bluuebunny/crossref_metadata_2025 huggingface dataset:
Total Wage — An Analysis
Authors: Hawke R. J.
Published: January 2019

If it is in any sense true that the establishment of the federal arbitration system created “a new province for law and order” as Higgins asserted, then it is certainly true that the concept of the basic wage as a foundational element in all awards of that system made in settlement of interstate industrial disputes became the single most important factor in the development of that law and of that order. From the Harvester judgment of 1907 emerged the structure of:

(i)

a basic wage common to all workers irrespective of the work upon which, or the industry in which, they were employed and

(ii)

a secondary wage or margin for the skill, responsibility, or particular circumstances of the work, or industry, in question

which was the distinguishing feature of wage determination in Australia for the next sixty years. All federal and State industrial tribunals operated with in this structural framework, either by legislative direction, or as a result of their own deliberate decisions based upon a common acceptance of this structure by the parties coming before these tribunals.
Particle swarm optimization-tuned adaptive fuzzy output feedback motion tracking control of piezo-positioning mechanism with unknown hysteresis
Authors: Hasanpour Naseriyeh Mohsen , Arabzadeh Jafari Adeleh , Zaeifi Mehrnoosh , Mohammadi Seyed Mohammad Ali
Published: January 2019

This paper considers the problem of observer-based adaptive fuzzy output feedback control for a piezo-positioning mechanism with unknown hysteresis. In this paper, fuzzy logic systems (FLSs) are used to estimate the unknown nonlinear functions, and also Nussbaum function is utilized to overcome the unknown direction hysteresis. Based on the Lyapunov method, the control scheme is constructed by using the backstepping and adaptive technique. In order to better control performance in reducing tracking error, the particle swarm optimization (PSO) algorithm is utilized for tuning the controller parameters. Proposed adaptive controller guarantees that all the closed-loop signals are semiglobally uniformly ultimately bounded (SGUUB) and the tracking error can converge to a small neighborhood of the origin. Finally, the simulation results are provided to demonstrate the effectiveness and robustness of the proposed approach.
Fractional-order Lagrange polynomials: An application for solving delay fractional optimal control problems
Authors: Sabermahani Sedigheh , Ordokhani Yadollah , Yousefi Sohrab-Ali
Published: January 2019

The main purpose of this work is to provide an efficient method for solving delay fractional optimal control problems (DFOCPs). Our method is based on fractional-order Lagrange polynomials (FLPs) and the collocation method. The FLPs are used to achieve a new operational matrix of fractional derivative. Also, we present a delay operational matrix of FLPs. These operational matrices are driven without considering the nodes of Lagrange polynomials. The operational matrices and collocation method are applied to a constrained extremum in order to minimize the performance index. Then, the problem reduces to the solution of a system of algebraic equations. Convergence of the algorithm and approximation of FLPs are proposed. Furthermore, the upper bound of the error for the operational matrix of fractional derivatives is obtained. Numerical tests for demonstrating the efficiency and effectiveness of the method are included. Moreover, the method is used for numerical solution of a mathematical model of chemotherapy in breast cancer.
Stress-Recovery Management: A Pilot Study Using a Single-Subject Experimental Design
Authors: Almén Niclas , Lisspers Jan , Öst Lars-Göran
Published: January 2019

Work-related stress is considered one of the biggest health and safety challenges among the member states of the European Union. A critical factor is recovery between periods of stress. The primary purpose of this study was to investigate whether a brief behaviorally oriented stress-recovery management intervention delivered in an individual setting could reduce stress symptoms among individuals with high levels of perceived stress. A single-subject experimental design with multiple baselines across three individuals was used. The results indicate, with at least moderate experimental control, a temporal relation between the start of the intervention and beneficial changes from baseline in continuous self-recordings of stress symptoms. The changes were maintained at 1-year and 5-year follow-up assessments. Also, self-reporting inventories measuring perceived stress, worry, anxiety, depression, burnout, type A behavior, unwinding and recuperation from work stress, and insomnia showed overall changes in beneficial directions at post-assessment, as well as the two follow-up assessments. The results indicate that a behaviorally oriented stress-recovery management intervention delivered in an individual setting can reduce stress symptoms in individuals with high levels of perceived stress. However, for firm conclusions to be drawn, further research is needed.
Continuous measurement of dynamic classroom social interactions
Authors: Messinger Daniel S. , Prince Emily B. , Zheng Minzhang , Martin Katherine , Mitsven Samantha G. , Huang Shengda , Stölzel Tanja , Johnson Neil , Rudolph Udo , Perry Lynn K. , Laursen Brett , Song Chaoming
Published: January 2019

Human observations can only capture a portion of ongoing classroom social activity, and are not ideal for understanding how children’s interactions are spatially structured. Here we demonstrate how social interaction can be investigated by modeling automated continuous measurements of children’s location and movement using a commercial system based on radio frequency identification. Continuous location data were obtained from 16 five-year-olds observed during three 1-h classroom free play observations. Illustrative coordinate mapping indicated that boys and girls tended to cluster in different physical locations in the classroom, but there was no suggestion of gender differences in children’s velocity (i.e., speed of movement). To detect social interaction, we present the radial distribution function, an index of when children were in social contact at greater than chance levels. Rank-order plots indicated that children were in social contact tens to hundreds of times more with some peers than others. We illustrate the use of social ties (higher than average levels of social contact) to visualize the classroom network. Analysis of the network suggests that transitivity is a potential lens through which to examine male, female, and mixed-sex cliques. The illustrative findings suggest the validity of the new measurement approach by re-examining well-established gender segregation findings from a new perspective.
Majoritarian systems, rural groups, and (arrested) welfare state development
Authors: Knutsen Carl Henrik , Rasmussen Magnus Bergli
Published: January 2019

