bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological variation in Acrossocheilus hemispinus (Teleostei: Cyprinidae: Barbinae), with comments on its taxonomic status
Authors: YUAN LE-YANG , ZHANG E
Published: January 2019

Differences in coloration and morphology between two subspecies of Acrossocheilus hemispinus were investigated based on museum-stored and freshly-caught specimens. There are marked differences in the coloration of either juveniles or adults, and in sexual dimorphism, between A. h. hemispinus and A. h. cinctus. Multivariate analysis of morphometric data too, shows the two taxa to be distinguishable from each other. Differences in body coloration and morphometric characters coincide with those of the mouthpart structure and the coiling pattern of the intestine in A. h. hemispinus and A. h. cinctus. Morphological distinction, coupled with different habitat and food preferences, supports the taxonomic elevation of the two hitherto subspecific populations of A. hemispinus to species.
Description, microhabitat and temporal distribution of the tadpole of Proceratophrys tupinamba Prado and Pombal, 2008
Authors: FATORELLI PEDRO , COSTA PAULO N. , LAIA RAFAEL C. , ALMEIDA-SANTOS MARLON , VAN SLUYS MONIQUE , ROCHA CARLOS FREDERICO D.
Published: January 2019

We present a description of the external morphology of the tadpoles of Proceratophrys tupinamba, and provide information on its temporal distribution and microhabitat use. Proceratophrys tupinamba differs from other larvae of species in the genus Proceratophrys described by the tooth row, which is similar to that of P. appendiculata. Comparing our description to the description of P. appendiculata, some differences are observed in the body proportion. Tadpoles were most abundant during the wet season (October-March), and it was positively related with average monthly rainfall. Tadpoles of P. tupinamba are benthonic and occur more often in lentic portions of the stream. They were found most frequently exposed on the sand, which also represented the most available microhabitat among those sampled in the stream studied.
On the evolution of the species complex Pachycondyla chinensis (Hymenoptera: Formicidae: Ponerinae), including the origin of its invasive form and description of a new species
Authors: YASHIRO TOSHIHISA , MATSUURA KENJI , GUÉNARD BENOIT , TERAYAMA MAMORU , DUNN ROBERT R.
Published: January 2019

Ants are one of the most successful and widespread organisms in the world. Although ants of the genus Pachycondyla (Hymenoptera: Formicidae: Ponerinae) are predominantly tropical in distribution, Pachycondyla chinensis (Emery) is especially abundant in temperate zones in Asia. Recently, P. chinensis has also become an abundant invasive ant species in the United States. However, it was well-known that the Pachycondyla chinensis species complex remained unresolved. Our molecular and morphological results allow us to distinguish two species in the species complex: the species P. chinensis and the new cryptic species P. nakasujii sp. nov., and these two species are widely and sympatrically distributed and abundant in temperate forests in Japan. Moreover, phylogenetic analysis showed that P. chinensis has been introduced into the United States from Japan. In conclusion, our finding of the new species P. nakasujii suggests that much remains undiscovered even in biologically fascinating and well-studied organisms.
Evaluation of Albumin 25% Use in Critically Ill Patients at a Tertiary Care Medical Center
Authors: Torbic Heather , Bauer Seth R. , Militello Michael , Welch Sarah , Udeh Chiedozie , Richardson Steven
Published: January 2019

Background: Albumin 25% has been studied and has demonstrated benefit in a limited number of patient populations. The use of albumin 25% is associated with higher costs compared with crystalloid therapy. The aim of this study was to describe the prescribing practices of albumin 25% at a tertiary-care medical center and identify opportunities for restriction criteria related to its use to help generate cost savings. Methods: This evaluation was a retrospective, noninterventional, descriptive study of albumin 25% use between June 2015 and February 2016. Inclusion criteria consisted of patients ≥18 years old and who received at least one dose of albumin 25% while admitted to a Cleveland Clinic main campus intensive care unit (ICU). Inclusion was restricted to 150 randomly selected patients. Results: A total of 539 albumin 25% orders were placed for the 150 included patients. The cardiovascular ICU more frequently prescribed albumin 25% compared with the medical, surgical, neurosciences, and coronary ICUs (51% vs 23% vs 11% vs 9% vs 6%, respectively). Although the cardiovascular surgery ICU most frequently prescribed albumin 25% compared with other ICUs, the medical ICU prescribed a larger total quantity of albumin 25% compared with the cardiovascular, surgical, neurosciences, and coronary ICUs (8705 g vs 7275 g vs 3205 g vs 2162 g vs 625 g, respectively). The majority of patients (61%) did not have an indication listed for albumin 25% use and only 9% of patients were prescribed for indications supported by primary literature. Of the patients prescribed albumin for other indications not supported by primary literature (30%), the most common reasons for albumin 25% were hypotension, acute kidney injury, and volume resuscitation. The median cost per patient of albumin 25% was $417 with a total cost of $122 164 for the cohort. Only 19% of the total cost aligned with dosing regimens evaluated in primary literature. Conclusion: Prescribing patterns of albumin 25% at a tertiary academic medical center do not align with indications supported by primary literature. These findings identified a major opportunity for prescriber education and implementation of restriction criteria to target cost savings.
Constituting Agricultural and Food Security Policy in Malawi: Exploring the Factors that Have Driven Policy Processes in the Farm Inputs Subsidy Programme
Authors: Nkhoma Peter R. , Bosman Martin M. , Eduful Michael
Published: January 2019

