Radiofrequency Procedures in the Management of Pain: State of the Art in the early 21st Century A AustrAlAsiAn AnAesthesiA 2009 AustrAlAsiAn AnAesthesiA 2009 Invited papers and selected continuing education lectures Editor: Richard Riley Department of Anaesthesia and Pain Medicine Royal Perth Hospital Published in 2009 by: Australian and New Zealand College of Anaesthetists 630 St Kilda Road Melbourne VIC 3004 ISSN 1032-2515 Requests to reproduce original material should be addressed to the Publisher. Printed by: McKellar Renown Press Pty Ltd 14-22 Woorayl St, Carnegie, VIC 3163 Contents radiofrequency Procedures in the Management of Pain: state of the Art in the early 21st Century 1 Roelof Van Wijk Preventing Maternal Morbidity and Mortality: Management of the Collapsed Obstetric Patient 11 Nolan J McDonnell Behaviours in the Operating theatre: From Observer to teacher 23 Jodi Graham What is Pain? i: terms, Definitions, Classification and Basic Concepts 29 Eric J. Visser and Stephanie Davies What is Pain? ii: Pain expression and Behaviour, evolutionary Concepts, Models and Philosophies 35 Eric J. Visser and Stephanie Davies Coagulation and Point-of-Care Monitoring of Platelet Function Assessment 45 Douglas Gray and Tom Collyer Cuff Pressure Monitoring in Paediatric laryngeal Mask Airways: is it Worth the Pain? 55 Britta S von Ungern-Sternberg Anaesthesia and Dubious surgery 59 David W. J. Mecklem the Green Anaesthetist 67 Forbes McGain, Eugenie Kayak and David Story the Gender revolution We had to have 77 Jane Margaret McDonald Mirrors, Magnets and Other Marvels: non-pharmacological treatments in Chronic Pain 83 Pam Eccles Post Operative and Maintenance intravenous Fluids in Children: how Much sodium should We Give? 93 Sarah McNab, Holly Robinson, and Andrew Davidson Airway Fires in the Operating room 101 Rebecca Branch and Jeremy Cooper Physician Assistants in Perioperative Medicine 111 Guy Ludbrook and Terri Peischl Anaphylaxis and Anaesthesia. What Can We Do Better? 115 Michael A Rose and Malcolm M Fisher Chemical restraint of estuarine Crocodiles – A Fresh Perspective 123 Catherine Hellier with assistance from Annabelle Olsson Peri-operative Management of Anti-platelet Drugs 129 Sharon Roche neuroinflammation: the Parasympathetic Anti-inflammatory Pathway 135 Simon Robertson extracorporeal Membrane Oxygenation: Modern techniques, indications, and Outcomes 139 Graeme MacLaren strategies to Accommodate Future intensive Care Demand in Australia 145 Charlie Corke and Evelyne de Leeuw the ethics of surrogate Decision Making in Medicine: Autonomy, Paternalism, or a Different Approach? 151 Sharyn Milnes the utility of non-invasive Cardiac Output Monitors in Anaesthesia 155 Tuong D Phan Anaesthesia for Coronary Artery surgery: imperatives, influences and evolution 163 Brendan Silbert Adjuvant intrathecal Drugs used with spinal Anaesthesia for lower segment Caesarean section 169 in new Zealand Anthony Young and John Barnard Faculty and regional sub-editors Joint Faculty of Intensive Care Medicine: Dr Neil Orford, Geelong Hospital, Victoria Faculty of Pain Medicine: Dr Robyn Campbell, Modbury Hospital, Adelaide New Zealand: Dr Doug Campbell, Auckland Hospital, Auckland New South Wales: Dr Sharon Tivey, St George Hospital, Sydney Australian Capital Territory: Prof Thomas Bruessel, Canberra Hospital, Canberra Victoria: Dr Rowan Thomas, St Vincent’s Hospital, Melbourne Queensland: Dr David Mecklem, Cairns Base Hospital, Queensland Western Australia: Dr Neville Gibbs, Sir Charles Gairdner Hospital, Perth AustrAlAsiAn AnAesthesiA 2009 Preface The role of editor for Australasian Anaesthesia is not as glamorous as one might think. On occasions I feel that my lot is to nag, cajole and even beg colleagues to put pen to paper in a timely fashion. This does not sit well with me, as anaesthetists are busy people who strive to achieve balance with their professional and personal lives. ANZCA welcomes feedback and I have received but one letter with suggestions for future improvements to Australasian Anaesthesia. In late October I was pleased to receive an inquiry from a Senior Registrar, busily preparing for his Part II exam, as to when it would be published. He added that, as far as he was concerned, Australasian Anaesthesia is “pure gold” for exam preparation. While I may not necessarily agree with him, a comment like this can make this job very rewarding. I thank the Regional and Faculty Sub-editors for their encouragement and to the authors themselves; who have been generous with their time. My role is made much easier because of ongoing support and encouragement from our College; especially Teresa Brandau-Stranks and her production team. Australasian Anaesthesia contains a diverse range of topics of interest to anaesthetists, intensive care physicians and pain medicine specialists. It retains an easy to read style and I hope all Fellows will find items of interest within. These papers will be available on the College website and of supplemental material, including a fire video, will be available for viewing by Fellows. Richard Riley