While some scholars suggest that rural groups contribute to welfare state expansion, we highlight their incentives to restrain it. The ability of rural groups to achieve this preference hinges on their power resources, but also on the electoral system. We propose that in majoritarian systems, rural groups can often veto welfare legislation. In proportional systems this is less feasible, even for resource-rich groups. Instead, agrarian groups sometimes accept welfare legislation in return for other policy-concessions in post-electoral bargaining. We illustrate the argument with British and Norwegian historical experiences, and test the implications using panel data from 96 democracies. We find evidence that resourceful agrarian groups effectively arrest welfare state development in majoritarian systems, but not in proportional systems. As expected, the electoral system matters less for welfare state expansion when agrarian groups are weak. The results are robust to using alternative estimators, measures, samples and model specifications.
Systematic Review of Temporal Bone–Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies
Authors: Liu George S. , Boursiquot Brian C. , Blevins Nikolas H. , Vaisbuch Yona
Published: January 2019

Objective

To systematically review literature evidence on temporal bone–resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies.

Data Sources

We searched PubMed, Embase, and the Cochrane Database. The period covered was from 1962 to 2018.

Review Methods

We included studies in all languages that reported resurfacing outcomes for patients with PT and radiographic evidence or direct visualization of sigmoid sinus wall anomaly, jugular bulb wall anomaly, or dehiscent or aberrant internal carotid artery.

Results

Of 954 citations retrieved in database searches and 5 citations retrieved from reference lists, 20 studies with a total of 141 resurfacing cases involving 138 patients were included. Resurfacing outcomes for arterial sources of PT showed 3 of 5 cases (60%) with complete resolution and 2 (40%) with partial resolution. Jugular bulb sources of PT showed 11 of 14 cases (79%) with complete resolution and 1 (7%) with partial resolution. Sigmoid sinus sources of PT showed 91 of 121 cases (75%) with complete resolution and 12 (10%) with partial resolution. Symptoms occurred more in females and on the right side. Most cases (94%) used hard‐density materials for resurfacing. Material density did not appear to be associated with resurfacing outcomes. Use of autologous materials was associated with improved outcomes for arterial sources resurfacing. Major complications involving sigmoid sinus thrombosis or compression were reported in 4% of cases without long‐term morbidity or mortality.

Conclusions

Resurfacing surgery is likely effective and well tolerated for select patients with PT associated with various vascular wall anomalies.
Right atrial myxoma detected in a child two months after open-heart surgery
Authors: Younes Mohammad , Al-Dairy Alwaleed , Albadr Alaa
Published: January 2019

Primary cardiac tumors are rare, and myxomas represent the most common type. Myxoma in a child is very rare. Herein, we present the case of a 4-year-old boy who was diagnosed with a right atrial mass two months after open-heart surgery for removal of a supra-mitral ring and repair of an interatrial septum aneurysm. He underwent surgery for resection of the mass, and pathological studies showed it was a cardiac myxoma. After 45 months of follow-up, the patient was alive without any recurrence or problems. This is the most rapidly growing myxoma ever reported in a child.
Poor outcomes for osteoporotic patients undergoing conversion total hip arthroplasty following prior failed dynamic hip screw fixation: a nationwide retrospective cohort study
Authors: Xu Qian , Lai Jiajie , Zhang Fan , Xu Yangkai , Zhu Fugui , Lin Jinluan , Zhao Mingdong , Ye Junxing , Wen Liming
Published: January 2019

Objectives

This study was performed to compare the long-term clinical and radiological outcomes of conversion total hip arthroplasty (CTHA) following prior failed InterTan nail (IT) fixation or dynamic hip screw (DHS) fixation in Asian patients with osteoporotic intertrochanteric hip fractures (IHFs) and to clarify which implant tends to be more favourable for CTHA.

Methods

Records of consecutive Asian patients with osteoporosis who underwent conversion of failed primary unilateral IT or DHS fixation to THA from 2010 to 2013 were extracted from the comprehensive database of the China Pacific Insurance Company Ltd. All consecutive procedures were managed by high-volume surgeons. The primary endpoint was the clinical outcome. The secondary endpoint was the radiological outcome.

Results

In total, 447 Asian patients with osteoporotic IHFs (DHS, n = 223; IT, n = 224) were assessed during a median follow-up of 46 months (range, 39–53 months). The two groups showed a significant difference in the Harris hip score at final follow-up and in the orthopaedic complication rate (DHS, 20.2%; IT, 9.8%).