Political economy analyses of agricultural and food security policies in Malawi have emphasized the role played by domestic politics and, more specifically, the centralization of power in the executive. This paper builds on this perspective by exploring the view that such policies are in fact negotiated outcomes of interactions at the state–donor interface. Using interview data gathered from expert key informants and a review of publicly available data, the paper explores how certain policy drivers have interacted to shape agricultural and food security policies in Malawi. The results reveal that policy processes in the recent past have been driven and mediated by fiscal considerations, sociopolitical pressures, and pragmatism, which accounts for the unique and complex peculiarities of the Malawi context.
Military Rule in South Korea Revisited: Different Survival Strategies and Different Pathways
Authors: Koo Bon Sang
Published: January 2019

This paper revisits the military rule in Korea by paying attention, like Korean specialists, to the disconnection in dictatorship but like comparativists, using the tools in comparative studies of modern authoritarian regimes. This paper argues that the differences in the military leaders’ orientations (personalist vs. party-based type) and survival strategies to deal with potential threat sources (key insiders, political opponents, and economic elites) entailed different regime pathways. Examining (a) how to form a ruling group in terms of unity (competing factions vs. a single dominant faction), (b) how to control the legislative branch (directly controlled organization vs. opposition parties indirectly supported by the government), and (c) how to manage capital owners (tight constraints vs. financial liberalization with occasional punishments), this paper provides an explanation as to why only the second military regime was able to open the door to democratization instead of giving way to authoritarian replacement in Korea.
The miracle (and mirage) of Mexican flight: Aviation development in Mexico, during and after the Second World War
Authors: Soland Peter
Published: January 2019

This paper explores the development of Mexican commercial aviation (and more specifically the trajectory of Compañía Mexicana de Aviación) against the background of Mexico’s Second World War alliance with the USA and its post-war economic expansion. USA foreign aid allowed Mexican president Manuel Ávila Camacho (1940–46) to further develop the country’s aviation network and personnel. The Second World War’s disruption of tourism allowed Mexico to reap the benefits of a rapidly growing vacation industry. The election of Miguel Aléman in 1946 reinforced commercial aviation and tourism as crucial, co-dependent elements in modernising the country and making Compañía Mexicana de Aviación a symbol of national progress. Although the Second World War emerges as a crucial point in the development of Mexican aviation, the same processes that buoyed commercial airlines also reinforced cultural stereotypes that were exploited for USA tourists and masked reckless financial decisions that nearly bankrupted Compañía Mexicana de Aviación’s in late 1950s.
Growing teratoma syndrome in primary mediastinal germ cell tumor: our experience
Authors: Sachdeva Ashwani Kumar , Penumadu Prasanth , Kohli Pavneet , Dubashi Biswajit , Munuswamy Hemachandren
Published: January 2019

Background

Growing teratoma syndrome is a rare phenomenon seen in nonseminomatous germ cell tumors after chemotherapy, where the tumor grows paradoxically despite normalization of tumor markers. It has been found in various locations, most commonly, the retroperitoneum in association with metastatic disease. The occurrence of growing teratoma syndrome in a mediastinal primary is very rare and there are only a few reports in the literature.

Methods

In a retrospective review, out of 12 patients with mediastinal involvement by a germ cell tumor, 5 had a primary from the mediastinum. We present a series of 3 cases of primary germ cell tumor of the mediastinum, which after chemotherapy, fulfilled the criteria for growing teratoma syndrome and were managed with surgical excision.

Conclusion

Development of growing teratoma syndrome in a primary mediastinal germ cell tumor is extremely rare. Its awareness and early detection can lead to successful surgical excision and long-term cure.
Toxic landfills, survivor trees, and dust cloud memories: More-than-human ecologies of 9/11 memory
Authors: Micieli-Voutsinas Jacque , Cavicchi Julia
Published: January 2019

The symbolic power of grass, trees, flowers, stones, water, and other everyday objects to evoke more-than-human experiences is a cornerstone of memorial practice. As survivors of traumatic events, nonhuman elements have long been preserved in, even added to, memorial landscapes for their representational capacities to “say what cannot be said.” Beyond their mobilization as passive symbols, the plants themselves also exert a “creative presence” that equally shapes memorial sites, wherein ecologies of memory are negotiated and coconstituted through human and nonhuman lives. In foregrounding ecologies of “9/11” memory and memorialization, this essay draws on more-than-human approaches that emphasize how both human and nonhuman matter and memory emerge from and transform each other in and around lower Manhattan. At the World Trade Center, both human and nonhuman experiences of violence and violation are implicated in the “ecologies of memory” preserved and curated at the site. Focusing on ecologies of 9/11 commemoration, we argue that spatially fixed narratives of trauma obfuscate the environmentally diffuse human victims of the September 11th terror attacks, as well as how nonhuman actors coconstitute, contradict, and transform these memorial spaces. We argue that these memorial spaces employ the affective power of nonhuman actors to reproduce exclusionary narratives of cultural trauma, while obscuring very real environmentally diffuse human victims and ongoing harms, domestically and abroad. As a result of these negotiations, divergent forms of “slow violence” are rendered visible within the memorial landscape.
Outcome measures in post-stroke arm rehabilitation trials: do existing measures capture outcomes that are important to stroke survivors, carers, and clinicians?
Authors: Duncan Millar Julie , van Wijck Frederike , Pollock Alex , Ali Myzoon
Published: January 2019

Objective:

We sought to (1) identify the outcome measures currently used across stroke arm rehabilitation randomized trials, (2) identify and compare outcomes important to stroke survivors, carers and clinicians and (3) describe where existing research outcome measures capture outcomes that matter the most to stroke survivors, carers and clinicians and where there may be discrepancies.

