in an intensive care area became hypercalcaemic whilst still receiving haemodialysis. Results of calcium, phosphate and parathyroid hormone estimations are presented and their disturbances in acute renal failure are discussed.
Pseudomonas Infection and the Anaesthetist
Authors: Cumpston P. , Narasimhan S.
Published: January 2019

Cultures of specimens taken from anaesthetic equipment after routine cleaning and chemical decontamination revealed contamination with Pseudomonas Aeruginosa. Attention is drawn to the widely practised but unsatisfactory methods of decontaminating equipment.

Consideration of the subject of decontamination of anaesthetic equipment led to the re-evaluation of our current practice, with surprising results. At the end of our brief look, we had changed our methods of decontamination dramatically and heightened awareness of a large section of theatre staff with regard to aseptic technique. We had also found a possible method of eliminating Pseudomonas Aeruginosa from the sinks in the operating theatre. Recommendations as to future practice are included.
Antibiotics — Their Administration, Choice and Prophylactic Use
Authors: Goodwin C. S.
Published: January 2019

A wider range of antibiotics is now available with the advent of two new cephalosporins — cefamandole and cefuroxime, and the first cephamycin — cefoxitin. These drugs may be particularly useful in the treatment of septicaemia, and when combined with ticarcillin are effective against nearly all pathogens. Cefuroxime can be given intramuscularly. Intravenous cotrimoxazole must be given in large doses to achieve therapeutic concentrations in the cerebrospinal fluid. The correct use of antibiotics for prophylaxis demands an accurate knowledge of the organisms likely to cause infection and the most efficient way of using the antibiotics to prevent that infection. There is little argument about the need for prophylaxis to prevent recurrent rheumatic heart disease or tetanus from a contaminated wound. However, in the various areas of surgery a wide range of antibiotics is used not always as a result of controlled trials having proved their value. Non-surgical situations for prophylaxis are briefly reviewed.
The Influence of Sampling Site upon the Distribution Phase Kinetics of Thiopentone
Authors: Barrett Robin , Graham G. G. , Torda T. A.
Published: January 2019

In six sheep anaesthetised with ketamine blood was sampled from the jugular and femoral veins and the femoral artery at frequent intervals for 12 minutes following the intravenous administration of 5 or 10 mg/kg sodium thiopentone. Samples were also taken from cubital veins and radial arteries of five patients who received 5 mg/kg thiopentone. The plasma concentration of thiopentone was determined by an HPLC assay. The time course of plasma concentration of thiopentone showed considerable variation according to sampling site as well as variation between individuals. Such sampling site-dependent variation may result in the appearance of acute tolerance.
Evaluation of the Technique of Central Venous Catheterisation via the External Jugular Vein using the J-Wire
Authors: Byth P. L.
Published: January 2019

This paper reports the results of a prospective study to evaluate the success rate and incidence of complications with the external jugular approach to central venous cannulation using a J-tipped spring guide wire. In a personal series of 100 consecutive patients in whom the technique was attempted, successful placement was achieved in 90, but more importantly there were no immediate technical complications. During the study, internal jugular cannulation was used in fourteen patients because either an external jugular vein was not visible (four patients), could not be cannulated (three patients), or the guide wire could not be manipulated into an intrathoracic position (seven patients). The technique is recommended as the initial method where central venous cannulation must be performed under suboptimal conditions and in very sick patients in whom a serious complication may prove to be fatal.
The Influence of Age on Plasma Lignocaine Levels following Tracheal Spray in Young Dogs
Authors: Hastings C. L. , Brown T. C. K. , Eyres R. L. , Oppenheim R. C.
Published: January 2019

A study was conducted in puppies of one litter beginning before they were three weeks old and repeated up to six times in the first four months of life to determine whether any age-related changes in peak plasma lignocaine levels occurred following tracheal spray. These were significantly higher in the youngest group (less than 20 days) than in dogs 2-3 months of age. There was a significant negative correlation between peak plasma levels and age up to four months. The maximum level attained by any puppy was 4.48 ug/ml after 4 mg/kg tracheal lignocaine spray.
Effect of Aprotinin in Adult Respiratory Distress Syndrome
Authors: Tuxen D. V. , Cade J. F.
Published: January 2019

The possible beneficial effect of aprotinin, a broad protease inhibitor, on the incidence and outcome of ARDS was examined in two complementary studies. In the first study, the effect of aprotinin was assessed in 147 patients admitted with multiple trauma or shock. In the 57 patients who developed ARDS, mortality was significantly less in those who had previously received aprotinin (8/20, 40%) than in those who had not (26/37, 70%). Although both treatment groups were well matched, this was a retrospective study and a second prospective, randomised, controlled study was therefore carried out. In 78 patients at risk of ARDS, there was no significant difference between treated and control patients in the incidence, duration or severity of ARDS, or in mortality or other major complications. It is concluded that aprotinin is not effective in improving any aspect of ARDS or its outcome in seriously ill patients.
Antimicrobial Activity of Bupivacaine and Pethidine
Authors: Grimmond T. R. , Brownridge P.
Published: January 2019

The antimicrobial activity of bupivacaine and pethidine in concentrations commonly used in epidural practice was studied by an agar dilution method against ten common micro-organisms. Both drugs showed increasing microbe inhibition with increasing drug concentrations. Bupivacaine at common epidural concentrations inhibited eight of the ten organisms and pethidine inhibited six. These findings confirm previous reports of microbe inhibition by bupivacaine, and in addition demonstrate a similar but slightly lesser activity by pethidine.

Although antimicrobial activity of epidural drugs can be regarded as a desirable property, clinical implications of such findings remain unclear.
The Effect of Halothane General Anaesthesia on Platelet Function
Authors: Sweeney D. , Williams V.
Published: January 2019

Major craniofacial surgery has the potential for very large blood loss, frequently greater than one blood volume. In order that an assessment could be made of any deficiencies of platelet function or coagulation, tests were performed at intervals during the operation. None of the coagulation parameters showed variation below normal limits during the operation, but in vitro platelet aggregation showed significant decreases to several agonists.
Attitudes of Anaesthetists and Nurses to Anaesthetic Pollution
Authors: Plummer J. L. , Sandison C. H. , Ilsley A. H. , Cousins M. J.
Published: January 2019

A survey was conducted to investigate the attitudes of anaesthetists and nurses to anaesthetic pollution. In order that the results could be viewed in context, attitudes to other possible occupational hazards, including radiation exposure and work-related stress, were also investigated. Four hundred (66%) completed questionnaires were returned. All the anaesthetists (n = 81) thought that their work involved some exposure to anaesthetic gases or vapours; however, 21 (7%) of the 319 nurses believed they were not exposed although they spent some time in operating theatres or recovery rooms. Fourteen per cent of anaesthetists and 24% of nurses were ‘quite concerned’ or ‘very concerned’ about possible effects of anaesthetic pollution on their health. Levels of concern were similar for radiation exposure; however, both occupational groups expressed higher levels of concern about work-related stress. Seventeen (21%) anaesthetists and 46 (14%) nurses reported having suffered adverse health effects which they thought were due to anaesthetic pollution. The most frequent complaints were headache and fatigue.