Conclusion

Conversion to THA following prior failed DHS fixation tends to be associated with poorer clinical and radiological outcomes in Asian patients with osteoporotic IHFs than that following prior failed IT fixation.
Tramadol—Present and Future
Authors: Shipton E. A.
Published: January 2019

The atypical opioid, tramadol, has recently been introduced into Australia and New Zealand. Tramadol's efficacy in a wide range of acute and chronic pain states, its multi-formulation availability, and its low serious side-effect potential at high doses and in prolonged therapy, combine to bestow on it a user-friendly profile, for short- and long-term use in hospitals and communities. This paper reviews the following: its formulation and routes of administration; its unique enantiomeric biochemistry and metabolism; its triple mechanisms of action; its pharmacokinetics and pharmacodynamics; its analgesic efficacy compared with other opioids; the indications for its clinical use in a variety of acute and chronic (including cancer) painful states; its specific use in the elderly, in paediatric and in obstetric patients; its adverse event (including drug interaction) and safety profile; its advantages in terms of its relative lack of respiratory depression, major organ toxicity and histamine release, and dependence and abuse potential. The review looks at new uses for this drug and what can be expected in this area in the future.\
Potential Use of Pharmacological Markers to Quantitatively Assess Liver Function during Liver Transplantation Surgery
Authors: Gao L. , Ramzan I. , Baker A. B.
Published: January 2019

Early functioning of the transplanted liver is of crucial importance to the recipient. This function may be assessed by measuring the disposition of substances that are mainly eliminated via the liver. None of the agents currently used is ideal for this purpose. Measurement of mono-ethyleneglycinexylidide (MEGX) formation from lignocaine is useful and has been widely used in liver transplantation to assess liver graft function. MEGX formation can be affected by the use of drugs that influence liver perfusion or interfere with the CYP450 enzyme system. Indocyanine green clearance is a convenient method but both blood flow and hepatocellular function affect the test results. Tests of caffeine clearance, galactose elimination capacity and antipyrine clearance all require time-consuming, technically cumbersome and expensive serial blood sampling. The aminopyrine breath test is non-invasive, but gastric emptying and the patient's physical state affect results. The potential hazard of exposure to radioactive compounds limits the wide clinical use of both aminopyrine and erythromycin breath tests. Monitoring the rate of recovery from neuro-muscular blockade induced by vecuronium and rocuronium can provide valuable information on liver function.
The Intubating Laryngeal Mask Airway: Effect of Handle Elevation on Efficacy of Seal, Fibreoptic Position, Blind Intubation and Airway Protection
Authors: Keller C. , Brimacombe J. R. , Rädler C. , Pühringer F. , Brimacombe N. S.
Published: January 2019

We conducted three studies to test the hypothesis that elevation of the intubating laryngeal mask (ILM) handle increases efficacy of seal, changes fibreoptic position, prevents aspiration of regurgitated fluid and improves intubation. In study 1, the ILM was inserted into 20 paralysed, anaesthetized patients and 20 cadavers. Oropharyngeal leak pressure and fibreoptic position were measured at an intracuff pressure of 0, 60 and 120 cm H 2 O with 0, 20 and 40 N of elevation force. In study 2, the oesophageal pressure at which regurgitation and aspiration occurred was measured in 20 cadavers with the ILM at the above intracuff pressures and elevation forces and 10 cadavers without the ILM (controls). In study 3, ease of blind intubation (first attempt only) was determined in 20 paralysed, anaesthetized patients at 0 and 40 N elevation force. In study 1, there was a significant increase in oropharyngeal leak pressure with increasing elevation force at an intracuff pressure of 0 and 60 cm H 2 O. There were no changes in fibreoptic position. Oropharyngeal leak pressure and fibreoptic position were similar between patients and cadavers. In study 2, oesophageal pressure for regurgitation and aspiration was usually greater for the ILM than controls (all: P<0.05. Aspiration and regurgitation usually occurred at the same oesophageal pressure. In study 3, blind intubation was more successful at 0 N than 40 N (15/20 v 8/20, P=0.03). We conclude that elevation of the ILM handle has little clinical utility other than as a temporary measure to improve the efficacy of the seal.
Recurrent Laryngeal Nerve Blockade in Patients Undergoing Carotid Endarterectomy under Cervical Plexus Block
Authors: Harris R. J. D. , Benveniste G.
Published: January 2019

We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.
The Effects on Increasing Cardiac Output with Adrenaline or Isoprenaline on Arterial Haemoglobin Oxygen Saturation and Shunt during One-Lung Ventilation
Authors: Russell W. J. , James M. F.
Published: January 2019

Theoretically, if the cardiac output were increased in the presence of a given intrapulmonary shunt, the arterial haemoglobin oxygen saturation (SaO 2 ) should improve as the venous oxygen extraction per ml of blood decreases. To test this hypothesis, eight pigs were subjected to one-lung ventilation and adrenaline and isoprenaline infusions used to increase the cardiac output. The mixed venous oxygen, shunt fraction and oxygen consumption were measured.

With both adrenaline and isoprenaline, although there was a small rise in mixed venous oxygen content, there was a fall in SaO 2. With adrenaline, the mean shunt rose from 48% to 65%, the mean oxygen consumption rose from 126 ml/min to 134 ml/min and the mean SaO 2 fell from 86.9% to 82.5%. With isoprenaline, the mean shunt rose from 45% to 59%, the mean oxygen consumption rose from 121 ml/min to 137 ml/min and the mean SaO 2 fell from 89.5% to 84.7%.