Methods:

First, we systematically identified and extracted data on outcome measures used in trials within a Cochrane overview of arm rehabilitation interventions. Second, we conducted 16 focus groups with stroke survivors, carers and clinicians using nominal group technique, supplemented with eight semi-structured interviews, to identify these stakeholders’ most important outcomes following post-stroke arm impairment. Finally, we described the constructs of each outcome measure and indicated where stakeholders’ important outcomes were captured by each measure.

Results:

We extracted 144 outcome measures from 243 post-stroke arm rehabilitation trials. The Fugl-Meyer Assessment Upper Extremity section (used in 79/243 trials; 33%), Action Research Arm Test (56/243; 23%), and modified Ashworth Scale (53/243; 22%) were most frequently used. Stroke survivors ( n = 43), carers ( n = 10) and clinicians ( n = 58) identified 66 unique, important outcomes related to arm impairment following stroke. Between one and three outcomes considered important by the stakeholders were captured by the three most commonly used assessments in research.

Conclusion:

Post-stroke arm rehabilitation research would benefit from a reduction in the number of outcome measures currently used, and better alignment between what is measured and what is important to stroke survivors, carers and clinicians.
Assessing the Clinical Impact of Risk Models for Opting Out of Treatment
Authors: Kerr Kathleen F. , Brown Marshall D. , Marsh Tracey L. , Janes Holly
Published: January 2019

Decision curves are a tool for evaluating the population impact of using a risk model for deciding whether to undergo some intervention, which might be a treatment to help prevent an unwanted clinical event or invasive diagnostic testing such as biopsy. The common formulation of decision curves is based on an opt-in framework. That is, a risk model is evaluated based on the population impact of using the model to opt high-risk patients into treatment in a setting where the standard of care is not to treat. Opt-in decision curves display the population net benefit of the risk model in comparison to the reference policy of treating no patients. In some contexts, however, the standard of care in the absence of a risk model is to treat everyone, and the potential use of the risk model would be to opt low-risk patients out of treatment. Although opt-out settings were discussed in the original decision curve paper, opt-out decision curves are underused. We review the formulation of opt-out decision curves and discuss their advantages for interpretation and inference when treat-all is the standard.
A simple cubication method for approximate solution of nonlinear Hamiltonian oscillators
Authors: Big-Alabo Akuro
Published: January 2019

A new cubication method is proposed for periodic solution of nonlinear Hamiltonian oscillators. The method is formulated based on quasi-static equilibrium of the original oscillator and the undamped cubic Duffing oscillator. The cubication constants derived from the present cubication method are always based on elementary functions and are simpler than the constants derived by other cubication methods. The present method was verified using three common examples of strongly nonlinear oscillators and was found to give reasonably accurate results. The method can be used to introduce nonlinear oscillators in relevant undergraduate physics and mechanics courses.
Organic Insecticides
Authors: Peter J. V. , Cherian A. M.
Published: January 2019

Organic insecticide poisoning continues to be a major health problem not only in the developing communities but also in the Western population. The insecticides commonly used are the organophosphates, organocarbamates, organochlorides and pyrethroids. Patients with organic insecticide poisoning present with a spectrum of manifestations ranging from gastrointestinal symptoms of nausea, vomiting and diarrhoea to severe neurological manifestations of fasciculations, seizures and neuromuscular weakness and paralysis or cardiac manifestations of arrhythmias and conduction disturbances. A strong clinical suspicion is necessary to make an early diagnosis of insecticide poisoning. Treatment is primarily supportive and includes decontamination, protection of airways and cardiac and respiratory monitoring. Specific therapy for organophosphates and organocarbamates includes the use of anticholinergics. The use of oximes, especially high dose, is controversial and may be associated with a higher mortality rate. Low-dose oximes given early in the course of the illness may be beneficial. This paper reviews the literature on organic insecticide poisoning worldwide.
Morphine-Sparing Effect of Ketoprofen after Abdominal Surgery
Authors: Rao A. S. , Cardosa M. , Inbasegaran K.
Published: January 2019

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P<0.05), we have determined that the administration of two doses of intravenous ketoprofen 100 mg, one at the end of surgery and the second 12 hours postoperatively, was associated with a significant reduction in morphine consumption at eight (P=0.028), 12 (P=0.013) and 24 hours (P=0.013) but not four hours (P=0.065) postoperatively, as compared to placebo, when assessed by patient-controlled analgesia. There was no difference between the groups in pain scores or in the incidence of nausea and vomiting. One patient in the placebo group suffered from excessive sedation while one patient from the ketoprofen group suffered from transient oliguric renal failure. There were no other adverse effects. The results of this study show that ketoprofen does provide a morphine-sparing effect in the management of postoperative pain after abdominal surgery.
The Accuracy of in vivo P50 at High Haemoglobin Saturation
Authors: Anstey C.
Published: January 2019

