Aim: To examine the effectiveness and safety of the sedative agents used in the emergency department following the introduction of ketamine as an agent for procedural sedation Methods: A 2-year prospective audit of sedation practice was undertaken. This specifically examined the rationale behind a doctor's choice of sedative agent, the depth of sedation achieved, adverse events and the time taken to regain full orientation. Results: 210 patients were included of whom 85 (40%) were given ketamine, 107 (51%) midazolam and 18 (9%) propofol. The median time to full orientation was 25 min for ketamine, 30 min for midazolam and 10 min for propofol. Complications occurred in 15.9% of sedations overall (14.6% of those given ketamine, 15.8% given midazolam and 22.2% given propofol). Apnoea and hypoxia most often occurred with midazolam and propofol, while hypertension and hypertonicity were encountered more frequently with ketamine. In addition, 19.5% of patients given ketamine suffered the reemergence phenomenon. The association between deep sedation with no response to pain and adverse events encountered with midazolam does not occur with ketamine. Conclusions: Ketamine is both safe and effective and compares favourably with midazolam as an agent for procedural sedation in the emergency department. Although the re-emergence phenomenon occurred, no psychological sequelae were encountered after return to full orientation. Ketamine may be particularly useful in groups of patients at high risk of adverse effects with midazolam.Ketamine produces a dissociative state and provides good analgesia at a subanaesthetic dosage.

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The increased regulation of mobility that accompanied its late nineteenth-century expansion and acceleration is widely recognized. Regulatory practices reached out to distant shores and on board ships, heightening uncertainties and reshaping meanings of voyage and transit, especially for non-white passengers and crews. Travel and mobility are common themes in historical and other literatures. But less is known about experiences of uncertain or thwarted arrivals, involuntary departures, and indefinite transit resulting from practices governing steam-age mobility. People in transit illuminate the conditional openings and closures in such tropes as mobility, transit, and destination. Few spaces embodied and actualized ‘transit’ better than ships, and this article focuses on the role of ships as vessels of confinement. In equal parts about passengers and crews, it explores experiences of nominally free persons uncertainly afloat in a world marked otherwise by assured or accelerated oceanic mobility in three contexts that illustrate physical, political, and cultural constraints on maritime mobility in the age of steam. They are the 1914 voyage of the Komagata-maru, British merchant vessels employing Indian crews, and wartime subjection and resistance of Chinese crews on British and Dutch vessels.

This paper explores the intimate connection between imperialism and a liberal global economy in the late nineteenth century and the inter-war period by distinguishing and disentangling the imperial and political dimensions of the pre-World War I gold standard, and interwar efforts to restore it. By doing so it attempts partial!y to redress the relative neglect of power in historical accounts of the international financial arrangements, and re-balance conventional liberal assumptions about the role of markets and incentives in the consolidation and spread of global institutions such as the gold standard. By re-embedding the intertwined financial histories of the imperial and Atlantic worlds into a global context, perspectives from the empire help develop more historically-situated analyses of global economic institutions and arrangements, and help clarify the many intersecting processes involving both power, in all its forms, and markets, that have historically shaped financial relations and institutions.

This paper offers a preliminary exploration of contexts and forms of protest and defiance of authority by Indian seafarers employed on ocean-going steam vessels over six decades to the end of World War II. Though relatively small in numbers and apparently untypical in many respects of a 'modern' industrial workforce, the study of Indian seafarers can shed interesting light on several wider aspects of Indian labour history. The transnational and trans-cultural context of employment of Indian seamen also helps illuminate their subjectivities, knowledges, and agencies in ways that are obscured in more insular histories, while their encounters with bosses and others in authority invite us to re-examine pervasive notions of cultural difference-'owned' as well as attributed.This paper is not about union-led protests, nor about 'everyday' forms of resistance. It dwells instead on a potentially vast and apparently uncharted middle ground of collective resistance by ships' crews. Such resistance, perhaps simmering for weeks at sea, came to head at key moments, usually upon arrival at a foreign port, close to sailing, or when seamen were being transferred from one vessel to another. It could involve, besides the seamen themselves and their ships' officers, a swathe of state agencies including local authorities, the police, and the judiciary, though rarely if ever, unions of local seamen.On the evidence here, the culture of work and protest of Indian seamen appears to have been informed by a certain rationality-a certain careful weighing of costs, benefits, and opportunities for engagement and disengagement, including through protest-that is altogether at odds with characteristic representations of Calcutta jute workers and British maritime workers enduring similar circumstances or facing similar 'choices'. At the same time this culture was open to modern, secular, and transnational solidarities grounded in universalist values. Paradoxes of this nature demand a sustained effort to recover and re-interpret the complex but immensely creative