It is concluded that potential improvement in SaO 2, which might occur from a catecholamine-induced increase in mixed venous oxygen content during one-lung ventilation, is more than offset by increased shunting and oxygen consumption which reduce SaO 2.
The Prevention of Pulmonary Aspiration with Control of Tracheal Wall Pressure Using a Silicone Cuff
Authors: Young P. J. , Burchett K. , Harvey I. , Blunt M. C.
Published: January 2019

A prospective open randomized controlled study was performed to assess the ability of Euromedical ILM endotracheal tube cuff (silicone cuff) to prevent pulmonary aspiration The inflation characteristics of this silicone cuff enables the control of tracheal wall pressure. The silicone cuffed tube was shortened and an adjustable flange was used to convert it to a cuffed tracheostomy tube. Twelve patients requiring a tracheostomy on a four-bed intensive care unit (ICU) in a district general hospital received either a silicone or a Shiley cuffed tracheostomy tube. Tracheal wall pressures of both cuffs were maintained at 30 cm H 2 O with a constant pressure inflation device. Blue food dye was instilled once daily into the subglottic space through a fine catheter above the cuff. There were six patients in the Shiley group and six patients in the silicone cuff group. Dye leaked to the trachea in six (100%) of the Shiley group compared with none (0%) of the silicone cuff group (P=0.001). This study confirms the effectiveness of this silicone cuff at preventing aspiration and the high incidence of leakage with the conventional high-volume low-pressure tracheostomy tube cuff.
Non-Invasive Cardiac Output Determination: Comparison of a New Partial-Rebreathing Technique with Thermodilution
Authors: Binder J. C. , Parkin W. G.
Published: January 2019

This study compares a derivative Fick technique using carbon dioxide (CO2) with the thermodilution pulmonary artery catheter (PAC), for determination of cardiac output (CO). Subjects were sedated, mechanically ventilated adults following elective cardiac surgery. Microprocessor controlled deadspace activation and side-stream capnography in a ventilator circuit enabled calculation of CO (COco2) every four minutes. Thermodilution CO (COtd) was performed as clinically indicated and at 20-minute intervals. Simultaneous COtd/COco2 pairs were recorded from time of admission to ICU for a minimum period of two hours for each patient. There were 358 COtd/COco2 pairs recorded from 41 patients. Cardiac output measurements ranged from 2.7 to 10.6 l/min. The bias (Bland-Altman) was 0.050 l/min (95% CI –0.024 to 0.125 l/min). The 95% limits of agreement were –1.354 to 1.455 l/min. This simple, non-invasive partial-rebreathing technique is a valid alternative to thermodilution for cardiac output determination in sedated, mechanically ventilated patients. There are significant implications for improved safety, reduced complexity and reduced cost in anaesthesia and intensive care.
A Standardized, Uniform and Universal Dental Chart for Documenting State of Dentition before Anaesthesia
Authors: Gatt S. P. , Aurisch J. , Wong K.
Published: January 2019

It is vital to have adequate and precise documentation of the condition of a patient's dentition before commencing an anaesthetic. The incidence of dental damage during anaesthesia is not low. To the authors’ knowledge, there is no standardized method used by anaesthetists to document the state of a patient's dentition. We propose the introduction of a standardized uniform dental chart to enable anaesthetists to accurately document the condition of their patients’ teeth. This vital information can be easily obtained during the preanaesthetic assessment. With the increase in medical litigation and demands for adequate documentation, we believe this chart can become an invaluable part of every hospital's preanaesthetic assessment form. The dental chart is to be offered as a service to anaesthetists in the form of a copyright-free “Freeware” computer diskette or adhesive sticker, and will be downloadable from the internet.
Patient-Controlled Spinal Analgesia for Labour and Caesarean Delivery
Authors: Pavy T. J. G.
Published: January 2019

Continuous spinal anaesthesia has not been widely used in Australia. Epidural anaesthesia is often inadequate in patients with previous spinal surgery, as distribution of local anaesthetic in the epidural space is unpredictable. Two cases are presented where continuous spinal anaesthesia enabled satisfactory analgesia and anaesthesia to be obtained for labour and caesarean delivery respectively.
Awake Craniotomy in an Adolescent
Authors: McDougall R. J. , Rosenfeld J. V. , Wrennall J. A. , Harvey A. S.
Published: January 2019

We present our approach to management of awake craniotomy for epilepsy surgery for an adolescent. The importance of patient selection and preoperative preparation is stressed. Anaesthetic management included regional scalp block and preincisional surgical infiltration of local anaesthetic and light sedation with propofol, fentanyl and midazolam. The patient remained responsive to voice for all but a small part of the procedure.
Hypotension in Elderly Patients Undergoing Spinal Anaesthesia for Repair of Fractured Neck of Femur. A Comparison of Two Different Spinal Solutions
Authors: Martyr J. W. , Clark M. X.
Published: January 2019

Intraoperative hypotension is a common and sometimes deleterious event in elderly patients undergoing spinal anaesthesia for repair of hip fractures. The synergism between intrathecal opioids and local anaesthetics may allow a reduction in the dose of local anaesthetic and reduce hypotension, while still maintaining adequate anaesthesia. We studied 42 elderly patients having insertion of a Richards pin and plate and compared 7.5 mg hyperbaric bupivacaine with added fentanyl 20 μg (group BF) to 12.5 mg hyperbaric bupivacaine alone (group B). Hypotension was defined as a fall in systolic blood pressure to less than 75% baseline or less than 90 mmHg and occurred with an overall incidence of 59.5%. There was no difference in the incidence or severity of hypotension between the two groups. Two patients from group B and one from group BF experienced mild discomfort. Pruritus was more common in group BF.
Change in Endotracheal Tube Cuff Pressure during Nitrous Oxide Anaesthesia: A Comparison between Air and Distilled Water Cuff Inflation
Authors: Ahmad N. L. , Norsidah A. M.
Published: January 2019