The in vivo P50 (P50iv) provides a useful index of haemoglobin-oxygen affinity and is calculated according to software algorithms incorporated into commercial blood gas analysers. These algorithms are known to be inaccurate at high haemoglobin saturation (SpO2 >97%) although just how inaccurate has not been documented. This study examines the arterial blood gas profiles of patients admitted to a busy secondary referral Intensive Care Unit and stratifies them according to haemoglobin saturation in order to quantify the accuracy and potential clinical utility of the Siggaard-Andersen algorithm (SAA) for assessing P50iv in blood with SpO2 >90%. Sicker patients, as identified by plasma pH <7.35 or [lactate] >2.0 mmol/l, were substratified and the SAA assessed as before. In both groups, the results show not only that the SAA is completely unreliable above 97% saturation, a fact acknowledged by Siggaard-Andersen in 1984, but it is also inaccurate in the range 92% ≤ SpO2 ≤ 97%, thus rendering P50iv calculations suspect in 90% of the patients in each of the study groups.
The Effect of Previous Administration of Nizatidine on the Neuromuscular Effects of Vecuronium and the Effect of Nizatidine on Gastric Secretion
Authors: Wajima Z. , Shitara T. , Inoue T. , Yoshikawa T. , Ogawa R.
Published: January 2019

Nizatidine, a new H2-receptor antagonist, has been reported to inhibit acetylcholinesterase activity. This could lead to an interaction with neuromuscular blocking drugs. This study examined the effects of nizatidine on the actions of vecuronium. Oral nizatidine has been reported to be an effective protective agent against acid aspiration syndrome, and we reevaluated this effect.

The control group (n=10) received a placebo with water 50 ml and the nizatidine group (n=10) received nizatidine 300 mg with water 50 ml two hours before arrival in the operating room. Gastric contents were aspirated and the volume and pH measured before induction of anaesthesia. Anaesthesia was induced in all patients with thiopentone 5 mg/kg and 1.5% isoflurane in 98.5% oxygen followed by vecuronium 0.1 mg/kg. Vecuronium onset time and duration time 25 (time from injection until recovery of 25% of vaseline twitch amplitude) were obtained using electromyography.

There were no significant differences between the two groups in vecuronium onset time or duration time 25. Gastric fluid volume was greater and gastric pH was lower in the control group than in the nizatidine group. 70% of the control group and none of the nizatidine group (P<0.005) had a gastric content pH <2.5 or volume >25 ml.
Streptoccocus Pyogenes: A Forgotten Cause of Severe Community-Acquired Pneumonia
Authors: Birch C. , Gowardman J.
Published: January 2019

We report a case of severe community-acquired pneumonia caused by Streptococcus pyogenes (Lancefield Group A streptoccocus) that was complicated by a streptococcal toxic shock syndrome. Although this micro-organism is an uncommon cause of community-acquired pneumonia, previously well individuals may be infected and the clinical course may be fulminant. A household contact was the likely point of infection. Invasive group A streptococcal disease continues to remain an important cause of morbidity and mortality in the community and therefore will continue to be encountered by intensive care physicians. Treatment of Group A streptococcal infection remains penicillin; however, clindamycin should be added in severe infection.
Fixed, Dilated Pupils in the ICU: Another Recoverable Cause
Authors: Cordova S. , Lee R.
Published: January 2019

A 41-year-old woman presented unconscious with fixed dilated pupils following a massive overdose of carbamazepine and an unknown quantity of venlafaxine prescribed for the management of bipolar affective disorder. Her course in the intensive care unit was marked by a number of complications related to the overdose including prolonged coma, seizures and cardiac arrest. The patient eventually recovered to leave hospital.
A Comparison of Carbon Dioxide Monitoring and Oxygenation between Facemask and Divided Nasal Cannula
Authors: Loughnan T. E. , Monagle J. , Copland J. M. , Ranjan P. , Chen M. F.
Published: January 2019

The divided nasal cannula is a device recently released in Australia that couples oxygen delivery and end-tidal carbon dioxide (PET CO2) monitoring. This study compares the accuracy of PET CO2 measurements by the divided nasal cannula and those measured by a modified facemask (as currently used in this institution), with arterial partial pressure of carbon dioxide (Paco2). In this crossover study, 30 patients who had arterial lines as part of their routine monitoring were given oxygen via nasal cannula and facemask preoperatively. The PETCO2 was measured with each device and a simultaneous Paco2 and Pao2 measured after equilibration. The results demonstrate a significant difference between the PET CO2 as measured by each technique. The divided nasal cannula more accurately reflects Paco2 (mean arterial to end expired gradient of 5 mmHg) and provides a more representative trace when compared to a traditional facemask system. Both methods provided adequate oxygenation.
Pulmonary Toxicity of Inhaled Aerosolized Prostacyclin Therapy—An Observational Study
Authors: van Heerden P. V. , Caterina P. , Filion P. , Spagnolo D. V. , Gibbs N. M.
Published: January 2019

Large white/landrace piglets (mass 11 to 21 kg) were exposed to aerosolized alkaline glycine diluent (n=2) or inhaled aerosolized prostacyclin (n=2) for five to eight hours. Pigs receiving these aerosols developed mild acute sterile tracheitis, involving the superficial layers of the trachea, shown histologically and ultrastructurally. Pigs receiving the diluent aerosol also showed mild inflammatory changes in the bronchioles. These findings suggest caution with the use of high volumes of aerosolized alkaline glycine diluent during inhaled aerosolized prostacyclin therapy.
Immunoassays in the Diagnosis of Anaphylaxis to Neuromuscular Blocking Drugs: The Value of Morphine for the Detection of IgE Antibodies in Allergic Subjects
Authors: Fisher M. M. , Baldo B. A.
Published: January 2019