In this prospective, randomized controlled trial, changes in endotracheal tube cuff pressure were studied in 60 patients undergoing elective surgery under general anaesthesia with nitrous oxide and oxygen. The cuffs were inflated with either air or distilled water. The mean pressure in the air-filled cuffs increased steadily throughout the procedure, reaching 47.5±7.3 cmH2O at one hour compared with 31.6±2.4 cmH2O mean pressure in the water-filled cuffs. The pressure and the rate of rise in cuff pressure were significantly lower (P<0.05) in the water-filled cuffs throughout the hour of study. When an endotracheal tube cuff is distended with water, the rise in cuff pressure during nitrous oxide anaesthesia is lower than that of an air-filled cuff.
The Use of a Questionnaire and Simple Exercise Test in the Preoperative Assessment of Vascular Surgery Patients
Authors: McGlade D. P. , Poon A. B. , Davies M. J.
Published: January 2019

We aimed to assess the reliability of patients as historians in terms of the self assessment of functional capacity and also examined the usefulness of a simple ward exercise tolerance test.

One hundred consecutive elective vascular surgery patients were interviewed preoperatively using a modified Duke Activity Status Index (DASI) questionnaire. To test reliability in reference to an independent observer, the questionnaire concerning the patient was also applied to each patient's closest relative who was blinded to the patient's responses. Patients were then asked to walk up two flights of stairs and the time taken to complete the task or the reason for failing to complete the task was recorded.

The DASI questionnaire was successfully applied to 98 of 100 patients. The average time for completion was five minutes. There was significant correlation between the scores obtained by each patient and that of their closest relative (r=0.883, P<0.01). Mean percentage score was 48.6, range 0 to 100. Fifty-nine of 100 patients selected were able to undergo the simple ward exercise test. DASI scores (mean, SD) were significantly different between those who completed two flights (67.2, 21.5), one flight (45.5, 15.6) or who were unable to climb at all (28.8, 25) (Mann-Whitney U test corrected for multiple comparisons, P<0.05). Patients with higher DASI scores were able to complete the task at a faster rate.

The DASI questionnaire is easy to administer and a useful method for quantifying exercise tolerance. We also demonstrated a high correlation between the responses of patients and relatives.
Anaesthesia in the Dili General Hospital, East Timor
Authors: Bennett E. J.
Published: January 2019

An analysis was performed of the anaesthesia caseload of the Dili General Hospital for a four-month period from April 21, 2000 to August 20, 2000.
The Effect of Cardiac Output Changes on End-Tidal Volatile Anaesthetic Concentrations
Authors: Kennedy R. R. , Baker A. B.
Published: January 2019

Cardiac output is a major determinant of the rate of uptake of volatile anaesthetic agents. Theoretical work suggests a 30% change in cardiac output will produce a measurable change in end-tidal volatile agent. We present three patients in whom significant changes in haemodynamic parameters, consistent with a large fall in cardiac output, were accompanied by an increase in end-tidal volatile agent concentrations. The changes in end-tidal volatile agent concentrations were comparable in magnitude but in the opposite direction to the changes in end-tidal CO2. Clinically, an unexplained change in end-tidal concentration of a volatile agent may signify a large change in cardiac output.
Bispectral Index in Assessment of Adequacy of General Anaesthesia for Lower Segment Caesarean Section
Authors: Yeo S. N. , Lo W. K.
Published: January 2019

Awareness among parturients during general anaesthesia for caesarean section, though now uncommon, remains a concern for obstetric anaesthetists. We examined the adequacy of our general anaesthetic technique for avoiding explicit awareness by determining the depth of anaesthesia using Bispectral Index (BIS) monitoring.

Twenty ASA 1 parturients having general anaesthesia for lower segment caesarean section were studied. The drugs and doses used for each anaesthetic were similar. Intraoperative Bispectral Index, haemodynamic parameters, end-tidal isoflurane concentration and inspired nitrous oxide fraction were measured and the postoperative incidence of explicit awareness was assessed. All anaesthetists were blinded to the Bispectral Index value throughout the operation. The depth of anaesthesia at various stages of the operation was evaluated by recording the Bispectral Index. Patients were interviewed for any intraoperative recall or awareness at the end of operation.

A median BIS of 70 or below was recorded on most occasions during surgery. The range was 52 to 70, with values reaching 60 and below at intubation, uterine incision and delivery. Haemodynamic stability was satisfactory and there was no case of uterine atony, fetal compromise or postpartum haemorrhage. No patient experienced intraoperative dreams, recall or awareness.