Radioimmunoassays (RIAs) for IgE antibodies to specific neuromuscular blocking drugs (NMBDs) are an important tool in the diagnosis of anaphylaxis during anaesthesia although they are performed in only a few laboratories throughout the world. NMBDs bind to antibodies by their substituted ammonium ions. We measured serum IgE antibodies to morphine and specific NMBDs in 347 patients with suspected anaphylaxis using blood specimens sent for mast cell tryptase assays. Morphine, which has a single substituted ammonium group, avidly binds in vitro to antibodies that react with NMBDs. The morphine RIA proved to be both a more sensitive and efficient test for the detection of IgE antibodies to NMBDs than the specific NMBD RIAs. We have adopted the morphine RIA in our laboratory in preference to the specific RIAs and predict that use of this single assay will become widespread for the in vitro diagnosis of allergic sensitivities to NMBDs.
Hours of Work and Fatigue-Related Error: A Survey of New Zealand Anaesthetists
Authors: Gander P. H. , Merry A. , Millar M. M. , Weller J.
Published: January 2019

A nationwide survey (70% response) documented anaesthetists’ hours of work, their perceptions about safety limits and their recollection of fatigue-related errors in clinical practice. In the preceding six months, 71% of trainees and 58% of specialists had exceeded their self-defined safety limits for continuous anaesthesia administration. For 50% of trainees and 27% of specialists, their average working week exceeded their own limits for maintaining patient safety, and for 63% of trainees and 40% of specialists, it exceeded their limits for maintaining their personal well-being. Fatigue-related errors were reported by 86% of respondents, with 32% recalling errors in the preceding six months. Specialists were more likely to report a fatigue-related error if they had exceeded their own safety limits for continuous anaesthesia administration, or for weekly work hours. Current measures are not preventing anaesthetists from working hours that they consider to be unsafe for patients or harmful to their own well-being.
The Use of End-Tidal Carbon Dioxide Monitoring to Confirm Intratracheal Cannula Placement Prior to Percutaneous Dilatational Tracheostomy
Authors: Coleman N. A. , Power B. M. , van Heerden P. V.
Published: January 2019

We tested the utility of intratracheal carbon dioxide monitoring (IT-CO2) in 10 patients undergoing percutaneous dilatational tracheostomy (PDT). We have found IT-CO2 monitoring reliable in confirming the correct position of the tracheal cannula prior to tracheal dilatation using the Portex technique.
Severe Hyponatraemia Secondary to Desmopressin Therapy in von Willebrand's Disease
Authors: Bertholini D. M. , Butler C. S.
Published: January 2019

A 42-year-old female with von Willebrand's disease was managed with desmopressin and tranexamic acid to aid haemostasis following a vaginal hysterectomy. Severe acute hyponatraemia (134 to 108 mmol/l) developed over two days, culminating in a generalized tonic-clonic seizure and cerebral oedema. Fluid restriction, cessation of desmopressin and hypertonic saline administration led to a full recovery. Desmopressin is known to reduce free water elimination and produce hyponatraemia, but its extent and rate of development in this patient was surprising. Close monitoring of serum sodium and fluid balance is recommended in these patients.
Video-Assisted Thoracoscopic Surgical Pleurodesis for Persistent Spontaneous Pneumothorax in Late Pregnancy
Authors: Reid C. J. , Burgin G. A.
Published: January 2019

A case of persistent spontaneous pneumothorax in the third trimester of pregnancy managed by video-assisted thoracoscopic surgical pleurodesis is presented. Anaesthetic and perioperative considerations are discussed.
Anaesthesia Alert: An Integrated, Networked, Register of Paediatric Anaesthetic Problems
Authors: Van Der Walt J. H. , Sainsbury D. A. , Pettifer R.
Published: January 2019

The Paediatric Register of Anaesthetic Problems (PaedRAP) is a network-based anaesthesia hazard alert system. It is integrated with pre-anaesthesia consultations and patient questionnaires. All files, both electronic and on paper, are available 24 hours a day close to the operating theatres. This ensures that pertinent information is readily available when and where it is most needed. The PaedRAP is also linked to the automated theatre booking system to print warnings on the theatre lists. This minimizes the chance that important information goes unnoticed. Documentation of the progression of the various categories of patient problems and evolving management strategies has been useful both for individuals and groups.
Tramadol for Postoperative Shivering: A Double-Blind Comparison with Pethidine
Authors: Bhatnagar S. , Saxena A. , Kannan T. R. , Punj J. , Panigrahi M. , Mishra S.
Published: January 2019

In most operating and recovery rooms, shivering is controlled by the use of humidifiers, warming blankets, and inhalation of humidified heated oxygen. However, pharmacological control is an effective alternate treatment modality. This randomized, double-blind trial, conducted in 30 ASA Grade I or 2 patients, was designed to explore the efficacy of tramadol and pethidine in the treatment of post-anaesthetic shivering.