Our current general anaesthetic technique appeared inadequate to reliably produce BIS values of less than 60 that are associated with a low risk of awareness. However, no patients experienced explicit awareness.
The Modified Cormack-Lehane Score for the Grading of Direct Laryngoscopy: Evaluation in the Asian Population
Authors: Koh L. K. D. , Kong C. F. , Ip-Yam P. C.
Published: January 2019

The use of a modified Cormack-Lehane scoring system (MCLS) of laryngoscopic views, as previously introduced in the Western population, was investigated during direct laryngoscopy in the Asian population. We studied the distribution of the different grades of MCLS, the predictive factors and rate of difficult laryngoscopy, and the association with difficult intubation. Six hundred and five patients requiring tracheal intubation during general anaesthesia were prospectively studied. The optimal views during direct laryngoscopy were scored using the 5-grade MCLS system. The distribution of the laryngoscopy scores was 73.9% Grade 1 (full view of the vocal cords), 21.0% Grade 2A (partial view of the vocal cords), 3.3% Grade 2B (only the arytenoids and epiglottis seen), 1.6% Grade 3 (only epiglottis visible) and 0.2% Grade 4 (neither the epiglottis nor glottis seen). External laryngeal pressure was necessary in 45.3% of cases to optimize laryngoscopic views. Grade 2B was associated with significantly higher incidence of difficult intubation compared with Grade 2A (65% vs 13.4%). The rates of difficult laryngoscopy and intubation were 5.1% and 6.9% respectively. The Mallampati classification and thyromental distance were associated with low predictive value for difficult laryngoscopy. The MCLS better delineates the difficulty experienced during laryngoscopy than the original Cormack-Lehane grading.
Systemic Reperfusion Injury during Arm Replantation Requiring Intraoperative Amputation
Authors: McCutcheon C. , Hennessy B.
Published: January 2019

This case describes the attempted replantation of an arm following its traumatic amputation. After a five-and-a-half hour ischaemic time, perfusion of the arm was re-established. However, over the ensuing hours, the patient developed hyperkalaemia, acidaemia and severe hypotension requiring high dose inotropic support. Ultimately re-amputation was necessary to treat the systemic effects of the ischaemia reperfusion syndrome.
Vibrio vulnificus Septicaemia
Authors: Sie M. Y. , Ip-Yam P. C. , Oon L. L. E.
Published: January 2019

Vibrio vulnificus is an opportunistic pathogen capable of causing a fulminant septicaemia in susceptible patients. Underlying chronic diseases such as liver impairment and immunosuppression are important factors contributing to the severity of the infection and outcome. Early suspicion and diagnosis with appropriate antibiotic therapy is important as delay can adversely affect outcome. For those who develop tissue necrotizing fasciitis, early surgical debridement is recommended to allow better penetration of antibiotics and also to reduce the severity of the septicaemia. Mortality is quoted as between 50% and 90%. Current antibiotic recommendations are intravenous ceftazidime 2 g tds and doxycycline 100 mg od.
The Effect of Anaesthetic Technique on Postoperative Nausea and Vomiting after Day-case Gynaecological Laparoscopy
Authors: Paech M. J. , Lee B. H. S. , Evans S. F.
Published: January 2019

Gynaecological surgery is of high emetogenic potential and both total intravenous anaesthesia (TIVA) and prophylactic antiemetic therapy may reduce the incidence of postoperative nausea and vomiting (PONV).

We studied 144 patients scheduled for day-case gynaecological laparoscopy in a randomized trial comparing balanced inhalational anaesthesia and prophylactic dolasetron (group I+D) with propofol TIVA and dolasetron (group T+D) or TIVA alone (group T). The primary outcome of “complete response” (no vomiting, no treatment for PONV) was not significantly different among groups (34%, 51%, 32%; groups I+D vs T+D vs T, P=0.12). During the first hour after surgery, group I+D had nausea of greater severity (P<0.03). During hospital admission, group T had more vomiting (P<0.03). From discharge until 24 hours postoperatively, 55% of group I+D experience nausea and 38% vomited. The incidence and severity of nausea were significantly lower in the TIVA groups (P<0.04 and < 0.05 respectively). There were no significant differences between groups T+D and T, although comparing all groups the complete response rate was highest and the post-discharge incidence and severity of nausea lowest in group T+D.

In conclusion, propofol TIVA, with or without dolasetron, reduced postoperative nausea, but not perioperative vomiting or antiemetic requirement, when compared with inhalational anaesthesia plus dolasetron.
The Effect of Selective Brain Cooling on Intracerebral Temperature during Craniotomy
Authors: Iatrou C. C. , Domaingue C. M. , Thomas R. D. , Nye D. H.
Published: January 2019

In this study we investigated the effect of topical application of cool irrigation fluid on brain tissue temperature during craniotomy.

Eight patients were given a standard general anaesthetic for craniotomy. Distal oesophageal and nasopharyngeal temperatures were measured continuously and systemic normothermia was maintained. A sterile needle temperature probe was inserted 18 mm into the cerebrum to measure brain temperature. Brain temperatures were recorded for five minutes while the brain was irrigated with 1000 ml of normal saline at a temperature of 30°C. Measurement continued until the brain temperature returned to baseline.

The mean maximum decrease in cerebral parenchymal temperature following irrigation was 1.6±0.5°C (P<0.01). The average time to return to baseline temperature after cessation of irrigation was 5.3±1.5 minutes.