Tramadol is an inhibitor of the re-uptake of serotonin (5-hydroxytryptamine) and norepinephrine in the spinal cord. This facilitates 5-hydroxytryptamine release, which influences thermoregulatory control. We compared the efficacy of tramadol with that of pethidine, presently a widely used drug for the control of shivering. Patients received either tramadol 1mg/kg or pethidine 0.5 mg/kg intravenously and the grade of shivering, pulse rate, blood pressure and respiratory rate were observed every 10 minutes after injection for one hour. Shivering was significantly more likely to have ceased in the tramadol group (12 of 15 versus 4 of 15 cases, P<0.05) at 10 minutes after drug administration and this control was better sustained. No patients receiving tramadol had a recurrence of shivering. It is concluded that intravenous tramadol 1 mg/kg is more effective for the treatment of postoperative shivering than pethidine 0.5 mg/kg.
Adrenocortical Response and Cortisone Replacement in Systemic Inflammatory Response Syndrome
Authors: Ihle B. U.
Published: January 2019

The use of steroids as an adjunct to antimicrobial therapy has been controversial for many decades. Recent reports of the use of steroids in supraphysiological rather than in “industrial” doses in patients with sustained circulatory instability has re-ignited the debate. Anecdotal reports of adrenal insufficiency in septic patients have suggested a relative cortisol deficiency in these patients with poor survival if not given supplementary steroids. The possibility that the hypothalamic pituitary adrenal axis is intimately involved in the pathogenesis of this entity has not previously been highlighted.

This review looks at the relationship of sustained cytokine release and the possibility of altering the stress response with progressive loss of adrenocorticotrophic hormone release and subsequent diminution in adequate cortisol levels. The reliance on, and misinterpretation of, the short synacthen test in diagnosing the possibility of this condition is emphasized.
Cryoprecipitate for the Correction of Coagulopathy Associated with Liver Disease
Authors: French C. J. , Bellomo R. , Angus P.
Published: January 2019

In patients with liver disease at risk of pulmonary oedema, cryoprecipitate (small volume) might be a viable alternative to fresh frozen plasma (FFP, large volume) in the correction of coagulopathy. However, the efficacy of cryoprecipitate in these patients has not been tested. We evaluated the role of cryoprecipitate in the correction of the coagulopathy of liver disease. To establish initial evidence of efficacy, six consecutive patients with hepatic failure and coagulopathy received five units of cryoprecipitate. Then, using a crossover design, 11 consecutive patients were randomized to receive either four units of FFP or five units of cryoprecipitate. Pre and post infusion International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT), fibrinogen D-dimers, Factors V and IX, and reptilase time were measured. In the first six patients, cryoprecipitate improved the INR, aPTT and fibrinogen concentration (P=0.03). In the crossover study, FFP administration produced a greater improvement in INR (P=0.007) and aPTT (P=0.005) than cryoprecipitate. However, there were no differences in any of the other measured variables. One patient developed acute pulmonary oedema while receiving FFP. Cryoprecipitate improves the coagulopathy of liver disease. Four units of FFP are more efficacious than five units of cryoprecipitate. Cryoprecipitate may have a role in correction of the coagulopathy associated with liver disease where concerns about pulmonary oedema exist.
Simulated Epidural Test Doses Using Adrenaline and Adrenaline/Clonidine in Sevoflurane-anaesthetized Children
Authors: Burstal R. , Hollard J. , Mcfadyen B.
Published: January 2019

A pilot study was conducted using a simulated epidural test dose to ascertain the effects adrenaline, adrenaline/clonidine mixture, and clonidine alone on the accepted criteria for determining the occurrence of an epidural intravascular injection. Seventy-five ASA 1 or 2 children aged from six months to twelve years were sequentially allocated to one of three groups: group A: adrenaline 0.5 μg/kg, group AC: adrenaline 0.5 μg/kg and clonidine 0.3 μg/kg, and group C: clonidine 0.3 μg/kg. Effects on heart rate, T-wave amplitude and systolic blood pressure were determined after induction of anaesthesia and stabilization using sevoflurane in nitrous oxide and oxygen. Heart rate varied from baseline in a biphasic manner. The maximal increase in mean heart rate for all groups was <10 beats per minute (bpm). A heart rate rise of >10 bpm was not seen at any time in 54% of groups A and AC and 92% of group C (Chi-square 11.4, P=0.003). T-wave changes were also biphasic. 50% of groups A and AC had no increase in T-wave size of >25% at any sample point, compared with 96% in group C (Chi square=49.4, P<0.0001). 34% of groups A and AC did not have a change in systolic blood pressure of >15 mmHg during the study compared with 100% of group C (Chi-square=30.2, P<0.0001). There were no significant differences between groups A and AC for any parameter. Negative predictive value estimates for the current criteria for intravascular injection were low. Clonidine 0.3 μg/kg produced no effects on the study variables.
Comparison between Tube Compensation and Pressure Support Ventilation Techniques on Respiratory Mechanics
Authors: Sasaki C. , Hoshi K. , Wagatsuma T. , Ejima Y. , Hasegawa R. , Matsukawa S.
Published: January 2019