Cooling the brain has a marked protective effect after brain injury, but systemic hypothermia can produce significant harmful effects. This study demonstrates that the use of cool irrigation fluid during neurosurgery is a simple and effective method of cooling the brain whilst minimizing the use of systemic hypothermia.
Theoretical Aspects of P-glycoprotein Mediated Drug Efflux on the Distribution Volume of Anaesthetic-related Drugs in the Brain
Authors: Upton R. N.
Published: January 2019

P-glycoprotein in the membranes of endothelial cells actively transports some drugs out of the brain.

The theoretical effect of P-glycoprotein mediated drug efflux on the cerebral distribution volumes of drugs was examined, with particular emphasis on anaesthetic-related drugs (often characterized by moderate to high permeability across the blood brain barrier due to their lipophilicity and intermediate molecular weight). An analytical equation for the cerebral distribution volume in the presence of the efflux was derived, and validated by modelling the same system using differential equations.

The efflux was shown to lower both the membrane and intracellular drug concentrations in parallel, and to reduce the time required for brain:blood equilibration. The net effect of the efflux was governed by the ratio of the P-glycoprotein drug clearance from the membrane (Pcl) and the permeability of the membrane (PS). It was therefore a balance between the rate that a drug could be pumped out of the membrane by the efflux system, and the rate that the drug leaked back in due to the permeability of the membrane for the drug. The effect of the efflux was therefore more pronounced for drugs with membrane-limited cerebral kinetics (e.g. morphine), but was nevertheless significant for drugs with more flow-limited kinetics (e.g fentanyl). The cerebral distribution volume was also influenced by the free fraction in blood and the free fraction in the intracellular space in the conventional manner.

There are no theoretical limitations to the P-glycoprotein system influencing the cerebral distribution volume of moderately lipophilic anaesthetic-related drugs.
The Effect of Neuromuscular Blockade on Oxygen Supply, Consumption, and Total Chest Compliance in Patients with High Oxygen Requirements Undergoing Mechanical Ventilation
Authors: Russell W. C. , Greer R. , Harper N. J. N.
Published: January 2019

We investigated the effects of neuromuscular blockade with atracurium on oxygen consumption, oxygen delivery and total chest compliance in 20 sedated intensive care patients who required mechanical ventilation with an inspired oxygen fraction of at least 0.6.

The reverse Fick method was used to measure oxygen consumption. Total chest compliance was measured from the ventilator pneumotachograph and pressure transducer. Measurements were made before neuromuscular blockade, at a standard level of neuromuscular blockade, and after demonstrated recovery of neuromuscular function.

There was no statistical difference in any of the parameters measured. However there were large changes in oxygen consumption (range -35% to +17%) and total chest compliance (range -19.7% to +9.7%) in individuals.

We conclude that in the setting of critical oxygenation, neuromuscular blockade cannot be assumed to reduce oxygen requirements or improve total lung compliance. If, however, neuromuscular blockade is selected as an adjunct to therapy, we recommend that the indices of oxygenation are calculated.
Adhesive Properties of Micropore®, Transpore®, Leucoplast® and Sleek®
Authors: Chaffer J. E. , Moyle E.
Published: January 2019

Adhesive tapes are a routine part of every anaesthetic. Until now there has been little clinical data on the efficacy of these tapes. This study compared Micropore® Transpore®, Leukoplast® and Sleek® to determine if any significant difference existed between the adhesive properties of these tapes. The tapes were trialled on bare skin, hairy skin, EMLA® covered skin, skin with Benzoin Compound Tincture applied, and skin with Opsite® spray applied.

There was no significant difference in adhesiveness between Transpore, Leukoplast and Sleek, whilst Micropore was marginally inferior. EMLA cream significantly decreased the adhesive properties of all tapes.
The Effect of a Disposable Probe Cover on Pulse Oximetry
Authors: Cheung P. , Hardman J. G. , Whiteside R.
Published: January 2019

The re-use of pulse oximeter probes presents the possibility of between-patient contamination. Use of a disposable polyethylene cover may reduce this risk. In a controlled, prospective study we examined the effect of such a cover on the accuracy of pulse oximetry. Each of ten volunteer subjects was monitored simultaneously by two identical Nellcor pulse oximeters, one with a plastic cover and the other, without a cover, used as a control. The pulse oximetry (SpO 2 ) reading for each probe was recorded while subjects breathed 21% O 2 and again while they breathed 10% O 2. The probe cover was then swapped onto the other probe and the recordings were repeated. Ninety-five per cent limits of agreement in SpO 2 (mean difference in SpO 2 (1.95 x standard deviation of difference) between covered and non-covered probes were -0.6% to 0.6% while breathing 21% oxygen and -2.0% to 2.9% while breathing 10% oxygen. We conclude that a protective plastic sheath may induce a small error in pulse oximetry reading that is most marked during hypoxaemia. This error is unlikely to be of clinical significance.
Atrial Fibrillation, Failed Cardioversion, and Electroconvulsive Therapy
Authors: Ottaway A.
Published: January 2019

A case is described in which an elderly male with atrial fibrillation and major depression underwent a course of electroconvulsive therapy. Two of the first three treatments were associated with other arrhythmias, during and after the procedure. Prior to the fourth treatment cardioversion was unsuccessful. During the fourth episode of electroconvulsive therapy, the patient reverted to sinus rhythm and remained in this rhythm. Reversion of atrial fibrillation to sinus rhythm may be associated with embolization if atrial thrombus has formed. Factors predisposing to changes in rhythm with electroconvulsive therapy and the management of patients with atrial fibrillation having electroconvulsive therapy are discussed.
Haemorrhage of a Thyroid Cyst as an Unusual Complication of Intubation
Authors: Szeto L. D. , Hung C. T.
Published: January 2019