In the intubated patient, the presence of an endotracheal tube increases the work of breathing during spontaneous breathing. The tube compensation technique was developed as a new ventilator mode that can compensate for that additional the work of breathing. We investigated the respiratory parameters during the pressure support ventilation 0, 5, 10 cmH 2 O and tube compensation 100% modes of the Puritan Bennett 840 ventilator in ten postoperative patients who had undergone radical surgery for oesophageal cancer. Measurements were performed just before extubation. The tidal volume, respiratory rate and other respiratory parameters were measured with a Ventrak respiratory monitor, and the duty ratio, mean inspiratory flow, and rapid shallow breathing index were calculated. In particular, we performed a comparison between pressure support ventilation 5 cmH 2 O and tube compensation 100%, because pressure support ventilation 5 cmH 2 O is the usual ventilating mode before the extubation in our intensive care unit. The tidal volume of pressure support ventilation 10 cmH 2 O was significantly larger and the respiratory rate was significantly lower than the other three modes. There was no significant difference in the minute volume, tidal volume, and respiratory rate between pressure support ventilation 5 cmH 2 O and tube compensation 100%. The duty ratio of pressure support ventilation 10 cmH 2 O was significantly smaller than the other three modes. There was no significant difference in the duty ratio and rapid shallow breathing index between pressure support ventilation 5 cmH 2 O and tube compensation 100%. It was concluded that the assist levels of pressure support ventilation 5 cmH 2 O and tube compensation 100% were almost equal for clinical purposes.
Cricoid Pressure Training: How Useful are Descriptions of Force?
Authors: Escott M. E. A. , Owen H. , Strahan A. D. , Plummer J. L.
Published: January 2019

Cricoid pressure has been used for over 200 years. During that time, training in the technique has not changed greatly, despite the well-documented potential for complications if performed improperly. Typically, training relies on quantitative or qualitative descriptions such as “firm” pressure, a number of Newtons of force or equivalent force to that causing pain while pressing on the nose. This study tests the value of these descriptive methods in training to apply cricoid pressure. Fifty subjects were asked to apply cricoid pressure after receiving a description of the force required and again after having tested how much finger pressure on the bridge of their nose was required to cause discomfort. Initial force, force at 45 seconds, minimum force, and maximum force was recorded. The results were analysed using the Wilcoxon signed ranks test, which showed no significant difference in performance between the two types of training. One subject maintained pressure in the range of 25 to 35 Newtons for the entire 45 seconds of the first attempt but no subject performed this well on the second attempt. The use of qualitative and quantitative descriptors of the appropriate pressure does not appear useful in the training of the technique of cricoid pressure. Training incorporating force feedback is recommended.
Use of Odds Ratios on Anaesthesia Related Studies
Authors: Ho K. M. , Marshall R. J. , Walters S.
Published: January 2019

In line with other medical journals, odds ratios are increasingly being reported in anaesthesia literature. the frequency of the use of odds ratio and how well it relates to the relative risk when it is interpreted as relative risk remains unknown. we investigated the use of odds ratio, and its relationship to relative risk and the incidence of outcome in this study. we identified 60 meta-analyses and 87 original articles that reported odds ratios. while relative risk could have been reported in 79% of the studies, only a small proportion (3%) of these studies have estimated and reported the relative risk in addition to the odds ratio. there is a significant bias if odds ratio is interpreted as relative risk, especially so when the incidence of outcome is high. while odds ratio is a valid measure of treatment effect in its own right, anaesthetists and investigators should be careful not to interpret odds ratio as equivalent to relative risk.
Long-term Outcomes following Percutaneous Tracheostomy Using the Griggs Technique
Authors: Sviri S. , Samie R. , Roberts B. L. , Van Heerden P. V.
Published: January 2019

Percutaneous tracheostomy is commonly performed in the intensive care unit. This study assesses the long-term outcomes following percutaneous tracheostomy using the Griggs technique. We carried out a prospective observational cohort study. Two hundred and eight patients who had undergone percutaneous tracheostomy between 1 September 1996 and 31 July 2000 and who were alive at least six months following the procedure, were included in the study. Median follow-up was at 30 months. All patients were sent questionnaires regarding relevant symptoms. One hundred and six (51%) responded and were invited for further follow-up. Forty-three (20.6%) patients underwent scar evaluation by the investigators and 41/208 (19.7%) underwent spirometry. Of the responders, 38% complained of some degree of voice change and 12% complained of ongoing severe cough. Thirty-one per cent complained of shortness of breath, with more than half of these having concomitant heart or lung disease, which may explain this. Eighty-one per cent of patients had minimally visible or a visible but neat scar. Eight patients (8/41 (19.5%)) had some evidence of upper airway obstruction on spirometry, but only 2/41 (5% of patients) were symptomatic (stridor or shortness of breath).

We conclude that percutaneous tracheostomy using the Griggs technique has an acceptable long-term complication rate.
Clinical Evaluation of the HemoSonic Monitor in Cardiac Surgical Patients in the ICU
Authors: Moxon D. , Pinder M. , Van Heerden P. V. , Parsons R. W.
Published: January 2019

The HemoSonic monitor (HemoSonic 100™, Arrow International, Reading, PA, U.S.A.) is a minimally invasive device to determine cardiac output by means of M-mode and pulsed Doppler ultrasound. We evaluated the HemoSonic monitor by comparing its output to paired measurements obtained by the standard thermodilution technique in patients who had recently undergone cardiac surgery. Forty-seven paired measurements were carried out in 13 patients. The correlation between the two methods was very good with a correlation coefficient of 0.81. Comparison of the two techniques using the method described by Bland and Altman showed a mean of the differences of –0.23. The limits of agreement were –2.35 to 1.89. There was a reduced correlation between techniques at higher values of cardiac output.

We concluded that the HemoSonic monitor has a place in intensive care monitoring, with good correlation with cardiac output measured by the thermodilution technique. It appears to be less suitable for use in patients with a high cardiac output state. The oesophageal probe is moderately difficult for patients to tolerate and is only appropriate for use in sedated patients. The accuracy of the device is somewhat operator-dependent.
Patient-controlled Epidural Analgesia: A Prospective Audit of Epidural Pethidine 4 mg/ml and Ropivacaine 0.2% with Fentanyl 2 μg/ml
Authors: Tay T. G. , Brake T. J. , Kwan A. S. K.
Published: January 2019

A prospective audit of one hundred and forty-seven (147) Acute Pain Service (APS) patients, who received postoperative patient-controlled epidural analgesia (PCEA) using pethidine 4 mg/ml or ropivacaine 0.2% with fentanyl 2 μg/ml in general surgical or orthopaedic wards over a twelve-month period, is presented. Data were collected from APS observation charts over a 48-hour period postoperatively. We found no significant difference in postoperative analgesia or side-effects between pethidine and ropivacaine with fentanyl in orthopaedic or general surgical patients.
Unexpected Complication of Attempted Epidural Anaesthesia: Cauda Equina Syndrome
Authors: Liu Y. C. , Wu R. S. C. , Wong C. S.
Published: January 2019

Cauda equina syndrome after regional anaesthesia is a serious and devastating complication. Its occurrence after epidural anaesthesia is rare. We report a 46-year-old male who received epidural anaesthesia for uretero-renoscopic lithotripsy and developed cauda equina syndrome postoperatively. Despite one failed attempt at entering the epidural space with an epidural needle resulting in dural puncture, an epidural catheter was inserted and 20 ml pH adjusted lignocaine 2% with 1:200,000 adrenaline injected via the catheter without untoward event. The possible causes of this complication are discussed. Fortunately, this patient recovered almost completely ten months later.
A Comparison of the Effects of Prolonged (>10 Hour) Low-flow Sevoflurane, High-flow Sevoflurane, and Low-flow Isoflurane Anaesthesia on Hepatorenal Function in Orthopaedic Patients
Authors: Fukuda H. , Kawamoto M. , Yuge O. , Fujii K.
Published: January 2019

This study compared the effects of low-flow sevoflurane, high-flow sevoflurane and low-flow isoflurane on hepatorenal function during and after more than 10 hours of anaesthesia. Twenty-five patients scheduled for elective orthopaedic surgery were categorized into three groups; low-flow sevoflurane (fresh gas flow at 1 litre/min, n=9), high-flow sevoflurane (5 l/min, n=7), or low-flow isoflurane (1 l/min, n=9). Inspiratory compound A concentrations were measured. The groups had similar duration of anaesthesia and exposure to anaesthetic agents. The area under the curve of concentration (mean, SD) of compound A in the low-flow sevoflurane group (359.8, 106.1 ppm.h) was greater than that in the high-flow sevoflurane group (61.1, 29.3 ppm.h; P<0.01). All groups showed normal plasma creatinine and creatinine clearance, and transient postoperative increases in plasma alanine aminotrans-ferase and alpha glutathione-S-transferase, as well as urinary glucose and alpha glutathione-S-transferase, with no significant differences between groups. There were no significant relationships between the area under the curve of concentration of compound A and the biomarkers. These findings suggest that prolonged anaesthesia with low-flow sevoflurane has similar effects on hepatorenal function to prolonged anaesthesia with high-flow sevoflurane and low-flow isoflurane.
The Type of Carbon Dioxide Absorbent has no Relation to the Concentration of Carbon Monoxide in the Breathing Circuit during Low-flow Isoflurane Anaesthesia in Smoking and Non-smoking Subjects
Authors: Yamakage M. , Yoshida S-I. , Iwasaki S. , Mizu-Uchi M. , Namiki A.
Published: January 2019

The present study was designed to investigate the concentrations of carbon monoxide (CO) in the anaesthetic circuit and of arterial carboxyhaemoglobin (COHb) during low-flow isoflurane anaesthesia in smoking and non-smoking subjects using three kinds of cardon dioxide (CO2) absorbent. Thirty smoking and 30 non-smoking subjects were selected for this study, and these two groups were each divided into three groups according to the type of CO2 absorbent used (Wakolime™ A, Drägersorb™ Free, and Amsorb™). Anaesthesia was maintained with 1.0% isoflurane and nitrous oxide (1.0l min–1)/oxygen (1.0l min–1). Concentrations of CO in the inspired breathing circuit and concentrations of arterial COHb were measured at 0, 1, 2, 3, and 4 hours after exposure to isoflurane. In the smoking groups there were no significant differences in CO concentrations in the circuit between the groups and the CO concentrations did not change significantly during the study period. There were also no significant differences in the arterial COHb values between the groups and the COHb concentrations remained constant. There was a significant linear correlation between the concentrations of CO and COHb (r=0.86, n=30, P<0.001). In the nonsmoking groups all of the parameters remained constant at low levels that were independent of the type of CO2 absorbents tested. The major source for increased intraoperative CO exposure is related to the patient's smoking status, and the type of CO2 absorbent used has no relation to an increase in CO concentration in the breathing circuit.