A case is presented of haemorrhage into a thyroid cyst after endotracheal intubation for an elective nasal operation in a healthy young man. The haemorrhagic cyst compressed the trachea and the patient was taken to the intensive care unit with the endotracheal tube left in situ. Hemithyroidectomy was performed uneventfully two days later. Causes of haemorrhage into thyroid cysts are reviewed.
Quinine Ocular Toxicity: Treatment of Blindness Using Therapy for Vasospasm
Authors: Barrett N. A. , Solano T.
Published: January 2019

A case of ocular toxicity with vasospasm secondary to quinine poisoning is described. Therapy for vasospasm using nimodipine, hypertension, haemodilution and hypervolaemia was instituted with subsequent resolution of symptoms.
Washing of Gloved Hands in Antiseptic Solution Prior to Central Venous Line Insertion Reduces Contamination
Authors: Kocent H. , Corke C. , Alajeel A. , Graves S.
Published: January 2019

Glove contamination at the time a central venous catheter is handled is highly undesirable and likely to increase the risk of subsequent line infection. This study was designed to determine how frequently gloves become contaminated during central venous line insertion and to demonstrate the value of glove decontamination immediately prior to handling of the central venous catheter.

During twenty routine internal jugular catheter insertions the sterility of the operator's gloved fingertips (just prior to handling the intravenous catheter) was assessed by touching the fingertips onto blood agar plates. The gloved hands were then rinsed in chlorhexidine/alcohol and after drying were placed onto a further plate. Contamination was detected in 55% of the prewash plates but in none of the postwash plates. Procedures performed by less experienced resident staff had a higher contamination rate despite there being no evident breach of sterile technique.

It is likely that glove contamination results from the persistance of bacteria within the deeper layers of the skin, despite surface disinfection. These bacteria may be released by manipulation of the skin when identifying landmarks. This hypothesis was supported by a subsequent observation that gloves were more highly contaminated after firm touching of the skin rather than light touching.

Glove contamination during central line insertion is frequent. Catheter contamination rates could be reduced (without risk or additional cost) by rinsing gloved hands in a solution of chlorhexidine (0.5%) in alcohol (70%) prior to handling the catheter.
High Dependency Units: Issues to Consider in Their Planning
Authors: Boots R. , Lipman J.
Published: January 2019

This review discusses the issues to be considered in establishing new or extending existing high dependency unit (HDU) services. A defined high dependency service becomes cost-effective when patient care requires more than one nurse for three patients. Professional guidelines for HDUs vary and there are no national accreditation criteria. Casemix and service delivery specifications for the HDU need to be defined and agreed upon within the institution. Establishing a new HDU service requires changes to care delivery. Many potential HDU patients are currently managed in general wards or in the intensive care unit. The service should be discussed widely and marketed within the institution, and the development of defined working relationships with the ICU and primary care teams on the wards is mandatory.
Career Choice Influences in Australian Anaesthetists
Authors: Roberts L. J. , Khursandi D. C. S.
Published: January 2019

All female members and a randomly selected group of male members of the Australian Society of Anaesthetists (n=488) were surveyed by questionnaire as part of a broader study of gender issues in anaesthesia. This paper reports on reasons for career choice and the importance of role models. Responses were received from 199 women and 98 men (60.9% of those surveyed), representing all States and one Territory. Most males (95.9%) and a majority of females (55.7%) worked full-time. Reasons for career choice varied with gender, with a significantly greater proportion of women (39.7%) than men (8.7%) choosing anaesthesia because of controllable hours, particularly the ability to work part-time. Experiences in anaesthesia during internship and residency were important for 19.1% of women and 14.1% of men, although very few mentioned undergraduate exposure. Other important factors in career choice were the application of physiology and pharmacology in patient care, practical and procedural aspects of practice, and chance. A majority of women (56%) and men (55%) named specific role models who were influential and encouraging in their choice. These results are similar to those of other studies.
Vancomycin Reaction during Spinal Anaesthesia
Authors: Duffy B. L.
Published: January 2019

A 77-year-old female received uneventful spinal anaesthesia for a total knee replacement. Upon the advice of the microbiologists and at the request of the orthopaedic surgeon, a vancomycin infusion was commenced prior to the application of the leg tourniquet. Five minutes later, having received only 40 mg of the antibiotic dose, she became unconscious and suffered severe cardiovascular collapse, from which she was resuscitated with intravenous ephedrine and adrenaline.
Excruciating Perineal Pain after Intravenous Dexamethasone
Authors: Neff S. P. W. , Stapelberg F. , Warmington A.
Published: January 2019

We describe two cases of unexpected perineal pain immediately after intravenous injection of fentanyl and dexamethasone (100 μg and 8 mg respectively) during induction of general anaesthesia. In both cases the pain was immediate (onset within 30 seconds), severe, localized to the genital region and of shooting and burning character. No other clinical signs or symptoms were observed in either case and both patients made an uneventful recovery without neurological sequelae.

We review the existing literature on perineal pain as an adverse effect of intravenous corticosteroid esters and recommend their administration either in diluted form or after induction of general anaesthesia.